UK women not being given real contraceptive choice
Posted on December 16, 2008
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One in three PCTs are rationing GP access to long-acting reversible contraception (LARC), according to an audit by a leading expert on contraception. NICE guidance published in 2005 recommended women should be offered the choice of a LARC, as they are more reliable and cost-effective than other forms of contraception. Three new QOF indicators and 10 extra points will be allocated to GPs from April 2009 for establishing a register of women on LARCs and offering advice on provision to women on other forms of contraception. 
Dr Martyn Walling, a GP in Lincolnshire and an expert on LARCs, presented research at the British Pregnancy Advisory Service last week showing some practices were funded to fit only a dozen implanons per month – less than the national average of 18 per 10,000 patients per month.
Rhiannon Holder is a woman on a mission - to empower Britain’s young women about their contraceptive choices. She says that despite there being 14 kinds of contraceptive options on offer, many young women are being offered little or no choice. And she says many GPs are reluctant to look further than the “old favourites” of the pill and condoms.
Rhiannon, a 21-year-old student, uses the contraceptive implant herself, as well as condoms to prevent sexually transmitted infections. She says that, because the implant is 99% effective in preventing pregnancy and is an easy no-fuss method to use, it would be a popular choice with young people like herself. The implant is a small, flexible tube - inserted under the skin in the upper arm - which slowly releases the hormone progestogen.
I think for me it was one of the most reliable methods of contraception as far as preventing pregnancy goes,” she said. “It lasts for three years and there is no user error. “Condoms and the pill are great and it is not about replacing them, but they are only great if they are used correctly. “Young people do get drunk, they do go out and party and they do get in late. If people are going to get drunk they do run the risk of getting pregnant.”It does not matter how organised you are, it is easy to forget your pill. “I lead a hectic lifestyle. I am always doing stuff, always going places.
Britain has one of the highest teenage pregnancy rates in Western Europe and earlier this year the government ploughed an extra £26.8m into improving access to contraceptives. NICE (National Institute for Health and Clinical Excellence) guidelines were published in 2005 which highlighted that if 7% of women switched from the contraceptive pill to Long Acting Reversible Contraceptive (LARC) methods - the coil, hormonal injection, and contraceptive implant - the NHS could save around £100m through reducing unintended pregnancies by 73,000.
But Rhiannon, who has acted as a “mystery shopper” for local authorities to test GP contraceptive advice, said she found this was not happening. “I do a lot of mystery shopping, where I go out to clinics to ask for contraceptives and feel the implant is not well promoted,” she said. “I would go in and pretend I was having problems with condoms and still the doctors would not offer the long-term contraceptives.
A pilot allowing pharmacists to give women the contraceptive pill without a prescription has been given the go-ahead for next year. Women and girls aged over 16 will be able to get the pill at two London primary care trusts, Southwark and Lewisham, Pulse magazine says.
If the pilots are successful, the pill could become available over the counter like the morning after pill. Officials say this might help reduce the UK’s high teen pregnancies. Although the teenage pregnancy rate in Britain is falling in many areas, it remains the highest in Western Europe.
Pharmacists will offer the pill under an arrangement called a patient group direction - a kind of mass prescription where a doctor authorises other health professionals to supply a product to a certain group of patients. Health minister Lord Darzi insisted last year that “robust” standards would be put in place to ensure staff were up to the job.
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Rhiannon Holder’s comments are very pertinent considering there are several ongoing campaigns for greater contraceptive choice, not least Company Magazines due to the demographic of its audience. I’ve started a series on the ins and outs of different forms of contraception and feel that one is due on LARKs. http://hannahflynn.wordpress.com/2008/12/28/behind-the-label-diaphragm/