Sexual health and blood borne virus action plan: 2023 to 2026

Contraception

Whilst contraception is not solely the responsibility of women, the majority of contraceptive options are available only to women. Access to the full range of high quality and effective contraception is vital to enabling women to take control of their reproductive health. Contraception, including condoms, should be easily accessible, across various parts of the health system, so it can be accessed in a timely manner as required. Condoms continue to play a major role not only in contraception but also in reducing STI transmission and therefore condom provision should not be forgotten when considering contraception provision.

Improving access to contraception is a priority in both this Action Plan and the WHP. Therefore, these two policies will work together to ensure prioritisation of this important intervention.

Longer Acting Reversible Contraception (LARC)

Longer acting reversible methods of contraception – the copper intrauterine device (Cu-IUD), hormone containing intrauterine device (LNG-IUD), the contraceptive implant and contraceptive injections are the most effective reversible methods of contraception available to women. These methods should be accessible to women easily, quickly and confidentially as part of the full range of contraception.

The impact of the COVID-19 pandemic has meant that women are experiencing difficulties in accessing these methods of contraception both through general practice and from specialist sexual health services. The abortion rate in Scotland between 2021 and 2022 rose by almost a fifth (19%) and the lack of availability of LARC is likely to be a contributing factor.

The WHP has a particular focus on LARC methods, and includes the following action intended to drive improvement:

'Increase availability of LARC as one of a range of options for contraception available for women'

Sexual Health and BBV officials will collaborate closely with WHP officials to progress the WHP actions regarding contraception and will continue to drive forward progress beyond the current iteration of the WHP, which ends in August 2024.

In order to understand the Scotland wide challenges in LARC and to develop potential solutions, the Women's Health Champion Professor Anna Glasier, has established the LARC Short Life Working Group (SLWG). The Group, which is accountable to the Women's Health Plan Implementation Programme Board, brings together experts from across the country to focus on improving access to LARC across general practice and specialist services.

Action 7: NHS Boards, Scottish Government and Women's health champion will collaborate to identify opportunities to improve women's access to LARC, as outlined in the WHP and working alongside LARC SLWG.

Post-partum Contraception

At least one in 13 women in the UK experience an unintended pregnancy or short interpregnancy interval within the year after childbirth. Unintended pregnancies soon after childbirth may lead to abortion or short inter-pregnancy intervals associated with adverse outcomes. Considerable work has been undertaken by the Scottish Post-Partum Contraception network in improving postpartum contraception (PPC) services, again linking to the action set out within the WHP.

'Ensure that discussions on contraception take place during pregnancy. Women should be offered adequate and appropriate information on their options, as well as rapid access to their preferred method where applicable'

Scottish Government has funded an NHS Lothian project to deliver five PPC outcomes:

• Develop a Scotland wide training package on immediate postpartum IUD insertion.
• Feature a dedicated and expanded suite of resources about PPC on NHS Inform.
• A pilot project of 'outreach' implant training for community-based practitioners.
• Evaluate the existing regional data collection mechanisms to determine key baseline data on postpartum pregnancy outcomes.
• Continue to support the work of the Scottish Postpartum Contraception Network (SPCN) and deliver a successful national PPC conference at the end of 2024.

Action 8 : As per the WHP and working alongside the Women's Health Plan Officials and the LARC SLWG, NHS Boards to ensure that discussions on contraception take place during pregnancy and that women are offered adequate and appropriate information on their options, as well as rapid access to their preferred method.

Post Abortion Contraception

The rate of abortion where woman, aged 15 to 44, self-reported one or more previous abortion has increased from 3.5 per 1,000 women in 2013 to 6.2 in 2022. The abortion rate increased rapidly between 2017 and 2021, and again between 2021 and 2022¹³. The reasons that women seek an abortion are complex and further work is needed to understand the increasing abortion rates.

Following abortion, fertility and sexual activity can resume quickly, therefore it is vital that women undergoing abortion have access to timely provision of contraception in order to prevent unplanned repeat pregnancy. We will work with service providers to improve the choice of, and access to, contraception for women across Scotland following an abortion.

Action 9: Scottish Government to work with NHS Boards to improve access to post-abortion contraception through co-design of service models in Scotland.

Progestogen-only pill (PoP) provision in pharmacy

Since 2021, women in Scotland have been able to obtain a three-month supply of the progestogen-only pill (PoP) from their community pharmacist, bridging the gap between emergency contraception and longer-term options. The introduction of this service has given women another alternative to access contraception and highlights the valuable role that community pharmacies can play in the delivery of sexual health and BBV services.

Over the three years of this Action Plan and starting in 2024, we will work to raise awareness of this service with women to ensure they are aware of the breath of options for accessing PoP. We will also evaluate the service and its provision, as well as the training available to community pharmacy teams, to ensure it meets women's needs. Scottish Government has funded NHS Lothian and NHS Tayside to explore the expansion of the pharmacy sexual and reproductive health offer to include other methods and services in addition to the PoP. This work feeds into the long-term ambition within the WHP to provide and promote a 'Women's Health Community Pharmacy Service'.

Action 10: Scottish Government to evaluate the existing provision of PoP in community pharmacies and consider how to further raise awareness of this service.