Women's health plan: second annual progress report - January 2024

Contraception, abortion, sexual health, and pre-pregnancy

Pre-pregnancy

Information and awareness: Providing support in planning pregnancy can help raise awareness of the importance of optimising health before pregnancy. Work is ongoing in this area, and new information has been published on the NHS Inform Women’s Health Platform. The information provides help for those planning a pregnancy to understand what might help improve fertility, their health and the health of any future pregnancy, as well as feel able to cope with the changes that having a baby can bring – from managing an existing health condition to practical things like finances or housing. There are also links to additional resources including a tool, developed by the charity Tommy’s, which provides personalised help and support for those planning a pregnancy.

Contraception

Changing trends in contraception project

A change in the methods of contraception being used by women and girls in Scotland has coincided with a rise in abortion rates across all age groups and demographics. Since 2021, there has been a 19% rise in abortion rates, with the highest rates in young women.

Given the impact of this on women, the Women’s Health Champion Professor Anna Glasier was keen to better understand the driving forces behind these changes and how to improve outcomes for women and girls’ reproductive health.

Through a short-term project, evidence is being collated on the trends in contraception looking at i) barriers in access and ii) attitudes towards contraception. Working with key stakeholders, the project will conclude with a report setting out a series of next step recommendations.

Alongside gathering the routine data, we have asked health care providers their views on the changing trends in contraception and abortion via semi structured questionnaires. The results demonstrate a mixture of complex and integrated factors that will require a whole systems approach to addressing the sexual and reproductive needs of women and girls in Scotland.

If you would like more information about this project, please email womenshealthplan@gov.scot.

LARC Short Life Working Group

The LARC Short Life Working Group was established in response to feedback from the Women’s Health Leads, who highlighted women’s difficulties in accessing LARC, across Scotland.

The group, chaired by the Women’s Health Champion, has met regularly since May 2023 and discussed the many challenges and opportunities that exist in improving access and provision. The final meeting will be held in early 2024, when the Group will agree their conclusions and recommendations.

Policy in Practice

LARC provision in Primary Care

Dr Louise Hamilton has secured funding to conduct a two year pilot project in West Dunbartonshire.

The aim is to develop and evaluate a training LARC hub to provide IUD fitting for the patients of all nine practices in the locality. Building on existing skills and experience, the service is hosted in a Practice which has existing arrangements for interpractice working, and there is a FSRH Faculty Recognised Trainer (FRT) who will lead on the service development and provision of supervised IUD fitting and mentoring.

The LARC hub will train peers, including nurses and GPs, to Faculty (FSRH) standards to obtain Letter of Competence (LoC) in intrauterine techniques.

The goal is to train at least one clinician to fit IUDs in each practice by the end of the two year project. The hub will provide 26 sessions per year (one session every fortnight) providing capacity for ten trainees, thus enabling around five trainees to be certified in Year One, and a further five in Year Two.

The anticipated benefits include:

• Increase access to IUD fitting within local area and reduce unwarranted variation in access to IUD provision
• Potential reduction in termination of pregnancy locally which is higher than national average
• Enhance the skills of local General Practice Nurses and GPs
• Provide additionality in services being available within Local General Practice Services increasing capacity within the NHS Provision for IUD fitting
• Patients don’t need to travel out with their Locality area for IUD Fitting and GPs and GPNs don’t need to travel out with the area for training / mentoring

A model pelvis has also been procured which will be used to train other practices in the area on how to remove coils. If you would like more information about this project, please email womenshealthplan@gov.scot.

Postpartum Contraception

Spotlight: The Scottish Postpartum Contraception Network

Postpartum contraception (PPC) work had already begun in a number of Boards, but the Women’s Health Plan served as a catalyst to reframe PPC through a national lens. And so, the Scottish Postpartum Contraception Network was born! This ‘grass roots’ network brings together a group of multidisciplinary healthcare professionals including midwifery, obstetrics, sexual health, pharmacy, public health and clinical researchers, with representatives from all of the 14 Scottish Board areas meeting quarterly.

Alongside this, in 2022/23 the Scottish Government provided funding for a national project focused on training, implementation and resource development for PPC, which was delivered by NHS Lothian with the support of the PPC Network.

Expanding access to training and education for staff

• A free two-part national webinar series ‘ABC of PPC’ was delivered to over 400 attendees. To allow flexible access, the sessions were recorded and made available to watch later on-demand.
• A new e-learning module dedicated to PPC has been developed with NHS Education for Scotland and will be available on the national professional development platform TURAS in early 2024 along with a range of supporting resources for staff.
• In Spring 2023, over 100 colleagues from across the UK gathered in Edinburgh for the 2nd Scottish Postpartum Contraception conference. The programme featured clinical, research and policy updates as well as practical training workshops and the long-awaited opportunity for some in-person networking. Feedback was overwhelmingly positive and there are plans to deliver another conference in late 2024.

But training is only one of the necessary elements required to achieve successful implementation of PPC into routine care.

A ‘shared learning’ approach is integral to achieving the wider dissemination of these interventions and in helping to overcome the common barriers encountered throughout the implementation process. We were keen to formalise this support in a more equitable way across Scotland and over the last 12 months have been offering implementation and training support visits to every Board.

As well as delivering ‘hands on’ training and re-igniting regional enthusiasm for PPC, these visits have also allowed us to strengthen network links and build up a more detailed picture of current PPC activity across Scotland. They have also identified the need to optimise current routine data collection systems to allow us to capture and share national PPC activity more accurately, a key focus for us going forward.

Improving information for service users

Another objective of this project was to develop and centralise national patient resources for PPC, including the creation of a new animation for use during the antenatal period. It can be accessed publicly online in English, Mandarin, Polish, Punjabi and Urdu with more languages and further method-specific animations to follow.

"I thought it (the animation) was very inclusive. It used a lot more images rather than jargon which is very useful for people with a language barrier, or people who are distracted and can’t always listen to the things being said to them." (Participant from evaluation study of PPC animation)

What next for PPC in Scotland?

We have lots to be proud of in terms of progress to date, but there is still much to do. In terms of training, we have had the first hospital women’s health pharmacist complete formal training in implant insertion and hope to expand this model to other members of the multidisciplinary team to support wider PPC provision.

We are developing a national training programme to expand knowledge and skills acquisition in immediate postpartum intrauterine device insertion and are also exploring how we can further integrate PPC into the curricula for midwifery and obstetric training to equip clinicians with the necessary skills for their future practice at the earliest stage.

All of this will help us move closer to the goal of ensuring that everyone has the opportunity to discuss their future fertility and contraception during pregnancy and has simplified access to the full range of contraceptive methods at the time of childbirth.

"I mean it’s a bit of no-brainer isn’t it? I probably wouldn’t get round to making an appointment afterwards (for contraception), looking after a new baby, getting no sleep. I’m all for anything that makes life easier!" (PPC research participant)

Dr Michelle Cooper, Consultant in Gynaecology and Sexual Health, NHS Lothian & Chair of Scottish PPC Network

Policy in Practice

NHS Highland: Improving access to Post-Partum Contraception (PPC).

Highland Sexual Health services, along with NHS Highland Public Health colleagues, are piloting a new model of PPC care. This includes ensuring that women can be supplied with their preferred method of contraception or a “bridging method” if there is a wait for a procedure. Ideally, this will be prior to discharge from hospital, or at least by day 10 postpartum.

In addition to this, NHS Highland are training a small number of community midwives within Caithness and Sutherland area to fit sub dermal implants. This is being done following the national training pathway and will enable midwives to fit sub dermal implants for contraception for post-natal women prior to day 10 post-partum. Caithness and Sutherland is a remote and rural area which covers a vast proportion of North Highland’s geography.

This pilot aims to ensure that women, who have delivered their baby and live within the Caithness and Sutherland area and choose an implant as their preferred long-acting reversible method of contraception, will have access to this service within 10 days of delivery. Discussions are taking place with Maternity services locally to try to establish implementation of providing progestogen only oral/injectable contraception for women prior to discharge from hospital, where desired.

Education and confidence levels around discussing, and prescribing/administering contraception are being explored and this will inform what additional support may be required to effectively discuss contraception in the ante natal period so there is a plan in place for women post-delivery.

Abortion

Safe access zones: Following the commitment made by the Scottish Government in September 2022 to provide full support to Gillian Mackay MSP’s proposed members bill on safe-access zones, Ms Mackay MSP introduced the Abortion Services (Safe Access Zones) (Scotland) Bill into parliament on 5^th October 2023.

Early Medical Abortion at Home (EMAH): Work continues to take forward the recommendations in the EMAH evaluation, published in March 2023. Updated Scottish Abortion Care Providers (SACP) guidance has been issued, emphasising the importance of informed patient choice throughout the early abortion care pathway and aiming to improve equity of access to EMAH across Scotland. High-quality patient information on abortion care is currently being developed for national use, and we continue to work closely with abortion care providers to help implement improvements to EMAH care. We have also published an approval to take mifepristone at home up to 24 weeks gestation following an in-person appointment when the patient will take misoprostol and pass the pregnancy in the hospital or clinic.