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18 March 2013

UK: Government publishes ‘A Framework for Sexual Health Improvement in England’

Ths long-awaited document sets out the government’s ambitions for improving sexual health, in relation to contraception, abortion, STIs, and sex and relationships education.

The ‘ambitions’ laid out in the document are designed to be used by local organisations when they are looking at how best to provide sexual health services in their area. These include:

- A fall in the number of unwanted pregnancies. The focus on unwanted pregnancy rather than abortion represents a move away from the problematising of abortion that initially was feared to be the case.

- Making sure that all people have rapid and easy access to appropriate sexual health services. There is a recognition that Long-Acting Reversible Contraceptives (LARCs) are not appropriate or right for every woman: ‘LARC methods are not acceptable or suitable for all women, and it is important that women are allowed to make informed choices, with all the possible side effects and how these can be managed explained to them.’ The document also supports early access to abortion: ‘For those women who request an abortion it is important that they have early access to services, as the earlier in pregnancy an abortion is performed the lower the risk of complications.’

- Offering counselling to all women who request an abortion so they can discuss the options and choices available with a trained counsellor. The document notes that: ‘There is evidence to suggest that NHS-funded abortion services provided by the independent sector offer all women the opportunity of seeing a trained counsellor, and that this offer is repeated at every stage of the care pathway. However, the situation in NHS hospitals that provide abortion is more variable, with some areas restricting access to counselling by age and, in some cases, no counselling being available at all.’

It goes on to state that, ‘For those women who accept an offer of counselling, this must always be provided in line with the following principles:

• It should not impact on timely access to services by creating barriers or delays to access.
• Mandatory requirements for counselling should never be imposed.
• The counselling must be non-judgemental, and the counsellor must be willing to discuss the full range of options open to the woman.
• If the counsellor is not contracted/employed by an abortion service, rapid onward referral should be made if abortion is the chosen option.
• Counselling must always be impartial and put patients’ needs first, irrespective of the contractor/employer of the counsellor.

- Greater efforts to prevent STIs and HIV.

- An increase in the number of people in high-risk groups being tested for HIV.

- Building an honest and open culture where everyone is able to make informed and responsible choices about relationships and sex.

The Department of Health states that effective commissioning is essential to improving outcomes. From April 2013, local authorities will commission most sexual health services, but clinical commissioning groups and the NHS Commissioning Board will also have a role. Support will be provided to these bodies by Public Health England.

Public Health Minister Anna Soubry said:

‘Despite some improvements, sexual health in England could be a lot better. We need to work together to see a more open and honest culture around sex and relationships. We want to encourage a culture which enables people to make informed decisions free from stigma, coercion and abuse. Sexual health can be a hidden problem, unspoken about among families and friends, and we need to work hard to change that.

‘To cut rates of STIs, and to increase access to contraception and thereby reduce the number of unwanted pregnancies, we need a concerted effort from everyone, but especially local councils who will start commissioning services from 1 April. With the launch of Public Health England, there is a real opportunity for local councils to make renewed efforts to improve the sexual health of their communities.’

In a statement, the British Pregnancy Advisory Service (bpas) said:

‘As commissioning of sexual health services moves to Local Authorities, with abortion services moving to Clinical Commissioning Groups (CCGs), it is an anxious time for third sector providers. It is more important than ever that there is top-down advice and support for commissioners trying to provide local communities with the care they need. Our hope is that this document sends a clear message that sexual health services must be available and accessible to all but beyond that there must be more detailed guidance for local authorities and CCGs on how to commission sexual health services effectively.

‘BPAS is delighted to see the acknowledgement that the support offered to women considering abortion by the independent sector is already in line with best practice guidance. We have always known that attempts to reform counselling were driven by a political agenda rather than the needs of women and it is very reassuring to see this recognised by the Department of Health.’

Sexual health improvement framework published. Department of Health, 15 March, 2013

British Pregnancy Advisory Service comment on publication of ‘A Framework for Sexual Health Improvement in England’. BPAS, 15 March 2013

A Framework for Sexual Health Improvement in England. Department of Health, March 2013.