The changing external landscape Sexual reproductive healthcare is essential healthcare, and access to timely services has a significant impact on women’s health outcomes. The underinvestment in reproductive healthcare since 2015, has disproportionally impacted women and girls as they are the most likely to be impacted by pregnancy, disproportionately responsible for childcare and more likely to experience barriers to reproductive choice. According to Public Health England, every £1 invested in contraception saves the Treasury £9 over 10 years. However, over the last decade there has been significant cuts in these services. There has been a 167% increase in the number of local authorities closing and cutting contraceptive services, with 32 councils closing services and a third of local authorities reducing the sites commissioned to provide contraceptive services according to the FRSH. At the same time there has been a growing demand for Reproductive Health services overall. Marginalised communities often face significant obstacles to receiving basic health care. This includes those marginalised by factors like race, wealth, immigration status, and sexual orientation. We know lack of contraception disproportionately affects those in living in the most deprived parts of the country, further exacerbating the existing health inequalities. Waiting times for IUDs varies depending on location but reports vary from 4 weeks to almost 12 months, some women with the financial means are seeking private provision which varies from £250 to £600 for coil fitting. Abortion services have been unfairly funded for a long time, despite the increased support of NHSE to address the issue of the current tariff. Even at 100% tariff it does not take into account the increasing need for internet service providers to invest in safeguarding, digital, IT and pathways for those with complex needs. There also remains a lack of accountability in terms of commissioners implementing NHSE recommendations for abortion commissioning which creates geographical inequalities for women due to the individual priorities of regional ICBs. 9 Marginalised communities often face significant obstacles to receiving basic health care. This includes those marginalised by factors like race, wealth, immigration status, and sexual orientation. We know lack of contraception disproportionately affects those living in the most deprived parts of the country, further exacerbating the existing health inequalities.
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