Executive summary

In 2021, Public Health England (PHE), which was previously an executive agency of the Department of Health and Social Care (DHSC), commissioned the London School of Hygiene and Tropical Medicine (LSHTM) to design and pilot a new Women’s Reproductive Health Survey (WRHS). Between 1 July and 17 August 2021, 13,450 participants in England responded to the first national survey pilot via social media. In September 2021, following the dissolution of PHE, the project transferred to DHSC.

The questions in the survey covered the following themes:

• menstrual health, from menarche (first period) to menopause
• preventing and planning pregnancy, including abortions
• pregnancy experiences and intentions: antenatal care, pregnancy outcomes, pregnancy loss and infertility

This analysis and report of the national pilot is focused on the most important findings on contraception and abortion.

Main points

The survey’s main findings were:

• 68.8% of heterosexually active participants who were not trying to get pregnant nor currently pregnant were using some form of reversible contraception
• a quarter of question respondents reported using a long-acting reversible contraception (LARC) method, which includes contraceptive patches, implants, injections, intrauterine devices and intrauterine systems. These were the most common type of contraceptive methods used. LARC methods also had the highest satisfaction rate of any method (84.8% of LARC users were either satisfied or very satisfied)
• 18% reported using no method or an unreliable method, including 10% reporting no method. Unreliable methods include no method, fertility awareness apps, withdrawal and calendar method. Barrier and withdrawal methods had the lowest satisfaction rating with 62.1% and 57.9% very satisfied or satisfied
• the most common source for accessing contraception was general practice, followed by sexual health clinics. More than 30% of question respondents reported getting their contraception through a retail outlet such as a pharmacy or over the counter at a supermarket
• about one third of respondents reported stopping or switching contraceptive method and the most common reasons were unwanted side effects (mood, bleeding and impact on sex life), wanting a non-hormonal method, and wanting to become pregnant. Of those who switched, 71% were able to access their preferred method at their preferred service
• 75.6% of respondents who had a birth or abortion in the previous year received information and advice about contraception around the time of birth or abortion
• 50% of respondents who reported an abortion and 11% of respondents who reported a live birth in the last year reported using a method of contraception immediately after the pregnancy ending

Background

Reproductive health shapes the mental and physical wellbeing of all adults, their families, future generations and wider society. The United Nations defines reproductive health as a:

…state of physical, mental, and social well-being in all matters relating to the reproductive system. It addresses the reproductive processes, functions and system at all stages of life… [it also] implies that people are able to have a responsible, satisfying and safe sex life and that they have the capability to reproduce and the freedom to decide if, when and how often to do so.

This government remains committed to prioritising women’s health, and the publication of these survey results is consistent with Labour’s manifesto commitment, ‘never again will women’s health be neglected’. Designing reproductive health policy that centres on the changing needs of the individual across their lives, rather than around specific conditions or issues, is a pillar of reproductive health as defined by the Public Health England (PHE) 2018 reproductive health consensus statement and is supported by the World Health Organization (see their report Health at key stages of life: the life-course approach to public health) and the Royal College of Obstetricians and Gynaecologists (RCOG) in their report Better for Women. Improving reproductive health is also a central aim of the United Nations Sustainable Development Goals target 3.7:

… ensure universal access to sexual and reproductive health-care services, including for family planning, information and education and the integration of reproductive health into national strategies.

Essential to this approach is knowing and understanding how the different aspects of reproductive health impact on women’s lives, what help they need and whether these needs are met. Official data on contraception prescribing, abortion rates and under-18 conceptions provides important insights into how reproductive health is managed clinically. Data from large national surveys such as the National Survey of Sexual Attitudes and Lifestyles (Natsal) is an additional source that provides estimates of population prevalence of contraceptive use. However, this survey is only conducted every 10 years, with the most recent data from 2010 to 2012. Significant gaps in data and research exist relating to women’s reproductive health experiences and preferences across the life course, many of which extend beyond a healthcare setting.

In 2021, under the previous government, DHSC published a call for evidence to inform development of the Women’s Health Strategy. At the same time, and to ensure that this listening exercise continued, LSHTM was commissioned to develop and pilot a validated women’s reproductive health survey tool. The resulting Women’s Reproductive Health Survey pilot was developed and delivered online between 1 July and 17 August 2021 to women in England aged between 16 and 55 years old. The survey was designed to:

• capture women’s experiences of reproductive health
• describe their patterns of service use
• identify disparities in access and outcomes

This publication describes the findings around contraception and abortion from the national pilot.

This pilot survey was followed by the publication of the Women’s Reproductive Health Survey (WRHS) 2023, which was a commitment of the previous government under the Women’s Health Strategy for England of 2022. LSHTM published their initial summary of findings from the WRHS 2023 on 17 October 2024.

Respondent demographics

The survey pilot used a digital recruitment strategy with the aim of recruiting a sample of the English population that was representative of the regional breakdown, age, ethnicity and educational status of the country. The survey was open to respondents who identified as female, non-binary and trans men aged 16 to 55.

Where possible, the following section compares the demographics of the survey population with data from the 2021 Census for the population of England for women aged 16 to 54. If 2021 data was not available then the most recent population estimates were used. Total number of respondents varies by table and is based on the number of respondents answering the relevant question in the survey.

In total:

• 97.6% of respondents identified as female
• 1.1% as non-binary
• less than 1% as a trans man or ‘other’

In comparison to the 2021 Census, a greater proportion of individuals who identified as female and non-binary aged 16 to 54 responded to the survey.

Table 1: gender-identity of respondents compared with England Census 2021 estimates

Gender identity	Number of survey respondents	Percentage of survey respondents	Percentage of population from England Census 2021 who were born female and identified as female or identified as non-binary, trans man, other or not answered aged 16 to 54
Female	13,125	97.6%	93.8%
Non-binary	155	1.1%	0.1%
Trans man	15	0.1%	0.1%
Other	30	0.2%	0.4%
Not answered	125	0.9%	5.4%
Total	13,450	100%	100%

There was an over-representation of survey respondents who identified as White (93.2% versus 77.9% in the England Census 2021), and an under-representation of respondents identifying as Asian or Asian British (2.2% versus 11.6%) or Black, Black British, Caribbean or African (1.5% versus 5.1%).

Table 2: ethnicity of survey participants compared with England Census 2021 estimates

Ethnic group	Number of survey respondents	Percentage of survey respondents	Percentage of population from England Census 2021 of women aged 16 to 55
White	12,370	93.2%	77.9%
Mixed or Multiple ethnic groups	405	3.0%	2.9%
Asian or Asian British	290	2.2%	11.6%
Black, Black British, Caribbean or African	200	1.5%	5.1%
Other ethnic group	10	0.1%	2.6%
Total	13,275	100.0%	100.0%

The sample was closer to England Census 2021 data for region and age. However, there was an over-representation of respondents in London. A relatively smaller proportion of respondents were under 25 when compared with the population of England as a whole. There was also over-representation for respondents between 25 to 39.

Table 3: region of residence of survey respondents compared with England Census 2021 estimates

Region in England	Number of survey respondents	Percentage of survey respondents	Percentage of population from England Census 2021 of women aged 16 to 55
North East	945	7.4%	4.5%
North West	1,140	9.0%	12.9%
Yorkshire and Humber	1,080	8.5%	9.5%
East Midlands	1,035	8.2%	8.4%
West Midlands	1,165	9.2%	10.3%
East of England	1,290	10.1%	10.8%
London	2,755	21.7%	18.2%
South East	2,060	16.2%	16.0%
South West	1,230	9.7%	9.4%
Total	12,690	100.0%	100.0%

Table 4: 5-year age band of survey respondents compared with England Census 2021 estimates

Age group	Number of survey respondents	Percentage of survey respondents	Percentage of population from England Census 2021 of women aged 16 to 55
16 to 19	605	4.5%	8.4%
20 to 24	930	6.9%	11.4%
25 to 29	1,955	14.5%	12.7%
30 to 34	2,445	18.2%	13.7%
35 to 39	2,010	15.0%	13.1%
40 to 44	1,755	13.1%	12.3%
45 to 49	1,565	11.6%	12.3%
50 to 55	2,180	16.2%	16.0%
Total	13,445	100.0%	100.0%

The overall proportion of women with degrees or equivalent was also considerably higher in the pilot survey than that reported in the England Census 2021: 74.3% versus 41.4%, respectively.

Table 5: educational attainment of survey respondents compared with England Census 2021 estimates

Has degree or equivalent	Number of survey respondents	Percentage of survey respondents	Percentage of population from Census 2021 of women aged 16 to 55
No	3,350	25.7%	59.6%
Yes	9,710	74.3%	41.4%
Total	13,060	100.0%	100.0%

Notes: ‘No’ equals less than level 4 qualification (higher national certificate, higher national diploma, bachelor’s degree or post-graduate qualifications); ‘Yes’ equals level 4 or higher qualification in the population.

Participants were also asked about their sexual preference. Over half of respondents (58.8%) were only attracted to males and never to females, while a significant minority were attracted more often to males and at least once to a female (see table 6).

Table 6: sexual preference

Sexual preference	Number of survey respondents	Percentage of survey respondents
Only to males, never to females	7,725	58.8%
More often to males, and at least once to a female	3,785	28.8%
About equally often to females and to males	865	6.6%
More often to females, and at least once to a male	320	2.4%
Only to females, never to males	150	1.2%
I have never felt sexually attracted to anyone at all	110	0.8%
Prefer not to say	175	1.3%
Total	13,130	100.0%

The majority of respondents (80.5%) reported good or very good health status. Less than half (43.8%) of participants reported a mental or physical illness or condition that lasted for or was expected to last for more than 12 months.

Preventing and planning pregnancy

An average woman is estimated to require access to contraception for 30 years to support her pregnancy choices. The most recent estimate of contraception prevalence in the UK comes from the Natsal-3 study. This survey estimated that 76% of women of reproductive age in the UK, as well as an unknown number of trans men and non-binary people, were using contraception at any one time in 2010.

It is important that women’s contraceptive needs can be met to help support family planning and reduce unplanned pregnancies. Pregnancy spacing of less than 18 months can increase the risk of health issues for the mother and baby such as premature birth, low birth weight and mental health disorders. By reducing rates of unintended pregnancies, effective contraception can also benefit education of girls and create opportunities for women to participate more fully in society. Given the benefits of contraception, it is also important that services reach those who may not be currently engaging with their contraceptive options. 

There are several contraceptive options women can choose from to help prevent pregnancies, some of which also protect from sexually transmitted infections and support gynaecological health (such as reducing heavy menstrual bleeding and relieving menstrual pain). Options include:

• user-dependent methods (under control of the user) such as condoms and the pill and patch
• LARC options that require a healthcare professional to insert and remove, such as the sub-dermal implant and intra-uterine system (IUS) or device (IUD)
• injections, to permanent methods such as hysterectomy

Despite the range of effective contraceptives available, the high prevalence of unplanned pregnancies and rising abortion rates suggest that not all women are having their contraceptive needs met. Barriers to accessing safe and effective contraception include:

• limited access to good quality services and method of choice
• a fear or experience of side effects
• cultural or religious opposition
• gender-based barriers

Patterns of contraception use

The most common type of contraceptives were LARC methods, closely followed by hormonal user-dependent methods (UDM) (types of contraception whereby effectiveness is reliant on regular and correct user adherence), such as contraceptive pills and patches, then barrier UDM such as condoms and diaphragms, and then those reporting no or unreliable method (see tables 7a to 7g); 11.8% reported having permanent contraception.

The single most common method was the male condom, which 21.2% of eligible respondents reported as their usual method, followed by the 11.9% of users reporting the IUS as their usual method.

Table 7a: LARC methods - number of users

Contraceptive method	Number of survey respondents	Percentage of survey respondents
Implant	375	5.5%
IUD	490	7.1%
IUS	815	11.9%
Injections	80	1.2%
Emergency copper coil (IUD)	10	0.1%
Total	1,770	25.8%

Table 7b: user-dependent methods (hormonal): number of users

Contraceptive method	Number of survey respondents	Percentage of survey respondents
Emergency contraceptive pill	10	0.1%
Progesterone only pill	555	8.1%
Contraceptive patch	20	0.3%
Contraceptive pill - don’t know	165	2.4%
Vaginal ring	15	0.2%
Combined pill	715	10.4%
Total	1,480	21.5%

Table 7c: user dependent methods (barrier): number of users

Contraceptive method	Number of survey respondents	Percentage of survey respondents
Male condom	1,455	21.3%
Other barrier (female condom, cap)	10	0.1%
Total	1,465	21.4%

Table 7d: no method or unreliable: number of users

Contraceptive method	Number of survey respondents	Percentage of survey respondents
Fertility awareness app	90	1.3%
No method used	675	9.9%
Withdrawal	390	5.7%
Calendar or rhythm method	85	1.2%
Total	1,240	18.1%

Table 7e: permanent methods: number of users

Contraceptive method	Number of survey respondents	Percentage of survey respondents
Partner sterilised (vasectomy)	655	9.6%
Sterilised (tubal ligation)	150	2.2%
Total	805	11.8%

Table 7f: other methods: number of users

Contraceptive method	Number of survey respondents	Percentage of survey respondents
Avoiding penetrative sex	20	0.3%
Lactational amenorrhoea	20	0.3%
Other method	45	0.7%
Total	85	1.3%

Table 7g: all methods: number of users

Contraceptive method	Number of survey respondents	Percentage of survey respondents
LARC methods	1,770	25.9%
UDM (hormonal)	1,480	21.5%
UDM (barrier)	1,465	21.4%
No method or unreliable	1,240	18.1%
Permanent methods	805	11.8%
Other methods	85	1.3%
Total	6,845	100.0%

In summary, 25.8% of question respondents reported using a LARC method, of which the IUS was the most common LARC method (11.9% of respondents), followed by the copper IUD (7.1% of respondents including emergency IUD); 5.5% used the contraceptive implant and 1.2% were using injections.

21.5% reported using a hormonal user-dependent method. The combined pill was the most common contraceptive pill taken (10.4% of respondents), followed by the progesterone-only pill (8.1% of respondents). 2.4% did not know what type of pill they were taking. The contraceptive patch (0.3%), vaginal ring (0.2%) and emergency contraceptive pill (0.1%) were the least common user dependent methods.

21.4% of respondents reported using a barrier method. Of these, the majority used a male condom (21.2%) with a small proportion using female condoms and caps or diaphragms (0.1%). Less than a fifth (18.1%) reported using no method or an unreliable method; of these, around half of respondents reported no method (9.9%), 5.7% reported the withdrawal method and 2.5% reported using a fertility awareness app or use of the calendar method. These users mainly reported avoiding penetrative sex, using a male condom or the withdrawal method during their fertile period.

11.8% of respondents reported that they or their partner had been sterilised, with the majority being via partner vasectomy.

Demographic variations in contraceptive use

These were analysed by age and educational attainment. Sample sizes by different ethnic groups were insufficient for subgroup analyses.

Age

Contraception method choice varied with age in our sample, with methods such as hormonal and barrier UDM more commonly used by younger women. While around half of 16 to 19 year olds reported using a hormonal UDM, only 18% of 35 to 39 year olds reported using hormonal UDM.  

In contrast, IUS and IUD use was very low in those under 20 and then fluctuated through the 20s and 30s. Implant use was highest in women under 20 (10.9%) while from 30 onwards there was a significant decline in the number of women who reported using implants. Increased age was also correlated to use of no method or unreliable method (see table 8).

Table 8: pill, condom, LARC and no method use - by age

Age group	Number of survey respondents	Hormonal UDM	UDM barrier methods	IUS or IUD (including emergency)	Implants	No method or unreliable
16 to 19	155	46.1%	30.8%	3.2%	10.9%	5.1%
20 to 24	580	37.7%	22.4%	17.9%	10.2%	9.3%
25 to 29	130	32.2%	21.7%	21.6%	9.5%	12.4%
30 to 34	1,430	24.0%	28.2%	19.0%	5.7%	17.0%
35 to 39	1,070	18.3%	27.5%	17.1%	4.5%	19.7%
40 to 44	970	13.4%	17.5%	21.1%	2.6%	20.8%
45 to 49	710	9.4%	12.6%	23.3%	2.4%	22.6%
50 to 55	630	5.9%	7.6%	16.1%	c	32.0%

Note: any count of 5 and less has been suppressed and is ‘c’ in tables.

Educational attainment

Prevalence of no or unreliable method use was slightly higher in respondents without a degree (20.3%) than those with a degree (17.4%).

Satisfaction with current method

In the survey, women who reported using a non-permanent (in other words, sterilisation) contraceptive method were asked to rate how satisfied they were with the method they used (see table 9). Around three-quarters (73%) were either satisfied or very satisfied with their current method. Satisfaction varied according to the method used.

LARC methods had the highest satisfaction rate of any method: 84.8% of LARC users were either satisfied (32.3%) or very satisfied (52.5%). Satisfaction was consistently high across all LARC types, but IUS had the highest rating (88.1% either satisfied or very satisfied), followed by IUD (84.2% either satisfied or very satisfied), and then the implant (79.8% either satisfied or very satisfied), injections (37% either satisfied or very satisfied).

Around three-quarters (73.3%) of hormonal UDM users were either satisfied (39.7%) or very satisfied (33.6%).

Barrier and withdrawal methods had the lowest satisfaction rating with 62% and 57.9% very satisfied or satisfied.

Table 9a: satisfaction by contraception method - long-acting reversible contraception

Satisfaction level	Percentage of survey respondents
Very satisfied	52.5%
Satisfied	32.3%
Neutral	6.7%
Not satisfied	6.3%
Very unsatisfied	2.1%

Table 9b: satisfaction by contraception method - user-dependent methods (barrier)

Satisfaction level	Percentage of survey respondents
Very satisfied	17.5%
Satisfied	44.5%
Neutral	22.6%
Not satisfied	13.8%
Very unsatisfied	1.5%

Table 9c: satisfaction by contraception method - user-dependent methods (hormonal)

Satisfaction level	Percentage of survey respondents
Very satisfied	33.6%
Satisfied	39.7%
Neutral	12.6%
Not satisfied	11.2%
Very unsatisfied	2.8%

Table 9d: satisfaction by contraception method - no method

Satisfaction level	Percentage of survey respondents
Very satisfied	24.6%
Satisfied	40.7%
Neutral	21.6%
Not satisfied	12.3%
Very unsatisfied	0.7%

Table 9e: satisfaction by contraception method - other methods

Satisfaction level	Percentage of survey respondents
Very satisfied	21.1%
Satisfied	36.8%
Neutral	10.5%
Not satisfied	15.8%
Very unsatisfied	15.8%

Access to contraception

Contraception is widely available in England from several sources and is provided free of charge from:

• general practices
• sexual health clinics
• young people’s clinics
• walk-in clinics
• some pharmacists under a patient group direction

Condoms are free on request at sexual health services as well as for young people through free condom distribution schemes, such as the C-Card. Condoms can also be purchased from pharmacies, supermarkets and other retailers. Emergency hormonal contraception (levonorgestrel and ulipristal acetate) may be provided free through pharmacies depending on local commissioning arrangements and is also available to purchase at some pharmacies and private clinics.

In 2021 progestogen-only pills were approved for purchase from pharmacies without a prescription. The NHS Pharmacy Contraception Service (PCS) was launched in April 2023, enabling pharmacists to issue ongoing supplies of contraception initiated in GP surgeries and sexual health services. The service relaunched in December 2023 to enable community pharmacies to also initiate oral contraception. This service offers greater choice in how people can access contraception services.

Heterosexually active participants who reported use of a non-permanent contraceptive method and were not currently pregnant or trying to get pregnant were asked about where they usually obtained their method. Participants could select more than one answer. The most common location that participants reported was their GP, followed by sexual health clinics (see table 10).

Table 10: usual source of contraception

Service	Number of survey respondents	Percentage of survey respondents (sum greater than 100 as multiple choice)
GP	2,205	46.7%
Sexual health clinic	955	20.3%
Over the counter at shop	790	16.7%
Pharmacy or chemist	735	15.7%
Paid for from online source	505	10.7%
Private doctor or clinic	45	0.9%
NHS post-natal clinic	25	0.5%
Free from online source	25	0.5%
Young People’s clinic, school, college or university services	10	0.2%

More than 30% of eligible respondents reported getting their contraception through a retail outlet although it was not possible to split this by over-the-counter purchases (condoms, progestogen-only pills or emergency contraception) and provision from a pharmacist via a patient group direction.

When only women who receive a hormonal UDM or LARC are included, the proportion who report receiving their contraception from GPs was 67.5% (2,195) compared with 28.2% (920) from a sexual health service and 8.4% (275) from a pharmacy.

Preferred source of contraception

We asked respondents about their preferred location for obtaining their method of contraception. Participants could not select more than one answer. GPs were the most preferred service (38.6%) for those who reported a non-permanent contraception method. A fifth (20.1%) of respondents said they preferred an online source (15.3% free online and 4.8% paid online). Next, 15.5% said that a sexual health clinic would be their preferred service, followed by pharmacy (12.1%), and then over the counter at a petrol station (10.5%).

Preferred sources of contraception also varied by method. Nearly two-thirds (61.7%) of women using LARC methods would prefer to get them from their GP, which is around 5% more than actually did (56.6%). For hormonal UDM, 41.9% women would prefer online retail or pharmacy sources, while only 19.5% actually obtained these methods in these locations. Most respondents bought condoms from retail or online sources but would prefer it if these were available free online (see tables 11a to 11c).

Table 11a: preferred source of contraception - long-acting reversible contraception

Actual and preferred	Sexual health clinic	GP	Retail and pharmacy	Online source (free)
Actual	46.3%	56.6%	0.2%	Not applicable
Preferred	33.8%	61.7%	0.7%	Not applicable

Table 11b: preferred source of contraception - user-dependent methods (hormonal)

Actual and preferred	Sexual health clinic	GP	Retail and pharmacy	Online source (free)
Actual	6.7%	80.6%	18.2%	1.3%
Preferred	5.9%	46.8%	21.9%	20.0%

Table 11c: preferred source of contraception - user-dependent methods (barrier)

Actual and preferred	Sexual health clinic	GP	Retail and pharmacy	Online source (free)
Actual	2.6%	0.8%	31.5%	0.4%
Preferred	3.0%	2.3%	16.1%	28.9%

Demographic variations

Across all methods, except barrier methods, GPs were the preferred source of contraception. Sexual health services were preferred by a significant minority of women under 30. Online access is also important across the age groups but diminished somewhat in the over-40s.

Switching contraception in the past year

Participants were asked about whether they stopped or switched a type of contraception in the past year and if so what the reason for this was. Participants could select more than one answer.

About one-third (1,880 out of 5,455) of respondents reported stopping or switching contraceptive method. The most common reasons were unwanted side effects (mood, bleeding and impact on sex life), wanting a non-hormonal method, and wanting to become pregnant (see table 12).

Table 12: reasons for stopping or switching contraception in the last year

Reason for stopping or switching method	Number of survey respondents	Percentage
Unwanted side effects - mood	590	10.8%
Wanted a non-hormonal method	505	9.2%
Unwanted side effects - bleeding changes	465	8.5%
To give my body a break from contraception	465	8.5%
Unwanted side effects - impact on sex life	460	8.4%
Wanted to become pregnant	385	7.0%
Unwanted side effects - weight change	310	5.7%
Health concerns	265	4.8%
Unwanted side effects - skin changes	260	4.7%
Unwanted side effects - other	258	4.7%
Other	220	4.0%
Wanted better protection against pregnancy	160	2.9%
Wanted something easier to use	140	2.6%
Wanted something that I could stop and start myself	95	1.7%
I wasn’t having sex	85	1.6%
I became pregnant while using the method	45	0.8%

Note: participants could select more than one response.

Women were also asked if they started a new contraceptive method in the last year (that is, to a method not previously used before). About 15% (1,245 out of 7,890) respondents reported starting a new contraceptive method in the last year. These participants were asked about if they were able to get their preferred method and how long it took to get it:

• 71% were able to access their preferred method at their preferred service
• 18% accessed their preferred method at a different service, and 12% were unable to access their preferred method
• 54% of women received their preferred method within a week, 26% received their preferred method within a month, and 20% received it in longer than a month

Post-pregnancy contraception

Sixty women reported having an abortion in the last year and 570 women reported having had a live birth in the last year. These women were asked about the provision of post-pregnancy contraception after their abortion or birth.

Three quarters (75.6% or 465 of 615) of respondents who had had a birth or abortion in the previous year reported receiving information and advice about contraception around the time of their last birth or abortion; responses were similar across either outcome.

Half (50%) of respondents who reported an abortion and 11% of respondents who reported a live birth in the last year reported using a method of contraception immediately after the pregnancy ending.

Table 13: contraception use within 2 months of abortion or live birth in last year by number and percentage of survey respondents

Description of contraception use	Following an abortion	Following a live birth	Total
No contraception use	10 (17%)	300 (53%)	310 (49%)
Yes, used immediately	30 (50%)	60 (11%)	90 (14%)
Yes, at 6 to 8 week check	c	150 (26%)	150 (24%)
Other	c	50 (9%)	50 (8%)
Did not answer	c	10 (2%)	10 (2%)
Total	60 (100%)	570 (100%)	630 (100%)

Note:

• due to small numbers, respondents reporting that they had received contraception at the 6 to 8 week check were combined with those who said they had received contraception at another time
• some numbers have been suppressed due to small numbers. Any count of 5 and less has been suppressed and is ‘c’ in tables
• due to rounding, the totals may be slightly different from the numeric sums of the columns

Method type shows significant variation in postnatal contraception used between abortion and live birth groups. The most common method that was used within 2 months of a live birth was barrier UDM (19%) followed by hormonal UDM (15%). In contrast, although hormonal UDM was the most commonly used following an abortion (25%), it was followed almost equally by LARC (25%).

Table 14: methods of contraception following a pregnancy (of those who said they used contraception) by number and percentage of survey respondents

Method received	Following an abortion	Following a live birth	Total
Hormonal UDM	15 (25%)	85 (15%)	100 (16%)
LARC	15 (25%)	30 (6%)	45 (7%)
Barrier UDM	c	110 (19%)	110 (17%)
Other	c	30 (5%)	30 (5%)
Not answered	15 (25%)	315 (55%)	330 (52%)
Total	60 (100%)	570 (100%)	630 (100%)

Notes:

• data for abortion is not presented due to small numbers
• ‘Other’ includes avoiding penetrative sex, withdrawal, sterilisation, calendar or rhythm method and other
• some numbers have been suppressed due to small numbers. Any count of 5 and less has been suppressed and is ‘c’ in tables
• due to rounding, the totals may be slightly different from the numeric sums of the columns

1,825 (15%) respondents reported ever having had an abortion. Of these, 60 (3%) of respondents reported having an abortion in the last year, most of whom were under the age of 45. This equates to less than 1% of respondents under the age of 45 reporting an abortion in the last year, which is significantly lower than Office for National Statistics (ONS) estimates (approximately 1.83 per 100 women aged 15 to 44). This is in keeping with a known under-reporting of abortion within surveys. Due to the small numbers of respondents who reported an abortion in the past year, further breakdowns of question answers are not reported here.

The latest official DHSC abortion statistics for England and Wales are published on GOV.UK.  

Methodology

Designing and running the survey

Respondents were recruited through Facebook and Instagram advertisements between 1 July and 17 August 2021. All participants gave consent to partake in the survey and for their data to be used in future analyses. Criteria for inclusion in the survey were:

• aged between 16 years and 55 years
• assigned female at birth
• resident of England

At the end of the first week, the sample was reviewed and compared with England’s population according to the England 2011 Census (the England 2021 Census had not yet been published). From week 2, recruitment was targeted at under-represented groups: non-White respondents, women with lower educational attainment, and younger women.

Limitations

Findings from this survey provide important insights into the reproductive health of the large group of women that participated but the following limitations should be considered when interpreting the results. Surveys delivered and recruited through online platforms are always subject to bias. Respondents required internet access and were self-selecting and, as detailed in the demographics section, are not representative of women aged 16 to 55 in England. This non-response bias means that the findings are not directly generalisable to the wider population. The COVID-19 pandemic had a significant impact on service access which may also have affected survey responses.

Data cleaning

Non-completers (the ‘partials’) were kept in the data set for analysis.

Data exclusions and groupings

In our survey, eligible women were asked to select their usual contraception method from the full range of available contraception options. Women were excluded from analyses relating to current contraception use if:

• they did not report having vaginal intercourse in the past 12 months
• they were currently pregnant
• they were currently trying to get pregnant
• their response was ‘does not apply, not having sex’

Once missing values were removed, 6,845 respondents were included in analyses relating to contraception (51% of total respondents).

For some analyses, contraceptive method types were also grouped into the following categories according to their mode of delivery and/or their effectiveness at preventing pregnancy:

• LARC: implant, IUD (including emergency), IUS and injection
• hormonal UDM: combined methods including pills, patches and the ring; progestogen-only methods including progestogen only pill
• UDM barrier methods: the male condom, female condom, cap or diaphragm
• permanent contraception methods: self or partner sterilised, vasectomy or tubal ligation
• no method or unreliable method: no method used at the moment, withdrawal, fertility awareness app or calendar method
• other methods including avoiding penetrative sex, lactational amenorrhoea (breastfeeding) or other

Statistical analysis

Where disclosure rules permit, all questions have been tabulated by frequency and proportion with further breakdowns by age, ethnicity and educational status. Only the most pertinent results to policy and public interest have been reported in this summary report.

Missing responses were included in tables.

Suppression

Any count of 5 and less has been suppressed and is ‘c’ in tables, and controlled rounding was applied so that all table values were rounded to multiples of 5.

Cell totals equal sum of their rounded cells, so that when columns are added the totals are correct.

Percentages are reported to one decimal place. Numbers in some tables may not sum due to rounding from 2 decimal places.

Some questions allowed multiple answers so totals may not sum.