Official Statistics

Reproductive health profiles: statistical commentary

Published 6 February 2024

Applies to England

What’s new

Indicators in the Sexual and Reproductive Health (SRH) profile were updated with data on contraception prescribing and use in England. These include prescriptions and activity from primary care and dedicated SRH services in England.

The latest data covers 2022 to 2023. Data for previous years back to 2016 was refreshed to reflect the updates to population estimates from the 2021 Census.

Introduction

Local authorities are mandated to commission comprehensive open access sexual and reproductive health services, including free testing and treatment, notification of sexual partners of infected persons, advice on, and reasonable access to, a broad range of contraception, and advice on preventing unplanned pregnancy. Contraception is also provided in hospital out-patient clinics, by general practitioners (GPs) and can be purchased over the counter at a pharmacy or in other retail settings.

Different methods of contraception are available from these settings, and there is no single dataset which captures all methods of contraception across all services which provide contraception. The Sexual and Reproductive Health Activity Dataset (SRHAD) consists of anonymised patient-level data, covering contraception prescribing at specialist SRH services. Prescribing data from primary care is available through NHS Business Services Authority. 

Methods of contraception prescribed to women include:

1.    Long-acting reversible contraception (LARC)

• injectables: progestogen-only injections which typically last 8 to 12 weeks
• implants: under the skin progestogen-only implants which last 3 to 5 years
• intrauterine devices: progestin-releasing or copper devices, effective for 3 to 7 years depending on type

2.    Short-acting reversible contraception

• combined oral contraceptives (COCs), which contain oestrogen and progestogen, are one of the most used pills by those starting contraception for the first time
• progestogen-only pills (POPs), which contain only progestogen are also called the mini-pill. These require precise daily timing for effectiveness

An increase in the provision of LARC is used as an indicator of wider access to the range of possible contraceptive methods and should also lead to a reduction in rates of unintended pregnancy.

Although injections are classified as LARCs, they are counted separately as they rely on timely repeat visits within the year and so have a higher failure rate than the other LARC methods. However, injections are easily administered and do not require the resources and training that other LARC methods require.

Main findings

In this update, a number of metrics demonstrate a sustained picture of improved choice of contraceptive method when compared to the previous year. While the overall prescribing rate of LARCs remain below the pre-pandemic level, the proportion of LARC among all prescribed contraceptives has increased. There is a corresponding decrease in the relative proportion of short acting contraceptive prescriptions compared with pre-pandemic levels. There was also a small overall increase in contraceptive provision in SRH services from 2021 to 2022 onwards, although the number of young men and women using SRH services remains below pre-pandemic levels.

The overall use of long-acting reversible contraceptives (LARC), excluding injections, has increased to a rate of 44.1 per 1,000 population in 2022 to 2023 compared with 41.8 per 1,000 in 2021 to 2022, although this remains significantly lower than the pre-pandemic period (49.2 per 1,000 in 2018 to 2019). This trend is similar in prescriptions from both primary care and specialist SRH services. Rates of LARC use, excluding injections are lowest in the London region and highest in the South West region.

The percentage of women under 25 choosing LARC in SRH services was 36.2% in 2022 to 2023, similar to the 37.3% in 2021 to 2022. These percentages have increased substantially from the pre-pandemic level of 27.6% in 2018 to 2019. The corresponding percentage for women over 25 is greater at 53.2% in 2022 to 2023 and 43.8% in 2018 to 2019.

Short acting combined oral contraceptive rates prescribed from primary care have slightly decreased from 128.3 per 1,000 in 2021 to 2022 to 117.0 per 1,000 in 2022 to 2023 and have increased from 7.6 to 8.1 per 1,000 when prescribed from SRH services in the same period. However, the rate remains 30% below the pre-pandemic level when prescribed from primary care and 50% below the pre-pandemic level when prescribed from SRH services. These same patterns are seen in the prescription rates of progesterone only pills and injectable contraceptives.

The attendance rate for women under 25 at specialist SRH services was 84.3 per 1,000 in 2022 to 2023 and this remains below the pre-pandemic level of 133.4 per 1,000 in 2018 to 2019. It was 82.5 per 1,000 in 2021 to 2022.

The attendance rate for men under 25 at specialist SRH services was 12.6 per 1,000 in 2022 to 2023 and this remains below the pre-pandemic level of 20.0 per 1,000 in 2018 to 2019. It was 11.5 per 1,000 in 2021 to 2022.

For further information or queries regarding this update, please contact lifecourseintelligence@dhsc.gov.uk.