Reproductive and sexual health – UK Government assessment

Funding cuts to the public health grant have affected sexual and reproductive health budgets, access to services across England varies, and the UK Government is yet to publish its national sexual health strategy. The overall rate of decrease in maternal deaths has slowed, and ethnic disparities have increased. Young people and those from deprived areas are more likely to have abortions. However, the roll-out of pre-exposure prophylaxis is a significant measure to reduce HIV transmission and the introduction of compulsory relationships, sex and health education in England may advance knowledge of reproductive and sexual health.

• The rate of decrease in maternal deaths has slowed in recent years across the UK, and did not change significantly between 2013 and 2018. Between 2016 and 2018, there was a four-fold difference in maternal mortality rates among Black women, and an almost two-fold difference among Asian women, compared with White women.
• The division of responsibilities for sexual and reproductive health between local authorities, NHS trusts and clinical commissioning groups in England has generated a ‘postcode lottery’, with some areas better protected against unplanned pregnancy than others.
• In July 2021, the House of Commons Health and Social Care Committee reported that ‘England is making good progress towards halving the rate of stillbirths and neonatal deaths by 2025’. However, the committee criticised ongoing variation in the quality of maternal care across England, and the lack of progress in reducing inequalities in maternal and neonatal outcomes.
• Young people aged 20–24 and women from deprived areas are more likely to have abortions than other population groups in England. However, there has been a sustained decline in abortion rates for under-18s since 2009. The conception rate for under-18s has continued to fall.
• There are concerns that a lack of awareness of the UK Government’s period poverty scheme has affected uptake. One survey found that, during the lockdown in March 2020, almost a third of girls and young women aged 14–21 struggled to afford or obtain sanitary products, with school and youth centre closures impeding access to the government scheme’s free products.
• There have been concerns about the impact of the coronavirus (COVID-19) pandemic on antenatal, perinatal and maternity services, with an inconsistent approach taken across NHS trusts and hospitals to the reinstatement of in-person support and birth partners, despite NHS guidance.
• The introduction of compulsory relationships education, relationships and sex education, and health education includes a focus on reproductive health, sexual abuse and sexuality.
• Parents have a statutory right to request that their child is excused from sex education. While this right does not apply to relationships or health education, there are concerns that it could pose an unnecessary safeguarding risk – it is important to balance parental rights to choose how their children are educated with children’s rights, including the right to education.
• Sexual and reproductive health budgets have been significantly affected by funding cuts to broader public health. Despite investments of over £600 million a year into sexual health services, the Local Government Association has pointed to increasing pressure on some councils.
• Though delayed due to the COVID-19 pandemic, the roll-out of the antiretroviral drug pre-exposure prophylaxis will widen access to preventative HIV treatment in England.
• The UK Government is yet to publish its national sexual health strategy, despite making a commitment in 2019 to develop a new strategy.