Reproductive and sexual health – Welsh Government assessment

The Welsh Government has legislated to make it mandatory for all school children aged 5–16 to learn about sexual and reproductive health in schools, although this legislation is yet to come into force. There have been improvements in sexual and reproductive health in recent years, including lower teenage pregnancy rates, and improved access to pre-exposure prophylaxis to prevent HIV. However, there remains a lack of specialist service provision in Wales in several fields related to reproductive health.

• The conception rate for under-18s in Wales has significantly declined in recent years. The conception rate was 19.7 conceptions per 1,000 women aged 15–17 in June 2018, compared with 35.3 in June 2011.
• Young women aged 20–24 are more likely to have abortions than other population groups in Wales. However, there has been a sustained decline in abortion rates for under-18s since 2008, stabilising in 2018 at 8.0 per 1,000 and 2019 at 8.1 per 1,000.
• According to the latest available figures, cases of chlamydia and syphilis have increased since 2016–17, although there have been decreases in gonorrhoea and first-episode herpes cases. These trends should be treated with caution due to variation in the completeness of data between Welsh health boards.
• The Welsh Government has increased access to online STI testing across Wales.
• In June 2020, the Welsh Government confirmed the full roll-out of pre-exposure prophylaxis to prevent HIV to anyone for whom it is clinically appropriate.
• A 2018 review of sexual health services in Wales found that an increase in attendance at sexual health clinics was putting pressure on service delivery, and that there was a disparity of service provision across Wales. Since then, there has been progress in reviewing services against specification standards, and developing a local sexual health services improvement plan.
• A review into prison sexual health services found that each prison had sexual health services, but they differed in the way they were being delivered. From this work, an inaugural sexual health workshop was held to bring together key clinicians working in sexual health services in prisons in Wales.
• There are currently no dedicated recurrent miscarriage clinics in Wales, and there is only one specialist endometriosis centre in Wales. A review in 2018 criticised the endometriosis service provision across primary, secondary, and tertiary care as not meeting need, resulting in lack of access to appropriate care for women across Wales. There has been no recent update on progress by the Welsh Government-commissioned Women’s Health Implementation Group to consider the review’s recommendations.
• In Wales, two full cycles of NHS fertility treatment are currently funded. While this is below the three cycles recommended by the National Institute for Health and Care Excellence (NICE) for eligible women, access criteria are consistent across the country.
• The Welsh Government’s progress in implementing the recommendations from the education inspectorate Estyn’s 2017 review of health relationships education has been slow, with the Curriculum and Assessment (Wales) Bill not introduced until 2020. Under the new relationship and sexuality education curriculum for children aged 5–16, sex education will become mandatory, although menstrual wellbeing throughout the life course will be optional.
• The Welsh Government has not updated or replaced its 2010–2015 sexual health strategy, nor stated an intention to do so.