Sexual and Reproductive Health

Sexual & Reproductive Health JSNA (May 2023)

Sexual & Reproductive Health JSNA Key Findings: Women’s Health (May 2023)
(PowerPoint Summary)

Good sexual and reproductive health is an important contributor to our overall wellbeing. The World Health Organisation (WHO) defines sexual health as a state of physical, mental and social wellbeing in relation to sexuality. This means being able to live within an environment that is respectful of an individual’s sexuality encouraging safe sexual experiences free from coercion, discrimination and violence.

The purpose of this Needs Assessment is to understand the Sexual and Reproductive Health (SRH) needs, demand and desires of the Wirral population.

This will be used to inform and shape the provision of Wirral’s SRH services in the future, to prioritise and identify key areas for development and ensure that any decisions are clearly based on the available evidence.

For further information please contact phintelligence@wirral.gov.uk

Key findings and recommendations

Overall

Establish an appropriate multi-agency governance forum to oversee the delivery of sexual and reproductive health in Wirral.

Ensuring that we have a workforce that is well trained and skilled to deliver a broad range of specialist and non-specialist sexual health services is critical. Workforce pressures have the potential to significantly impact on delivery of these services. Workforce planning, development and training needs to be prioritised at a local and regional level.

Sexually Transmitted Infections (STIs)

STI diagnoses were greatly impacted by the pandemic. Whilst early indications show that STI diagnoses are beginning to increase following the pandemic drop-off, we need to continue to monitor STI diagnoses as it is difficult to draw any strong conclusions from data during 2020 and 2021.

Whilst Wirral sexual health services appear to be well utilised by people from our most deprived neighbourhoods, we need to continue to develop insight with our underserved and most at risk communities in Wirral and work with these groups to understand how we can develop the STI testing and treatment offer locally.

Qualitative feedback indicates there is a need to improve knowledge on how to access testing, both online and in clinic, ensuring services are discrete, non-judgemental and inclusive. There is also an identified need for improved education in schools, but also throughout the lifecourse.

In Wirral, there are fewer STI diagnoses (proportionately) amongst men when compared to national data. Further analysis is needed to understand the reason for this. Sexual health service provision should explore opportunities to engage with men and increase uptake of STI testing.

Improved recording of ethnicity, sexual orientation and gender identity within sexual health services is needed to help us understand if an equitable service is being provided and enable services to be developed accordingly. This is important as it is likely these encompass some of our underserved communities who are most vulnerable and at risk. Without this data, these communities are invisible.

Partner notification is crucial to help contain the spread of STIs and is an integral role of sexual health services, but identifying and treating anonymous partners remains a challenge. Opportunities and innovations to increase partner notification within our local sexual health service needs to be fully explored.

It is important that people engaging in Chemsex are able to access the right support to minimise risk. Local intelligence around the use of Chemsex is limited; further insight and intelligence is needed to inform future service provision for both sexual health and substance misuse services and to raise the profile locally.

Chlamydia and the National Chlamydia Screening Programme (NCSP)

Achievement of the revised female-only detection rate target of 3,250 per 100,000 (aged 15 to 24yrs) is unlikely to be met in Wirral without focussed activity to increase chlamydia screening, particularly within the community. A scaling up of the NCSP within community settings to increase chlamydia screening is needed, in particular settings such as outpatient departments, walk in centres, maternity and gynae services as well as settings specifically for young people such as colleges and youth services.

A guidance document to support the implementation of the NCSP outlines the minimum standards required to support an evidence-based and cost-effective approach. The local service should audit practice against the latest 2022 NCSP Standards to identify if any standards are not being met and possible areas for development.

National data suggests that chlamydia positivity is higher amongst Black communities. In Wirral, ethnicity recording for chlamydia testing has declined over recent years. Ethnicity recording needs to be improved so that equity of access can be effectively monitored.

HIV (Human Immunodeficiency Virus)

Wirral is not an area of high HIV prevalence but increasing the number of people that are diagnosed promptly should be a priority.

We need to increase the number of people being tested for HIV in Wirral. This includes those most at risk, (historically gay and bisexual men and other men who have sex with men (GBMSM)) but also amongst heterosexual men and women who nationally, make up a greater proportion of people diagnosed.

Opportunities to normalise HIV testing should be explored, including increasing provision of testing in primary care and emergency departments. Testing in a wider range of services such as drug and alcohol services, pharmacies and abortion services is also recommended.

There is a need for the continuation of outreach services to engage with high-risk communities such as people with multiple and overlapping sexual partners to improve access to testing. Other innovative methods for engaging with underserved communities should be explored.

HIV postal testing has proved to be a highly acceptable route for testing. This should continue to be widely promoted and other options for discrete delivery to be explored, such as a click and collect services. Improved equality monitoring of the postal offer is recommended to help identify inequities in access and improve engagement with those that are digitally excluded.

Stigma associated with HIV infection still exists. There is a need for continued work to address this including HIV social marketing campaigns that raise awareness of U=U (Undetectable = Untransmissable) and treatment as prevention.

Partner notification (PN) should remain a key part of sexual health service provision as an effective means to identify people with an undiagnosed HIV infection. There should be a consideration for alternative methods of PN including both digital and non-digital approaches.

Ensuring access to pre-exposure prophylaxis (PrEP) to all groups is important for all high risk groups but in particular higher risk heterosexual men and heterosexual and bisexual women where uptake has been lower.

There is a need to further review the discrepancies between nationally and locally reported HIV testing coverage data in our Wirral sexual health service to understand whether performance is genuinely below recommended practice or whether this is a data recording issue.

Unplanned Pregnancy

Wirral has had a high abortion rate for many years. Women need good access to local contraception services with the full range of contraception options on offer. Engaging with underserved communities, including young women and women from deprived and disadvantaged communities in particular should be prioritised.

Sexual and reproductive health services should continue to deliver a comprehensive Long Acting Reversible Contraception (LARC) service, with outreach activity and enhanced provision for groups at greater risk of unplanned pregnancy, or who historically are underserved by mainstream provision (e.g. people with a disability, or people from different minority ethnic backgrounds).

System partners should build on the on a 2023/24 pilot which will provide an enhanced LARC service in the Brighter Birkenhead group of GP practices. Focussed work is needed with primary care to improve availability of contraception, and to ensure that a full range of contraceptives is proactively offered by healthcare professionals.

Maximum uptake of the NHS Community Pharmacy Contraception Pilot needs to be ensured, encouraging more pharmacies in the Wirral to provide this service. This will help to improve accessibility to oral contraception and help to relieve the burden on sexual health services and primary care, creating more capacity for focused delivery of LARCs. This appears to be highly acceptable amongst women with many stating they would be happy to get their contraceptive pill from non-traditional clinical settings such as pharmacies or online.

Postnatal and post-abortion contraception offers need to be improved. All women should be offered contraception following a termination, with clear pathways for provision. Postnatal contraception needs to be strengthened so that women are encouraged to consider their contraception preferences post-partum and are actively supported to take up their contraception of choice.

Ensure joined-up commissioning for gynaecological and reproductive health in line with the recommendations from the Women’s Health Strategy. There should be a system-wide approach to women’s reproductive health, with partners within the Wirral Integrated Care Partnership so that women and girls can have more of their health needs met within integrated services.

Teenage Conceptions

Wirral has a high conception rate for both under 18s and under 16s when compared to England as a whole. System wide strategic leadership is required in order increase the profile locally and to enable a co-ordinated response across a range of stakeholders.

To help identify gaps and opportunities locally, and to support a co-ordinated response, a review of the Teenage Pregnancy Framework guidance is recommended including completion of the self-assessment checklist.

Cervical Screening

Commissioners must work together to understand inequalities in Human papillomavirus (HPV) uptake, and develop focused plans to reduce these, including ensuring comprehensive catch up for those cohorts where rates were lower because of the pandemic.

The Wirral system must work to ensure that declines in cervical screening seen nationally and regionally are not seen in Wirral.

Primary Care Networks should explore models for increasing accessibility to cervical screening focusing on groups with low rates of uptake and consider how to address barriers to uptake (as identified in the qualitative research).

Women’s Menstrual and Gynaecological Health

Overall, there is limited intelligence and insight available on women’s wider reproductive and gynaecological health in Wirral. We recognise that menstrual and gynaecological health are important components of both reproductive health, and women’s health through the life course.

This topic merits further investigation, as it was beyond the intended scope of this JSNA.

Sexual & Reproductive Health JSNA (May 2023)

Groups most at risk

Poor sexual health varies by age, gender, deprivation, sexuality and ethnicity, nationally and in Wirral. These are described in more detail in the succeeding chapters, but overall, the following groups are most at risk of poor sexual and reproductive health outcomes:

  • Young people
  • Women
  • Gay and bisexual men and other men who have sex with men (GBMSM)
  • Transgender, non-binary and gender diverse people
  • Deprived populations
  • Ethnic minority groups
  • Those impacted by adverse childhood experiences (ACEs)

Please read pages 17 - 21 of full report 

Other risk factors for poor sexual and reproductive health outcomes include:

People with learning disabilities

Evidence suggests that young people with a mild to moderate learning disability are more likely to practice unsafe sex and more likely to have been pregnant when compared to young people from the general population. Uptake of cervical screening is also lower for women with a learning disability.

Substance misuse

The use of drugs can lead to a loss of inhibition resulting in unplanned sexual activities, this is more likely to have a negative impact such as increasing the likelihood of contracting a STI, an unwanted pregnancy or experiencing regret, shame and mental anguish.

Research indicates a strong link between binge drinking and/ or drug use and risky sexual behaviours amongst young people. Earlier alcohol use is associated with early onset of sexual activity and is a marker of later sexual risk-taking, including lack of condom use, multiple sexual partners, sexually transmitted infection and teenage pregnancy. Sexual assault is strongly correlated with alcohol use by both victim and perpetrator.

Sex workers

Sex workers are at an increased risk of poor physical and mental health. Many work in unsafe environments and the stigma associated with this work means they are marginalised and socially excluded. Whilst sex workers are predominantly women, there is a significant minority of male and trans sex workers; most people using these services are men. Street sex workers have often experienced extensive trauma including child abuse and domestic and sexual violence. Health issues generally in this population are further impacted by the experience of discrimination and stigma, leading to reduced health service seeking behaviour.

Key Messages: Sexually Transmitted Infection (STI) testing

How Wirral performs?

  • Consistently lower STI testing rate overall, compared to national and regional figures. Rates dropped during the pandemic but have now bounced back.

  • Consistently lower STI positivity, compared to national and regional figures. Positivity fell during the pandemic and has continued to fall.

  • The rate for all new STI diagnoses in Wirral is lower than national and regional figures.

  • Consistently lower gonorrhoea diagnostic rate than national and regional rates. Clear increase in rate before the pandemic but following a sharp decline has remained at lower levels in 2021.

  • The number of syphilis diagnoses remains low overall, below national and regional levels and declined during the pandemic.

  • Chlamydia diagnoses (amongst over 25s) have declined over the last four years and are below national and regional averages.

  • Chlamydia forms a greater proportion of STI diagnoses in Wirral than in other areas.


Who is affected?

  • Nationally the burden of sexually transmitted infections (STIs) is greatest in young people aged 15-24 years, black ethnic minorities, GBMSM and areas of deprivation.

  • 49% of patients diagnosed with an STI in Wirral come from the 20% most deprived areas in Wirral.

  • 70% of people diagnosed with an STI in Wirral are female.

  • Ethnicity is poorly recorded – we cannot say how STIs affect different ethnic groups in Wirral. 

  • In Wirral, the highest rates of STIs are found in those aged between 19-32 years. This excludes chlamydia in under 25s which would account for an even greater number of diagnoses amongst young people.

  • 80% of people diagnosed with an STI in Wirral define themselves as heterosexual, but for 11% of people sexual orientation is unknown.


What this means?

  • In Wirral there are increasing testing rates paired with lower test positivity which implies a decrease in STI prevalence overall.

  • Sexual health services were seriously impacted by the pandemic, so caution is needed when drawing conclusions from data during 2020 and 2021.

    Wirral sexual health services are well utilised by people from our most deprived neighbourhoods.

  • It is difficult to determine whether an equitable service is being provided for ethnic minority groups and GBMSM, this is important as STI diagnoses are higher amongst these groups.

  • In Wirral, there are considerably fewer STI diagnoses amongst men, in contrast to the national picture where there are more STI diagnoses in men over the age of 25.


Recommendations

  • Continue to monitor trends in STIs diagnoses, which were all greatly impacted during the pandemic.

  • There should be ongoing work with underserved and high-risk communities in Wirral to better understand and inform how to develop the STI testing and treatment offer locally and in line with best practice guidance (including Public Health England Guidance on promoting the sexual health and wellbeing of gay, bi sexual and other men who have sex with men39).

  • Further analysis is needed to understand the reason for the low proportion of STI diagnoses amongst men in Wirral. Sexual health service provision should explore opportunities to engage with men and increase uptake of STI testing.

  • Improved recording of ethnicity, sexual orientation and gender identity within sexual health services so equity of access to services can be effectively monitored and services developed accordingly. Ensuring services are accessible and adapted appropriately for people with a disability, including learning disability is also essential.

  • Consider opportunities and innovations to increase partner notification within sexual health services.

  • Develop intelligence around the use of Chemsex in Wirral to inform future service provision for both sexual health and substance misuse services and raise the profile locally.

  • Qualitative feedback indicates there is a need to improve knowledge on how to access testing, both online and in clinic, ensuring services are discrete, non-judgemental and inclusive.

  • Strengthen sexual health promotion, prevention and treatment efforts in non-clinical settings, including increased options for discrete and anonymous STI testing.

  • Improve the education and access to information on sexual health and STIs, in schools, but also throughout the lifecourse.

Key Messages: Chlamydia and the National Chlamydia Screening Programme (NCSP)

Chlamydia is the most commonly diagnosed bacterial sexually transmitted infection in England. The National Chlamydia Screening Programme (NCSP) promotes opportunistic screening to sexually active young people aged under 25.

 
How Wirral performs?

Prior to 2019, Wirral was meeting the recommended chlamydia detection rate of 2,300 per 100,000 population (aged 15-24). Performance has improved more recently but the current detection rate is still below the recommended target.


Who is affected?

Women aged 15-24 are the most at-risk group for chlamydia diagnoses.

Overall, chlamydia detection is higher amongst young people from our more deprived areas, in line with the national picture. However, the actual rates of diagnoses in our more deprived areas
are lower, suggesting that there is more to be done to improve detection in these communities.


What this means?

In 2018, Wirral was effectively targeting those most at risk, as evidenced by a high detection rate paired with a lower screening rate. In this year, there were more tests undertaken in settings defined as ‘other,’ which includes NHS services such outpatient departments, walk in centres, maternity and gynaecology as well as schools (via school nurses), youth services, colleges and
outreach events. Since 2019 the detection rate has decreased, in parallel with activity in settings classed at the above settings.

Achievement of the revised female-only detection rate target of 3,250 per 100,000 (aged 15 to 24yrs) is unlikely to be met in Wirral without focussed activity to increase chlamydia screening, particularly within the community.


Recommendations

  • Audit practice against the 2022 NCSP Standards to identify if there are any standards that are not currently being met.

  • An overall focus on improving rates of chlamydia detection in our more deprived neighbourhoods.

  • A scaling up of the NCSP within community settings particularly aimed at providing an enhanced service for groups likely to have higher rates of undetected infections.

  • Improved ethnicity recording for chlamydia testing so that equity of access can be effectively monitored.

  • An overall focus on achieving the new, female only, chlamydia detection rate target.

Key Messages: HIV (human immunodeficiency virus)

How Wirral performs?

Wirral is not an area of high HIV prevalence and amongst those diagnosed, 98.5% of people have an undetectable viral load (which exceeds the UNAIDS target of 80%).

Too many residents in Wirral are being diagnosed at a late stage of infection which could have a detrimental impact on their health and life expectancy and increase transmission of the virus. This is across all population groups and is not just applicable to gay and bisexual men and other men
who have sex with men (GBMSM). It is important to note however that the number of HIV diagnoses in Wirral overall is low and the small numbers can give an inflated percentage of late diagnoses.


Who is affected?

Historically, GBMSM and ethnic minority groups have been disproportionately affected by HIV. But since 2020, transmission via heterosexual contact for men and women combined has overtaken
transmission by GBMSM.


What this means?

There is a need locally to increase and normalise HIV testing. This includes amongst those most at risk, which historically has been the GBMSM community but also amongst heterosexual men
and women who nationally, make up a greater proportion of people diagnosed.


Recommendations

  • Opportunities to normalise HIV testing should be explored, including increasing provision of testing in primary care and emergency departments. Testing in a wider range of services such as drug and alcohol services, pharmacies and abortion services is also recommended. 

  • To review the discrepancies between national and local HIV testing coverage data to understand whether there is a need for Wirral to improve in this area.

  • There is a need for the continuation of outreach services to engage with high-risk communities such as people with multiple and overlapping sexual partners to improve access to testing. Other innovative methods for engaging with underserved communities should be explored.

  • HIV postal testing has proved to be a highly acceptable route for testing. This should continue to be widely promoted and other options for discrete delivery to be explored, such as a click and collect services. Improved equality monitoring of the postal offer is recommended to help identify inequities in access and improve engagement with those that are digitally excluded.

  • Ensuring access to PrEP to all groups is important for all groups but in particular heterosexual men and heterosexual and bisexual women where uptake has been lower. 

  • Stigma associated with HIV infection still exists. There is a need for continued work to address this including HIV social marketing campaigns that raise awareness of U=U (undetectable = untransmissible) and treatment as prevention.

  • Consider how misinformation and stereotypes around HIV can be  addressed in sexual health and drugs education, such as addressing people’s perception of not being at risk. 

  • Partner notification (PN) should remain a key part of sexual health service provision. There should be a consideration for alternative methods of PN including both digital and nondigital approaches.

Key Messages: Unplanned pregnancy

How Wirral performs?

It is estimated that nationally half of all pregnancies are unplanned.

Wirral consistently performs poorly on a range of abortion indicators, including overall abortion rate, abortion rate amongst the under 25s, repeat abortions in under 25s and abortions following a birth.

The number of women fitted with LARC had been increasing in Wirral, but due to the pandemic dropped considerably in 2020.
Wirral’s sexual health service has  consistently provided a good level of LARC fits (with the exception of 2020) and these have been taken up by women from some of Wirral’s more disadvantaged areas. LARC fits in primary care however have been lower than national and regional averages.


Who is affected?

Unplanned pregnancies are higher amongst vulnerable and socially disadvantaged groups, including women misusing drugs and alcohol, women with poor mental health, women experiencing domestic abuse, women with complex needs, young women and women from ethnic minority communities.


What this means?

There is a need for improving the uptake and utilisation of reliable contraception methods amongst women locally and potentially missed opportunities within healthcare services. 

It is essential that women have good local access to contraception services with the full range of contraception options on offer, including LARC methods, which are the most and cost-effective contraception over other user dependent hormonal methods and condoms.

Engaging with underserved communities, including young women and women from deprived and disadvantaged communities in particular should be prioritised.


Recommendations

  • Continue to deliver a comprehensive LARC service via sexual and reproductive health services, with outreach activity and enhanced provision for groups at greater risk of unplanned pregnancy, or who historically are underserved by mainstream provision (e.g. people with a disability, or people from different minority ethnic backgrounds).

  • Build on the 2023/24 pilot to provide an enhanced LARC service in the Brighter Birkenhead group of GP practices. Focussed work is needed with primary care to improve availability of contraception, and to ensure that a full range of contraceptives is proactively offered by healthcare professionals.

  • Ensure maximum uptake of the NHS Community Pharmacy Contraception Pilot, encouraging more pharmacies in the Wirral to provide this service. This will help to improve accessibility to oral contraception and help to relieve the burden on sexual health services and primary care, creating more capacity for focused delivery of LARCs. This appears to be highly acceptable amongst women with many stating they would be happy to get their contraceptive pill from non-traditional clinical settings such as pharmacies or online.

  • Improve the contraception offer post-termination and postnatally. All women should be offered contraception following a termination, with clear pathways for provision. Postnatal contraception needs to be strengthened so that women are encouraged to consider their contraception preferences post-partum and are actively supported to take up their contraception of choice. 

  • Ensure joined-up commissioning for gynaecological and reproductive health in line with the recommendations from the Women’s Health Strategy. There should be a system-wide approach to women’s reproductive health, with partners within the Wirral Integrated Care Partnership so that women and girls can have more of their health needs met within integrated services.

Key Messages: Teenage conceptions

How Wirral performs?


Wirral has a high conception rate for both under 18s and under 16s when compared to England as a whole and our CIPFA (Chartered Institute of Public Finance and Accountancy) nearest neighbours – most notably for under 18 conceptions. 

Poverty and education attainment are strongly associated with teenage conception rates. Overall, Wirral has fewer children living in poverty compared to regional and national averages and educational attainment is similar overall although children in care perform particularly poorly.


Who is affected?

Teenage conceptions are strongly linked to child poverty and unemployment. This is clearly evidenced in Wirral, with teenage conceptions considerably higher amongst girls from our more deprived areas.


What this means?

There is a general downward trend locally for teenage conceptions but whilst this is reducing, improvement lags behind our comparators. More needs to be done in Wirral to address this.


Recommendations

  • System wide strategic leadership is required in order increase the profile locally and to enable a co-ordinated response across a range of stakeholders.

  • Review the Teenage Pregnancy Framework and complete the self-assessment checklist to identify gaps and opportunities locally.

Key Messages: Cervical Cancer – Human papillomavirus (HPV) vaccination and cervical screening

How Wirral performs?

  • The incidence (new cases) of cervical cancer in Wirral in 2020 was 17. Numbers are low and fluctuate over the years, but overall rates have been slightly higher in Wirral compared to England (in 2020 the Wirral rate was 10.3 per 100,000 versus England rate of 8.5 per 100,000).

  • The HPV vaccination programme was seriously impacted during the pandemic. First dose coverage for females (aged 12-13yrs) has bounced back to 89% in 2020/21 (higher than national average of 79.5%). A further breakdown of the data is not available, so we are unable to identify whether HPV vaccination uptake is lower in any particular group (for example by ethnicity or geographical area).

  • Cervical screening for 25- to 49-year-olds in Wirral remains stable in 2021/22, and above the national average (72.5%, vs 68.6%).

  • Cervical screening in 2021/22 for 49- 64-year-olds is below the national rate and declining locally and nationally (72.9% and 74.7%)

  • Primary Care Networks in more deprived areas have lower screening rates.

Who is affected?

Cervical screening uptake is lowest in our more deprived neighbourhoods. Nationally, uptake is lower amongst the following groups: people from areas of higher  deprivation, people from black or other minority ethnic groups, people with disabilities, people with mental illness and people from LBT community. 

Research has shown that lesbian and bisexual women are up to 10 times less likely to have had a cervical screening test in the past three years than heterosexual women.

There is a misconception that lesbian and bisexual women do not need to attend screening if
they do not have sex with men. However, the human papillomavirus (HPV), which causes the vast majority of cases of cervical cancer, is a common virus that is passed on through body fluids.

Females who have not received the HPV vaccine are at a higher risk of cervical cancer. The groups with lower cervical screening uptake strongly overlap with those with lower HPV vaccine uptake.

What does this mean?

To reduce inequalities in screening – and therefore cervical cancer, it will be important to continue to support patient choice and provide women with an alternative setting to primary care to have their cervical sample taken.
Women need to be able to access screening at a location, time and service appropriate to them.

Recommendations

  • Commissioners must work together to understand inequalities in HPV uptake, and develop focused plans to reduce these, including ensuring comprehensive catch up for those cohorts where rates were lower because of the pandemic.

  • The Wirral system must work to ensure that declines in cervical screening seen nationally and regionally are not seen in Wirral. 

  • Primary Care Networks should explore models for increasing accessibility to cervical screening focusing on groups with low rates of uptake and consider how to address barriers to uptake (as identified in the qualitative research).

Qualitative Insight Report

This research was carried out by the Qualitative Insight Team on behalf of the Public Health Team in Wirral Council to supplement the full Sexual and Reproductive Health JSNA (May 2023) produced by Wirral Intelligence Service (Public Health Intelligence Team).

Gaps in knowledge

  • We cannot be confident that sexual health services in Wirral are providing equitable support as the equality monitoring data is incomplete in particular for ethnicity, sexual orientation and gender identity. This is not an issue just pertinent to Wirral or sexual health services, but it is important as it is likely these encompass some of our underserved communities who are most vulnerable and at risk of poor sexual health outcomes.

  • Research around ACEs is relatively new, and little data exists for Wirral as an area of need. For now, we can make links between areas of high deprivation in Wirral and high probability of ACEs, from national research. Work is in progress to incorporate ACEs across public health.

  • Local intelligence around the use of Chemsex is limited; further insight and intelligence is needed to inform future service provision for both sexual health and substance misuse services and to raise the profile locally.

  • HPV vaccination data is only available at a Wirral level; without a further breakdown of the data, then it is not possible to identify whether HPV vaccination coverage is equitable.

  • Termination of pregnancy data is only available at a Wirral level so it is not possible to identify any socio demographic groups with a greater utilisation of the service.

  • Contraception prescribing data is not available within Wirral termination services, so then it is not possible to know whether there is a need locally for focussed action to strengthen the contraception offer.

  • There is limited intelligence and insight available on women’s wider reproductive and gynaecological health in Wirral. This was outside of the scope of this needs assessment and possibly warrants further consideration.

Conclusions/next steps

This JSNA demonstrates that there is a lot of good work happening locally on the sexual and reproductive health agenda. Overall, local STI rates are lower than national and regional rates, Wirral is an area of low HIV prevalence and contraception activity in our specialist sexual  health service is consistently higher than England, most notably in the areas most deprived communities.

But there is clearly more work that can be done. Our rates of STI testing are below the national rate, and although activity is higher in our more deprived communities, it is not clear if this is proportionate to the level of need. Long Acting Reversible Contraception (LARC) prescribing in general practice lag behind the national rate, and there is work to be done to ensure women have better access to contraceptive options.

Recommendations

Recommendations are made at the beginning of the document and the evidence for these are weaved throughout the chapters but overall, key priorities can be summarised as:

  • Programme of action to address high termination of pregnancy rates and under 18 conceptions in the borough.

  • Develop the contraception offer within the community and wider healthcare settings, ensuring that contraception is accessible and minimise missed  Opportunities to prevent unplanned pregnancies.

  • Prioritising prevention and access for vulnerable groups, including effective and clinically focused outreach that enables rapid support and  Identification of STIs and HIV in high risk populations.

  • The need to understand who is using our services, and more importantly who is not. Improved recording of ethnicity, sexual orientation and gender identity will enable us to identity if we are providing an equitable service to communities that are often underserved and/ or at risk of poor SRH outcomes.

  • Rebuild and scale up the delivery of the National Chlamydia Screening Programme, particularly within community settings that engage effectively with groups likely to have higher rates of undetected infections.

  • Improved local partner notification to curb the onward spread of infection.

  • The sexual health workforce needs to be developed and nurtured locally including both specialist and non-specialist provision).

  • Develop data and insight on women’s wider reproductive and gynaecological health in Wirral and use this intelligence to inform future service provision.

Nationally there is a renewed focus on sexual and reproductive health. For example, the publication of the Women’s Health Strategy with clear commitments on how women should expect to experience high quality reproductive health throughout the life course and the HIV Action Plan with the ambition to achieve zero new infections, AIDS and HIV-related deaths in England by 2030. It is important that action is aligned with these national directives and they are
embedded at a local level.

In order to facilitate delivery of the priorities and recommendations made within this JSNA, a Wirral multi-agency governance SRH group should be established. 

This will facilitate a much-needed system wide, co-ordinated action on sexual and reproductive health in Wirral.

Sexual & Reproductive Health JSNA (May 2023)

Contact details

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Below are previous JSNAs and information related to sexual and reproductive health

Previous JSNAs

Please note: this JSNA nor previous SHNA cover domestic abuse or child sexual exploitation (CSE). Please see the separate section of the JSNA for Domestic Abuse

Further information