Scarlett McNally: Let’s talk about contraception
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* Scarlett McNally

Worldwide, 50% of pregnancies are unplanned.1 In 2021 the number of women in England and Wales who had abortions reached a record 214 256, up by 16% since 2016.2 Around a quarter of all pregnancies in the UK are terminated.23 The reasons for this are multifactorial, but if we want women and girls to have as much choice and autonomy as possible we must stop being so coy about sex, contraception, and sexual consent.

Age appropriate RHSE—relationship, health, and sex education—became statutory in schools in 2020. Its potential should be maximised to equip young people with an understanding of fertility and contraception.4 For adults, meanwhile, we need to reduce societal taboos and provide clear and accessible information about sex, contraception, and sexual consent.

Academic, medical, and parliamentary5 groups in the UK argue powerfully for improvements to women’s access to contraception. The government launched a Women’s Health Strategy for England in 2022,4 but this will fail unless it receives adequate funding and sees a change in priorities. The government should think seriously about what these groups are calling for: better funding of contraceptive services and cross sector collaboration; greater use of the wider healthcare workforce in providing contraception—including the involvement of pharmacists—with training in long acting reversible contraception (LARC); and sex education for the public and schoolchildren. Investment in contraceptive services also makes economic sense: £9 is saved for every £1 spent.6

Having an abortion or an unplanned baby can have emotional, physical, or life changing effects on women, as well as lifelong repercussions for the child’s father and any siblings. An additional child can put a strain on family finances, and poverty is the largest contributor to ill health worldwide. Children whose birth wasn’t planned have a higher risk of mental, physical, developmental, and behavioural problems.7 For example, fetal alcohol spectrum disorder (FASD) with developmental and behavioural issues is more likely after an unexpected pregnancy.8

In many countries, nearly half of women are not free to make their own decision about whether to have sex or use contraception.9 We need to value every woman beyond her role (or potential role) as a mother. The United Nations argues that reduced fertility rates can improve economic opportunities across whole economies10; yet 28% of countries11 have “pro-natalist” policies.12 Supporting smaller families or valuing child-free lives would help to maximise health for all.

Healthcare professionals should advocate for individuals and communities, as this issue crosses cultural and religious norms. Funding and planning to improve access to contraception, and to ensure that everyone has access to adequate advice and knowledge about sex and sexual consent, should be priorities for everyone.

## Footnotes

*   Competing interests: The author is president of the Medical Women’s Federation. She is a consultant orthopaedic surgeon with four grown-up children and has had two miscarriages.

*   Provenance and peer review: Commissioned, not externally peer reviewed.

## References

1.  Bearak J, Popinchalk A, Ganatra B, et al. Unintended pregnancy and abortion by income, region, and the legal status of abortion: estimates from a comprehensive model for 1990-2019. Lancet Glob Health2020;8:e1152-61. [https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(20)30315-6/fulltext](https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(20)30315-6/fulltext). doi:10.1016/S2214-109X(20)30315-6 pmid:32710833
    
    [CrossRef](https://www.bmj.com/lookup/external-ref?access_num=10.1016/S2214-109X(20)30315-6&link_type=DOI) 
    
    [PubMed](https://www.bmj.com/lookup/external-ref?access_num=32710833&link_type=MED&atom=%2Fbmj%2F381%2Fbmj.p862.atom) 

2.  Office for Health Improvement and Disparities. Abortion statistics, England and Wales: 2021. Updated 24 Mar 2023. [https://www.gov.uk/government/statistics/abortion-statistics-for-england-and-wales-2021/abortion-statistics-england-and-wales-2021](https://www.gov.uk/government/statistics/abortion-statistics-for-england-and-wales-2021/abortion-statistics-england-and-wales-2021)
    
    

3.  Office for National Statistics. Births in England and Wales: 2021. 9 Aug 2022. [https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/livebirths/bulletins/birthsummarytablesenglandandwales/2021](https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/livebirths/bulletins/birthsummarytablesenglandandwales/2021)
    
    

4.  Department of Health and Social Care. Women’s health strategy for England. Updated 30 Aug 2022. [https://www.gov.uk/government/publications/womens-health-strategy-for-england/womens-health-strategy-for-england#access-to-services](https://www.gov.uk/government/publications/womens-health-strategy-for-england/womens-health-strategy-for-england#access-to-services)
    
    

5.  All Party Parliamentary Group on Sexual and Reproductive Health. Women’s lives, women’s rights: strengthening access to contraception beyond the covid-19 pandemic. Faculty of Sexual and Reproductive Healthcare. 10 Dec 2020. [https://www.fsrh.org/policy-and-media/all-party-parliamentary-group-on-sexual-and-reproductive-health/](https://www.fsrh.org/policy-and-media/all-party-parliamentary-group-on-sexual-and-reproductive-health/)
    
    

6.  Public Health England. Contraception: economic analysis estimation of the return on investment (ROI) for publicly funded contraception in England. 2018. [https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment\_data/file/730292/contraception\_return\_on\_investment\_report.pdf](https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment\_data/file/730292/contraception\_return_on_investment_report.pdf)
    
    

7.  Public Health England. Health matters: reproductive health and pregnancy planning. 26 Jun 2018. [https://www.gov.uk/government/publications/health-matters-reproductive-health-and-pregnancy-planning/health-matters-reproductive-health-and-pregnancy-planning](https://www.gov.uk/government/publications/health-matters-reproductive-health-and-pregnancy-planning/health-matters-reproductive-health-and-pregnancy-planning)
    
    

8.  BMA. Alcohol and pregnancy: Preventing and managing fetal alcohol spectrum disorders. Updated Feb 2016. [https://www.bma.org.uk/media/2082/fetal-alcohol-spectrum-disorders-report-feb2016.pdf](https://www.bma.org.uk/media/2082/fetal-alcohol-spectrum-disorders-report-feb2016.pdf)
    
    

9.  Hundreds of millions of women living lives “governed by others,” UN report shows. *UN News* 2021 Apr 14. [https://news.un.org/en/story/2021/04/1089702](https://news.un.org/en/story/2021/04/1089702)
    
    

10. United Nations Department of Economic and Social Affairs. World Population prospects 2019. 2019. [https://population.un.org/wpp/Publications/Files/WPP2019\_Highlights.pdf](https://population.un.org/wpp/Publications/Files/WPP2019_Highlights.pdf)
    
    

11. Scigliano M. Welcome to GILEAD: pronatalism and the threat to reproductive rights. Population Matters. 2021. [https://populationmatters.org/resources/welcome-to-gilead-report/](https://populationmatters.org/resources/welcome-to-gilead-report/)
    
    

12. Oppenheim M. More countries “trying to coerce women to have more children,” report finds. *Independent* 2021 Nov 30. [https://www.independent.co.uk/news/world/politics/pronatalist-countries-women-children-b1966249.html](https://www.independent.co.uk/news/world/politics/pronatalist-countries-women-children-b1966249.html)