Sexual and Reproductive Health Services (Contraception), England, 2018/19 [NS]

Analysis of uptake in this part relates to females only¹, and just those for whom a method of contraception was recorded during the year; this was 798,500 females in 2018/19.

Almost all contraception provided to males by SRH services is the male condom (99 per cent), with spermicides and natural family planning representing the only other options available.

For all data on main method of contraception, a person contacting the same service multiple times during the year will only be counted once. From 2014/15, in cases where there are multiple contacts/methods for the same person, the methodology used to identify the main method was revised. As such, any data broken down by main method prior to 2014/15 is not directly comparable, though general trends over time are not affected. See appendix C for more details.

Information presented here is not necessarily representative of the uptake of contraception across the whole population. Contraceptives can be obtained from other sources such as GPs or direct from pharmacies, whilst non-prescription items like condoms can be obtained without a visit to a medical specialist. C-card schemes have also improved access to free condoms for young people through alternative channels.

Contraceptive methods are classified as either User Dependent  or Long Acting Reversible Contraceptives (LARCs)². LARCs are not reliant on regular user adherence.

The NICE guidelines on LARCs for England and Wales published in October 2005 (and updated in 2014) suggested that increased uptake of long-acting methods would reduce unintended pregnancy and be most cost-effective for the NHS.

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^{1. A female and male attending together will be recorded as a female contact.}    

^{2. See table 6 of the Excel data tables for inclusions in the User Dependent and LARC classifications.}

Uptake of user dependent contraceptives / LARCs, by year

56% of females in contact with SRH services for contraception, had a user dependent main method, and 44% were using a LARC.

Over the last ten years, LARC uptake has been increasing and uptake of user dependent methods has been decreasing³.

Uptake of user dependent contraceptives / LARCs, by age

The proportion of females who choose LARCs as a main method of contraception is lowest in younger women: less than 40% of those aged under 24, compared to 57% of those aged 35 and over.

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^{3. In 2014/15 there was change to the methodology for identifying the main method of contraception. Although this means there is no directly comparable time series before 2014/15, the general trends over time are not affected. See appendix C for more details of the change in methodology.}

Uptake of user dependant contraceptives, by method and year

Uptake of oral contraceptives has fallen from 45% in 2014/15 to 39% in 2018/19, though they remain the most common of any method (whether user dependant or LARC). They were the most common method in all age groups, with the exception of those aged 45 and over, for whom IU systems were most common (see section on LARCs).

The male condom was the next most common user dependent option, with 14% choosing them as a main method. However, as the male condom is easily available without prescription from other sources such as retail outlets, and free via C-card schemes for persons under 25, the proportion of women using them as a main method across the full population is likely to be much higher. The fall in the proportion choosing male condoms as a main method between 2010/11 and  2015/16 may reflect an increase in the number of people obtaining condoms by these different means.

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^{4. In 2014/15 there was change to the methodology for identifying the main method of contraception. Although this means there is no directly comparable time series before 2014/15, the general trends over time are not affected. See appendix C for more details of the change in methodology.}

LARC uptake, by method and year

Implants are the most common type of LARC, being the main method of contraception for 17% of females, with younger age groups more likely to use them; 29% of under 16's compared to 11% of those aged 45 and over.

The increase in overall LARC uptake over the last 10 years has been primarily driven by a rise in the use of implants, and more recently IU systems and devices. In 2018/19 IU systems were being used by 10% of females, and IU devices by 8%.

Use of IU devices and systems increases with age, with 42% of those aged 45 and over using one or the other as their main method of contraception.  This compares to 6% of 18-19 year olds and less then 5% of those under 20.

Injectable contraceptives are the only LARC method where uptake (9%) has not risen in recent years. Studies suggest that injectable contraceptives are less cost effective than other LARC methods, with a higher failure rate (see Appendix E for examples). 

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^{5. In 2014/15 there was change to the methodology for identifying the main method of contraception. See appendix C for more details of the change in methodology.}

LARC uptake⁶,by Local Authority (LA)

39 LAs recorded a LARC uptake of 50% or more, up from 19% in 2017/18. The highest proportions were in Poole (65%), Isle of Wight (63%), Lincolnshire (63%), and Coventry (62%).

The lowest levels were in St. Helens (30%), West Sussex (31%) , and Halton (31%).

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^{6. Based on percentage data that has been rounded to the nearest whole number.}