Sexual and Reproductive Health Services, England (Contraception) 2020/21

The data sources used in this report are described below.  Any issues with data quality are included in the Data Quality Statement which accompanies this report.

SRH Services data

The annual Sexual and Reproductive Health (SRH) services report primarily presents information on community based SRH services in England. It includes national and regional tables as well as tables by local authority and provider organisation.

Data on Sexual and Reproductive (SRH) services has been collected since 1988/89 through the KT31 return, and since 2010/11 via the Sexual and Reproductive Health Activity Dataset (SRHAD). Between 2010/11 and 2013/14 providers were able to submit either a KT31 return or SRHAD.

SRHAD is an activity based collection with each contact being a record within the dataset. An updated version (SRHAD version 2) was introduced on 1st January 2015, which includes additional fields and extends the remit of the collection to include non-face to face contacts. All providers have been required to submit this new version since 2016/17.

Further details of the SRHAD collection are available. 

Prescribing data

Prescription items dispensed in the community are sourced from the Prescribing team at NHS Digital. Information is taken from the Prescription Cost Analysis System (PCA), supplied by the Prescription Services Division of the NHS Business Services Authority (NHS BSA) and is based on the full analysis of all prescriptions dispensed in the community (i.e. by community pharmacists and appliance contractors, dispensing doctors, and prescriptions submitted by prescribing doctors for items personally administered in England). Also included are prescriptions written in Wales, Scotland, Northern Ireland and the Isle of Man but dispensed in England. The data do not cover drugs dispensed in hospitals, including mental health trusts, or private prescriptions. Prescribers are GPs, nurses, dentists and hospital doctors. Prescriptions are written on a prescription form known as a FP10. Each single item written on the form is counted as a prescription item.

Hospital data

Information on sterilisations and vasectomies is sourced from Hospital Episode Statistics (HES) hosted by NHS Digital. HES is a data warehouse containing details of all admissions to NHS hospitals in England. It includes private patients treated in NHS hospitals, patients who were resident outside of England and care delivered by treatment centres (including those in the independent sector) funded by the NHS. HES also contains details of all NHS outpatient appointments in England as well as detailed records of attendances at major A&E departments, single specialty A&E departments, minor injury units and walk-in centres in England.

The unit of measurement used in this report for sterilisations and vasectomies is a finished consultant episode (FCE).  An FCE is a period of care under one consultant within one healthcare provider and a patient may experience more than one FCE in a single admission. FCEs are counted against the year in which the episode finishes.

The procedure codes used for identifying sterilisations and vasectomies are contained within Appendix C.

A contact is defined as a contact with the service (including external contacts, i.e. where an individual patient receives care outside the clinic setting i.e. in his or her own home or other location). Non-face to face contacts were added to the scope in version 2 of the Sexual and Reproductive Activity Dataset (SRHAD) from 2015/16.

Modernisation of services and the multidisciplinary team approach means this professional contact may include a nurse working under a Patient Group Direction (PGD) to supply and administer contraceptives and provide advice, with health advisers, youth workers, and reception staff. Additionally, individuals attending for 'other' services such as cervical cytology, pregnancy testing and menopause advice are recorded.

The main method of contraception for new clients is that chosen after counselling; for existing clients it is the main method in use unless a change is advised.  In cases where a person contacts a service on more than one occasion during the reporting year, the methodology for determining which main method to report is shown in Appendix C.

Vasectomies and occasionally sterilisation procedures, can take place at SRH service clinics and are recorded as an SRH care activity in SRHAD. However, they are not considered as a main method of contraception for the purpose of this analysis.

Where a couple are seen together only one contact is recorded; if  the male condom is the main method chosen by the couple it is recorded as a male contact and if any other method is chosen it is recorded as a female contact.

Long Acting Reversible Contraceptives (LARCs) are defined by NICE as contraceptive methods that require administration less than once per cycle or month. Their effectiveness does not depend on daily concordance. In this publication they consist of Inter-Uterine Devices (IUD), Intra Uterine System (IUS) injectable contraceptive and implants.

Index of Multiple Deprivation (IMD) is a Lower Super Output Area (LSOA) level measure of deprivation, and is made up of seven LSOA level domain indices. These relate to income deprivation, employment deprivation, health deprivation and disability, education skills and training deprivation, barriers to housing and services, living environment deprivation, and crime which reflect the broad range of deprivation that people can experience. IMD is a measure of the overall deprivation experienced by people living in a neighbourhood, although not everyone who lives in a deprived neighbourhood will be deprived themselves.

IMD data presented in this publication is based on the 2019 index.

Disclosure control rules

From 2019-20 the SRHAD disclosure control rules were updated in line with the NHS Digital central suppression rules, which have already been assessed and implemented for secondary care and other datasets.

This means that all sub-national counts between 1 and 7 are suppressed, with other sub-national counts rounded to the nearest 5. Sub-national percentage and rate calculations are performed on rounded data and the result shown to the nearest whole number.  Calculations based on suppressed counts are also suppressed.

Additionally, where a calculation would be made where the rounded denominator is less than 400, we will not display this result. This is because we cannot be sure that the resulting value (as based on rounded data) is of sufficient accuracy when compared to the 'true' percentage (if based on unrounded data).

For further details see the methodological notice.

Count of persons

Where ‘persons’ are referred to in the report, a person is only counted once during the year, even if they had multiple contacts with the same service provider. If the same person attends clinics run by different service providers then they will be counted more than once. 

Main method of contraception

Where a person contacts a service on multiple occasions during the year, it is necessary to select only one of these contacts as their main contraception method. Prior to 2014/15, this was based on a person’s first contact in the year.

From 2014/15 the methodology was updated, to be based on:

• a person’s final visit to a service in the year where a main method of contraception was identified i.e. if a person’s final visit during the year related to advice or non-contraception related activity only, then this has been discounted from the analysis in favour of an earlier visit, IF in that earlier visit a main method of contraception was recorded.

This method ensures that it reflects the most current main method of a person, and that contacts where a main method of contraception was recorded, are prioritised over non-contraception related contacts.

Compilation of sterilisation and vasectomy data

The following OPCS-4.7 codes classify vasectomy, vasectomy reversal, female sterilisation and female sterilisation reversal:

Procedure codes identifying vasectomies

N17.1 Bilateral vasectomy

N17.2 Ligation of vas deferens NEC

N17.8 Other specified excision of vas deferens

N17.9 Unspecified excision of vas deferens

Procedure codes identifying vasectomy reversals

N18.1 Reversal of bilateral vasectomy

N18.2 Suture of vas deferens NEC

N18.8 Other specified repair of spermatic cord

N18.9 Unspecified repair of spermatic cord

Procedure codes identifying female sterilisations

Q27.1 Open bilateral ligation of fallopian tubes

Q27.2 Open bilateral clipping of fallopian tubes

Q27.8 Other specified open bilateral occlusion of fallopian tubes

Q27.9 Unspecified open bilateral occlusion of fallopian tubes

Q28.1 Open ligation of remaining solitary fallopian tube

Q28.2 Open ligation of fallopian tube NEC

Q28.3 Open clipping of remaining solitary fallopian tube

Q28.4 Open clipping of fallopian tube NEC

Q28.8 Other specified other open occlusion of fallopian tube

Q28.9 Unspecified other open occlusion of fallopian tube

Q35.1 Endoscopic bilateral cauterisation of fallopian tubes

Q35.2 Endoscopic bilateral clipping of fallopian tubes

Q35.3 Endoscopic bilateral ringing of fallopian tubes

Q35.4 Endoscopic bilateral placement of intrafallopian implants

Q35.8 Other specified endoscopic bilateral occlusion of fallopian tubes

Q35.9 Unspecified endoscopic bilateral occlusion of fallopian tubes

Q36.1 Endoscopic occlusion of remaining solitary fallopian tube

Q36.2 Endoscopic placement of intrafallopian implant into remaining solitary fallopian tube

Q36.8 Other specified other endoscopic occlusion of fallopian tube

Q36.9 Unspecified other endoscopic occlusion of fallopian tube

Procedure codes to identify female sterilisation reversals

Q29.1 Reanastomosis of fallopian tube NEC

Q29.2 Open removal of clip from fallopian tube NEC

Q29.8 Other specified open reversal of female sterilisation

Q29.9 Unspecified open reversal of female sterilisation

Q37.1 Endoscopic removal of clip from fallopian tube

Q37.8 Other specified endoscopic reversal of female sterilisation

Q37.9 Unspecified endoscopic reversal of female sterilisation

Department of Health and Social Care (DHSC) and Public Health England (PHE) use these statistics to inform policy and planning.

The Secretary of State for Health has a statutory duty to protect health and address inequalities, and promote the health and wellbeing of the nation.  DHSC and PHE will use SRHAD data to support these public health functions with regard to sexual and reproductive health.

The data supports the Government's Sexual Health Strategy objective to reduce unintended pregnancies. It also feeds into the Sexual and Reproductive Health Profiles produced by PHE which provide a suite of nationally agreed indicators at local authority level (http://fingertips.phe.org.uk/profile/sexualhealth), and into their local authority sexual health epidemiology reports (LASERs) which describe STIs, HIV and reproductive health in the local area.

Local authorities use these statistics to support their legal duty to improve the public’s health.  Specifically they are used in the planning and management of service delivery (commissioning) and for performance management of sexual health services. They can help forecast the demand for services and assist in planning how services will be delivered. Statistics and findings have been used to support Joint Strategic Needs Assessments of the health and wellbeing of local communities.

The information supports NHS trusts by providing a key source of sexual health information for public health and performance management. As set out in the 2009/10 NHS Operating Framework, services to reduce teenage pregnancy rates, including provision of a full range of contraceptive services, have a key role in keeping children well, improving their health and reducing health inequalities.

National Institute for Health and Clinical Excellence (NICE) used the data in cost effectiveness studies of Long Acting Reversible Contraceptives.

The statistics are used by NHS Digital to answer Parliamentary questions, freedom of information requests and ad-hoc queries.

The statistics are used by the media to underpin various articles/journals etc. on matters of public interest.

Unknown Users

This publication is free to access via the NHS Digital website, and consequently the majority of users will access the report without being known to us. Therefore, it is important to put mechanisms in place to try to understand how these additional users are using the statistics and also to gain feedback on how we can make these data more useful to them. On the webpage where the publication appears there is a “Contact us” link at the bottom of the page.  Any responses are passed to the team responsible for the report to consider.

For detail on the SRHAD collection. 

General NICE guidance

NICE LARC advice for main method of contraception

Department of Health’s Sexual Health Improvement Framework 2013

Government's Public Health Outcomes Framework, which includes three sexual health outcomes

Public Health England’s Sexual and Reproductive Health Profiles

Public Health England’s guide to data on sexual and reproductive health

Governments Teenage Pregnancy Strategy 2010

Advisory Group on Contraception (AGC) recommendations to NHS England 2014

Findings from a study by Public Health England on condom distribution schemes (CDS) Condom Distribution Schemes, England 2015/16

Examples of studies/information on the effectiveness of different types of contraception:

https://www.nhs.uk/conditions/contraception/how-effective-contraception/

https://srh.bmj.com/content/familyplanning/32/1/3.full.pdf

https://academic.oup.com/humrep/article/23/6/1338/586572

https://link.springer.com/article/10.2165/11591290-000000000-00000

Comments on this report would be welcomed. Any questions concerning any data in this publication, or requests for further information, should be addressed to:

The Contact Centre
NHS Digital
7 and 8 Wellington Place
Leeds
West Yorkshire
LS1 4AP

Telephone: 0300 303 5678

Email: [email protected]

Press enquiries should be made to:

Media Relations Manager:

Telephone: 0300 303 5678

Email: [email protected]

This and previous reports on Sexual and Reproductive Health Services in England can be found at:

https://digital.nhs.uk/data-and-information/publications/statistical/sexual-and-reproductive-health-services