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

Analysis of uptake in this part relates to females only (female and male attending together will be recorded as a female contact), and just those for whom a method of contraception was recorded during the year; this was 467,642 females in 2020/21.

Almost all contraception provided to males by SRH services is the male condom (99%), 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 part C of the Appendices 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.

C-card distribution schemes - Why, what and how

Contraceptive methods are classified as either User Dependent  or Long Acting Reversible Contraceptives (LARCs). LARCs are not reliant on regular user adherence. See table 6 of the Excel data tables for inclusions in the User Dependent and LARC classifications.

The NICE guidelines on LARCs for England and Wales published in October 2005 (and updated in 2019) suggested that increased uptake of long-acting methods would reduce unintended pregnancy and be most cost-effective for the NHS.

https://www.nice.org.uk/guidance/cg30/chapter/1-Recommendations

Uptake of user dependent contraceptives / LARCs, by year

Note: 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 part C of the Appendices for more details of the change in methodology.

54% of females in contact with SRH services for contraception had a user dependent main method, and 46% were using a LARC.

Over the last ten years, LARC uptake had been increasing and uptake of user dependent methods had been decreasing. However, the figures in 2020/21 were unchanged from 2019/20.

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 age groups; 35% to 43% of those aged under 25, compared to 56% to 59% of those aged 35 and over.

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For more information: Data tables 6 and 7

Uptake of user dependant contraceptives, by method and year

Uptake of oral contraceptives has fallen from 45% in 2014/15 to 39% in 2020/21, 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 11% 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 over the last ten years may in part reflect an increase in the number of people obtaining condoms by these different means.

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For more information: Data tables 6 and 7 

LARC uptake, by method and year

Implants are the most common type of LARC, being the main method of contraception for 18% of females, with younger age groups more likely to use them; 35% of under 16's compared to 12% of those aged 45 and over.

The increase in overall LARC uptake over the last 10 years has been driven by a rise in implants, IU systems and devices. In 2020/21, IU systems were the main method for 12% of females, and IU devices for 9%.

Use of IU devices and systems increases with age, with 43% of those aged 45 and over using one or the other as their main method of contraception.  This compares to 15% of 20-24 year olds and less then 5% of those under 18.

Injectable contraceptives are the only LARC method where uptake (7%) 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 part E of the Appendices for examples). 

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For more information: Data tables 6 and 7

LARC uptake, by Local Authority (LA)

29 LAs recorded a LARC uptake of 55% or more, up from 26 in 2019/20. The highest proportions were in Rotherham (68%), Stockport (66%), and Northamptonshire (64%).

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For more information: Data tables 17