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Publication, Part of

Sexual and Reproductive Health Services, England (Contraception) 2022/23

Accredited official statistics

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Part 2: Methods of contraception

Introduction

Analysis of uptake in this part relates to females using SRH services 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 472,840 females in 2022/23.

Almost all contraception provided to males by SRH services is the male condom (94%), 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


Comparing uptake of user dependant / long acting reversible contraceptives

Uptake of user dependent contraceptives / LARCs (at SRH services), by year

55% of females in contact with SRH services for contraception were using a LARC, a decrease of 1 percentage point from 56% in 2021/22. The remaining 45% had a user dependent main method. 

Over the last ten years, LARC uptake has been increasing and uptake of user dependent methods has been decreasing. The pause in this increase seen in 2020/21 was likely due to more restricted access to LARCs during the Covid-related lockdowns. In 2021/22, LARC uptake at SRH services was above user dependent uptake for the first time, a trend that continues in 2022/23. The large change seen in 2021/22 was driven by a sharp decrease in women using contraceptive pills as their main method, and rises in the use of IU systems, IU devices, and implants (see later sections for more detail). 

Note that at the end of July 2021, progesterone-only pills became available to purchase over the counter at pharmacies without prescription. This is likely to have impacted the number of women needing to attend SRH services for the contraceptive pill, and thus the SRH services uptake figures for this method (and user dependant methods as a whole).

Change in methodology 2014/15

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.


Uptake of user dependent contraceptives / LARCs (at SRH services), by age

The proportion of females who choose LARCs as a main method of contraception is lowest in younger age groups; 42-44% of those aged under 20, compared to 65-68% of those aged 35 and over.


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For more information: Data tables 6 and 7


Uptake of user dependant contraceptives

Uptake of user dependant contraceptives (at SRH services), by method and year

Uptake of oral contraceptives at SRH services has remained the same at 27% in 2022/23 and they remain the most common of any method (whether user dependant or LARC). Though uptake was already on a downwards trend since 2014/15, the large fall seen in 2021/22 was likely influenced by the availability from July 2021 of progesterone-only pills over the counter at pharmacies.

Oral contraceptives were the most common method in all age groups, with the exception of those aged 35 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.


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For more information: Data tables 6 and 7


Uptake of long acting reversible contraceptives

LARC uptake (at SRH services), by method and year

The increase in overall LARC uptake over the last 10 years has been driven by a rise in implants, IU systems and devices, and all saw similar uptake in 2022/23. Implants (the most common type of LARC), were now the main method of contraception for 22% of females using SRH services. 16% were using IU systems as their main method, and 10% IU devices. 

Younger age groups more likely to use implants; 35% of under 16's, compared to 15% of those aged 45 and over. Use of IU devices and systems increases with age, with 51% of those aged 45 and over using one or the other as their main method.  This compares to 19% of 20-24 year olds, 10% of 18-19 year olds, and 5% of 16-17 year olds.

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 (at SRH services)by Local Authority (LA) of patient residence

A LARC uptake of 60% or more was recorded for SRH services patients from 52 LAs, down from 56 in 2021/22. The highest proportions were in Sheffield (91%), North Northamptonshire (76%), Dorset and Rotherham (both 75%) and Redcar and Cleveland (74%). The lowest were in Bristol (34%), Harrow (41%) and Portsmouth, St. Helens and Southampton (all 42%). 


Equivalent data by service provider can be found in table 17b.

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For more information: Data tables 17a and 17b


Last edited: 27 September 2023 3:25 pm