Skip to main content

Access to Contraceptive Services

Volume 456: debated on Tuesday 6 February 2007

I beg to move,

That leave be given to bring in a Bill to make provision about access to contraceptive services; and for connected purposes.

This Bill is very timely, given that contraception awareness week starts on Monday. This Government have an excellent record on sexual health, having made it one of the top six priorities for the first time in the history of the NHS. There has been unprecedented and much needed investment to fight the large numbers of sexually transmitted infections and bring down teenage pregnancy rates in the UK. They are the highest in Europe, and HIV is also on the increase.

Condoms are the focal part of the Bill, and they are still the best form of contraception both to prevent pregnancy and to stop the spread of sexually transmitted infections, including HIV. The Bill has three main objectives—to include condoms in the category of free contraception that may be dispensed without charge by general practices, to ensure that commissioned sexual and reproductive health services include the free provision of condoms, and to require that any publicity material on sexual health provided in a general practice will promote the availability of free condoms to those who want them.

General practitioners provide 80 per cent. of contraception for people in the UK, and contraception has been free on the NHS since 1975. There are 14 different types of contraception available, and GPs can provide all of them free—with the exception of condoms. Neither male nor female condoms are included in what GPs can provide free. Although some GPs set aside part of their budget to allow free provision, that is by no means universal. The Bill seeks to correct that strange anomaly. It is a historical legacy that condoms are not freely available at GPs’ surgeries, and given the massive preventive benefits that greater access to condoms would bring, it is time to right that wrong.

When contraception was first prescribed free of charge on the NHS in 1975, condoms were exempt because they were classed as “non-medical devices”. I recently found an article written by Toni Belfield from the Family Planning Association in 1989—almost 20 years ago. Depressingly, it highlights the same anomaly and quotes from a GP’s letter to the British Medical Journal in 1975:

“It is surely the last straw if the government intends to insult us by filling up our surgeries with lots of louts queuing up for the issue of condoms.”

Thankfully, attitudes to sexually transmitted infections, and GPs, have moved on since then. Everyone now understands that with infections such as HIV using a condom can save someone’s life.

When we speak of making condoms freely available on the NHS, of course someone has to pay, but it would be a small up-front investment that resulted in massive long-term savings: savings on preventing unwanted pregnancy and the need for abortion or maternity services; savings on preventing sexually transmitted infections, reducing the need for treatment and the demand for screening; savings on the massive price of medication to treat HIV—a lifelong infection for which there is still no cure—and savings on the human cost of that and other infections, such as chlamydia, which leave an ever-increasing number of both men and women infertile, and cost the NHS huge amounts in fertility treatment.

Condom provision must be free because, as with any consumer product, the higher the price, the lower the take-up. In the July 2004 edition of The Lancet the RAND corporation reported an interesting experiment that proves the point. The corporation distributed 13 million free condoms annually in Louisiana through almost 2,000 retail outlets and publicly funded clinics. After three years, there was an increase in condom use from 40 to 54 per cent. by men and from 28 to 36 per cent. by women. At the end of the three years, the corporation tried to recoup some of the programme’s costs by selling heavily subsidised condoms to retail outlets and letting them resell the condoms for just 25 cents each. Instantly, condom distribution nose-dived by 98 per cent. Free distribution was reinstated, and condom use rose again.

As the author of the RAND report says:

“The lesson: even in the world’s richest country, the right price for condoms is zero.”

The question is not whether we can afford to dispense free condoms at GP surgeries, but whether we can afford not to. We need to make it easier for young people and those in hard-to-reach groups to get hold of condoms free. That way, they are more likely to get them and more likely to use them. The GP’s surgery is the most logical place for people to go, and providing condoms in general practice will encourage patients to start talking about contraception and sexual health to doctors and practice nurses. That would be another massive step in the right direction.

The Government have done much to raise awareness of good sexual health and the need for protection. The current awareness campaign, “Condom Essential Wear”, is a good example and was welcomed by the independent advisory group on sexual health and HIV, but it, too, stressed the need for sufficient free condom supplies and said that GP surgeries were a key outlet for provision to

“meet demand stimulated by the campaign and support the message”.

The Government are due to give their response to the independent advisory group’s report in March. It would be great if they took account of its recommendation and allow GPs to dispense free condoms, which would go at least some way towards easing the difficulties faced by contraceptive services in the UK as a whole.

Many family planning and community contraceptive clinics are being closed or reduced because primary care trusts have to cut their budgets. Contraceptive services and centres are an easy target, and as they remain the only outlets where condoms are provided free, there is now an even bigger access issue. As such centres close down, more and more contraceptive services are pushed into general practice, so it is only right that GPs should be able to provide equally comprehensive services and extend their provision of free contraception to condoms. The general practice of the future may commission services as well as provide them. The Bill is forward-thinking and would ensure that if GPs commission sexual health services, the provision of condoms free of charge is included as a matter of course.

The final aspect of the Bill concerns promoting and advertising free access to condoms. Signposting is fundamental to encourage take-up and promote education, and will help normalise the use of condoms, which in turn will lead to more responsible condom use and greater awareness of the importance of sexual health.

The Bill is supported by the Family Planning Association, the Terrence Higgins Trust, the Royal College of General Practitioners, the Royal College of Nursing and the British Association of Sexual Health and HIV. The all-party pro-choice and sexual health group, the all-party AIDS group and the independent advisory group on sexual health and HIV also support it. I hope that the House will do likewise.

Question put and agreed to.

Bill ordered to be brought in by Natascha Engel, Mr. Neil Gerrard, Chris McCafferty, Norman Lamb, Lynne Featherstone, Lorely Burt, Anne Main, Laura Moffatt, Dr. Howard Stoate, Dr. Doug Naysmith, Dr. Evan Harris and Mr. David S. Borrow.

Access to Contraceptive Services

Natascha Engel accordingly presented a Bill to make provision about access to contraceptive services; and for connected purposes: And the same was read the First time; and ordered to be read a Second time on Friday 15 June, and to be printed [Bill 57].

On a point of order, Mr. Speaker. I noticed that during the excellent speech made by my hon. Friend the Member for North-East Derbyshire (Natascha Engel) on her ten-minute Bill, there was not a single Opposition Front-Bench health spokesman present. Is it not a convention—