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Sexual Health Services Mapping
The following information sets out key information about sexual health services in London. It can be viewed in sections or as a complete download at the bottom of this page.
- Teenage pregnancy and deprivation
- Young people focused contraceptive and sexual health services
Conclusion and recommendations
The full report is also available to download
This report maps under-18 conceptions, deprivation rates and the location of sexual health services on a borough-by-borough basis across London. It is intended for use by Teenage Pregnancy Partnership Boards and commissioners to plan priorities and service developments. It will also be useful for those working at regional and national level and offers further evidence of the relationship between under-18 conceptions and deprivation.
The mapping will also inform the research currently being undertaken to identify the underlying causes of the high abortion and repeat abortion rate for under-18s in London.
The data sources used for the mapping exercise were ward level under-18s conception rates 2003-05 (ONS), the Index of Multiple Deprivation (IMD) 2007, and information about sexual health services submitted to the Sexwise database by local teenage pregnancy co-ordinators during Spring and Summer 2008. The Sexwise data represents a snapshot at a given moment in time, and in an environment where services are constantly evolving.
For any information about this work contact:
Judy Mace
Regional Teenage Pregnancy Co-ordinator
Tel: 020 7217 3725
Email: judy.mace@gol.gsi.gov.uk
Teenage pregnancy and deprivation
There are a number of risk factors which impact on teenage pregnancy rates, not least of which is deprivation. Variations in under-18 conception rates largely mirror the pattern of deprivation with 50% of all conceptions happening in the 20% most deprived wards. Under-18 conception rates are more than four times higher in the most deprived 10% of wards in England compared to the 10% least deprived.
Deprivation is not the whole story, with a number of other factors also playing a part. These include poor and inconsistent contraceptive use, low attainment and attendance and a general disengagement from services. When a number of these factors coincide, the risk of teenage pregnancy increases. Effective local teenage pregnancy partnerships will use the analysis of risk factors for teenage pregnancy to target delivery of their local strategy towards geographical areas and at risk groups.
Young people focused contraceptive and sexual health services
The Deep Dive of high performing areas, undertaken in 2005 by the Teenage Pregnancy Unit (TPU), found that the provision of young people focused contraception and sexual health services, trusted by teenagers and well known by professionals was the factor most commonly cited as having the biggest impact on conception rates. These services reflected the Best Practice Guidance on the Provision of Effective Contraception and Advice Services for Young People (TPU, 2000) and the You’re Welcome criteria (Department of Health 2007). The text box below summarises these:
Features of effective young people-focused sexual and reproductive health service provision include:
• Easy access in the right location with opening hours convenient to young people
• Provision of the full range of contraceptive methods, including long acting methods
• A strong focus on sexual health promotion as well as reactive services
• Access to pregnancy testing, referral to NHS abortion services and antenatal care
• A condom distribution scheme involving a wide range of local agencies and/or access to emergency hormonal contraception in non-clinical settings
Teenage Pregnancy Next Steps: Guidance for Local Authorities and Primary Care Trusts on Effective Delivery of Local Strategies (DCSF 2006) calls for all areas to ensure that young people have access to services which reflect this criteria.
There is also clear evidence that improving access to contraceptive services that offer a full range of methods for young people is a major contribution to reducing the teenage conception rate. “86% of the decline in the US teenage pregnancy rates is attributed to improved contraceptive use ”.
Funding for services
£26.8 million additional funding has been made available for use in 2008/09 by Department of Health to improve young people’s access to contraception. £14 million of this has been distributed to strategic health authorities for innovative new ways of helping young people to access sexual health and contraceptive services. The remaining £12.8 million has been allocated directly to primary care trusts in their main allocation. This additional funding provides an opportunity to review clinical provision to ensure that it is young people focused.
Progress towards 2010
All local areas have been set differentiated targets to achieve a reduction in under-18 conceptions of between 40% and 60% by 2010 from a baseline in 1998. Nationally and in London progress is slower than is needed. London as a region has seen some steady and very positive decreases (Hammersmith and Fulham, Kingston, Hackney) but there are rates in some areas that stubbornly refuse to head in a downward direction.
Every local area is given a RAG (red, amber, green) traffic light rating, based on the latest year for which under-18 conceptions data is available (Office for National Statistics, 2006). The map below shows the RAG ratings across London. In London 24 boroughs are Red or Amber-red. These boroughs will wish to review their contraceptive and sexual health services to ensure that the services provided are in line with the evidence about effective provision of young people focused services.
Click on the image above to view a larger version of this map
Methodology
Individual borough maps have been created showing ward level under-18 conception rates (03-05 is the latest data available), and the 20% most disadvantaged super-output areas (using Index of Multiple Deprivation (IMD) 2007). These have been over-laid with details of sexual and reproductive health services, as submitted to Sexwise (the database supporting RUthinking.co.uk) by local teenage pregnancy co-ordinators during spring 2008.
The quality of the analysis in this report is very much dependent on the accuracy of the information submitted to Sexwise. Teenage Pregnancy Co-ordinators are required to update this database on an annual basis, feeding as it does into one of the main sources of information for young people about local sexual health services. All local areas were contacted to ensure that the information submitted to Sexwise reflected the most up to date picture. The draft report was circulated to all local areas in June 2008 and amendments made.
All clinical services, emergency hormonal distribution and condom distribution points are categorised and shown on the maps. Young people’s sessions have been included in the mapping if they are part of a condom distribution scheme, offer pregnancy testing in addition to information and advice or a more complete clinical service.
A short commentary has been written for each borough. This covers the following factors:
• Teenage Pregnancy rates over time, and pattern of increase/decrease between the baseline being set (1998) and the latest year for which data is available (2006)
• Consistency between high levels of deprivation and high teenage conception rates
• The location and spread of services – whether individual contraceptive clinics are dotted throughout the borough or whether services have developed using a specialist hub with general spokes. Are there services in hotspot areas?
• Are young people able to access services which provide integrated sexual and reproductive health services?
• Frequency of services (days and times)
• What are the opening hours of the services? Will these be accessible to young people in education, training or employment? Are services available Monday-Saturday?
• Is there access to the full range of contraceptive methods, including long acting methods
• Are there services for young people which provide a clinical service as well as a strong focus on sexual health promotion?
• Is there access to pregnancy testing, referral to NHS abortion services and antenatal care
• Is there a condom distribution scheme involving a wide range of local agencies and/or access to free emergency hormonal contraception (EHC) in pharmacies?
While the report comments on location and frequency of services, it does NOT cover the capacity, activity or patterns of service use. Teenage pregnancy partnerships will need to use local intelligence to complete the service picture.
At the end of the individual borough commentary, suggestions for future service developments have been made. These are based on the gap between current service provision, as submitted to Sexwise in Spring 2008, and recognised best practice. When considering future service developments, local areas will wish to consider the opportunities offered by extended school services, children’s centres and integrated young people’s services as well as traditional sexual and reproductive health services.
Click on the image above to view a larger version of this map
Click on each borough above to view their individual sexual health service mapping information
Conclusion and recommendations
London is incredibly diverse, with vastly differing deprivation and teenage conception levels between and within boroughs. The London map on page 8 shows different models and patterns of services, both of which bring benefits. North-east London is characterised by a large number of access points, geographically distributed across the borough, and condom distribution scheme operating in a number of boroughs. The picture for the south-east London boroughs is one of having more centralised services, offering comprehensive services based in one place and offering a range of services throughout the week.
This report does not attempt to describe a “perfect” service model. What it does is hold a mirror up against each London borough and contrasts this with what is known about best practice in service provision for young people’s sexual health services. There are a number of messages that emerge from this exercise that are general points and these are set out below; specific recommendations are made for each borough under the Suggestions for future developments section.
1. Service location: Services do not always appear to have been established with the idea of a “right location” for young people in mind. Sometimes this will be historical; services may be attached to a hospital or primary care centre, but it is important for commissioners and planners to undertake needs assessments before commissioning or decommissioning services. The right location may be close to home, but equally it could be close to or in a school or college. A recent Sex Education Forum report found that as a region London had the lowest number of school-based sexual health services. or a bus route.
2. Convenient opening hours: When young people are asked when they would like services to be open, they consistently respond that they would like to be able to attend during the afternoon and early evening throughout the week, and that they would also like some form of service to be available at weekends. In some London boroughs the majority of services are concentrated on a few days, there is no Saturday service and most sessions take place during the morning. In a smaller number the opening hours of GUM services are not made available to Sexwise, and the ruthinking.co.uk website resource and so cannot be assessed for the availability and convenience of opening times for young people
3. Access to long acting methods of contraception: A consistent recommendation for most boroughs is that long acting methods of contraception need to be available, and availability needs to be included in information submitted to the Sexwise database. This is because from the service information available it is unclear whether services are offering the full range of contraceptive methods.
4. Sexual health promoting as well as reactive services: Similarly it is difficult to tell from the information provided to Sexwise what the quality of the service provided is, and whether there is a focus on both sexual health promotion and reactive services. Certainly, those boroughs that offer young people’s services that have both drop-ins, discussions, condom distribution points and clinical services, are more likely to be offering both promotion and reactive services.
5. Access to pregnancy testing, referral to abortion and ante natal care. All boroughs offer access to pregnancy testing and referral to either abortion or ante natal services. This service is largely provided by community contraceptive or sexual and reproductive health clinics. In some cases young people’s services offer testing and referral. More often it appears that only testing is offered. This is a possible area for service development.
6. Existence of condom distribution and EHC in pharmacy schemes. Only Bromley, Hackney, Hammersmith and Fulham, Islington, Kingston and Tower Hamlets have fully developed condom distribution schemes, with a large number of access points in a range of settings across the borough. A number of boroughs have two or three distribution points but no fully developed scheme. This is disappointing and a clear area for service development, with evidence based gains to be had. Many more boroughs have developed EHC in pharmacy schemes, with most including participating pharmacies from across the borough. Where more limited schemes have been developed, in the majority of cases these are quite clearly targeted to high conception rate areas within the borough. There are a small number of boroughs which have developed neither EHC in pharmacy nor condom distribution scheme.
7. Updating Sexwise. The RUthinking.co.uk, which the Sexwise database supports is one of the main source of web-based information about sexual health services, and is widely used by young people and professionals. The Department of Health’s evaluation of the Want Respect? Campaign found that young people in London are less likely to be aware of places to go for advice on sex and relationships and where to get contraception than young people in other parts of the country. This finding shows how vitally important it is that the Sexwise database is updated as services change, and on at least an annual basis.
8. Repeating the borough mapping. Now that the initial mapping has been undertaken, it would be a relatively simple exercise to repeat this exercise annually. In this way demographic and service change could be logged over time. A future mapping could also consider including population density, mobility, and more in depth service information.