Over a third of women did not attend their last smear test despite the cervical screening programme being able to prevent up to 70% of deaths from cervical cancer, according to a new report from the Royal College of Obstetricians and Gynaecologists (RCOG).

The “Better for Women” report, which will be launched in the House of Commons today, is a survey of over 3,000 women in the UK and shows many are struggling to access basic healthcare services including contraception, abortion care and menopause support.

It emphasises the need for national strategies to meet the needs of girls and women across their life course – from adolescence, to the middle years and later life. There should also be greater focus on moving the UK away from providing a disease intervention service towards a preventative health service, says the report.

The report recommends that one-stop women’s health clinics provide reproductive and sexual healthcare services – such as contraception, STI testing, cervical screening, and treatment and advice about the menopause – in one location and at one time to improve services for women and make savings for the NHS.

These clinics should be available in the evenings and at the weekends to improve accessibility for girls and women, says the RCOG, and will help to address social and economic inequalities.

Under-funding and fragmentation of sexual and reproductive healthcare services

Nearly four in 10 women (37%) are unable to access contraception services and 60% of women cannot access unplanned pregnancy services, including abortion care locally.

Latest statistics show that abortions are at an all-time high and highlight the unmet contraceptive needs of women. In 2018, there were 200,608 abortions across England and Wales – an increase of 4% on the previous year.

Only half (50%) of women are able to access sexually transmitted infections (STI) services and 56% of women are unable to seek help for menstrual health issues, such as for heavy/painful periods, locally.

Also, just over half of women (58%) cannot access menopause services, despite almost every woman going through the menopause at some point in life.

Poor access to basic women’s health services leads to a rise in unplanned pregnancies, abortions, poor patient experiences and outcomes, and increases damaging postcode lotteries across the country.

Professor Lesley Regan, President of the Royal College of Obstetricians and Gynaecologists (RCOG), said: “It is time for a new and bold approach to transform women’s health services and we look forward to working with many key partners to bring about much needed changes across the NHS and particularly in the community.

“Many of the barriers to access to women’s healthcare services can be improved by ensuring services are joined up and more responsive to the needs of girls and women. It is important we provide a comprehensive health service for girls and women throughout their lives. We want to empower 51% of the population to be as healthy as possible and ensure no one is left behind.

“This doesn’t need to come at a great financial cost to the NHS. In fact, we believe we can do better for less.”

One-stop shop for women's health needed

The survey found almost half (48%) of women think that a one-stop-shop women's health clinic for all routine women's health services could improve their access to these services.

Almost half (45%) of women think that drop-ins for specific services, for example, cervical screening, could improve access, and over 2 in 5 (42%) women think that more convenient appointment times would help. In addition, half (43%) of women with an income of less than £15,000 did not attend their last smear test, compared to 24% of women on higher incomes – highlighting social and economic inequalities.

Dr Asha Kasliwal, President of the Faculty of Sexual and Reproductive Healthcare (FSRH), said: “I see a patient in my contraception clinic who requires a difficult fitting of the coil. She is also due her cervical smear test. This is the perfect opportunity to provide both services. However, my clinic is not commissioned to provide smears, so I am unable to do so. Instead of having all of her needs met in one go, this woman now has to book two appointments for two different vaginal examinations. It is expensive, frustrating for me as a doctor and unfair for the woman. Something has to change.

“This is why this report is calling for a joined-up approach to the commissioning of sexual and reproductive healthcare services. Cuts to Public Health budgets and a fragmented commissioning system have created barriers for women to access holistic care.

“Collaborative commissioning can improve the quality and availability of sexual and reproductive healthcare services, increase access and reduce inequalities. Collaborative commissioning must become the norm, with enhanced accountability across the system.

“This would be cost-effective for the NHS in the long-term whilst providing women and girls with high-quality, integrated sexual and reproductive healthcare.”