Why Are We Still Waiting for a National Reproductive Health Strategy?

From long waits to limited local services, 49% of women in the UK face challenges when trying to access contraception. The Local Government Association warns that fragmented services and £880 million in real-terms public health cuts since 2015 are pushing care to breaking point. Despite a growing demand now reaching 4.5 million sexual health consultations annually, England still lacks a national reproductive health strategy.

The WHO defines Reproductive Health as a state of complete well-being and autonomy in all matters relating to sexuality and reproduction. Yet England still has no national SRH strategy to reaffirm this definition. Countries such as France and the Netherlands have integrated SRH into their public health planning. So why is England still falling behind?

Despite an internationally recognised definition, reproductive healthcare in England fails to deliver equitable access. Essential services like contraception, abortion, fertility treatment, and menstrual health support vary widely by region, creating a ‘postcode lottery’ that undermines universal care. The Women’s Health Strategy for England sets goals but lacks a fully integrated approach. Without a unified framework, services remain fragmented, inconsistently commissioned, and perpetuate inequalities across the nation.

England’s Disjointed Landscape: A “Postcode Lottery” in Action

The current state of sexual and reproductive health services in England reveals a fragmented system marked by inconsistent access and quality, heavily influenced by regional differences.

Expanding but unequal access to contraception

The NHS Pharmacy Contraceptive Service, launched in 2023, allows patients to access repeat oral contraceptive prescriptions without GP visits. However, access to long-acting reversible contraception (LARC) like implants and IUDs remains uneven due to variations in commissioning by Integrated Care Boards and workforce shortages, as highlighted by the UK Parliament’s 2023 Women and Equalities Committee investigation.

Inconsistencies in abortion care provision

Access to abortion services is inconsistent. Some regions have adopted telemedical abortion, an approach endorsed by the RCOG and NICE for its safety, effectiveness, and patient acceptability. However, despite these rigorous endorsements, adoption and implementation of this method remain inconsistent, with complex commissioning structures continuing to restrict uniform access.

Inequities in fertility treatments

Fertility treatment across England highlights stark inequity. The Human Fertilisation and Embryology Authority reports considerable variation in NHS-funded IVF eligibility and funding, with some regions offering fewer or no cycles, despite NICE recommending up to three for eligible women under 40. This means that fertility support is increasingly becoming a luxury, only accessible to some, leaving many women without the care they need to start a family.

Delays and neglect in menstrual health

Patients with menstrual health conditions like endometriosis often experience long diagnostic delays, averaging 8 years and 10 months across the country, according to Endometriosis UK.  During this prolonged wait, patients frequently endure chronic pain and face an increased risk of infertility. Despite the Women’s Health Strategy promoting integrated care through Women’s Health Hubs, gynaecology still has the longest NHS waiting list, with over 586,000 patients in December 2024 waiting for care.

A system under strain

These issues are compounded by workforce shortages highlighted in the NHS Long Term Workforce Plan, further limiting capacity and deepening disparities, emphasising the urgent need for a coordinated national strategy.

Learning from Elsewhere: Integrated Models in Europe

Whilst England continues to operate without a dedicated reproductive health strategy, some of our European counterparts have demonstrated that coordinated, evidence-led approaches are both achievable and effective.

Learnings from France’s unified national strategy

France provides a compelling example of how a comprehensive national approach to sexual and reproductive health can be effectively implemented. Its National Strategy for Sexual Health (2017–2030) brings together contraception, abortion care, STI prevention, and education within a unified policy framework, along with multiple Strategy Roadmaps, displaying how they will achieve the aims of the strategy. One of the many positive impacts of France’s strategy is reflected in significant improvements in HIV care, with a study showing that between 2009-2011 and 2018-2019, the median time from HIV diagnosis to viral suppression in France decreased from 254 days to 73 days, indicating faster treatment initiation and a lower risk of onward transmission.

Learnings from Netherlands’ preventative model

The Netherlands’ Solid Start programme targets the first 1,000 days from preconception to early childhood, integrating digital healthcare and social support to reduce inequalities. Using indicators and stakeholder input, it monitors progress, identifies gaps, and tailors interventions.

What England can learn

England should act on these examples by implementing a unified, evidence-based reproductive health strategy. Starting with investing in accessible services, improving data collection to identify gaps, and promoting community engagement to close care disparities and drive better equity and outcomes.

Conclusion: Time for Action

England’s fragmented reproductive healthcare system is failing those who rely on it most. The postcode lottery and patchy services leave too many without essential care. A unified, comprehensive, and evidence-led national reproductive health strategy isn’t just a goal, it’s an urgent necessity. Investing in this framework is vital for the health, equality, and future of the entire nation.