Sexual and Reproductive Health Services, England (Contraception), 2023-24

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 519,942 females in 2023-24.

Almost all contraception provided to males by SRH services is the male condom (97%), 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

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

54% of females in contact with SRH services for contraception were using a LARC, with the remaining 46% having a user dependent main method. 

LARC uptake is 17 percentage points higher than in 2014-15, though has fallen slightly over the last 2 years (from 56% in 2021-22). LARC uptake at SRH services has been above user dependent uptake since 2021-22. 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).

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 63-66% of those aged 35 and over.

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For more information: Data tables 6 and 7

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

Uptake of oral contraceptives at SRH services was 28% in 2023-24, similar to the previous 2 years. Uptake is 18 percentage points lower than in 2014-15, but they remain the most common of any method (whether user dependant or LARC). Though uptake was already on a downwards trend, 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 13% 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

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. Since 2021-22 however, there has been little change in the uptake of IU systems and devices, whilst implant uptake has fallen by 3 percentage points. Implants are still the most common type of LARC, being the main method of contraception for 20% of females using SRH services in 2023-24. 16% were using IU systems as their main method, and 10% IU devices. 

Younger age groups are more likely to use implants; 35% of under 16's, compared to 12% 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, 11% of 18-19 year olds, and 6% of 16-17 year olds.

Injectable contraceptives are the only LARC method where uptake (8%) has not risen over the last 10 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 28 LAs, down from 52 in 2022/23. The highest proportions were in Sheffield, Darlington (both 92%), North Northampton (77%), Redcar and Cleveland, and Stockton-on-Tees (both 74%). The lowest were in Southampton, Harrow (both 39%), Lewisham (41%), Westminster, Southwark, Blackburn with Darwen, and Lambeth (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