All-Party Parliamentary Group on Sexual and Reproductive Health in the UK

The All-Party Parliamentary Group on Sexual and Reproductive Health in the UK (APPG) aims to raise awareness in parliament of the needs of women seeking abortion and the importance of improving the sexual health of people in the UK.

The APPG is co-chaired by Diana Johnson MP and Baroness Barker and supported by FPA, the Faculty of Sexual and Reproductive Healthcare, the British Association for Sexual Health and HIV and the Royal College of Obstetricians and Gynaecologists.

Latest news

AGM and women’s reproductive health, November 2018

AGM business

The AGM confirmed the financial statement and the officers of the Group. Diana Johnson MP and Baroness Barker will remain the co-chairs of the group. Sir Peter Bottomley MP, Baroness Flather and Baroness Tonge will remain vice chairs of the group.

Women’s reproductive health

The NHS turned 70 this year. Over the course of those 70 years, the needs of women have changed dramatically and the majority of women are now living longer in their post-reproductive years. As a result, the issues that affect women need to be considered across a longer spectrum, with greater opportunities to improve outcomes across the life course.

This meeting took the opportunity to consider some of the problems women experience in accessing reproductive and sexual health services, as well as some of the potential solutions.

Dr Asha Kasliwal, President of the Faculty of Sexual and Reproductive Healthcare (FSRH), and a consultant working in community gynaecology and reproductive healthcare in Greater Manchester, opened the meeting by exploring some of the issues relating to access to services.

She highlighted examples of problems, including that she is unable to perform a cervical smear while doing a specialist IUD/IUS fitting. This is not because she is not trained to carry out the procedure, but because the clinic is not commissioned to carry out cervical smears and there is subsequently no infrastructure to analyse or manage the results. For similar reasons she is only able to fit an IUS for contraceptive reasons, not for gynaecological reasons.

Problems with access, which often affect the most vulnerable, are associated with complex commissioning arrangements – which arose from the 2012 Health and Social Care Act – as well as funding cuts, which were highlighted by a recent report published by the Advisory Group on Contraception.

Dr Kasliwal closed by calling for prevention and sexual and reproductive health to be included in the NHS 10-year plan, a mandate for joined-up commissioning, investments in women’s health and for women to be put at the centre of the system.

Kate Sanger, from Jo's Cervical Cancer Trust, opened by highlighting recent declines in cervical screening attendances. At present, national screening rates are 72% but the target is 80%. Figures are particularly low among groups including young women, women with a learning disability and women from black, Asian and minority ethnic (BAME) backgrounds. At 62.1%, screening coverage among 25-29-year-olds is significantly lower than the national average.

Kate explored barriers to screening – including psychological, cultural and other obstacles, as well as physical barriers – and reported that women increasingly report they can’t get an appointment. Data from Jo’s Trust show 1 in 8 women find it “difficult or even impossible” to book a test. She suggested that the decline in women accessing cervical screening in sexual health clinics (between 2010 and 2017 the numbers of samples collected in sexual health settings dropped by 60%) has contributed to this. This, she suggested, is concerning given that sexual health clinics are a key venue for screening, with samples taken in sexual health clinics more likely to show abnormalities. At present there is no national requirement for sexual health services, which are commissioned by the local authorities, to deliver cervical screening nor is there national funding or national guidance.

Kate closed by calling for better guidance on commissioning arrangements, greater collaboration between public health and primary care and funding for provision of cervical screening in sexual health to be included within the public health functions agreement.

Professor Lesley Regan, President of the Royal College of Obstetricians and Gynaecologists (RCOG), opened by discussing the creation of a Women’s Health Taskforce that has been tasked with countering some of the problems around women’s health. The taskforce will have a particular focus on prevention. It will be jointly led by Professor Regan and Jackie Doyle-Price MP.

Women represent 51% of the UK population and while they play a very influential role in the nation’s health, for example providing childcare and care for older people, they are disproportionately affected by inequalities in access to and quality of care. The Women’s Health Taskforce is determined to change this.

The taskforce will focus on three key life stages, child health and adolescence (0-25), adulthood (25-51) and later life (51+). Professor Regan outlined some of the key concerns and closed by stating that the taskforce will be broad and inclusive. It will draw on the experiences not only of health professionals and politicians but also of a wide sector of society. As the work of the taskforce progresses, the APPG will be notified and information will be shared.

Please email [email protected] for full minutes of the meeting.

November 2018: Notice of next meeting

The AGM of the APPG on Sexual and Reproductive Health will take place on Wednesday 14 November from 5pm- 6.30pm, at Room A, 1 Parliament Street.

The meeting will also be an opportunity to consider women’s reproductive health across the life course. Speakers will include Dr Asha Kasliwal, President of the Faculty of Sexual and Reproductive Healthcare, Kate Sanger from Jo's Cervical Cancer Trust and Professor Lesley Regan, President of the Royal College of Obstetricians and Gynaecologists.

Public health funding and the impact of cuts on sexual and reproductive health services, June 2018

In recent years, public health funding has experienced sustained and substantial cuts. This, combined with problems relating to commissioning, has had a significant impact on sexual health services.

The All-Party Parliamentary Group (APPG) on Sexual and Reproductive Health came together to discuss the impact of these cuts on sexual and reproductive health services. The meeting was chaired by Baroness Barker and heard from a number of experts in the field.

Dr Margaret Kingston, a consultant physician in GU Medicine, opened by outlining the complex and fragmented commissioning landscape which currently exists for sexual health services. She considered the impact of this fragmentation, combined with cuts to the public health budget on patients and staff.

She argued patients are having to travel further, are being turned away, and are receiving fragmented care as a result of commissioning structures. Staff are experiencing increasing stress, and many are leaving the profession. This combined with the loss of training posts is, she suggested, leading to the pool of experience being shrunk.

She closed by calling for a long-term sustainable funding plan.

Dr Anne Connolly, a GP with a special interest in gynaecology, highlighted the importance of maintaining choice and access. She suggested that while those with money, confidence, education, language skills and wherewithal will be able to seek out a moved or changed service, the most compromised are affected to the greatest degree, and cost-saving decisions need to take this into account. Cuts to text messaging services and the movement of condom distribution services from pharmacies – which also, for example, provide methadone – to cheaper locations disproportionately affects sex workers.

Dr Connolly closed by outlining opportunities, including understanding the population and seeing women as part of a bigger picture, for which cross-commissioning is necessary.

Robbie Currie opened by referring to current arrangements as a balancing act between the NHS, CCGs and Local Authorities. He highlighted key differences between local authorities and the NHS: the NHS is allowed to run a deficit, while local authorities are not, local authorities are experiencing year on year funding decreases and while the NHS is nationally accountable, local authorities are locally accountable.

He went on to outline positive consequences including innovations such as the integration of sexual and reproductive health services, the development of the Integrated Sexual Health Tariff (ISHT), and the growth in e-services, which have increased capacity. He also outlined negatives, such as wide variances in the availability of contraception (particularly long-acting reversible contraception), increasing costs, a fragile provider market, and workforce recruitment and retention issues.

Robbie closed by considering opportunities including innovation, the clinical strengths of organisations including BASHH / BHIVA / FSRH / RCGP / NICE / PHE and finally the huge opportunity that the introduction of statutory relationships and sex education will provide.

Adrian Kelly introduced the London Sexual Health programme, which is a partnership between 27 local authorities who work together to commission an e-service for the testing of sexually transmitted infections. Commissioning of physical services is done by the individual local authority.

To date, 20,000 kits have been issued, with a return rate of 76%. It has resulted in 500 diagnoses of chlamydia and 140 cases of gonorrhoea. 200 people have been treated for simple chlamydia and 300 people have been directed to clinics for confirmatory tests, including 50 for HIV.

Baroness Barker closed by highlighting the importance of engaging with NHS England on this subject. She also highlighted the importance of engaging with politicians. This should include local councillors and opposition councillors, MPs and Peers. She added her support for keeping the subject on the parliamentary agenda.

Relationships and Sex Education, February 2018

Last year, the government announced that they would amend the Children and Social Work Act to make relationships and sex education compulsory in all secondary schools, and create statutory relationships education (RSE) in primary schools. In December 2017, the Department for Education launched a public consultation to support the development of high-quality guidance for schools.

The All-Party Parliamentary Group (APPG) on Sexual and Reproductive Health came to together to discuss RSE, covering a broad range of issues including teacher training, funding for resources and linking young people to their local services. The meeting was chaired by Baroness Barker and heard from experts in the field.

Lucy Emmerson, the National Coordinator of the Sex Education Forum, began the meeting by welcoming the achievement of statutory RSE and highlighting the importance of gathering good practice from schools to underpin the new guidance. She went on to outline the 12 principles of good quality RSE, including:

  • that RSE is an identifiable part of PSHE, which has planned and timetabled lessons
  • that RSE is taught by regularly trained staff; lessons where pupils feel safe and encouraged to participate
  • that RSE is evidence-based and distinguishes between fact and opinion.

Finally, she spoke about the importance of including mechanisms to change and review the guidance, as well as a training strategy that is supported by a financial commitment.

Jonathan Baggaley, the Chief Executive of PSHE Association, spoke about RSE as a fundamental part of PSHE and said that RSE should be viewed and taught against a backdrop of societal and technological changes.

He highlighted the importance of areas which are known to be effective, including that RSE is appropriate to a pupil's age and maturity, varied teaching styles, the avoidance of scare tactics, and lessons which are structured around themes which are repeated multiple times with increasing complexity, so that previous learning can be built upon.

He closed by speaking about the necessity of teaching PSHE regularly, as a whole subject, assessed and taught by trained teachers, in all schools to all pupils.

Alison Hadley the Director of the Teenage Pregnancy Knowledge Exchange spoke about the Teenage Pregnancy Strategy as a catalyst for improving RSE. She outlined improvements including:

  • the guidance published in 2000
  • the funding of Continued Professional Development (CPD) for teachers and school nurses
  • the embedding of RSE in the National Healthy Schools Programme
  • training for governors.

She also spoke about the clear commitment of councils and the amount already done by councils, such as providing direct support to schools and integrating RSE into wider commissioning for children and young people. She went on highlight examples of particularly innovative and impressive approaches by councils to support schools to deliver high-quality RSE, to improve parent engagement and to link RSE to health professionals.

Alison closed by making a number of recommendations directed at government. These included making PSHE education statutory and anchoring guidance in the latest evidence base. She also called for the government to commit to fund the training of teachers and to ensure that schools use accurate, evidence-based information from reliable professional sources. Finally, she called for the establishment of a process to audit improvements in quality RSE.

Baroness Barker concluded the meeting, suggesting there are a few actions that supporters can take to aid the implementation of RSE. This includes the provision of clear and simple messages to MPs, the provision of a strong evidence base to the Minister for Women and Equalities and the provision of simple and accessible information and recourses to schools.

Women and HIV, November 2017

Women make up 52% of people living with HIV. Of 103,000 people living with HIV in the UK, 30,000 are women, the majority of whom are black Africans or from other black and minority ethnic backgrounds. Public Health England figures show that 25% of new HIV diagnoses in 2016 were in women, and women are more likely than men who have sex with men to be diagnosed with a CD4 count lower than 350; a marker of late diagnosis.

The All-Party Parliamentary Groups (APPGs) on Sexual and Reproductive Health and HIV and AIDS came together to discuss some of the unique challenges faced by women in the UK who are at risk of, or living with, HIV. Co-chaired by Baroness Gould of Potternewton and Baroness Barker, the meeting heard from leading clinicians and activists, who were invited to make recommendations about how to improve care and support.

Dr Nneka Nwokolo, a consultant physician in HIV and sexual health at the innovative Soho clinic 56 Dean Street, began the meeting. She explained that women are often unaware of prevention methods such as pre-exposure prophylaxis (PrEP) and that people on treatment for HIV with an undetectable viral load cannot transmit the virus. She also told the APPGs about the multiple challenges women living with HIV face, including discrimination with regard to housing and access to services and a significantly higher risk of gender-based violence.

She called on the government to improve funding for support services given their importance for isolated women, citing National AIDS Trust research that estimates that between 2015/16 and 2016/17 there has been an approximately 30% reduction in local authority funding for HIV support services in England. In terms of clinical care and public awareness, she said that women must be better represented in trials and that there needs to be a review of HIV and sexually transmitted infection (STI) testing, including home testing and home sampling as well as online PrEP provision, which could help expand access to services.

The next speaker, Juno Roche, spoke about her experience as a trans woman living with HIV. Her talk covered the importance of reforming the Gender Recognition Act 2004 to ensure that trans people get access to healthcare and the lack of data about trans people. She explained that the only data that exists about trans women’s increased risk is global, and mostly relates to trans women of colour living in India or Bangladesh. She said that there is no specific European data, which has resulted in a lack of understanding of how best to effectively target and support trans people. She asked the APPGs to support trans people through the reform of the law and transphobic media backlash.

Deputy CEO of Positively UK, Silvia Petretti, also spoke about her experiences living with HIV. She told the APPGs about her experience with Positively Women as a peer support worker and as the current  Deputy Chief Executive of Positively UK, and her work to challenge stereotypes and offer support. Silvia ended her speech by calling for a holistic approach to women’s HIV care, which includes contraception and abortion services.

Finally, Mercy Ngulube, Chair of the Children’s HIV Association (CHIVA) Youth Committee, spoke about transitioning from paediatric to adult HIV care, and the need for better services particularly outside of London. She also highlighted the need for public awareness campaigns that reflect what living with HIV is like today, rather than the 1980s’ tombstone adverts.

Baroness Barker concluded the event by a pledging to ask the government about women’s inclusion in the PrEP Impact Trial and continue the APPGs work to ensure that everyone in the UK has access to the highest standard of prevention and treatment services. 

New Chair, November 2017

The APPG is pleased to welcome Baroness Barker as the new co-Chair of the APPG. We would also like to thank Baroness Gould of Potternewton, who has chaired the Group for over 20 years and been a tireless advocate for sexual and reproductive health and rights. 

Officers of the APPG

Officers of the APPG make decisions about the APPG’s meetings and topics. They are elected by the other members of the APPG at the Annual General Meeting.

Co-Chairs: Baroness Barker (Liberal Democrat), Ann Clwyd MP (Labour), Diana Johnson MP (Labour)
Vice Chairs: Sir Peter Bottomley MP (Conservative), Baroness Flather (Crossbench) and Baroness Tonge (Independent Liberal Democrat) 
Treasurer: Baroness Blood (Labour) 

The UK Parliament website holds a full list of the registered members of the APPG.

Reports by the APPG

The APPG produces reports on key sexual health issues. You can download some of these below.

 Income and Expenditure Statement (2016) (PDF, opens in new window)

 Minutes of the AGM (2016) (PDF, opens in new window)

Breaking Down the Barriers (2015) full report (PDF, opens in new window)

Breaking Down the Barriers (2015) executive summary (PDF, opens in new window)

Healthy Women. Healthy Lives?(2012) full report (PDF, opens in new window)

Healthy Women. Healthy Lives? (2012) executive summary (PDF, opens in new window)

Further information

For further information about the APPG contact Emily James on 020 7608 5258 or [email protected]