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Case study 3 - Importance of holistic counselling and support 

Comprehensive and holistic contraceptive counselling is a person-centred approach that provides accurate, tailored information on the full range of contraceptive options while addressing an individual’s health and contraceptive needs, preferences, life circumstances, and reproductive intentions. Despite NICE guidelines stating that all women should be “given information about, and offered a choice of, all methods including long-acting reversible contraception”, our report found that fewer than 30% of women have all contraceptive options discussed with them by a healthcare professional before choosing a method. This is especially concerning for women from marginalised groups who may have more complex requirements or require additional support to choose the best methods for their needs.   

Layla's story

Layla who previously worked as a nurse, is a model and sex worker. Layla, now post menopause, used contraception for 40 years. Following the end of an abusive marriage, Layla began online dating and wanted to access contraception to both avoid pregnancy and protect herself against sexually transmitted infections (STIs). 

 

Layla attended her GP to have her coil inserted, which she felt was a smooth procedure and that she was well supported with advice and information. However, Layla felt discriminated against when she asked for condoms as well as her coil. The GP was surprised at her request and actively questioned why she would need condoms as well as her coil, which made Layla feel judged and embarrassed. Layla felt was the GP making the assumption that due to her age, she would only have one partner and therefore not be at risk from STIs, not considering Layla’s job, preferences, or life circumstances. Layla has also been unable to freely access emergency contraception (EC) due to her age. 

 

By contrast, Layla has had more positive experiences at her local sexual health clinic (SHC). As a sex worker, primarily working in adult media where health, safety and STI testing is very strict, Layla attends her local clinic for STI check-ups every four weeks. She also chose to have her coil removed at the clinic. Layla described the care they provide as holistic, and felt the healthcare professionals (HCP) cared about her, her circumstances, her health and wider life. As part of this, service users are asked to fill in a questionnaire at their appointment, which asks questions around topics including alcohol and drugs and domestic violence. Moreover, at the SHC, Layla’s appointment time was long enough for her needs to be properly addressed. Layla was able to ask the nurses anything, without judgment or shame, and can contact a specific nurse directly via the phone, making her feel she is receiving personalised care and support.  

 

Layla suggested that the Government should place awareness materials in public spaces such as supermarkets, buses, and trains to raise awareness about contraceptive options. She recalled seeing an impactful campaign for women who had experienced sexual violence, and believes similar efforts can reduce stigma and reach those hesitant to engage with HCPs. Layla also recommends that HCPs create an environment where individuals feel comfortable sharing personal details, including sexual preferences.  

To find out more about the AGC and our work, please contact agc@incisivehealth.com

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