Background

Sexual and reproductive healthcare (SRH) is highly cost effective.1 ,2 Of all modern healthcare interventions, contraception has had one of the most profound and positive effects on the health of women and society. In the UK, the extent of the benefit is not always recognised, but the importance of access to care has been. This is not the case globally: there is still significant political and religious opposition to contraception and good SRH in many regions of the world, which impacts on women's health and wellbeing. From a woman's perspective, contraception and sexual health are seen as an integral part of women's health, and part of a continuum with gynaecological care. Yet gynaecology, contraception and sexual health as separate entities are a remnant of historic medical divisions. For the individual woman, it is inappropriate to separate them.

The clinics historically known as family planning clinics provided far more than contraception. They were holistic services, mostly developed by women for women, and were safe places for women to seek care as complementary services to general practice. Those who led the development of these services, and similar services in general practice, understood the importance of good gynaecological care, contraceptive choice, of planning when to have a family, family spacing or abortion, and the impact of sexual ill health and sexual violence. Poor provision of care impacts socially and economically on women, families and society, and while this is generally understood, there is still inequity in attitude amongst healthcare professionals and in service delivery. This means that the provision of open-access women-centred health services is essential.

Changing services

Over the last 15 years, specialist services and general practices providing SRH care, including sexually transmitted infection (STI) care, have undergone major changes; this modernisation was mostly driven by clinicians wanting to improve both the public …