Covid-19 impact on women’s health: FOI release

Information requested

You asked for information on blood clots and the AstraZenica COVID-19 vaccine, women’s sexual health and the current Government plan of action to vaccinate the under 30s.

Response

1. Women’s Sexual Health

The Scottish Government is working to develop a Women's Health Plan aiming to reduce health inequalities for women and girls and to improve information and services for women. Initial priorities for this plan are to improve information and services in relation to menstrual health, endometriosis, menopause, sexual health, abortion, contraception, sexual health, heart health and women’s general  health.

Work has begun to develop a comprehensive women’s health information platform on NHS Inform. Two women’s health information campaigns have been launched on the NHS Inform website, one in relation to women’s general health throughout different life stages, which you can access here. The second campaign, launched in February to mark heart health awareness month, aimed to raise awareness of importance of heart health for women, you can access this campaign here.

In terms of wider sexual health priorities, the Scottish Government first published the Sexual Health and Blood Borne Virus (SHBBV) Framework in 2011 and updated in 2015. In 2011, it brought together policy on sexual and reproductive health and wellbeing, HIV and viral hepatitis for the first time. It set out five high-level outcomes which the Government wished to see delivered, and it sought to strengthen and improve the way in which the NHS, academia, the third sector and local authorities supported and worked with individuals at risk of poor sexual health and/or blood borne viruses.

In recognition of the planning and effort required in recovering from the pandemic, we have committed in the 2020-21 Programme For Government to develop an interim Recovery Plan for SHBBV services, ahead of a more fundamental review of the Framework in 2022. This Plan, coproduced with our NHS and third sector partners, takes stock of the impacts of the COVID-19 pandemic on SHBBV services and people that use them. It will provide an opportunity to reflect on the challenges and build on the positive reforms, while identifying recovery priorities in 2021.

The Recovery Plan will also inform the outcomes and approach in the next multi-year Sexual Health and Blood Borne Virus framework due to be published in 2022.

2. Contraception

The Scottish Government is committed to ensuring women have the support they need so they can manage their reproductive health, which includes providing them with a choice of contraceptive options.

We are aware that evidence shows that longer acting, reversible methods of contraception (LARC) are more effective in enabling women to prevent unintended pregnancy and are more cost effective than barrier methods or oral contraceptives, and work is ongoing to increase numbers of women choosing LARC as a method to manage their reproductive health.

However, as you note in your letter, women can be prescribed the contraceptive pill in order to manage other symptoms such as heavy and painful periods, therefore it is extremely important that they are informed of increased risks of thromboembolism, and other possible side effects when they are prescribed the pill.

3. Provision of free sanitary products during the pandemic

At the start of the Covid-19 pandemic, the Scottish Government asked local authorities and further and higher education institutions to make alternative arrangements to ensure products could be accessed during lockdown.

For school pupils, products were made available to take home in the last few days of school, in some places there was provision of products in food boxes, and products continued to be accessible via those schools that remained open during lockdowns and community hubs.

Some local authorities put in place home delivery options through the social enterprise Hey Girls, and in one area products were available to be collected for free from a number of local convenience stores. Further examples of alternative local authority provision include:

• Where payments were being made to families in lieu of free school meals; £5 was added monthly where pupils are also eligible for sanitary products
• Where students were eligible for free school meals, food for the whole family was delivered to the door and these packs also included other essential such as period products
• An online order system was set up so that individuals could have products delivered directly to their home address – these were advertised widely and highlighted to local NHS services in case key workers were in need
• 3 months’ supply delivered to anyone who requested them through a ‘Support for People’ scheme
• Inclusion of period products in items that could be delivered to the door by community support volunteers
• Distribution though third sector networks/community anchor organisations

For college and university students, the Scottish Funding Council liaised with Hey Girls to offer home delivery kits and redeemable online codes and a number of institutions took this up. For those who did not take up this offer, students could also access free products via their local community hubs. In addition where food parcels were provided for self-isolating students, in many cases period products were also provided.

Alongside these arrangements, FareShare continued to ensure access to free period products to those who need them through its network of third sector organisations.

We are supporting Hey Girls to develop a free period products locator app, which will make identifying locations where products are available in an easy and dignified way, without having to ask anyone. Implementation of this app has been delayed due to Covid-19 but we hope to launch this as restrictions are further eased.

Finally, as you may be aware, the Period Products (Free Provision) (Scotland) Bill passed Stage 3 on 24 November 2020, and gained Royal Assent on 12 January 2021 to become the Period Products (Free Provision) (Scotland) Act 2021. The Act places duties on local authorities and education
providers to make period products obtainable for free to anyone who needs to use them and will, by the end of 2022 at the latest, place a duty on local authorities to consult with people who may wish to access free period products on where and how they would like to obtain them.

4. Access to services during the pandemic – cervical screening and implant removal

The COVID-19 pandemic brought unprecedented challenges in many areas, and the impact on the provision of services, including sexual health care has been significant with services necessarily limited to urgent and essential care only during lockdown.

As we come out of lockdown, general practices, which provide the routine removal and fitting of Intrauterine Contraceptive Devices (IUDs), are following Health Protection Scotland’s advice to restrict face to face appointments in primary care settings, reserving it for those consultations where the GP decides it is clinically necessary. This is not just to prevent the general transmission of the coronavirus but to protect general practices as medical spaces for patients who have a clinical reason for face to face attendance. General practices will continue to restrict face to face appointments as long as there is a danger of a patient contracting the coronavirus in a primary care setting.

You may be interested to know guidance from The Faculty of Sexual and Reproductive Healthcare of the Royal College of Obstetricians and Gynaecologists advises that certain long-acting reversible contraceptives can be safely used for longer than their licence period. This advice is based on published research and is designed to reduce women’s chances of an unplanned pregnancy.

We understand the considerable anxiety your friend may have experienced while waiting to receive their cervical screening results. The cervical screening programme was paused in the early stages of the first lockdown on 30 March 2020. This was a difficult decision and the pause was implemented in order to reduce the risk of participants becoming infected with Covid-19, to enable physical distancing, and to minimise the impact on essential NHS services as they responded to the virus.

Cervical screening resumed last summer on 29 June 2020. During July and August, participants who receive more frequent screening because of a past result and who had not received their invitation or reminder due to the pause, were prioritised and were sent their invitations first. Invitations for routine screening began to be issued again in September. However the impacts of Covid-19, including the need for physical distancing and increased infection control, continue to pose challenges to capacity. Because of this, women and people with a cervix may find they have to wait longer than usual for a screening appointment due to fewer appointments at GP practices and cervical screening results may take a little longer than usual to process. We are working closely with health boards to monitor and address these.

5. Current Government Plan of Action to vaccinate Under 30’s

The Scottish Government has taken an age based approach to the Vaccination programme as per the advice from the JCVI: Joint Committee on Vaccine Immunisation:

Phase 1 First doses are now complete and we are now operationally into Phase 2 which is based on the age groups below

• All those aged 40-49 years
• All those aged 30-39 years
• All those aged 18-29 years

This approach is supported by evidence that the risk of hospitalisation and critical care admission with COVID-19 increases with age, those at highest risk of hospitalisation outside of cohorts 1-9 are those aged 40-49 years. Calling people forward in age cohorts is operationally very simple and efficient and this process has already worked well during the earlier stages of the programme.

The aim is to have all phase 2 cohorts completed for first doses by the end of the summer, which is dependent on many issues, with uptake being one of these. Therefore, a key priority as we continue through the programme is that we make every effort to ensure that younger people, who may be at less risk themselves of severe outcomes from COVID-19, are encouraged and supported to take up the offer of vaccination – both first and second doses.

The Vaccine programme is making excellent progress and is part of many measures assisting Scotland move out of lockdown and help uplift restrictions. Scotland’s current route map out of lockdown is attached via this link.

6. Mental Health

We would like to reassure you that mental health was identified as a clinical priority for NHS remobilisation. However, the Covid-19 pandemic has of course impacted on services’ ability to see people, and so emergency and urgent cases have been prioritised. We know this has had a regrettable knock-on effect in terms of timescales for the delivery of treatment and care. Services are now in the process of returning to previous levels of activity and dealing with any backlogs that have developed.

We acknowledge that this pandemic has impacted people’s lives and wellbeing, and has had deep effects on young people. We are acutely aware of the sacrifices people are making to follow restrictions and guidelines. We do not intend to keep these measures in place longer than needed.

In making decisions as to whether to maintain, tighten or relax lockdown restrictions, we consider the advice from experts across science, public health, education, the economy and beyond. Navigating the right course through the pandemic involves taking difficult decisions, based both on the science and evidence as to the wider harms caused by the imposition of restrictions, as well as the overall prevalence of COVID-19.

The Scottish Government’s strategy and approach in dealing with this pandemic has and continues to be guided by the latest scientific advice from the Scientific Advisory Group for Emergencies (SAGE), the Health Protection Scotland and the Chief Medical Officer. You can find more details of their discussions and evidence here: https://www.gov.scot/groups/scottish-government-covid-19-advisorygroup/. Additionally, we continue to monitor and work closely with the World Health Organisation (WHO) and the International Community. All decisions have been and continue to be for the benefit of the public.

Please note that this information is constantly evolving as we learn more about the virus and as the situation continues to develop. Therefore, our approach may change depending on the current evidence and the emerging evidence from the scientific community.

We fully acknowledge the unprecedented mental health challenges that the pandemic has caused so many. That is why we have committed to an ambitious and wide-ranging response. Earlier this year, we announced £120 million for a Mental Health Recovery and Renewal Fund. The Fund will ensure delivery of our Mental Health Transition and Recovery Plan and will include a focus on community support provision.

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