Women's Health Plan: Phase Two (2026 - 2029)

6 Sexual Health, Abortion and Contraception

Recent data in Scotland indicates a shift in patterns of contraception use. Overall prescribing rates for contraception have seen a decline in recent years^[28], while abortion rates have increased^[29]. This shift reflects global patterns, with studies highlighting a rise in the use of non-hormonal methods of contraception. It is important that we understand contraception use throughout Scotland, including for gynaecological reasons, so we can shape service delivery. Furthermore, post-partum and post-abortion access to contraception remain a priority and ongoing work in this area will continue.

Women and girls should have access to accurate information and effective contraception to prevent unintended pregnancy. But it is also right that anyone who needs access to abortion care should be able to access services in a safe, inclusive and timely manner. It is estimated that one-in-three women in Scotland will access abortion services in their lifetime, making abortion care a core component of reproductive healthcare. We intend to build on the actions set out in Phase One of the Women’s Health Plan to improve consistency and equity in abortion provision across Scotland, considering both geographical and service barriers. Patient choice must be at the heart of abortion care, and it is essential that services reflect this by offering a full range of clinically appropriate options. It will be important to develop and improve training and clinical capacity, alongside standardising care pathways and ensuring that the information we receive about abortion services helps to meaningfully monitor access. It is our overall aim that women will be able to access the full range of abortion care they need in Scotland, supported by a legal and clinical framework that reflects modern clinical practice and supports safe and timely access to care.

Sexual health and wellbeing is particularly important for young people as they navigate the complex terrain of sexual development, healthy relationships, consent, health and wellbeing and reproductive choices. We are committed to ensuring that young people have access to the information, support, and resources needed to make informed decisions about their sexual and reproductive health.

6.1 Sexual Health, Abortion and Contraception – Ambition, Aims, Actions

Ambition

For all women and girls to enjoy the best possible sexual and reproductive health and wellbeing, free from harm, throughout their lives.

Aims

1. For women and girls to be empowered to make informed and autonomous choices about their sexual and reproductive health, free from stigma and harm, throughout their lives.

2. For women and girls to have inclusive and timely access to the full range of contraceptive care.

3. For women and girls to have safe, inclusive and timely access to the full range of abortion care.

Actions

Contraception

30. To better understand the issue of hormone hesitance, the Scottish Government will:

• Deliver an academic-policy knowledge exchange fellowship project specifically looking at hormone hesitancy in Scotland.
• Build an evidence base to understand the factors influencing changing attitudes to the use of hormones, particularly amongst young women.
• Utilise this research to support women and girls in Scotland to make informed decisions about their reproductive health from trusted sources.

31. The Scottish Post Partum Contraception Network, with Public Health Scotland, will develop a standardised, national minimum dataset for post-partum contraception activity, for use across maternity systems in Scotland.

32. NHS Boards will integrate existing NHS Scotland educational resources on postpartum contraception into maternity staff training, to support timely access to the full range of contraception options after childbirth for those who request this (including implant and intrauterine device insertion).

Sexual Health

33. The Scottish Government will ensure that young people have access to the information, support, and resources needed to make informed decisions about their sexual health by:

• Delivering a national Summit on Young People’s Sexual Health and Wellbeing in partnership with NHS Boards, academia and the Third Sector. This summit, co-designed with young people, will generate consensus for shared actions to improve the wellbeing of young women and girls, including to:
• Improve awareness and understanding in professionals and young people of the health impacts of Non-Fatal Strangulation.
• Update the ‘Key Messages for Young People on Healthy Relationships and Consent’ resource using the most recent evidence and input from young people.

Abortion

34. The Scottish Government will continue the review of the law on abortion to ensure that abortion is seen, first and foremost, as a healthcare matter.

35. NHS Boards will establish a service for abortion up to 24 weeks for all indications, within Scotland.

36. NHS Education for Scotland (NES) and the Scottish Government will improve training and skillsets for abortion provision across Scotland by:

• Developing training on pain management for abortion.
• Developing and implementing a national training pathway within Scotland for surgical abortion at all gestations, including treatment room surgical procedures for early surgical abortions.
• Encouraging and funding training with third sector providers, in anticipation of a national training pathway for abortion up to 24 weeks for all indications.

37. The Scottish Government will work with NHS Boards to, where appropriate, standardise abortion care across Scotland.

• Scottish Abortion Care providers will produce national guidelines on abortion care to 24 weeks gestation.
• The Scottish Abortion Care Providers will be supported to standardise data collection on access to abortion, including waiting times, across Scotland.

38. NHS Boards will increase choice and flexibility of how patients can access their abortion medication for ‘early medical abortion at home’, including local pharmacy collection and home delivery where appropriate.

39. NHS Boards will review theatre lists for surgical abortion and treatment room surgical procedures provision for induced and spontaneous abortion and increase provision where necessary to ensure that women can be offered a choice between medical and surgical abortion, without delay.

40. The Scottish Government and NHS Boards will use existing data to improve access to postabortion contraception.