Intended for healthcare professionals

Opinion Dissecting Health

Scarlett McNally: Let’s talk about contraception

BMJ 2023; 381 doi: (Published 19 April 2023) Cite this as: BMJ 2023;381:p862
  1. Scarlett McNally, professor
  1. Eastbourne
  1. scarlettmcnally{at}
    Follow Scarlett on Twitter @scarlettmcnally

Worldwide, 50% of pregnancies are unplanned.1 In 2021 the number of women in England and Wales who had abortions reached a record 214 256, up by 16% since 2016.2 Around a quarter of all pregnancies in the UK are terminated.23 The reasons for this are multifactorial, but if we want women and girls to have as much choice and autonomy as possible we must stop being so coy about sex, contraception, and sexual consent.

Age appropriate RHSE—relationship, health, and sex education—became statutory in schools in 2020. Its potential should be maximised to equip young people with an understanding of fertility and contraception.4 For adults, meanwhile, we need to reduce societal taboos and provide clear and accessible information about sex, contraception, and sexual consent.

Academic, medical, and parliamentary5 groups in the UK argue powerfully for improvements to women’s access to contraception. The government launched a Women’s Health Strategy for England in 2022,4 but this will fail unless it receives adequate funding and sees a change in priorities. The government should think seriously about what these groups are calling for: better funding of contraceptive services and cross sector collaboration; greater use of the wider healthcare workforce in providing contraception—including the involvement of pharmacists—with training in long acting reversible contraception (LARC); and sex education for the public and schoolchildren. Investment in contraceptive services also makes economic sense: £9 is saved for every £1 spent.6

Having an abortion or an unplanned baby can have emotional, physical, or life changing effects on women, as well as lifelong repercussions for the child’s father and any siblings. An additional child can put a strain on family finances, and poverty is the largest contributor to ill health worldwide. Children whose birth wasn’t planned have a higher risk of mental, physical, developmental, and behavioural problems.7 For example, fetal alcohol spectrum disorder (FASD) with developmental and behavioural issues is more likely after an unexpected pregnancy.8

In many countries, nearly half of women are not free to make their own decision about whether to have sex or use contraception.9 We need to value every woman beyond her role (or potential role) as a mother. The United Nations argues that reduced fertility rates can improve economic opportunities across whole economies10; yet 28% of countries11 have “pro-natalist” policies.12 Supporting smaller families or valuing child-free lives would help to maximise health for all.

Healthcare professionals should advocate for individuals and communities, as this issue crosses cultural and religious norms. Funding and planning to improve access to contraception, and to ensure that everyone has access to adequate advice and knowledge about sex and sexual consent, should be priorities for everyone.


  • Competing interests: The author is president of the Medical Women’s Federation. She is a consultant orthopaedic surgeon with four grown-up children and has had two miscarriages.

  • Provenance and peer review: Commissioned, not externally peer reviewed.