Sexual and Reproductive Health

This topic area covers statistics and information relating to sexual and reproductive health in Hull including local strategic need and service provision. Further information is available on Sexually Transmitted Infections under Health Factors within Adults. Further information is available within Pregnancy and Maternal Health, and Birth and Infant Health under Pregnancy, Infants and Early Years under Children and Young People. Information on Under 18 Conceptions is given under Health Factors within Children and Young People.

This page contains information from the Office for Health Improvement & Disparities’ Fingertips. Information is taken ‘live’ from the site so uses the latest available data from Fingertips and displays it on this page. As a result, some comments on this page may relate to an earlier period of time until this page is next updated (see review dates at the end of this page).

Headlines

• In 2019, there were 3,175 live births to females aged 11+ years in Hull giving a birth rate of 60.2 per 1,000 female population aged 15-44 years (compared to 57.7 for England). The fertility rate has been consistently higher than England since at least 2010, and is higher in Hull among younger ages.
• In 2020, there were 984 terminations in Hull giving a rate of 18.8 terminations per 1,000 females aged 15-44 years which was similar to England (18.9). Among under 25s in Hull, there were 364 terminations in Hull, and whilst fewer of them had had a previous termination (22.0% versus 29.2%), a much higher percentage had had a previous birth compared to England (40.7% versus 27.1%).
• In relation to contraception, the rate of long-acting reversible contraception (LARC) excluding injections was around the same in Hull as England (33.3 versus 34.6 per 1,000 women aged 15-44 years) in 2020 although it had fallen in Hull significantly from 54.3 in 2019 when it was slightly higher than England (50.8). Sexual and Reproductive Health Services were severely disrupted during the COVID-19 pandemic particularly during the first lockdown. Men and women in Hull were much more likely to use specialist contraceptive services rather than services through their GP practice.
• In 2019/20, the rate of hospital admissions for pelvic inflammatory disease among women aged 15-44 years was slightly higher in Hull compared to England (284 versus 255 per 100,000 women aged 15-44 years) with around 150 admissions in total, although the rate has been quite variable over time, and 2019/20 is the first time that the rate in Hull was not statistically significantly higher than the rate in England. In 2019/20, there were around 50 admissions for ectopic pregnancy in Hull which was similar to England (91.7 versus 90.0 per 100,000 female population aged 15-44 years).
• Between April 2020 and March 2021, there were approximately 50 patients with female genital mutilation (FGM) identified as having had FGM undertaken including 1-7 new patients (numbers 1-7 are rounded to five so the actual number is between one and seven), and in total these women had approximately 65 attendances during 2020/21. This was lower than 2019/20 when there were approximately 75 patients (approximately 30 newly recorded) with approximately 95 attendances. Numbers above seven cases are rounded to the nearest five so all numbers are approximate. Around 190 women with FGM have been identified since 2015/16 who lived in Hull at the time.

The Population Affected – Why Is It Important?

From the World Health Organisation, sexual health is a state of physical, mental and social well-being in relation to sexuality. It requires a positive and respectful approach to sexuality and sexual relationships, as well as the possibility of having pleasurable and safe sexual experiences, free of coercion, discrimination and violence. The NHS (One You) states sexual health is an important part of physical and mental health as well as your emotional and social wellbeing. It’s important to take care of your sexual health and to talk about sex and relationships with your loved ones.

The Hull Picture

Pregnancy and Maternal Health

Further information on the use of folic acid, obesity and smoking in early pregnancy, access to maternity services, age of mother, and chronic severe mental illness among women in the perinatal period is covered within Pregnancy and Maternal Health under Pregnancy, Infants and Early Years under Children and Young People. Information on Under 18 Conceptions is given under Health Factors within Children and Young People.

Births

In Hull, there were almost 3,900 births in 2012, but this has been gradually reducing and there were 3,175 births to Hull residents during 2019. Reductions in the general fertility rate have also occurred in England and across the region over the same time period.

Further information on the percentage of mother from Black, Asian and Minority Ethnic groups, caesareans, age of mother, multiple births, premature births, low birth weight and screening and infant health checks is available within Birth and Infant Health under Pregnancy, Infants and Early Years under Children and Young People. Information on Under 18 Conceptions is given under Health Factors within Children and Young People.

Terminations

The Office for Health Improvement & Disparities’ Fingertips presents information on termination rates which shows that termination rates are marginally lower in Hull for all ages and for over 25s for 2020.

For women of all ages, the termination rate in Hull has increased significantly between 2012 and 2020 with rates more than doubling. In 2020, there were 984 terminations among women in Hull.

Among over 25s, the rate has also increased in Hull but similar to all ages, the rate is generally lower than England. In 2020, there were 620 terminations among women in Hull aged over 25 years. There were 364 terminations among women aged 25 years equating to 37% of all terminations.

The percentage of repeat terminations among under 25s is lower in Hull than England, but the percentage of terminations among under 25s who have already given birth to a child or children is higher in Hull.

The percentage of repeat terminations among the under 25s is the number of females aged under 25 years having a termination in the year who have had a previous termination in any year divided by the number of females aged under 25 years having a termination in the year.

The percentage of terminations among under 25s is the number of females aged under 25 years having a termination in the year who have previously given birth to a child or children in any year divided by the number of females aged under 25 years having a termination in the year.

Whilst there has been a small increase over time in the percentage of repeat terminations among women aged 15-24 years, the percentage in Hull has been consistently below the percentage in England (around one-quarter lower).

However, in contrast the percentage of under 25s having a termination in the year who have previously given birth to a child or children has consistently been much higher in Hull than England. Between 2014 and 2019, the percentage had been decreasing in England and appeared to be decreasing for Hull although the trend is less clear. However, for both Hull and England, particularly so for Hull, the rate increased in 2020. The COVID-19 pandemic could be a possible explanation for this increase. The percentage in Hull for 2020 at 40.7% is the highest it has been since 2014. Whilst the percentage increased between 2019 and 2020 for England and across the Yorkshire and Humber, the increase was smaller and the overall percentage in 2020 was not the highest it had been since 2014. The larger increase in Hull is perhaps not surprising given the higher rate of conceptions among under 25s in Hull and the increased deprivation and resulting lower financial security in Hull during the pandemic.

The percentage of terminations under 10 weeks is lower than England though thus there is a slightly higher percentage of late terminations in Hull. The percentage of terminations that are under 10 weeks that are due to medical reasons is considerably lower in Hull compared to England and excessively low compared to other local authorities across Yorkshire and Humber for 2020 (69% for Hull, 82% for East Riding of Yorkshire and ranging from 94% to 99% for the other 13 upper-tier local authorities across the region, and 93% for England).

The percentage of terminations under 10 weeks was considerably lower in Hull compared to England in 2012 at 53% compared to 78% in England. The rate increased sharply in 2013, but between 2013 and 2020, the percentage in Hull has been consistently lower than England and for the majority of these years, the rate in Hull has been statistically significantly lower than England. The rate increased quite sharply between 2019 and 2020 for England, the region and Hull with the sharpest rise for Hull.

In 2014, the percentage of terminations under 10 weeks that were medical was around 60% for both Hull and England. However, the percentage in Hull remained at around 60% even falling slightly to 57% in 2019 whereas the percentage in England has steadily increased to 84% in 2019 and then to 93% in 2020. The rate in Hull increased substantially between 2019 to 2020 to 69%, but is still much lower than England. The rates in East Riding of Yorkshire have also been consistently lower than England and have followed a same pattern to Hull albeit with slightly higher percentages (60% in 2014, around 65% for 2015 and 2016, around 67% for 2017-2019 and 82% in 2020).

Contraception

In 2020, rate of long-acting reversible contraception (LARC) excluding injections was lower in Hull than England (33.3 versus 34.6 per 1,000 women aged 15-44 years).

There was a noticeable difference as to where LARC was prescribed with much lower rates of prescriptions from GPs for Hull compared to England (2.5% versus 21.1%) and much higher rates of prescriptions at Sexual and Reproductive Health (SRH) Services (30.8% versus 13.4%). However, this may simply represent the differences in the way the Sexual and Reproductive Health Services are commissioned in Hull or increased choice available.

Men and women in Hull aged 15-24 years were around twice as likely to attend specialist contraceptive services in Hull compared to England.

The prescription rate of LARC in Hull has consistently been the same or higher than England with the exception of the most recent year 2020. The rate was highest in 2014 at 63% and fell to 49% for 2015, but increased to 61% in 2018. The rate further fell in 2019 to 54% but has fallen significantly in 2020 to 33%. There was also a similar decrease for England and across the Yorkshire and Humber region, and it is likely that access to Sexual and Reproductive Health Services were disrupted due to the COVID-19 pandemic.

There was a change in the way Sexual and Reproductive Health Services were commissioned in Hull commencing 2015, and this had an impact on the percentage of LARC prescribed at GPs or through Sexual and Reproductive Health Services, although there was a more gradual increase through Sexual and Reproductive Health Services as opposed to the rapid reduction with GP prescribing.

For women aged 15-24 years, the rate (per 1,000 women) attending specialist contraceptive services in Hull has been consistently much higher than England, although the rate has fallen the last two years. The fall between 2019 and 2020 is likely due to problems accessing services because of the COVID-19 pandemic.

The rate of men aged 15-24 years (per 1,000 men) attending specialist contraceptive services was drastically higher in 2014 in Hull compared to England being five times higher (95 versus 22 per 1,000 men). The rate reduced to almost one-seventh of that rate in 2015 (14 per 1,000 men) which was slightly lower than England. The rate in Hull has since increased gradually and was 22 per 1,000 men in 2018, and then there was a sharp increased to 36 per 1,000 men in 2019. The decrease between 2019 and 2020 is again likely associated with the COVID-19 pandemic.

The changes over time may simply reflect changes in the way Sexual and Reproductive Health Services in Hull are commissioned, and the differences in the commissioning relative to other local authorities across England.

As women in Hull were more likely to use Sexual and Reproductive Health Services compared to primary care (GP) services for contraception the rates of women choosing LARC or injections as their main method of contraception at Sexual and Reproductive Health Services was higher in Hull compared to England, although the percentage choosing short-acting contraceptive methods and user-dependent methods as their main method of contraception was lower. This means that the rates of short-acting contraceptive methods and user-dependent methods in Hull will truly be lower given that the use of Sexual and Reproductive Health Services is so much higher in Hull generally. Short-acting contraception methods are hormonal short-acting reversible contraceptives such as the contraceptive pill, patch or vaginal ring. User-dependent methods of contraception include any method of contraception that relies on daily compliance including ‘natural family planning’.

The percentage of women aged 15-24 and 25+ years who choose LARC at Sexual and Reproductive Health Services has increased in Hull over time between 2014 and 2019, with a slight fall between 2019 and 2020 likely associated with problems accessing services due to the COVID-19 pandemic.

The percentage of women who choose injections at Sexual and Reproductive Health Services in Hull has remained relatively constant at just over 13% between 2015 and 2019 with a slight fall to 12% for 2020.

Since 2015 when 40% of women choose short-acting contraception at Sexual and Reproductive Health Services in Hull there has been a gradual fall to 33% in 2019, although an increase back to 40% for 2020.

There has been a similar pattern for user-dependent methods with the percentage decreasing from a high of 59% in 2014 to 41% in 2019, with a slight increase to 46% for 2020.

Hospital Admissions

In 2019/20, the rate of hospital admissions for pelvic inflammatory disease among women aged 15-44 years was higher in Hull compared to England (284 versus 255 per 100,000 women aged 15-44 years).

The rate of admissions for pelvic inflammatory disease has been very variable in Hull between 2008/09 and 2019/20 with rates between 287 and 822 per 100,000 women aged 15-44 years, although the rate has been consistently higher than England, and significantly so for all except 2019/20.

In 2019/20, there were approximately 150 admissions among women in Hull for pelvic inflammatory disease (figures rounded to nearest five), and this was among the lowest with the highest number being over 450 in 2011/12.

The hospital admission rate of ectopic pregnancy in Hull is slightly higher than England for 2019/20 per 100,000 women aged 15-44 years.

The admission rate of ectopic pregnancy has been relatively variable over time in Hull ranging from 56 to 117 per 100,000 women, although throughout the entire period 2008/09 to 2019/20 the rate in Hull has been higher than England but not significantly so, with the rate significantly lower in Hull compared to England for two years (2013/14 and 2018/19).

In 2019/20, there were 50 ectopic pregnancy admissions during 2019/20 (figures rounded to nearest five).

Female Genital Mutilation

The number of women with female genital mutilation (FGM) are released at local authority and CCG level each quarter and financial year, but includes all patients and all attendances during the reporting period where FGM was identified or a procedure for FGM was undertaken. Women or girls may have one or more attendances within the reporting period. The numbers also include newly recorded and previously identified women and girls. In some cases, women are identified during pregnancy and as a result can have multiple health care appointments relating to antenatal during the same quarter or financial year. Numbers are also rounded. Where the numbers are 1-7, the number is reported as five, and the where the numbers are above seven, the numbers are rounded to the nearest five. Thus numbers do not necessarily add up to the total when subgroup analyses are completed.

In Hull, in the year April 2020 and March 2021, there were around 60 attendances of women and girls where FGM was identified or a procedure for FGM was undertaken with 50 individuals in total of which five were newly recorded.

Of the approximately 50 cases recording in 2020/21:

• Type: 15 unknown, 20 were type 1, five were type 2, five were type 3 and five were type 4.
• Age at latest attendance: five were aged 18-24 years, 10 were aged 25-29 years, 20 were aged 30-34 years, five were aged 35-39 years and five were aged 40-44 years.
• Country of birth: Eastern Africa (10), Northern Africa (15), Western Africa (10), Western Asia (15) or the rest of Asia (5) with country of birth not stated for 5 individuals.
• Age when procedure was carried out: aged <1 year (5), aged 1-4 years (10), aged5-9 years (20) and aged 10-14 years (10) with age unknown or not stated for 10 cases.
• Treatment function area: midwifery service (20), obstetrics (35) and gynaecology (5).

Of the approximately 65 attendances in 2020/21:

• Referred from: GP (5), NHS organisation (30) and self-referral (30).
• Pregnant: yes (20) and no (40).

It should be noted that for the year 2019/20, there were 75 individual patients with 30 of those cases newly recorded, and they had a total of 95 attendances over the period April 2019 to March 2020. Many services were disrupted over the period April 2020 to March 2021 due to COVID-19 with the first lockdown occurring a week or so before the start of this financial year. Therefore, it is possible that this is an explanation of why the numbers are lower in 2020/21 than for 2019/20. So it is possible that numbers could be slightly higher in 2021/22 than for 2020/21.

Due to the reporting of rounding numbers and most of the figures for Hull quoted as five, it means that the true numbers are really anywhere between one and seven. Thus it is difficult to obtain precise numbers, but the information can give an idea of the number of new cases of FGM in Hull. However, it is difficult to ‘translate’ the nationally produced data by local authority into estimates of the total number of women affected in Hull due to the way the data is presented, although it is possible to examine the numbers over time to give an idea of the total numbers known to have FGM in Hull. This gives a total of around 190 women identified as having FGM who lived in Hull at the time (with the rounding mentioned above, the likely range is probably somewhere between 176 and 202 women). Some of these women may have moved away from Hull since, however, it is possible that some women previously identified as having had FGM who lived in other areas at the time could have moved into Hull.

Financial year	Individual patients	Newly recorded	Total attendances
2015/16	45	45	50
2016/17	55	45	65
2017/18	60	35	75
2018/19	65	30	85
2019/20	75	30	95
2020/21*	50	5	60

Use of Sexual Health Services

During 2021, there were 8,589 patients seen at Wilberforce Health Centre which involved 13,550 new consultations and 3,888 follow-up consultations. Over half of patients seen at Wilberforce Health Centre lived in Hull, whilst almost 2 in 5 lived in East Riding of Yorkshire.

There were 5,043 Hull residents seen with 8,315 new consultations and 2,675 follow-up consultations (with the majority seen at Wilberforce Health Centre).

There were 1,772 consultations involving new sexually transmitted infections, 534 consultations related to existing or subsequent presentations of sexually transmitted infections, 929 consultations for other sexual health related activity such as pregnancy or other conditions requiring treatment at a genitourinary medicine clinic, and 13,980 consultations for other services which were mainly related to routine surveillance of high risk groups, vaccinations, partner notification of sexually transmitted infections or testing of sexually transmitted infections.

Sexually Transmitted Infections

Further information is available on Sexually Transmitted Infections under Health Factors within Adults.

Strategic Need and Service Provision

Hull Clinical Commissioning Group (and its successor organisation Hull’s Health & Care Partnership) and Hull City Council provides an integrated community-based service. Over the last decade Hull has significantly changed the way it delivers sexual health services, with an increasing emphasis on prevention and health promotion to challenge perceived social norms and deliver behaviour change.

The Relationships Education, Relationships and Sex Education and Health Education (England) Regulations 2019 made under sections 34 and 35 of the Children and Social Work Act 2017 make Relationship Education compulsory for all pupils receiving a primary education and Relationships and Sex Education (RSE) compulsory for all pupils receiving secondary education.

The RSE programmes within schools cover the following topics in primary school: families and people who care for me; caring friendships; respectful relationships; online relationships; and being safe. Knowledge on these topics is continued within secondary school with additional topics as follows: families; respectful relationships including friendships; online and media; being safe; and intimate and sexual relationships including sexual health.

A multi-agency strategy is currently being developed to prevent FGM and those who have been subject to it.

It is clear there have been significant disruption to Sexual Health and Reproductive Services because of the COVID-19 pandemic, although it appears that the impact locally might have been greater than the effect observed nationally and regionally. This disruption would have been particularly evident at the start of the first lockdown in March 2020 when people and services were learning and working out the best way to deal with the pandemic and its lockdowns. However, the knock-on effects of this disruption might be felt for some time, even after services were ‘back to normal’ or almost ‘back to normal’. The impact is evident for access to contraception, but also in the number of STIs detected (see Sexually Transmitted Infections under Health Factors under Adults).

Resources

World Health Organisations. Sexual health: https://www.who.int/topics/sexual_health/en/

NHS One You. Sexual Health: https://www.nhs.uk/oneyou/for-your-body/sexual-health/

The Office for Health Improvement & Disparities’ Fingertips: https://fingertips.phe.org.uk/

NHS Digital, Female Genital Mutilation: https://digital.nhs.uk/data-and-information/publications/statistical/female-genital-mutilation

HIV/STI Data Exchange: https://hivstidataexchange.phe.gov.uk/hivsti/Dashboard/Index

Updates

This page was last updated / checked on 28 November 2022.

This page is due to be updated / checked in February 2023.