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).