Access to reproductive health services: findings from the 2023 Reproductive Health Survey for England

Background Recent research has documented poor reproductive health among women and people assigned female in England. Access to reproductive health services is hindered by an opaque and fragmented system. Methods We conducted the 2023 Reproductive Health Survey for England, a non-probability online survey, in September and October 2023 (N = 59,332). In this analysis, we examined access to reproductive health services across three domains: heavy menstrual bleeding and severe pain, gynaecological symptoms and conditions and menopause-related symptoms. Weighting the sample to match the 2021 Census age distribution, we assessed differences by ethnic group, subjective financial situation, educational attainment and region across the domains using logistic regression analysis and controlling for age. Results Respondents reported low access to reproductive health services overall, including 34.8% (8,644/24,952) of those with heavy bleeding or severe period pain, 44.7% (6,709/15,569) with menopausal symptoms and 55.3% (21,010/37,411) with gynaecological symptoms or conditions. When controlling for age, there were decreased odds of service access for menopause-related symptoms and increased odds of service access for gynaecological symptoms or conditions among Black ethnic groups. Respondents with a higher education degree had greater access to services for heavy bleeding or severe pain and gynaecological symptoms and conditions. Compared to London, all other regions had lower access to services for heavy bleeding or severe pain. Satisfaction ranged from 16.5% (741/4,666) for polycystic ovary syndrome services to 80.2% (166/207) for reproductive cancer services. Conclusions Access to reproductive health services is poor in England and requires urgent action to address barriers to access.