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 2022, there were 3,109 live births to females aged 11+ years in Hull giving a birth rate of 56.3 per 1,000 female population aged 15-44 years (compared to 51.9 for England). The fertility rate has been consistently higher than England since at least 2010, and is higher in Hull among younger ages.
• In 2021, there were 981 abortions in Hull giving a rate of 18.6 abortions per 1,000 females aged 15-44 years which was marginally lower than England (19.2). Among under 25s in Hull, there were 351 abortions in Hull, and whilst fewer of them had had a previous abortion (26.2% versus 29.7%), a much higher percentage had had a previous birth compared to England (40.5% versus 26.0%).
• In relation to contraception, the rate of long-acting reversible contraception (LARC) excluding injections in Hull was lower than (38.4 versus 44.1 per 1,000 women aged 15-44 years) in 2022 although it had fallen in Hull significantly from 58.7 in 2018 when it was higher than England (48.1). Prior to 2019, the rate in Hull had been higher than for England. Sexual and Reproductive Health Services were severely disrupted during the COVID-19 pandemic particularly during the first lockdown, although quick changes were made to the services throughout the pandemic to allow access to services. Since the low in 2020, the rate has increased for both Hull and England, but the rate of increase has been much greater for England. In Hull, more women choose LARC, and fewer choose short-acting contraceptives and user-dependant methods compared to the national average. Men and women in Hull were much more likely to use specialist contraceptive services through the Sexual and Reproductive Health Services rather than via their GP practice but this simply reflects different commissioning arrangements in Hull.
• During 2022/23, the rate of hospital admissions for pelvic inflammatory disease among women aged 15-44 years in Hull was higher than England (263 versus 227 per 100,000 women aged 15-44 years) with around 145 admissions in total. There has been considerable year-on-year variability with the rate ranging from 255 to 823 admissions per 100,000 population between 2008/09 and 2022/23 (excluding 2020/21 when the rate was particularly low at 182 per 100,000 population due to the COVID-19 pandemic).
• During 2022/23, there were around 50 admissions for ectopic pregnancy in Hull which was similar to England (90.5 versus 89.0 admissions per 100,000 female population aged 15-44 years). Whilst the rate of admissions for ectopic pregnancy has varied considerably between 2008/09 and 2022/23 ranging from 54 to 117 admissions per 100,000 population, the rate in Hull has generally been comparable to England or lower than England.
• Between April 2022 and March 2023, there were approximately 70 patients with female genital mutilation (FGM) identified as having had FGM undertaken including 40 new patients (numbers are rounded to nearest five). During the eight year period 2015/16 and 2022/23, around 255 women with FGM have been newly identified, although as numbers are rounded to the nearest five, the actual number is likely to be anywhere between 234 and 271 women. Furthermore, these women were identified whilst they were living in Hull, and it is possible that some may have moved away (or other women with FGM have moved into Hull).

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

The fertility rate in Hull was slightly higher than England in 2022 at 56.3 live births per 1,000 women aged 15-44 years.

In Hull, there were almost 3,900 births in 2012, but this has been gradually reducing and there were 3,109 births to Hull residents during 2022. 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 mothers from minority ethnic backgrounds, the percentage of caesareans undertaken, the age of mother, and information on 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.

Abortions

The abortion rates which shows that abortion rates are marginally lower in Hull for all ages and for over 25s for 2021.

For women of all ages, the abortion rate in Hull has increased significantly between 2012 and 2020 with rates more than doubling, although the rate in Hull has tended to be lower than England. In 2021, there were 981 abortions 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 2021, there were 630 abortions among women in Hull aged over 25 years. There were 351 abortions among women aged 25 years equating to 36% of all abortions.

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

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

The percentage of abortions among under 25s is the number of females aged under 25 years having an abortion 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 an abortion in the year.

Whilst there has been an increase over time in the percentage of repeat abortions among women aged 15-24 years particularly between 2020 and 2021. Throughout the entire period 2012 to 2021, the percentage in Hull has been consistently below the percentage in England at around one-quarter lower although is only 12% lower for 2021.

However, in contrast the percentage of under 25s having an abortion 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 decreased slightly for England, although the trend in Hull 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, and whilst there has been a small decrease between 2020 and 2021, the current percentage in Hull is 56% higher than England.

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 which is likely compounded by the cost of living crisis.

The percentage of abortions under 10 weeks is lower than England though thus there is a slightly higher percentage of late abortions in Hull. The percentage of abortions 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 2021 (73% for Hull, 80% for East Riding of Yorkshire and ranging from 97% to 99% for the other 13 upper-tier local authorities across the region, and 96% for England).

The percentage of abortions 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, and a similar percentage was maintained for 2021.

In 2014, the percentage of abortions 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 96% 2021. The rate in Hull increased substantially between 2019 to 2020 to 69% with a further increase to 73% in 2021, but is still much lower than England.

Contraception

In 2022, the rate of long-acting reversible contraception (LARC) excluding injections was lower in Hull than England (38.4 versus 44.1 per 1,000 women aged 15-44 years).

There was a very noticeable difference as to where LARC was prescribed, but this is simply reflective of the way Sexual and Reproductive Health Services are commissioned in Hull.

Men and women in Hull aged 15-24 years were 2-3 times more 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 until 2020. There was a sharp decrease between 2019 and 2020 likely due to the COVID-19 pandemic. The decrease was greater in Hull compared to England, and the prescription rate for LARC in Hull for the first time since 2014 was lower than England. The percentages increased between 2019 and 2020, but the percentage increase was lower in Hull compared to England, so this increased the gap between England and Hull with the rate in Hull 13% lower than England for 2022.

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.

However, whilst the rate of prescribing LARC though Sexual and Reproductive Health Services increased in Hull between 2015 and 2018, the rate decreased between 2018 and 2019. The rate decreased at a much faster rate between 2019 and 2020 which was likely associated with the pandemic. The rate has increased between 2020 and 2022 in Hull, but the current prescribing rate for LARC through Sexual and Reproductive Health Services is lower than it was in 2014 prior to the change in commissioning arrangements.

There has been a reduction in the women attending specialist contraceptive services in Hull and a recent increase for men, although any 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.

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 sharply in Hull between 2018 and 2021 (almost halving). The COVID-19 pandemic could have influenced the numbers attending through changes in the need for the services and reduced access particularly in the first couple of months of the pandemic, although as the rate decreased in Hull between 2018 and 2019, the decrease between 2019 and 2020 (which was a similar magnitude) could have been reflective of other changes. There were further reductions between 2020 and 2021, but of a much smaller magnitude, and the rate remained relatively unchanged between 2021 and 2022 in Hull.

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. In contrast to women where there was a reduction since 2018, the rate increased for men to around 36 per 1,000 men between 2019 and 2022 (although there was a slight reduction for 2020 likely associated with the pandemic).

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, and the percentage choosing short-acting contraceptive methods and user-dependent methods as their main method of contraception was lower.

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 changes over time in the percentage of women who choose LARC at Sexual and Reproductive Health Services is very similar in Hull among females aged 15-24 and females aged 25+ years, although the overall percentages are higher among those aged 25+ years. For both age groups, the percentages increased gradually between 2014 and 2019, fell slightly between 2019 and 2020 likely associated with problems accessing services at the start of the COVID-19 pandemic, and have increased relatively sharply between 2020 and 2011.

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 2022/23, the rate of hospital admissions for pelvic inflammatory disease among women aged 15-44 years in Hull was higher than England (263 versus 227 per 100,000 women aged 15-44 years) although not statistically significantly higher.

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 the last four years (2019/20 to 2022/23).

In 2022/23, there were approximately 145 admissions among women in Hull for pelvic inflammatory disease (figures rounded to nearest five), and this was among the lowest number (excluding 2020/21 which was influenced by the pandemic) with the highest number being 455 in 2011/12.

The hospital admission rate of ectopic pregnancy in Hull is also reasonably similar to England for 2022/23 per 100,000 women aged 15-44 years with 91 admissions per 100,000 population in Hull compared to 89 admissions per 100,000 population for England.

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 reasonably comparable to England or lower.

In 2022/23, there were 50 hospital admissions among Hull women for ectopic pregnancy (figures rounded to nearest five).

Female Genital Mutilation

The number of women with female genital mutilation (FGM) are released at local authority and sub-Integrated Care Board level, 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.

For Hull local authority, in the year April 2022 and March 2023, there were around 85 attendances of women and girls where FGM was identified or a procedure for FGM was undertaken with 70 individuals in total of which 40 were newly recorded.

Of the approximately 70 individuals recorded in 2022/23:

• Type: 35 had type unknown, 20 were type 1, 10 were type 2, five were type 3, five were type 4, and five had history of type 3.
• Age at latest attendance: five were aged 18-24 years, 15 were aged 25-29 years, 30 were aged 30-34 years, 15 were aged 35-39 years and five were aged 40-44 years.
• Country of birth: Eastern Africa (10), Northern Africa (10), Western Africa (25), rest of Africa (5), UK (5), Western Asia (20) and rest of Asia (5) with country of birth not stated for 5 individuals.
• Age when procedure was carried out: aged <1 year (15), aged 1-4 years (20), aged5-9 years (15) and aged 10-14 years (5) with age unknown or not stated for 20 cases.
• Number of daughters aged under 18 years: none (35), one (25), two (5) and three or more (5).
• Newly diagnosed (40).

Of the approximately 85 attendances in 2022/23:

• Referred from: NHS organisation (15) and self-referral (70) with referral not noted for five attendances.
• Treatment function area: midwifery (65), obstetrics (15), gynaecology (5) and other (5).
• Pregnant: yes (50) and no (35) with pregnancy not noted for five attendances.

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 255 women identified as having FGM who lived in Hull at the time over the last eight years (with the rounding mentioned above, the likely range is probably somewhere between 234 and 271 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
2021/22	55	25	80
2022/23	70	40	85

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 (restricted access)

Updates

This page was last updated / checked on 17 June 2024.

This page is due to be updated / checked in December 2024.