Executive summary
TERMINATION OF PREGNANCY IN MANCHESTER:
BME COMMUNITY ENGAGEMENT AND CONSULTATION
Manchester BME Network in association with
Centre for Local Economic Strategies

The Manchester BME (Black and Minority Ethnic) Network was commissioned by NHS Manchester to undertake community engagement and consultation with women from BME communities across the City. The consultation aimed to better understand the women’s sexual health needs, and to promote and increase access to sexual health and contraception services amongst BMEcommunities.

The NHS Health Equity Audit: Termination of Pregnancy report (2007-2009) showed that amongst some BME communities the incidence of terminations of pregnancy was higher than expected. Recent termination data showed that, for some groups of women, it was significantly higher, particularly in the following wards: Ardwick; Harpurhey; Cheetham; Longsight; Hulme; and Moss Side.

The Manchester BME Network, in partnership with the Centre for Local Economic Strategies, undertook research and consultation with women in these target wards to explore the reasons why termination rates were higher, and to better understand women’s experiences, views and practices on matters related to termination, contraception and sexual health.

Using the findings from the research and consultation, information on sexual health services in Manchester, and demographic data from the target wards, this toolkit has been compiled to enable practitioners and policymakers to better understand how sexual health services can meet the needs of BME women, and how to better monitor change in BME women’s sexual health needs.

Sexual health, termination and contraception services across Manchester

A range of sexual health and contraception services are available at specialist clinics, GPs and pharmacies across Manchester. Palantine clinics, Fresh clinics and the Brook clinic offer free and confidential contraception services, and other sexual health services and advice to men and women of all ages; these are walk-in services thus a GP referral is not necessary. There are also three specialist GUM clinics (infection testing) in Manchester that offer free sexual health and contraception services; an appointment may be required to use a GUM clinic.

All GPs in Manchester provide essential sexual health services; 15 GPs are also able to fit or remove contraceptive implants or an IUD (coil), and screen for sexually transmitted diseases. NHS Manchester has also commissioned a number of pharmacies across Manchester to provide free emergency hormonal contraception. Some of these also offer first and repeat prescriptions of oral contraception and Chlamydia screening.

The British Pregnancy Advisory Service (BPAS) arranges consultation appointments at termination clinics in Greater Manchester. This central booking service can arrange appointments for a termination on the NHS or through a private clinic: 0845 365 0565. The sexual health clinics can discuss the termination service with you and book an appointment. All information is kept confidential and you do not need to inform your GP if you have a termination.

There are a number of organisations across Manchester that provide advice and support on sexual health issues. Manchester residents are also able to access sexual health services outside of Manchester.

Manchester demographics by ward

Manchester has a very diverse population which varies considerably across its different wards. The largest ethnic group in Manchester are those of a White ethnicity, representing just less than three quarters of the Manchester population; the second largest ethnic group is Asian/Asian British which represents 17% of the Manchester population. Almost half of the population of Manchester identify themselves as Christian; there are also large proportions of the population which have no religion (25%) or are Muslim (16%). Far smaller numbers of people identify themselves as Buddhist, Jewish, Sikh, Hindu or another religion.

The socio-economic status of Manchester residents also varies greatly between the different wards; the Index of Multiple Deprivation (2010) shows thatthe areas experiencing the highest levels of deprivation are mainly located in the north and east of Manchester. Areas to the north and the very south of Manchester have higher numbers of people receiving Income Support than more affluent areas to the south of the City Centre. The areas with the highest numbers of people with no qualifications are found in the north east of Manchester.

Termination of pregnancy in Manchester

The termination of pregnancy data recorded in Manchester between 2007 and 2009 show that among the black and minority ethnic groups, termination of pregnancy was most common among women of Black/Black British ethnicity. When Manchester’s ethnic profile is compared to the percentage of terminations in Manchester per ethnic group, it is clear that the Black/Black British ethnic group and the Chinese/other ethnic group are experiencing higher rates of terminations than other ethnicities.

The data also shows that the number of terminations among White women decreases with age from the age of 18, whereas the number of terminations for Asian/Asian British women and Black/Black British women increases with age. These patterns found in the data were explored through research and consultation with women from these ethnic groups to better understand how and why they use sexual health services.

Focus on the six hotspot wards

Based on the latest BME termination of pregnancy data (2007-09), this study focused on the following six wards: Ardwick; Harpurhey; Cheetham; Longsight; Hulme; and Moss Side. These wards have been chosen because they have the top two wards with the highest number of terminations of pregnancy for the three target ethnic groups. The toolkit provides data on the demographic profile, socio-economic indicators, and the number of terminations of pregnancy in each ward. The toolkit also lists the sexual health services available in the ward and the main women’s support groups and BME community groups in each target ward.

Supporting women to access sexual health services: Challenges and opportunities

Our consultation therefore focused on women from specific ethnic backgrounds living in the hotspot areas of: Ardwick; Harpurhey; Cheetham; Longsight; Hulme; and Moss Side.

Ethnic groups / Age groups / Hotspot wards / No. of interviews
Asian/Asian British: Indian; Pakistani; and Bangladeshi origins / 30-35+ years old / Cheetham
Longsight / 20
Black/Black British: African; and Caribbean origins / 20-35+ years old / Ardwick
Harpurhey / 20
Chinese: Vietnamese; Malaysian; and Afro-Asian origins / 20-29 years old / Hulme
Moss Side / 20

For the community consultation, four members of the Manchester BME Network were engaged: Wai Yin Chinese Women’s Association; Manchester Women’s Empowerment Group; Creative Hands; and My Communities UK. Two volunteers from each of these organisations were trained as community researchers to undertake the neighbourhood level consultation. In total, 60 women took part in the face-to-face interviewing process and 6 focus groups were held, one in each of the locations identified.

Sexual health

The findings from the consultation explored women’s views and experiences of using sexual health services, in particular contraception. The key findings were:

information and accessibility – overall, the women consulted were well informed as regards sexual health and how to access contraceptive services. Across all ethnic groups, contraceptive methods are considered easily accessible and nearly all women are registered with a GP[1];

barriers – three issues emerged as main barriers to accessing contraceptive services:

  • language and communication – both limited English language skills and cultural differences in terminology and attitude are barriers to women accessing sexual health services. Foreign nationals often do not speak English sufficiently well to express themselves, or understand the literature available on sexual health services.

Although interpretation services are available, these are not perceived as effective and the personal nature of the topic means that women may find using an interpreter awkward. Moreover, women who have just arrived in the UK are unlikely to understand how the health system works;

  • gender of sexual healthcare professionals – thegender of the GP is often crucial in enabling women to disclose matters which are personal and confidential. Women often felt more at ease with a female doctor who they felt could better understand their needs;
  • anonymity and confidentiality –a further barrier in accessing appropriate contraception is fear of disclosure. Some women fear that someone they know might see them using a local clinic; this is a common issue, particularly among Chinese, Black British and Black African groups;

suggestions for improvements – a number of suggestions were brought forward, in particular:

  • better information to newcomers;
  • simpler language;
  • sensitivity to cultural needs;
  • community provision;
  • reaching foreign students.

Termination of pregnancy

This research also explored BME women’s experiences and perceptions of termination of pregnancy services:

perceptions of termination of pregnancy – in general, women from all three ethnic groups express hesitancy about whether termination of pregnancy is morally permissible. Their main concerns with termination relate to their religious belief; however the attitude of their family and partner were also very influential. In general, termination of pregnancy is a taboo subject for women from all ethnicities. Women of an Afro-Caribbean ethnicity are usually more open and willing to discuss their opinions of termination, while women of Asian and Chinese ethnicities are far less willing to discuss the issue;

reasons for having a termination – the main reasons for having a termination were age, religion and culture, and health. Many women felt the pregnancy had occurred at the wrong timein their life while others did not want to bear the shame and disapproval of their family and community if their pregnancy had occurred outside of marriage;

experience of termination services – generally, termination services were described as being professional and women were wellinformed about the medical aspects of the procedure. However, some women still felt unsure about the possible sideeffects of a terminationand many, especially those who were religious, felt there was a lack of emotional guidance and aftercare. Difficulty communicating and concerns over privacy were notable among Chinese students, who may use the private Pall Mall medical clinic in Central Manchester instead of trying to negotiate NHS services;

suggestions for improvements – a number of suggestions were brought forward, in particular:

  • counselling services available before and after a termination;
  • more information on the services available, the central booking system, interpretation services, possible cost, and the procedure;
  • availability of female GP and interpreter of the same ethnicity as the patient;
  • information available in different languages;
  • female community workers to visit homes;
  • signposting to information online.

Monitoring change in BME women’s sexual health needs

The NHS has a central monitoring system in place for everyone entering the system which captures data on ethnicity. Providers of termination of pregnancy services also capture data at the clinical level, including: ethnicity for under 18’s; postcode; need for interpreters; current contraception practice; and history. There is a lot of data that is currently collected, but it is unclear whether the data collected at the service level is the same across all service providers.

To improve the consistency of collection of monitoring data, the following issues could be explored further at the provider level:

Census;

self-definition (how would you define your ethnic group?);

first language;

country of origin;

religion.

Improvements could also be made to the collection, use and sharing of data in order to inform the planning of future services.

[1] Only four out of the 60 women interviewed were not registered with a GP. Two from the Chinese group sampled stated it was for VISA issue (i.e. the visa had expired). The other two from the Asian group had moved recently to the area