The history of sexual and reproductive health in our communities
Sexual and reproductive health is a vital aspect of public health, influencing healthy relationships, planned pregnancies, and disease prevention. It is essential for individuals throughout their lives. In England, access to quality sexual and reproductive health services enhances the health and wellbeing of both individuals and communities.
It’s worth reminding ourselves that local council’s responsibility for improving sexual and reproductive health in our communities is not new but has a long and prestigious history. The history of sexual health services in local government is marked by significant progress and ongoing challenges. From the early regulations and establishment of clinics to modern integrated services and the use of technology, councils have continually adapted to meet the sexual and reproductive health needs of their communities.
In July 1916, the Local Government Board issued the Public Health (Venereal Diseases) Regulations. This began the process of providing free, confidential diagnosis and treatment for sexually transmitted infections (STIs) in the UK. The Regulations were the enactment of the recommendations of the Royal Commission on Venereal Diseases, which issued its report in 1916. At that time syphilis death rates were 22-46 per million, 17 per cent of pregnancies in families with syphilis resulted in miscarriages or stillbirths.
30 per cent of children in blind schools were there due to syphilis and 50 per cent of infertility in women was due to gonorrhoea. During World War I about 5 per cent of men in Britain’s armies were infected with an STI and over 400,000 British or allied troops were admitted to hospital due to infection.
Following the formation of the NHS in 1948, local authorities took over maternity and child welfare centres, providing discretionary contraceptive advice. During the 1960s, huge progress was made. The first oral contraceptive was introduced in 1961 and in 1967 laws surrounding sexuality began to change, accurately reflecting public attitudes and the problems faced by people in everyday society.
The Abortion Act legalised abortion, in certain circumstances, in the UK and was a key public health driver, reducing the incidence of maternal mortality and morbidity.
The Family Planning Act 1967 enabled local authorities to give contraceptive advice and supplies under the NHS and included unmarried women, although it was at the discretion of the authority.
During the 1980s, local councils played a crucial role in HIV prevention efforts, particularly in cities heavily affected by the epidemic. Councils collaborated with health organizations to launch public awareness campaigns aimed at educating the community about HIV/AIDS. These campaigns focused on dispelling myths, promoting safe practices, and encouraging testing.
Roll forward to 2025 and the responsibility for sexual health commissioning sits with councils, working in collaboration with NHS partners, to maintain and improve access for their residents to sexual, reproductive health and HIV services and to ensure seamless pathways of care.
A consistent fall in teenage pregnancies over recent years, down to the lowest rate since 1969, is a testament to the systematic application of successful strategies, including education, support and access to comprehensive sexual health services.
Sexual Health Services are open access, and we understand that differences in provision should be minimal, so that patients know where to seek services and are less at risk of falling out of the system without receiving the care they need.
However, sexual health inequalities persist, disproportionately affecting young people under 25, gay and bisexual men, more deprived communities and black and minority ethnic groups. Addressing these inequalities requires targeted interventions and a comprehensive approach involving various sectors. Pathways for services should reflect the reality of the patient journey so that people are able to seek the treatment and care they need, easily and quickly.
Councils, and their partners, have also been at the forefront of the digital revolution in sexual health services. With the public increasingly using online services to do everything from shopping to banking, it is only right that people can get advice and access testing online.
Major service transformation has been achieved in many areas in the face of significant cuts to both local authority central revenue funding and public health grants, as well as unprecedented demand for sexual health services.
In 2023, there were 4.6 million consultations at sexual health services compared with 2.9 million in 2013. This surge in demand has put immense pressure on services, which are also grappling with funding cuts and workforce shortages. In this context, the capacity of councils to further innovate and create efficiencies is now limited without an increase in spending power.
We therefore look to the forthcoming Spending Review to provide a level of public health funding that will enable us to maintain high-quality sexual and reproductive health services and invest in prevention. This will not only improve people’s sexual health and wellbeing, but also provide savings down the line for NHS and social care services.
The LGA and the ADPH continue to call for a sustainable, national 10-year sexual and reproductive health strategy, increased funding, and a comprehensive workforce development plan to meet current and future demands.
It is vital that we do not see sexual matters as being purely in the realm of the clinician. It is important that approaches are tailored to the needs of different local populations and to the resources available.
We support the need for more joint working between local councils and the NHS to co-commission services for sexual and reproductive health. Integrated care pathways are key, as poorly connected services mean a risk of people falling out of the system without receiving the care they need.
We have come a long way since 1917, but we have much still to do if we are to improve the sexual and reproductive health of the nation. It really is too important to neglect.
Greg Fell, ADPH President
Councillor David Fothergill, Chair, LGA Community Wellbeing Board
James Woolgar, Chair, English HIV and Sexual Health Commissioners’ Group
Read our History of sexual health explainer which we published to mark the 175th anniversary of the first public health act.