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Colleagues at Nottinghamshire Healthcare have been working with our partners at Sexual Health Nottingham and Nottinghamshire and Framework to deliver a fantastic project supporting vulnerable women to access contraception.

What started as a simple performance target to increase access to the long-acting reversible contraception (LARC) method of Depo-Provera (a hormonal birth control injection) for women who experience severe and multiple disadvantage (SMD), has led to the development of a project in its own right, now titled 'Project Margaret' SMD is a term used to describe people who experience multiple challenges in their lives, which can affect their mental and physical health.

Margaret Sanger (14.09.1879 - 06.09.1966) was a pioneer for birth control in America for women who were living in poverty. Margaret opened the first birth control clinic for women in 1916, which led to her being arrested for 'distributing contraception information'.

Margaret believed that women should have an equal footing in society and to lead healthier lives, they needed to detriment when to bear children. She also wanted to prevent back-alley abortions which were common at the time.

The Partnership Liaison Manager, Anna Murphy from Nottinghamshire Healthcare, worked hard at the start of the project to set up Depo-Provera and made sure all the correct pathways and processes were in place. The nurse leading the provision from The Health Shop began to offer it to women accessing a variety of specialist services across the city. However, she soon realised that this wasn't suitable for many of the women she saw due to the set criteria that allowed her to give Depo-Provera.

In addition to this, from listening to the women she saw, the lead nurse recognised that women wanted a choice of contraception, something which the Trust could not do. They wanted this provided by staff who understood their needs, in an environment they were comfortable in. Some women experiencing SMD may have worked in the sex industry, have had children removed by social care, had multiple terminations, and been subjected to sexual abuse and trauma. Many feel judged and shamed. Discussing sexual health can be very difficult, especially when accessing mainstream services.

A partnership and pathway has been developed with Sexual Health Services Nottingham and Nottinghamshire, who set up a dedicated clinic run by two clinical prescribers offering full sexual health testing and treatment, and contraception, including the offer of all long acting reversible contraception methods and smear tests. 

Women who experience SMD can be taken by the clinical nurse specialist to the dedicated clinic at Victoria Health Centre on one afternoon per month, where they will receive holistic Sexual Health Care in a safe, accessible space.

Beth Maloney, Clinical Nurse Specialist at Nottinghamshire Healthcare said: This has been a brilliant project to lead and work in partnership with Sexual Health Services Nottingham and Nottinghamshire and Framework to offer the best care to our patients. The staff working at Sexual Health Services Nottingham and Nottinghamshire have been incredible. The reception team are so welcoming and the clinical staff who provide a variety of interventions are kind and patient and provide trauma informed care.

The lead nurse has worked across a variety of services across the city providing training around long-acting reversible contraception, Project Margaret and supporting staff to make referrals. Many of these referrals have come from the Nottingham Recovery Network, which is a Framework led service but part of a partnership with Nottinghamshire Healthcare, Double Impact and Al-Hurraya. 

Amy Eagle, Care Group Director of Community Health and Specialist Services at Nottinghamshire Healthcare said:

We're really proud to be leading this brilliant partnership project. The teams have worked together to provide the best possible service to vulnerable women, ensuring they get the support they need. Well done to all.

The project is already seeing great results, with over 80 women having engaged with The Health Shop team and some of these have also had treatment with Sexual Health Services Nottingham and Nottinghamshire as a result.

Just a few examples of the success of the project include 59 Depo Provera's being given via the Health shop, 11 expired implants removed, 18 new implants fitted, and more than 15 Hepatitis B vaccinations given.

Susan Bull, Clinical Nurse Specialist at Sexual Health Services Nottingham and Nottinghamshire said We have worked as a team to adapt the service to the patients' needs. We have tried to make it as welcoming as possible, following consultation with the patients we offer food, drink, hygiene and other necessary products to provide a holistic service. We really value being part of this collaboration.

A service user said: Going to the doctor's and health clinics, most appointments don't end up happening but going to the health centre with Beth made it easy and made me want to go as I always get welcomed like I'm meant to be there. Also, you have someone with you which makes life that little bit better, makes dreadful appointments something that are not that bad. Always receive support in all directions of life. I was putting it off for a very long and I look forward to meeting the nurses.

Alongside contraception support, Sexual Health Services Nottingham and Nottinghamshire have also been able to support in other areas, such as referrals to hospital and support around domestic violence. Five women are also accessing drug treatment as a direct result of their contact with Project Margaret.

Another service user commented: You're the best honestly always here to help. I've literally put it off for years because of you I actually did it. Can you sign me up to more things please so I can see you more! Thank you for everything I really appreciate you.

To support women who may want to access Project Margaret but find it difficult to come into services, the team are trialling late-night evening outreach utilising the clinically fitted Health Bus to travel to hostels, street locations and other areas taking Project Margaret directly to the women who need it.