General information Family Planning is offering a range of sexual and reproductive health services, including contraception services, during the Covid-19 lockdown. Services are being offered virtually rather than face-to-face. On 31 March alone close to 500 people had an appointment with one of our clinicians. Available services include: ·
pill starts and repeats
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emergency contraception
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advice and information about abortion services.
· people requiring depo provera or those who are due to have an implant replaced are being offered a pill prescription We’ve also removed the co-payment charge for New Zealand Residents, making our services entirely free for them during the lockdown. Clients are being encouraged to use the ask for an appointment form on our website to connect with us. Information for clinicians Family Planning has developed guidance for clinicians about the provision of contraception during a pandemic lockdown. The guidance is based on guidelines developed by the Faculty of Sexual and Reproductive Health in the United Kingdom, adapted to suit New Zealand contraception usage and availability. There will be ongoing need for contraception during the lockdown, just as there is during any other emergency, and we hope our guidance will be of assistance to GPs and others who are not regularly prescribing contraception. People are concerned about managing pregnancy risk and we want to support our clinical colleagues to provide these services, especially when we know many of them will be working as we are, offering services remotely. They can be reassured that providing progestogen only pill is a really safe option within minimal assessment for the majority of women. Assistance for clinicians is also available by emailing advice@familyplanning.org.nz. In addition; Family Planning continues working with the MoH to clarify which sexual and reproductive health consultations are considered essential services. I want to reassure you that the MoH has been incredibly helpful getting us through any of the challenges that we have found while getting our services up and running. They are also clear that contraception is an essential service. We initially closed the clinics and cancelled appointments for two days (24 and 25 March) and worked to enhance our virtual services. On Thursday 26 March we opened our on-line booking with the revised services we were able to offer. We are only taking bookings through our web based booking requests (ask for an appointment) as this helps us filter out the requests that are outside of what we can provide virtually. We now have up to 40 clinicians working on virtual appointments throughout the country. They have fairly full clinics, prioritising ECP and abortion information requests and providing contraceptive pills.
We are following the Faculty of Sexual and Reproductive Health guidelines for the provision of contraception in a pandemic and Dr Beth Messenger, our National Medical Advisor, has written a guideline for the NZ context. Below is the link to this through our website. https://www.familyplanning.org.nz/advice/covid-19-contraception-information-for-clinicians In line with this we are providing the following: •
Repeats for the combined oral contraceptive pill and the progestogen-only pill.
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Starts for the progestogen-only pill.
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Emergency contraceptive pill
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Abortion information/ referral
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Progestogen-only pill for those requiring depo provera or implant changes
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EMA service continues uninterrupted at our Tauranga Clinic
Provision of the progestogen-only pill is an issue. It is understood that supplies are low and the pill is unavailable in some areas. This compounds issues for those needing depo provera repeats or implant replacements. Supplies of Norimin and Brevinor1 are also low. We are working with the MoH on this. Added to the above we have asked the MoH to see if it is possible to make pregnancy tests free through pharmacies to improve access. This looks like a possibility. Also there is also currently no STI testing unless clients are symptomatic. We are trying to determine how we can refer symptomatic clients for testing and treatment. We are currently working on setting up depo provera repeat face-to-face consultations in our clinics that are easily accessible and not in malls (e.g. Westfield Manukau) with good parking for clients. We hope to trial this towards the end of the week in 3 or 4 of our clinics including Tauranga. Below are the answers to questions received from Dr Joe Bourne, BOPDHB ·
Name of service: Family Planning Sexual and Reproductive Health Services
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Key contact: Jackie Edmond 021 729 372 jackie.edmond@familyplanning.org.nz or Kirsty Walsh 021 271 5560 kirsty.walsh@familyplanning.org.nz
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Outline of normal service is available on our website https://www.familyplanning.org.nz/ For Tauranga clinic: · Services provided include: o Contraception o STI testing and treatment o Pregnancy testing o Fertility services
o o o o o o o o o o ·
Early medical abortion Pregnancy counselling Cervical screening Menopause Sexual dysfunction or issues Pre Menstrual Syndrome (PMS) Abortion referral Condoms Emergency contraception - ECP Emergency contraception - copper IUD Normal opening hours, which includes drop-in hours: Monday / Rāhina 9.00am - 5.00pm Tuesday / Rātū
9.00am - 7.30pm
Wednesday / Rāapa
9.00am - 7.30pm
Thursday / Rāpare
9.00am - 5.00pm
Friday / Rāmere
9.00am - 5.00pm
Saturday / Rāhoroi
9:30am - 12.30pm (first Saturday each month)
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Numbers of patients usually seen Approximately 1800 to 2000 consultations per month in the Tauranga clinic and just over 16,000 per month nationally. ·
Current service provided Virtual consultations as above, early medical abortion and currently working on setup of depo provera repeats ·
Risk to the population associated with any change in service Unwanted pregnancy is the major risk Unmanaged STI with a result in increased prevalence ( mitigated by people not out and about with new sexual contacts) is a risk People desiring pregnancy may have delay in IUD or implant removal In line with NSU recommendations - stop cervical screening temporarily which will likely have limited impact on cervical cancer rates unless lockdown goes on for a very long time ·
Constraints that are impacting on the service – For our Tauranga clinic there are no particular constraints in terms of access to the clinic as there is great parking, it is not in a public thoroughfare and is next door to the pharmacy for clients needing scripts. We do have some of our workforce who are immunosuppressed, are over 70 or have other health issues that means they need to stay in lockdown which may have some limitation on service but as a number of our consults are done virtually, the impact should be minimal. If we were to do LARC insertion we do require two health professionals to be in the clinic for safety reasons and there is a possibility (workforce dependent) that the number of appointments may be reduced compared with our normal operation.
Unavailability of STI testing ·
What actions you have been able to implement yourselves to maintain service? As above, virtual consultations - this is BAU for us but we have expanded our service during the lockdown
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What assistance you might need in order to re-establish services – at least as close as possible to normal service – i.e. access to buildings, PPE, technology etc. As we were not deemed an essential service until a few days after lockdown PPE is an issue for us. We do not have masks in our clinics and for the last 3-4 weeks hand sanitiser is still on back order. We should have enough supply for a couple of weeks and hope to take delivery of hand sanitiser at the end of this week. Masks will be our limiting factor.
If you require any further information, please do not hesitate to get in touch, Nga mihi Kirsty
Kirsty Walsh National Director Operations
Family Planning New Zealand Whakamanahia. Equity. Access. Choice. Level 2, Newpark Centre, 5 Short Street, Newmarket, Auckland, 1023 Private Bag 99 929, Auckland 1149 T:09 524 3357 M:021 271 5560 F:09 522 0130