London

United Kingdom / London

OVERVIEW

As one of the largest cities in Europe, you'll find an incredible range of health care resources in London. Even better, many of these services are accessible to the public and free of charge, supported by the National Health Service (NHS). In the United Kingdom, contraception is legal and diverse in choices, but remember that a prescription is required. To obtain emergency contraception (the morning after pill), a prescription is also required, and it's recommended to visit a special clinic for EC if you're under 16. You can find ellaOne, the longest-lasting EC, in the United Kingdom. For STI testing and support, there are many free and anonymous facilities in London. If you are interested in a public testing facilities, Better2Know is recommended. For menstrual needs, you'll be able to find common products, like pads and tampons, as well as less commonly used products, like menstrual cups, at select UK sellers. Maternity leave is covered for women under certain conditions for up to 52 weeks. Finally, abortion is generally legal, but there are certain restrictions and requirements that should be observed.

Contraception

General Note: There are many types of contraceptives, also known as "birth control," including IUDs, oral contraceptives, patches, shots, and condoms, etc. If you would like to view a full list, click here.

Laws & Social Stigmas

In the United Kingdom, a prescription is required to obtain birth control. Overall, contraceptive use is very common with an estimated 84% of women of reproductive age using some form of contraception and 22% of women using oral contraceptives. Furthermore, it's estimated that the United Kingdom has the second most prevalent usage of condoms in the world.

Contraceptive services are outside the NHS. While GPs can give advice on where to go for service, they will not prescribe contraception.

What to Get & Where to Get It

• Brook: "Brook has services across the UK offering free and confidential sexual health advice and contraception to young people under 25. Appointments are not usually necessary as we work on a drop in basis." Drop in services are frequently only available to younger people. For other services, an appointment is necessary. If you go into a GP in the area you live in, they can give you a list of the clinics in the area to call for appointment availability.

Note that there may be long queues to get an appointment for prescription for birth control, and more than one appointment may be necessary to get long lasting contraception such as IUDs, which are largely handled by doctors. Nurses can place the implant and handle patient intake. Waits of more than a month are not uncommon in certain areas, such as London. However, you can call daily to get an appointment slot at an earlier time, as there are frequently cancellations.

Emergency Contraception

Important Notes: Emergency contraception may prevent pregnancy for three days (72 hours) and sometimes five days (120 hours) after unprotected sex. Take EC as soon as possible after unprotected sex. If you don't have access to dedicated EC, oral contraceptives can be used as replacement EC, but remember the following: 1) Only some contraceptives work as EC 2) Different contraceptives require different dosages and time schedules to work as EC 3) You must only use the first 21 pills in 28-day packs and 4) They may be less effective than dedicated EC. For general information on emergency contraceptives, click here and here.

Laws & Social Stigmas

EC is available OTC to women over 16 in the UK without a prescription. EC may also be prescribed, dispensed by GPs, or available at sexual health clinics.

What to Get & Where to Get It

Note: The longest-lasting EC is currently ellaOne. It lasts up to 5 days (120 hours) after unprotected sex. Check to see if your country carries ellaOne. If your country doesn't carry ellaOne, copper IUDs may also prevent pregnancy up to 5 days after unprotected sex. If none of these options are available, and it's been over 3 days since you had unprotected sex, you can still take EC, which may work up to 5 days. Note that EC pills are not 100% effective and should be taken as soon as possible.

The NHS recommends IUDs, which are only placed at clinics, as EC.

In the United Kingdom, you can obtain oral EC without a prescription.

Here's what you can get:

Dedicated Products / Anti-Progestin Take 1 pill within 120 hours after unprotected sex:

• ellaOne (link to UK website)

Dedicated Products / Progestin Only Take 1 pill within 120 hours after unprotected sex:

• Levonelle 1500
• Levonelle One Step
• Levonelle-1

Take 2 pills within 120 hours after unprotected sex:

• Levonelle-2 (available from a pharmacist without a prescription)

Oral Contraceptives used for EC / Progestin Only Take 40 pills within 120 hours after unprotected sex:

• Neogest

Take 50 pills within 120 hours after unprotected sex:

• Microval
• Norgeston

Oral Contraceptives used for EC / Progestin-Estrogen Combined Note: in 28-day packs, only the first 21 pills can be used Take 4 pills within 120 hours after unprotected sex and take 4 more pills 12 hours later:

• Eugynon 30ED
• Microgynon
• Microgynon 30 ED
• Microgynon-30
• Ovranette

Costs

EC is free through the NHS, or can be purchased at many pharmacies for about £25.

LNG: € 6,97, as of 2013; UPA: € 19,75, as of 2013.

Sexually Transmitted Infections (STIs/STDs)

Important Notes - Learn about PEP and PrEP: If you think that you've been recently exposed to HIV (i.e. within 72 hours), seek out PEP (Post-Exposure Prophylaxis). It's a month-long treatment to prevent HIV infection after exposure, and it may be available in your city. Take PEP as soon as possible. For more information, click here. If you are at risk of HIV exposure, seek out PrEP (Pre-Exposure Prophylaxis). It's a daily oral pill that can prevent HIV infection before exposure. To learn more about PrEP, click here.

Laws & Social Stigmas

In August 2016, the High Court ruled that the NHS is responsible for funding PrEP. However, as reported by AIDSMap: "NHS England said today in response that the High Court ruling does not mean the medication will end up being funded by the NHS, and warned today that manufacturer Gilead Sciences now faces a blindfold bidding war with other pharmaceutical companies to make its product affordable enough to be prioritised by NHS England for funding." For now, a small amount has been given for NHS funding, while a legal battle is ongoing regarding which level of government, the national or local (counsil) level is responsible for PrEP.

What to Get & Where to Get It

Testing Facilities

Here's a comprehensive list of testing facilities in London, provided by NHS.

• Better2Know UK: "The UK's Largest Private HIV, STI & STD Testing Provider. Fast STI & HIV Test Results

Nationwide Clinics or Test At Home. See Your Private Nurse at Any of Our Nurse Stations. 100% Confidential & Completely Anonymous."

• Imperial College: "The Jefferiss Wing at St Mary's Hospital is an internationally renowned centre of excellence for the diagnosis, treatment and care of people with sexually transmitted infections, including HIV. We offer both outpatient and inpatient services. The centre offers a free, friendly, confidential, walk-in sexual health clinic where no appointment is needed, five days a week."
• Terrence Higgins Trust: Provides HIV & STI testing. Largest volunteer-run HIV and sexual health service in UK. Also does PrEP consultations.
• Middlesex-London Health Unit: "At the Sexually Transmitted Infections (STI) Clinic in London and Strathroy, you'll find a safe, non-judgemental atmosphere where you can have an open discussion about your sexual health." Free testing for sexually transmitted infections. Free treatment of sexually transmitted infections. Free pregnancy testing.

Support

• Herpes Viruses Associations UK
• NHS Choices: Hepatitis C
• Information on PrEP Access in the United Kingdom
• Positively UK: "Living with HIV? Want to talk? Call: 020 7713 0444. Email: info@positivelyuk.org. We can help. We are positive."
• HIV i-Base: Treatment information
• The National AIDS Trust: Policy development and campaigning organization
• National HIV Nurses' Association

Medications & Vaccines

What to Get & Where to Get It

Travel vaccines are given by private clinics. Nurses at the GP handle standard, non-travel vaccinations.

Note that the UK does not typically give the chickenpox vaccine.

Costs

Many standard vaccines are covered by the NHS. Vaccinations for the following conditions are usually available free on the NHS: cholera diphtheria, polio, tetanus and MMR booster hepatitis A some combined vaccines, such as combined hepatitis A and B typhoid

People in certain risk groups may be offered extra vaccines. These include vaccinations against diseases such as hepatitis B, tuberculosis (TB), flu and chickenpox.

Other vaccines may be accessed from private clinics but will vary in price.

Menstruation

Note: In addition to pads and tampons, you can also use menstrual cups and menstrual underwear for your period. To learn more about menstrual cups, click here. To learn more about menstrual underwear, click here.

What to Get & Where to Get It

In the United Kingdom, you can find pads, pantyliners, tampons and menstrual cups. For basic menstrual needs, you should be able to find them at most drug stores, like Boots or Superdrug. For DivaCup, check out Feminine Wear UK, Moontimes, The Raw Greek or [http:.//www.StressNoMore.co.uk Stress No More]. For Mooncup, check out Earthwise Girls. For natural, reusable menstrual products, check out Honour Your Flow.

Gynecological Exams

What to Get & Where to Get It

If you are going through the NHS, your GP intake will include a standard PAP smear, STI testing, and a physical check on an IUD placement. You will have to go to the GP, register, then make an appointment for a later day, where you bring a urine sample and then do a standardized patient intake followed by a PAP smear.

Costs

Gynocological exams handled by nurses at GPs through the NHS are free.

Pregnancy

Laws & Social Stigmas

In the United Kingdom, you're eligible for maternity leave is you're an employee, not a "worker." You must earn earn on average at least £112 a week and, until the "qualifying week," you must have worked for your employer for 26 weeks continuously. Note that the "qualifying week" means the 15th week before the expected week of childbirth. You must have proof of pregnancy. You must also give your employer proper notice according to protocol.

Regarding time, statutory maternity is leave is for 52 weeks in the United Kingdom. This includes ordinary maternity leave (first 26 weeks) and additional maternity leave (last 26 weeks). According to the law, you are not required to take off 52 weeks. But you must take off at least 2 weeks after your baby is born (or four weeks, if you work in a factory). You can typically begin your maternity leave 11 weeks before your due date (at the very earliest). You must give your employer at least 8 weeks' notice if you wish to change your return date.

In terms of payment, you receive 90% of your weekly earnings (before taxes) for the first 6 weeks. For the next 33 weeks, you receive £139.58 or 90% of your average weekly earnings (whichever is lower). Check out this Maternity Pay Calculator to see what you may get.

You can still get maternity leave if your baby is born early, is stillborn (after the start of the 24th week of pregnancy) or dies after birth.

For more information, check out the UK Maternity Pay & Leave website.

Abortion

Important Note: There are two main types of abortions: medical (also known as the "abortion pill") and surgical (also known as "in-clinic"). For medical abortions, you take a pill to induce abortion. For surgical abortions, a procedure is performed to induce abortion. For general information about medical and surgical abortions, click here.

Laws & Social Stigmas

In the United Kingdom, with the exception of Northern Ireland, abortion is permitted during the first 24 weeks of gestation. Women are allowed to obtain abortions for the following reasons: to save the life of the woman, to preserve physical health, to preserve mental health, rape or incest, fetal impairment or economic/social reasons. Abortion is not available on request in the UK.

To obtain an abortion, spousal consent is not required. But medical consent is required. Two registered medical practitioners (or, in an emergency, only one) need to certify that the abortion is required on medical grounds, as stipulated in the Abortion Act 1967. The abortion must be performed in a National Health Service (NHS) hospital or in an NHS-approved place, which may be a private hospital, nursing home or another facility.

When a woman is up to nine weeks pregnant, medical abortions can be performed with Mifepristone (abortion pill). From the seventh to fifteenth week, the suction/vacuum aspiration is most commonly performed. From the fifteenth to eighteenth week, surgical dilation and evacuation methods are most commonly performed. It is estimated that 30% of abortions in the United Kingdom are medical rather than surgical.

Abortion in the United Kingdom is protected under the Abortion Act of 1967, which was amended by the Human Fertilization and Embryology Act of 1990. The Act applies to England, Wales and Scotland. It does not apply to Northern Ireland. According to the Act, "a person shall not be guilty of an offence under the law relating to abortion when a pregnancy is terminated by a registered medical practitioner if two registered medical practitioners are of the opinion, formed in good faith" that the pregnant woman falls under criteria for permitted abortions.

In 1991, the UK became the second country, after France, to approve the use of RU-486 (the abortion pill). The pill is currently controlled by the National Health Service, which distributes it to gynecological units in the UK. In 2011, the BPAS attempted to force the Health Secretary to allow women to administer second dosages of medical abortion treatments at home. This was lost in High Court.

Generally, Great Britain is pro-choice. In 2004, a poll found that 75% of Britons believe abortion should be legal.

Personal accounts of obtaining an abortion in the UK:

• The Guardian: Nine women share their personal stories of abortion
• Abortion: The unheard stories

What to Get & Where to Get It

• NHS Abortion Services: You may be eligible for a free abortion through NHS at various hospitals. Check out this link to find an NHS service near you.
• British Pregnancy Advisory Service (BPAS): "British Pregnancy Advisory Service was established as a registered charity in 1968 to provide a safe, legal abortion service.... Today we provide services on behalf of the NHS across the country from Cornwall to Scotland and in Wales also. Today over 95% of the women we take care of have their treatment paid for by the NHS."
• Marie Stopes UK: "Our team of highly skilled doctors, nurses, counsellors and health care assistants provide reproductive and sexual health services through the NHS for over 100,000 women and men every year in our network of clinics around the UK."
  • Marie Stopes International Central London Centre: Marie Stopes House, 108 Whitfield Street, London W1P 5BE, Tel: 0845 300 8090
  • Marie Stopes International South London Centre: 1a Raleigh Gardens, Brixton Hill, South London SW2 6AB, Tel: 0845 300 8090
  • Marie Stopes International West London: 87 Mattock Lane, Ealing, London W5 5BJ, Tel: 0845 300 8090
• [he National Unplanned Pregnancy Advisory Service http://www.nupas.co.uk/]: "One of the leading abortion care, advice and support providers in the UK. National Unplanned Pregnancy Advisory Service (NUPAS) offers NHS and private abortion treatments in various locations based in the North West, Midlands and South of England."
• Leigham Clinic: 76 Leigham Court Road, Streatham, London, SW16 2QA, Tel: 08457 30 40 30
• London Central Day Surgery Unit: bpas, 26-27 Bedford Square, London, WC1B 3HP, Tel: 08457 30 40 30

Costs

According to UKHealthCentre: "Having an abortion with the NHS should not cost you anything but this very much depends on the local NHS Trust in your area. Sometimes the NHS will pay for you to have an abortion at a private clinic. Private clinics charge different prices. These costs can depend on the number of weeks you are pregnant and prices range from £400 - £800. It is often cheaper and quicker to have an abortion earlier in your pregnancy."

Advocacy & Counseling

Laws & Social Stigmas

In the UK, counseling is unregulated. However, there are licensing organizations such as the BACP (British Association for Counslling and Psychotherapy) and UKCP (United Kingdom for Counseling and Psychotherapy). Depending on the circumstances, the NHS may cover counseling, but queues for counseling services can vary widely by region and practitioner.

What to Get & Where to Get It

• Relate: The UK's largest counseling service for relationship support, sexual issues, etc. You must be 18+ to contact them for sexual issues.
• LifeCentre: "We are here to support survivors of rape and sexual abuse and their supporters. We trust this web site will be a positive start to giving you the hope and information you may need. Our services are for women and men, girls and boys of all ages and backgrounds."
• Rape and Sexual Abuse Support Centre: National Freephone Helpline: 0808 802 9999, 12:00 – 14:30 daily, 19:00 – 21:30 daily. "Rape Crisis South London run the Rape Crisis National Helpline for female survivors of sexual violence. The Helpline is accessible 365 days a year to women aged 14 + who have survived any form of sexual violence, no matter how long ago. We offer specialised, confidential support, information and referral details completely free of charge." Also offers counseling, advocacy, outreach.

List of Additional Resources

• In England, for medical advice contact NHS: Dial 111
• NHS’s Worth Talking About helpline: 0300 123 29 30, Mon-Fri, 2pm-8pm Sat-Sun 2pm-4pm.
• National Sexual Health Helpline: Free on 0300 123 7123. Your call will be treated with sensitivity and in strict confidence. The Sexual Health Helpline is open from 9am-8pm, Monday-Friday.
• Revenge Porn Helpline - 0845 6000 459 - open from 10.00am - 4.00pm, Monday to Friday. Emails can be sent at any time to help@revengepornhelpline.org.uk. Call for free, confidential advice and support, which may include removal of images online.
• NHS Common Questions: Sexual Health
• BISH: "A guide to sex, love and you. For everyone over 14."
• The Family Planning Association: Provides information on STIs, pregnancy, abortion, etc. "Every year we answer thousands of questions about sexual health through our website and publications. We help parents talk to their children about growing up, support health professionals, campaign for better sexual health services and fight for the rights of all young people to have high-quality relationships and sex education."
• The Sexual Advice Association: "Download our SMART SAA app! Sexual Management, Advice, Resources and Tips from the Sexual Advice Association. We are a charitable organisation which aims to help improve the sexual health and wellbeing of men and women, and raise awareness of the extent to which sexual problems affect the general population."
• Respect Yourself: A sexual health site for young people in the UK
• Switchboard LGBT+ Hotline: "Welcome to Switchboard – the LGBT+ helpline – a place for calm words when you need them most. Phone Us: 0300 330 0630. 10am-10pm every day."
• Gender Trust: Provides support for people dealing with gender identity issues. Call them on 01527 894 838.
• Mermaids UK: Provides services for children and teens with gender identity issues. 08443 340550. Mobile only - 03443 340550.
• The Beaumont Society: "We are the largest and longest established transgender support group in the UK, and have developed a support network which has been at the forefront of the transgender, transvestite, transsexual and cross-dressing community since 1966!"