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Logo of bmjThis ArticleThe BMJ
BMJ. 2007 March 31; 334(7595): 658–659.
PMCID: PMC1839220

Sexual healing

As calls are made for changes in the Abortion Act, a seasoned campaigner reflects on the scant attention given to sexual health services

If pharmacists had not had to work on Saturdays in the 1950s, Baroness Gould of Potternewton, then plain Joyce Gould, might have continued working for the Leeds branches of Timothy Whites & Taylors, and Boots for many years, advancing perhaps to the highest echelons of dispensing practice. But the pull of Labour Party politics and the women's movement of the '50s was something Gould could not resist. And she wanted to have her Saturdays free to follow her passion.

Fifty years on, during which Gould spent nearly 40 years working for the Labour party—most latterly as director of organisation—she finds many of the concerns that drew her into politics half a century ago are making a resurgence: nuclear weapons, funding for family planning services, discrimination, and abortion.

Gould was actively involved in promoting the 1967 Abortion Act and says, “It is very distressing that the Abortion Act has come round again.” She accepts, however, that some aspects of the act need to be reviewed, although she insists that “if there are going to be changes to the act they have to be changes that are positive for women.”

Gould has campaigned for many years for better access to earlier abortions (under 10 weeks) but would not like to see any time shaved off the current 24 week abortion limit. Although they are not common, late abortions are sometimes necessary for various reasons, such as presenting late, waiting for test results, and being deterred from having a termination by a general practitioner, she says.

“The act should be improved. It is a nonsense that two doctors are still needed to approve an abortion—only one doctor's signature should be required,” she said. “Northern Ireland should also be included in the act. Had we tried to get Northern Ireland included in the act at the time, it would not have gone through. But we must put an end to the need of women from Northern Ireland to have to come here for an abortion.”

Being made a life peer in 1993 by the then Labour leader, John Smith, led to “an instant new life,” says Gould. After working more than 100 hours a week at Labour HQ running campaigns, elections, and by-elections and enforcing party discipline (Gould played a key role in purging Militant from the party in the 1980s), there was little chance that she would take it easy once she reached the upper house.

Gould doesn't attend many of the receptions laid on almost daily for members of the House. “It is not what I see as my main agenda,” she says. But being a peer has enabled her at last to set her own work agenda and take a lead in driving government policy. She has taken this opportunity to revisit some of the concerns that inspired her in her youth—mainly women's issues, health, and equality.

Gould sits on many select committees and all party groups in the Lords, holding numerous posts, including chairwoman of the epilepsy group and chairwoman of the pro-choice and sexual health group. She also chairs the Independent Advisory Group on Sexual Health and HIV, a group of 26 experts that was set up in 2003 to monitor the progress of the government's national strategy for sexual health.

The group's first annual review published two years ago was well received by government, which has now acted on 90% of the recommendations made, including setting the target for a maximum 48 hour wait to be seen by genitourinary medicine services and the rolling out of a national screening programme for chlamydia.

Gould, however, feels frustrated by the often casual and slipshod way that sexual health services are regarded by health commissioners.

When the government earmarked £300m (€440m; $580m) in November 2004 for funding the sexual health initiatives outlined in its public health white paper Choosing Health, she thought that at last sexual health services were to get the attention they deserved, until it became clear that very little of the money reached its intended target, most of it being siphoned off to rescue primary care organisations from financial catastrophe.

Among Gould's complaints is the battering taken by contraceptive services. Although some general practitioners will pick up the loose ends, she says, many simply haven't got the training to provide a thorough service, particularly in long term contraceptive options.

She said: “£40m for contraceptive services has not been seen. Ringfencing has not been seen. We have to rethink how we are going to guarantee that the money is spent on the purpose for which it was meant. The way to protect contraceptive services is to have a contraceptive target—and we need to have that dialogue with government.”

Gould blames the funding crisis on the devolution of services to primary care trusts. When the trusts are finalised it will be vital for the sexual health group to “home in on chairs of strategic health authorities” to tell them of the need for better sexual health services.

She would also like to see a national strategy to provide more holistic services for sexual health and other risky behaviours, particularly for young people. At the moment a person may be referred to separate clinics to access each type of service, a set-up seemingly designed specifically to lose people from the system rather than to offer opportunistic public health advice.

“Young people need a one-stop shop where they can see a multiskilled professional and have a one to one conversation that covers many aspects of their life, such as alcohol, drugs, and sex,” says Gould.

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