Access to reproductive health services: findings from the 2023 Reproductive Health Survey for England

Ona McCarthy, Melissa Palmer, Knai C, Warren E, Jakubowski B, Pacho A, Rebecca French
2026 · doi:10.64898/2026.06.26.26356647
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The 2023 Reproductive Health Survey for England found poor access to services for heavy menstrual bleeding, severe pain, and gynaecological conditions across diverse populations, highlighting regional and socioeconomic disparities.

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The 2023 Reproductive Health Survey for England analyzed data from over 59,000 respondents to evaluate access to services for heavy menstrual bleeding, gynecological conditions, and menopause. The study found that overall access was poor, with significant disparities linked to ethnicity, education, and geographic region, such as lower access for Black ethnic groups regarding menopause symptoms. Researchers noted that the non-probability online survey design limits generalizability despite weighting adjustments for age distribution. Relevance to endometriosis: heavy menstrual bleeding and severe period pain are primary clinical indicators of endometriosis, making this paper relevant as it documents systemic barriers to diagnosing and treating these specific symptoms within the English healthcare system.

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Abstract

Background Recent research has documented poor reproductive health among women and people assigned female in England. Access to reproductive health services is hindered by an opaque and fragmented system. Methods We conducted the 2023 Reproductive Health Survey for England, a non-probability online survey, in September and October 2023 (N = 59,332). In this analysis, we examined access to reproductive health services across three domains: heavy menstrual bleeding and severe pain, gynaecological symptoms and conditions and menopause-related symptoms. Weighting the sample to match the 2021 Census age distribution, we assessed differences by ethnic group, subjective financial situation, educational attainment and region across the domains using logistic regression analysis and controlling for age. Results Respondents reported low access to reproductive health services overall, including 34.8% (8,644/24,952) of those with heavy bleeding or severe period pain, 44.7% (6,709/15,569) with menopausal symptoms and 55.3% (21,010/37,411) with gynaecological symptoms or conditions. When controlling for age, there were decreased odds of service access for menopause-related symptoms and increased odds of service access for gynaecological symptoms or conditions among Black ethnic groups. Respondents with a higher education degree had greater access to services for heavy bleeding or severe pain and gynaecological symptoms and conditions. Compared to London, all other regions had lower access to services for heavy bleeding or severe pain. Satisfaction ranged from 16.5% (741/4,666) for polycystic ovary syndrome services to 80.2% (166/207) for reproductive cancer services. Conclusions Access to reproductive health services is poor in England and requires urgent action to address barriers to access.
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Abstract

Background Recent research has documented poor reproductive health among women and people assigned female in England. Access to reproductive health services is hindered by an opaque and fragmented system.

Methods

We conducted the 2023 Reproductive Health Survey for England, a non-probability online survey, in September and October 2023 (N = 59,332). In this analysis, we examined access to reproductive health services across three domains: heavy menstrual bleeding and severe pain, gynaecological symptoms and conditions and menopause-related symptoms. Weighting the sample to match the 2021 Census age distribution, we assessed differences by ethnic group, subjective financial situation, educational attainment and region across the domains using logistic regression analysis and controlling for age.

Results

Respondents reported low access to reproductive health services overall, including 34.8% (8,644/24,952) of those with heavy bleeding or severe period pain, 44.7% (6,709/15,569) with menopausal symptoms and 55.3% (21,010/37,411) with gynaecological symptoms or conditions. When controlling for age, there were decreased odds of service access for menopause-related symptoms and increased odds of service access for gynaecological symptoms or conditions among Black ethnic groups. Respondents with a higher education degree had greater access to services for heavy bleeding or severe pain and gynaecological symptoms and conditions. Compared to London, all other regions had lower access to services for heavy bleeding or severe pain. Satisfaction ranged from 16.5% (741/4,666) for polycystic ovary syndrome services to 80.2% (166/207) for reproductive cancer services.

Conclusions

Access to reproductive health services is poor in England and requires urgent action to address barriers to access. Competing Interest Statement The authors have declared no competing interest. Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The Ethics Committee of the London School of Hygiene and Tropical Medicine gave ethical approval for this work (LSHTM Ethics Ref: 29389). I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes Data Availability All data that support the findings of this study are available from the authors upon reasonable request and with permission of Department of Health and Social Care.

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