Unity Sexual Health Update Day Making Sustainable Choices in Sexual and Reproductive Healthcare Dr Lesley Black, GP - 11th May 2021

Unity Sexual Health Update Day
             11th May 2021

Making Sustainable Choices in Sexual and
       Reproductive Healthcare

          Dr Lesley Black, GP
           lesley.black8@nhs.net

Why am I talking about this?
●   Climate Change and the effects on Planetary Health & Human Health
●   Average temperatures rising due to human release of CO2 & other
    greenhouse gases, trapping heat from the sun
    –   Burning of fossil fuels, deforestation, industrial agriculture
    –   Currently 1ºC above pre-industrial levels

Why am I talking about this?
●   Clear need to limit warming to

What do I mean by Sustainable?

SDG's relevant for SRH
●   Target 3.3 - By 2030:
      – End epidemics of AIDS, TB, malaria
        & tropical diseases
      – Combat hepatitis, water-borne
        diseases & other communicable
        diseases
●   Target 3.7 - By 2030:
      – Ensure universal access to SRH, incl
        FP, info & education
      – Integration of reproductive health
        into national strategies &
        programmes

SDG’s relevant for SRH

         ●   Target 5.6 -
             –   Ensure universal access to SRH &
                 reproductive rights

SDGs with reference to SRH in
                England/Bristol
●   Unmet need for Family Planning
    –   45% of pregnancies & 1/3 births in England are unplanned

●   Adolescent birth rate (per 1000 women aged 15-17)
    –   Falling, but x2 higher in most deprived areas
    –   2019 data: England 15.9, Bristol 13.6, NS 15.7, SG 9.0

●   New HIV diagnoses
    –   2018 data: England 8.7/100,000, South West 4.8/100,000 (but more Dx late)
    –   Bristol HIV prevalence 2.7/1000

●   Communicable diseases: STI’s – 2018 data: 5% increase on 2017
●   Access to SRH, information, education: Is this universal..?

Public Health England; Office for National Statistics

NHS England

Sustainable Choices

Patient empowerment & self-care

Prevention

Low carbon alternatives

Low carbon alternatives

●   NBT/UHBW Sustainable Development Units, Green Impact Scheme
    –   NHS Plastic Pledge, Healthcare Without Harm

●   SusQI:

●   FSRH now has a climate change working group

Generic Sustainable Choices
●   Prescribe thoughtfully
●   Minimise paper use
●   Energy – renewable supplier, conservation
●   Use Ecosia search engine
●   Use correct bins for waste
●   Minimise travel – walk/cycle to work/virtual meetings/remote consulting
●   Join local Green groups
●   Talk about climate change
●   Lobby for change – support the CEE bill
●   Use the GI schemes to appraise current practice and make changes

Condoms
●   Life cycle assessment of a natural rubber condom: 90% of the
    environmental impact is production stage onwards
●   Companies such as einhorn, Fair Squared, Sustain all working on
    sustainable solutions

Contraception
●   Which method is the most sustainable?
●   No LCA’s (yet?)
●   Most discussion centres around packaging
    waste, & hormone excretion
    –   LARC: less packaging, less sanitary waste
    –   Hormone compounds in water from
        contraception low vs other sources, but do
        have negative impact
    –   But avert some oestrogen release through
        preventing pregnancy
●   IUD least impact

Sanitary Protection &
                    Period Poverty
●   1 in 10 women in Britain suffer from
    period poverty
●   A disposable sanitary pad takes over 500
    years to decompose
●   1.5-2 billion sanitary items flushed down
    toilets in UK each year
●   The waste is toxic & hazardous to human
    & marine health
●   Reusable sanitary towels & menstrual
    cups - excellent solution to expense of
    menstrual products & impact on the
    environment

Specula

●   Are plastic or metal specula more sustainable?
●   Life cycle assessment evaluating carbon footprints of 3 vaginal
    specula: a single-use acrylic model, a grade 304 and a grade 316
    reusable stainless steel model in the US
    –   Reusable stainless steel grade 304 speculum lower carbon
        footprint

Ethical Trade & Procurement
●   BMA Ethical Procurement for Health
    –   “...an uncomfortable paradox in providing healthcare in the NHS at
        the expense of workers’ health in its supply chains”
●   Staff power – ethical champions
●   NHS Supply Chain – greater visibility
    –   “Ethical sourcing .. key priority .. Labour Standards Assurance
        System for our high risk categories … looking to continually map
        risk and understand where products and services come from.”

Summary
●   The NHS is moving towards sustainability of care and net zero
●   SRH well positioned to encompass all 4 principles of sustainable
    healthcare
●   FRSH will hopefully bring more guidance on specifics for SRH
●   Great tips from Green Impact Schemes and the CSH, especially on
    SusQI

Resources to use
●   sustainabledevelopment@nbt.nhs.uk – and info on NBT website
●   sustainabledevelopment@uhbw.nhs.uk – and info on UHBW trust intranet page
●   Healthcare Without Harm: https://noharm.org/
●   Green Impact For Health: http://www.greenimpact.org.uk/GIforHealth
●   Greener Practice: https://www.greenerpractice.co.uk/
●   Centre for Sustainable Healthcare: https://sustainablehealthcare.org.uk/
●   Terracycle: https://www.terracycle.com/en-GB/brigades/medicine-packet-uk
●   Climate Hero Carbon Calculator: https://climatehero.me/
●   The Climate and Ecological Emergency Bill Alliance: https://www.ceebill.uk/
●   Ethical Trade: www.ethicaltrade.org/ethical-procurement-for-health

From Atoms, Big Bang,
Chaos, Dinosaurs, Evolution,
the Fine-tuning of the
Galaxies to Humans.
Imagine that Journey
of Knowledge through
Language and Music,
Nodes Overflow with the
Poetry of Quantum Revolution.
As the Sublime Trickles
through the Universe’s Veins,
we Wonder, Explore, Yearn,
and Zoom out once again.
When we zoom out we realise
how small it becomes,
so either none of it matters              The Blue Marble
or all of it does.

- An A-Z of Time and Space, Harry Baker

Thank you!
 Any questions?

References
●   A pathway to net zero emissions for healthcare. Renee N Salas et all. BMJ 2020;371:m3785
●   NHS is unprepared for risks posed by climate change, warn leading UK health bodies. BMJ 2016;352:i178
●    A comparative carbon footprint analysis of disposable and reusable vaginal specula. Laura M Donahue et
al. Am J Obstet Gynecol. 2020 Aug;223(2):225
●   A condom’s footprint - life cycle assessment of a natural rubber condom. Maik Birnbach et al. The
International Journal of Life Cycle Assessment(2020) 25:964–979.
●   Delivering a ‘Net Zero’ National Health Service. October 2020.
●Contraceptive Options and Their Associated Estrogenic Environmental Loads: Relationships and Trade-Offs.
Khan, Usman; Nicell, Jim A. PLoS One; San Francisco Vol. 9, Iss. 3, (Mar 2014): e92630.
DOI:10.1371/journal.pone.0092630
●Are Oral Contraceptives a Significant Contributor to the Estrogenicity of Drinking Water? Amber Wise, Kacie
O’Brien, and Tracey Woodruff. Environ. Sci. Technol. 2011, 45, 1, 51–60. Publication Date:October 26, 2010.
https://doi.org/10.1021/es1014482
●   https://www.gov.uk/government/publications/health-matters-reproductive-health-and-pregnancy-
planning/health-matters-reproductive-health-and-pregnancy-planning
●   PHE - Sexual and reproductive health and HIV: applying All Our Health; Updated 16 December 2019
●   A greenprint for sustainable contraceptive research and development. Kirsten Moore, John Townsend, Jeff
Spieler, Patricia S. Coffey, Diana Blithe, Elizabeth Arndorfer and Elizabeth Dawes. Contraception, 2013-03-01,
Volume 87, Issue 3, Pages 347-351, Copyright © 2013 Elsevier Inc.

References
●   PHE: Annual epidemiological spotlight on HIV in the South West, 2018 data
●  Global Energy Review: CO2 Emissions in 2020 - Understanding the impacts of Covid-19 on global CO2
emissions
●   PHE: Trends in HIV testing, new diagnoses and people receiving HIV-related care in the United Kingdom:
data to the end of December 2019. Health Protection Report Volume 14 Number 203 November 2020
●  HEE: Improving the delivery of sexual health services: Sexual health, reproductive health and HIV
workforce scoping project report September 2018
●   "The Climate Mitigation Gap: Education and Government Recommendations vs. Effective Individual
Actions" Wynes S and Nicholas K 2017 Environ. Res. Lett. 12 074024
●  Townsend, Jeff Spieler, Patricia S. Coffey, Diana Blithe, Elizabeth Arndorfer and Elizabeth Dawes.
Contraception, 2013-03-01, Volume 87, Issue 3, Pages 347-351, Copyright © 2013 Elsevier Inc.
●   https://www.bma.org.uk/media/1134/ethical-trade-overview-1.pdf
●Several Synthetic Progestins with Different Potencies Adversely Affect Reproduction of Fish. Tamsin J.
Runnalls, Nicola Beresford, Erin Losty, Alexander P. Scott, and John P Sumpter. Environ. Sci. Technol. 2013, 47,
4, 2077–2084. Publication Date:January 29, 2013. https://doi.org/10.1021/es3048834
●Safe and sustainable waste management of self care products. Pachauri, Ash; Shah, Prerna; Almroth,
Bethanie C; Sevilla, Norma P M; Narasimhan, Manjulaa. BMJ : British Medical Journal (Online); London Vol.
365, (Apr 1, 2019). DOI:10.1136/bmj.l1298
●Environmental impact of contraceptive use: An overview of available evidence. Ehiri, John E; Birley, Martin.
Environmental Management and Health; Bradford Vol. 13, Iss. 1, (2002): 55-65