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Towards a more responsive health system?

“Responsiveness” has become a key aim of NHS policy, but what does it mean? The following articles show that there are a number of ways to approach the issue at different levels. Some seek to involve patients in the planning of care, others to reach out to groups who find it difficult to access health care. For many, responsiveness has economic connotations. Other articles consider ways to make clinical teams and organisational management more responsive.

A paper in the BMJ explores “women’s accounts of their use and non-use of emergency contraception”. Although recent efforts have increased access “among teenagers in inner city areas, there has been low use of free emergency contraception provided by local pharmacies”. The researchers highlight some barriers in the circumstances and minds of young women to taking up improved access, based on 30 in-depth interviews.

Women with the “strongest desire to avoid pregnancy”—and likely to use emergency contraception, if necessary—“tended to have strong aspirations for education, careers, travel, or lifestyle”. Pregnancy for this group would be a “complete disaster”.

The paper describes different kinds of “contraceptive behaviour” among women, ranging from “obsessive concern” to a sense of having a “low vulnerability” to pregnancy. “Evaluations of the risk of pregnancy conferred by different contraceptive behaviours were based on advice and experience. In particular, the women cited their own or friends’ experience in becoming or not becoming pregnant”, suggesting that women in different social circumstances build up quite different contraceptive behaviours.

Being in the position of needing emergency contraception was seen as “a personal failure” and shameful, particularly if it was the second or third time. Women are concerned about what people will think of their sexual behaviour, and this can prevent them from accessing emergency contraception. “A few women disassociated themselves from emergency contraception entirely, reporting that …