Termination of Pregnancy in Manchester – BME Community

August 2013

TERMINATION OF PREGNANCY IN MANCHESTER: BME COMMUNITY ENGAGEMENT AND CONSULTATION Toolkit prepared by Manchester BME Network in association with Centre for Local Economic Strategies Presented to NHS Manchester

The Centre for Local Economic Strategies is a company limited by guarantee no 4242937 with charitable status no. 1089503. Termination of pregnancy in Manchester: BME community engagement and consultation 1

CONTENTS PAGE NO.

1 INTRODUCTION TO THE TOOLKIT 9

2 SEXUAL HEALTH, CONTRACEPTION AND TERMINATION SERVICES ACROSS MANCHESTER 10 2.1 Introduction 10 2.2 Palantine CASH service and Fresh clinics 10 2.3 Brook clinic 10 2.4 Specialist genitourinary medicine (GUM) clinics 11 2.5 GPs and pharmacies offering local enhanced services 11 2.6 Termination of pregnancy services 13 2.7 Prevention, advice and support services 13

3 MANCHESTER DEMOGRAPHICS BY WARD 15 3.1 Age 15 3.2 Ethnicity 15 3.3 Religion 21 3.4 Socio-economic indicators 25

4 TERMINATION OF PREGNANCY IN MANCHESTER 30

5 FOCUS ON SIX HOTSPOT WARDS 33 5.1 Introduction 33 5.2 Ardwick 33 5.2.1 Ward demographics 33 5.2.2 Termination of pregnancy data in Ardwick 36 5.2.3 Contraception and termination support services in Ardwick 37 5.2.4 Women’s support groups and BME community groups in Ardwick 37 5.3 Harpurhey 38 5.3.1 Ward demographics 38 5.3.2 Termination of pregnancy data in Harpurhey 41 5.3.3 Contraception and termination support services in Harpurhey 41 5.3.4 Women’s support groups and BME community groups in Harpurhey. 41 5.4 Cheetham 43 5.4.1 Ward demographics 43 5.4.2 Termination of pregnancy data in Cheetham 46 5.4.3 Contraception and termination support services in Cheetham 46 5.4.4 Women’s support groups and BME community groups in Cheetham 46 5.5 Longsight 48 5.5.1 Ward demographics 48 5.5.2 Termination of pregnancy data in Longsight 51 5.5.3 Contraception and termination support services in Longsight 51 5.5.4 Women’s support groups and BME community groups in Longsight 51 5.6 Hulme 53 5.6.1 Ward demographics 53 5.6.2 Termination of pregnancy data in Hulme 56 5.6.3 Contraception and termination support services in Hulme 56 5.6.4 Women’s support groups and BME community groups in Hulme 56 5.7 Moss Side 57 5.7.1 Ward demographics 57 5.7.2 Termination of pregnancy data in Moss Side 60 5.7.3 Contraception and termination support services in Moss Side 60 5.7.4 Women’s support groups and BME community groups in Moss Side 60

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6 SUPPORTING BME WOMEN TO ACCESS SEXUAL HEALTH SERVICES: CHALLENGES AND OPPORTUNITIES 61

7 SEXUAL HEALTH 62 7.1 Introduction 62 7.2 Information and advice about sexual health 62 7.3 Knowledge and use of contraception methods 62 7.4 Accessibility of sexual health services (contraception) 62 7.5 Barriers in accessing services (contraception) 63 7.5.1 Language and communication barriers 63 7.5.2 Gender of sexual healthcare professional 64 7.5.3 Anonymity and confidentiality 64 7.6 Suggestions to improve contraception services 64 7.6.1 Better information to newcomers 64 7.6.2 Simpler language 64 7.6.3 Sensitivity to cultural needs 64 7.6.4 Community provision 65 7.6.5 Reaching foreign students 65

8 TERMINATION OF PREGNANCY 66 8.1 Perceptions of termination of pregnancy 66 8.1.1 Religious beliefs 66 8.1.2 Family and partner’s influence 66 8.1.3 Stigmatism 66 8.2 Reasons for having a termination 67 8.2.1 Age 67 8.2.2 Religion and culture 67 8.2.3 Health 67 8.3 Experience of termination services 67 8.3.1 Emotional support 67 8.3.2 Privacy 68 8.4 Suggestions of how termination services may be improved 68 8.4.1 Aftercare support 68 8.4.2 Information and awareness 68

9 MONITORING CHANGE IN BME WOMEN’S SEXUAL HEALTH NEEDS 70 9.1 Ethnic diversity 70 9.2 What has driven this change? 70 9.3 What is the balance between migration and births? 70 9.4 Issues with monitoring and reporting 70 9.4.1 Unreported language diversity (Census 2011) 70 9.4.2 Monitoring ethnicity 71 9.4.3 Termination of pregnancy services 71 9.5 Future developments 71

FIGURES

Figure 1: Location of GPs and pharmacies offering enhanced services 12 Figure 2: Age distribution for the population of Manchester 15 Figure 3: Ethnic diversity of Manchester 15 Figure 4: Population of minority groups in Manchester 16 Figure 5: Asian/Asian British population in Manchester 16 Figure 6: Black/Black British population in Manchester 17 Figure 7: Wards with highest Asian/Asian British population in Manchester 17 Figure 8: Number of Asian/Asian British in Manchester 18 Figure 9: Wards with highest Black/Black British population in Manchester 18 Figure 10: Number of Black/Black British in Manchester 19

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Figure 11: Wards with highest Asian/Asian British; Chinese population in Manchester 19 Figure 12: Number of Chinese/Chinese British in Manchester 20 Figure 13: Religious diversity in Manchester 21 Figure 14: Number of Christians per ward in Manchester 22 Figure 15: Number of Muslims per ward in Manchester 23 Figure 16: Number of Hindus per ward in Manchester 24 Figure 17: Number of Income Support claimants in each lower super output area in Manchester 25 Figure 18: Percentage of households in each ward experiencing three or four dimensions of deprivation in Manchester 26 Figure 19: Percentage of people in Manchester over sixteen with no qualifications 27 Figure 20: Number of economically inactive people in Manchester who are unemployed 28 Figure 21: Index of Multiple Deprivation scores for lower super output areas across Manchester 29 Figure 22: Number of terminations of pregnancy in Manchester between 2007 and 2009 30 Figure 23: Termination of pregnancy compared to population 30 Figure 24: Termination trend by ethnicity and age 31 Figure 25: Age distribution of Ardwick population 33 Figure 26: Ethnicity of Ardwick 34 Figure 27: Religious diversity of Ardwick 34 Figure 28: Unemployment and economic inactivity in Ardwick 35 Figure 29: Percentage of households in three or four dimensions of deprivation in Ardwick 35 Figure 30: Percentage of Ardwick population with no qualifications 36 Figure 31: Terminations of pregnancy in Ardwick 2007-2009 36 Figure 32: Age distribution of Harpurhey population 38 Figure 33: Ethnicity of Harpurhey 38 Figure 34: Religious diversity of Harpurhey 39 Figure 35: Unemployment and economic inactivity in Harpurhey 39 Figure 36: Percentage of households in three or four dimensions of deprivation in Harpurhey 40 Figure 37: Percentage of Harpurhey population with no qualifications 40 Figure 38: Terminations of pregnancy in Harpurhey 2007-2009 41 Figure 39: Age distribution of Cheetham population 43 Figure 40: Ethnicity of Cheetham 43 Figure 41: Religious diversity of Cheetham 44 Figure 42: Unemployment and economic inactivity in Cheetham 44 Figure 43: Percentage of households in three or four dimensions of deprivation in Cheetham 45 Figure 44: Percentage of Cheetham population with no qualifications 45 Figure 45: Terminations of pregnancy in Cheetham 2007-2009 46 Figure 46: Age distribution of Longsight population 48 Figure 47: Ethnicity of Longsight 48 Figure 48: Religious diversity of Longsight 49 Figure 49: Unemployment and economic inactivity in Longsight 49 Figure 50: Percentage of households in three or four dimensions of deprivation in Longsight 50 Figure 51: Percentage of Longsight population with no qualifications 50 Figure 52: Terminations of pregnancy in Longsight 2007-2009 51 Figure 53: Age distribution of Hulme population 53 Figure 54: Ethnicity of Harpurhey 53 Figure 55: Religious diversity of Hulme 54 Figure 56: Unemployment and economic inactivity in Hulme 54 Figure 57: Percentage of households in three or four dimensions of deprivation in Hulme 55 Figure 58: Percentage of Hulme population with no qualifications 55 Figure 59: Terminations of pregnancy in Hulme 2007-2009 56 Figure 60: Age distribution of Moss Side population 57 Figure 61: Ethnicity of Moss Side 57 Figure 62: Religious diversity of Moss Side 58 Figure 63: Unemployment and economic inactivity in Moss Side 58 Figure 64: Percentage of households in three or four dimensions of deprivation in Moss Side 59

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Figure 65: Percentage of Moss Side households with no qualifications 59 Figure 66: Terminations of pregnancy in Moss Side 2007-2009 60 Figure 67: Experience of sexual health service 61

TABLES

Table 1: Peak age for termination of pregnancy for different ethnic groups 31 Table 2: Number of terminations by Black/Black British women 32 Table 3: Number of terminations by Asian/Asian British women 32 Table 4: Number of terminations by Chinese, Mixed and Other White women 32 Table 5: Top two wards for each BME group 33 Table 6: Consultation 61

APPENDICES

1 Sexual health and contraception services i 2 Umbrella support groups in Manchester vi

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EXECUTIVE SUMMARY

The Manchester BME (Black and Minority Ethnic) Network was commissioned by NHS Manchester to undertake community engagement and consultation with women from BME communities across the City. The consultation aimed to better understand the women’s sexual health needs, and to promote and increase access to sexual health and contraception services amongst BME communities.

The NHS Health Equity Audit: Termination of Pregnancy report (2007-2009) showed that amongst some BME communities the incidence of terminations of pregnancy was higher than expected. Recent termination data showed that, for some groups of women, it was significantly higher, particularly in the following wards: Ardwick; Harpurhey; Cheetham; Longsight; Hulme; and Moss Side.

The Manchester BME Network, in partnership with the Centre for Local Economic Strategies, undertook research and consultation with women in these target wards to explore the reasons why termination rates were higher, and to better understand women’s experiences, views and practices on matters related to termination, contraception and sexual health.

Using the findings from the research and consultation, information on sexual health services in Manchester, and demographic data from the target wards, this toolkit has been compiled to enable practitioners and policymakers to better understand how sexual health services can meet the needs of BME women, and how to better monitor change in BME women’s sexual health needs. Sexual health, termination and contraception services across Manchester

A range of sexual health and contraception services are available at specialist clinics, GPs and pharmacies across Manchester. Palantine clinics, Fresh clinics and the Brook clinic offer free and confidential contraception services, and other sexual health services and advice to men and women of all ages; these are walk-in services thus a GP referral is not necessary. There are also three specialist GUM clinics (infection testing) in Manchester that offer free sexual health and contraception services; an appointment may be required to use a GUM clinic.

All GPs in Manchester provide essential sexual health services; 15 GPs are also able to fit or remove contraceptive implants or an IUD (coil), and screen for sexually transmitted diseases. NHS Manchester has also commissioned a number of pharmacies across Manchester to provide free emergency hormonal contraception. Some of these also offer first and repeat prescriptions of oral contraception and Chlamydia screening.

The British Pregnancy Advisory Service (BPAS) arranges consultation appointments at termination clinics in Greater Manchester. This central booking service can arrange appointments for a termination on the NHS or through a private clinic: 0845 365 0565. The sexual health clinics can discuss the termination service with you and book an appointment. All information is kept confidential and you do not need to inform your GP if you have a termination.

There are a number of organisations across Manchester that provide advice and support on sexual health issues. Manchester residents are also able to access sexual health services outside of Manchester. Manchester demographics by ward

Manchester has a very diverse population which varies considerably across its different wards. The largest ethnic group in Manchester are those of a White ethnicity, representing just less than three quarters of the Manchester population; the second largest ethnic group is Asian/Asian British which represents 17% of the Manchester population. Almost half of the population of Manchester identify themselves as Christian; there are also large proportions of the population which have no religion (25%) or are Muslim (16%). Far smaller numbers of people identify themselves as Buddhist, Jewish, Sikh, Hindu or another religion.

The socio-economic status of Manchester residents also varies greatly between the different wards; the Index of Multiple Deprivation (2010) shows that the areas experiencing the highest levels of deprivation are mainly located in the north and east of Manchester. Areas to the north and the very south of Manchester have higher numbers of people receiving Income Support than more affluent areas to the south of the City Centre. The areas with the highest numbers of people with no qualifications are found in the north east of Manchester.

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Termination of pregnancy in Manchester

The termination of pregnancy data recorded in Manchester between 2007 and 2009 show that among the black and minority ethnic groups, termination of pregnancy was most common among women of Black/Black British ethnicity. When Manchester’s ethnic profile is compared to the percentage of terminations in Manchester per ethnic group, it is clear that the Black/Black British ethnic group and the Chinese/other ethnic group are experiencing higher rates of terminations than other ethnicities.

The data also shows that the number of terminations among White women decreases with age from the age of 18, whereas the number of terminations for Asian/Asian British women and Black/Black British women increases with age. These patterns found in the data were explored through research and consultation with women from these ethnic groups to better understand how and why they use sexual health services. Focus on the six hotspot wards

Based on the latest BME termination of pregnancy data (2007-09), this study focused on the following six wards: Ardwick; Harpurhey; Cheetham; Longsight; Hulme; and Moss Side. These wards have been chosen because they have the top two wards with the highest number of terminations of pregnancy for the three target ethnic groups. The toolkit provides data on the demographic profile, socio-economic indicators, and the number of terminations of pregnancy in each ward. The toolkit also lists the sexual health services available in the ward and the main women’s support groups and BME community groups in each target ward. Supporting women to access sexual health services: Challenges and opportunities

Our consultation therefore focused on women from specific ethnic backgrounds living in the hotspot areas of: Ardwick; Harpurhey; Cheetham; Longsight; Hulme; and Moss Side.

No. of Ethnic groups Age groups Hotspot wards interviews Asian/Asian British: Indian; Pakistani; and Cheetham 30-35+ years old 20 Bangladeshi origins Longsight Ardwick Black/Black British: African; and Caribbean origins 20-35+ years old 20 Harpurhey Chinese: Vietnamese; Malaysian; and Afro-Asian Hulme 20-29 years old 20 origins Moss Side

For the community consultation, four members of the Manchester BME Network were engaged: Wai Yin Chinese Women’s Association; Manchester Women’s Empowerment Group; Creative Hands; and My Communities UK. Two volunteers from each of these organisations were trained as community researchers to undertake the neighbourhood level consultation. In total, 60 women took part in the face-to-face interviewing process and 6 focus groups were held, one in each of the locations identified. Sexual health

The findings from the consultation explored women’s views and experiences of using sexual health services, in particular contraception. The key findings were:

information and accessibility – overall, the women consulted were well informed as regards sexual health and how to access contraceptive services. Across all ethnic groups, contraceptive methods are considered easily accessible and nearly all women are registered with a GP 1; barriers – three issues emerged as main barriers to accessing contraceptive services: • language and communication – both limited English language skills and cultural differences in terminology and attitude are barriers to women accessing sexual health services. Foreign nationals often do not speak English sufficiently well to express themselves, or understand the literature available on sexual health services.

1 Only four out of the 60 women interviewed were not registered with a GP. Two from the Chinese group sampled stated it was for VISA issue (i.e. the visa had expired). The other two from the Asian group had moved recently to the area

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Although interpretation services are available, these are not perceived as effective and the personal nature of the topic means that women may find using an interpreter awkward. Moreover, women who have just arrived in the UK are unlikely to understand how the health system works; • gender of sexual healthcare professionals – the gender of the GP is often crucial in enabling women to disclose matters which are personal and confidential. Women often felt more at ease with a female doctor who they felt could better understand their needs; • anonymity and confidentiality – a further barrier in accessing appropriate contraception is fear of disclosure. Some women fear that someone they know might see them using a local clinic; this is a common issue, particularly among Chinese, Black British and Black African groups; suggestions for improvements – a number of suggestions were brought forward, in particular: • better information to newcomers; • simpler language; • sensitivity to cultural needs; • community provision; • reaching foreign students. Termination of pregnancy

This research also explored BME women’s experiences and perceptions of termination of pregnancy services:

perceptions of termination of pregnancy – in general, women from all three ethnic groups express hesitancy about whether termination of pregnancy is morally permissible. Their main concerns with termination relate to their religious belief; however the attitude of their family and partner were also very influential. In general, termination of pregnancy is a taboo subject for women from all ethnicities. Women of an Afro-Caribbean ethnicity are usually more open and willing to discuss their opinions of termination, while women of Asian and Chinese ethnicities are far less willing to discuss the issue; reasons for having a termination – the main reasons for having a termination were age, religion and culture, and health. Many women felt the pregnancy had occurred at the wrong time in their life while others did not want to bear the shame and disapproval of their family and community if their pregnancy had occurred outside of marriage; experience of termination services – generally, termination services were described as being professional and women were well informed about the medical aspects of the procedure. However, some women still felt unsure about the possible side effects of a termination and many, especially those who were religious, felt there was a lack of emotional guidance and aftercare. Difficulty communicating and concerns over privacy were notable among Chinese students, who may use the private Pall Mall medical clinic in Central Manchester instead of trying to negotiate NHS services; suggestions for improvements – a number of suggestions were brought forward, in particular: • counselling services available before and after a termination; • more information on the services available, the central booking system, interpretation services, possible cost, and the procedure; • availability of female GP and interpreter of the same ethnicity as the patient; • information available in different languages; • female community workers to visit homes; • signposting to information online.

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Monitoring change in BME women’s sexual health needs

The NHS has a central monitoring system in place for everyone entering the system which captures data on ethnicity. Providers of termination of pregnancy services also capture data at the clinical level, including: ethnicity for under 18’s; postcode; need for interpreters; current contraception practice; and history. There is a lot of data that is currently collected, but it is unclear whether the data collected at the service level is the same across all service providers.

To improve the consistency of collection of monitoring data, the following issues could be explored further at the provider level:

Census; self-definition (how would you define your ethnic group?); first language; country of origin; religion. Improvements could also be made to the collection, use and sharing of data in order to inform the planning of future services.

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1 INTRODUCTION TO THE TOOLKIT

The Manchester BME Network was commissioned by NHS Manchester to undertake community engagement and consultation with women from BME communities across the City in order to better understand their sexual health needs, and to promote and increase access to sexual health and contraception services amongst BME communities.

The NHS Health Equity Audit: Termination of Pregnancy report (2007-2009) showed that amongst some BME communities, the incidence of terminations of pregnancy was higher than expected. Recent termination data showed that, for some groups of women, it was significantly higher, particularly so in the following wards: Ardwick; Harpurhey; Cheetham; Longsight; Hulme; and Moss Side.

The Manchester BME Network, in partnership with the Centre for Local Economic Strategies, undertook research and consultation with women in these target wards to better understand their experiences, views and practices on matters related to termination, contraception and sexual health. For the community consultation, four members of the Manchester BME Network were engaged: Wai Yin Chinese Women’s Association; Manchester Women’s Empowerment Group; Creative Hands; and My Communities UK. Two volunteers from each of these organisations were trained as community researchers to undertake the neighbourhood level consultation.

Consultation also took place with providers and commissioners of sexual health services through the Greater Manchester Sexual Health Network. The University of Manchester Sexual Health Service was also consulted.

This report presents the findings from the research and the community consultation phase of this project. The final phase of the project will be guided by the findings of this work, with the objective of promoting and increasing access to sexual health services amongst BME women across the City.

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2 SEXUAL HEALTH, CONTRACEPTION AND TERMINATION SERVICES ACROSS MANCHESTER

2.1 Introduction

A range of sexual health and contraception services are available at specialist clinics, GPs and pharmacies across Manchester. Termination of pregnancy services can be arranged through one central booking service and there are several abortion clinics in Manchester. There are also various organisations offering advice and support on sexual health issues to women and men. Sexual health and termination of pregnancy clinics do not pass patients’ information onto their GP (without the consent of patients) and they can be accessed by anyone, regardless of whether or not they are a resident of Manchester. 2.2 Palantine CASH service and Fresh clinics

Palantine clinics are open to women and men of all ages, and are free and confidential. You do not need to be referred by your GP; you can just walk in without an appointment. Palantine clinics offer:

all contraceptive methods, including fitting and removing intrauterine devices (IUDs) and implants;

emergency hormonal contraception;

pregnancy testing and advice;

information about abortion and referral to termination of pregnancy clinics;

testing of common sexually transmitted infections (STIs), including HIV;

condoms.

Palatine also offers a number of specialist services, including:

treating common STIs, including Chlamydia and Gonorrhoea; cervical smears; psychosexual counselling; vasectomy counselling and operations; menopause care.

Fresh clinics are contraception and sexual health services for young people aged 24 and under, including under 16s. Fresh clinics are free and confidential; you do not need to be referred by your GP, you can just walk in without an appointment. Fresh clinics offer:

contraception, including the pill, implants and injections; emergency contraception; condoms; testing for sexually transmitted infections, including HIV; RUClear Chlamydia and Gonorrhoea testing and treatment; pregnancy testing and advice; termination of pregnancy information and referral; someone to talk to about your sexual health worries or concerns.

See Appendix 1 for the location and contact information of Palantine and Fresh clinics in Manchester. 2.3 Brook clinic

Brook is a contraception and sexual health clinic for young people aged 19 and under, including under 16s. It is free and confidential, and you do not need an appointment. Brook is open seven days a week and offers:

contraception, including the pill, implants and injections; emergency contraception; condoms; testing for sexually transmitted infections, including HIV;

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RUClear Chlamydia and Gonorrhoea testing and treatment; pregnancy testing and advice; termination of pregnancy information and referral; someone to talk to about your sexual health worries or concerns.

Brook also offers counselling. The counsellor will listen to you and give you a safe space to share your thoughts and feelings.

The Brook clinic in Manchester is in the City Centre:

Commonwealth House 81 Lever Street Manchester M1 1FL T: 0161 237 3001

2.4 Specialist genitourinary medicine (GUM) clinics

There are three specialist GUM clinics in Manchester which provide contraception and sexual health services:

North Manchester GUM Department – the GUM Department will test and treat all STIs, and provide sexual health information, advice and counselling. The centre also offers clinical care and management for patients with HIV. Appointments are required before visiting the clinic;

GU Manchester Centre – the Manchester Centre for Sexual Health will test and treat all STIs, and provide sexual health information, advice and counselling. The centre also offers clinical care and management for patients with HIV. Appointments are not required;

GU South Manchester – the South Manchester Centre for Sexual Health will test and treat all STIs, and provide sexual health information, advice and counselling. The centre also offers clinical care and management for patients with HIV. Appointments are required before visiting the clinic.

2.5 GPs and pharmacies offering local enhanced services

All GP practices in Manchester provide the following sexual health and contraception services:

contraception and sexual health information and advice; prescribing of contraception supplies and devices; prescribing of emergency hormonal contraception 2; providing advice in the cases of planned or unplanned conception; referral to specialist sexual health services.

Fifteen GP practices are also providing the following additional sexual health and contraception services:

fitting and removal of contraceptive implants and IUDs (coil); screening and treatment of common STIs.

See Appendix 1 for the location and contact details of these GPs.

Manchester City Council (Public Health) has also commissioned a number of pharmacies to provide free emergency hormonal contraception. Some of these also offer first and repeat prescriptions of oral contraception and Chlamydia screening. A list of pharmacies can be found on the Any Plans Tonight website: http://www.anyplanstonight.co.uk/web/content/view/49/63/ .

Figure 1 displays the location of the GPs and pharmacies offering these enhanced services.

2If the GP has a conscientious objection to either emergency contraception or abortion, (s)he must offer prompt referral to a contractor who has no such objection

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Figure 1:Location of GPs and pharmacies offering enhanced services

Legend Pharmacy GP

Map data: Crown copyright. Crown Copyright material is reproduced with the permission of the controller of HMSO and the Queens Printer for Scotland. Ordnance Survey ©Crown Copyright. All rights reserved. Reference number 10001877/CLES3328

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2.6 Termination of pregnancy services

The British Pregnancy Advisory Service (BPAS) arranges consultation appointments at termination clinics in Greater Manchester. BPAS can be accessed directly through self referral; you do not need to go via your GP unless you want to choose that pathway. This central booking service can arrange appointments for a termination on the NHS or through a private clinic:

Central Booking Manchester: 0845 365 0565 Opening hours: Monday to Friday 08:00 – 21:00; Saturday: 09:00 – 18:30; Sunday: 09:30 – 14:30

If you would prefer to speak to someone in person, you can go to a Brook, Fresh or Palantine sexual health clinic and they will arrange a consultation for you. It is rare for anyone to be refused a termination. A doctor may have moral objections to termination of pregnancy; however if this is the case, a referral should be made to another doctor who can help. By law, two doctors have to agree to a termination: the first doctor you see; and a second doctor who will perform the abortion.

All information is kept confidential, unless you choose to inform others. You can also ask the hospital or clinic not to inform your GP. If you are under 16, your doctor is not obligated to inform your parents. If you wish, you can ask to have the termination somewhere other than your local clinic or hospital.

Please see Appendix 1 for the location and contact details of clinics in Manchester which provide termination of pregnancy services. 2.7 Prevention, advice and support services

The following organisations provide a range of advice and support related to sexual health services:

Public Health Development Service Victoria Mill Lower Vickers Street Miles Platting Manchester M40 7LJ T: 0161 861 2546 http://www.manchesterpublichealthdevelopment.org/mphds/sexual-health/sexual-health.html

The University of Manchester Student Occupational Health Service Waterloo Place 182-184 Oxford Road Manchester M13 9GP T: 0161 275 2858 B22 The Mill Sackville Street Manchester M13 9PL T: 0161 306 5806 http://www.studentnet.manchester.ac.uk/occupational-health/

The Lesbian and Gay Foundation (LGF) 5 Richmond Street Manchester M1 3HF T: 0845 330 3030 http://www.lgf.org.uk

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Black Health Agency (BHA) 464 Chester Road Manchester M16 9HE T: 0845 450 4247 http://www.thebha.org.uk/

Manchester Action on Sexual Health (MASH) 94-96 Fairfield Street Manchester M1 2WR T: 0161 273 4555 http://www.mash.org.uk/

George House Trust 75-77 Ardwick Green North Manchester M12 6FX T: 0161 274 4499 http://www.ght.org.uk

Condom distribution schemes Young men and women can get free condoms from: Brook clinic (under 20s); Fresh clinics (under 25s); and C-Card (http://www.takecovermanchester.com/ ).

The C-Card scheme allows people aged 14-18 years old to get free condoms, lubricant and advice about relationships and sex. The service is free and confidential; however you must register first in order to receive a C-Card which you use to collect condoms or lubrication. To register, your date of birth and postcode is required. A C-Card worker will have a private chat with you to explain the scheme. If you are under 14, you can get free condoms from Brook or Fresh clinics. Men and women of all ages can get free condoms from: Palatine contraception and sexual health clinics; GUM clinics; and through the Lesbian and Gay Foundation.

Sterilisation and vasectomy Services are available at Acute Hospital Trusts and abortion providers. This service requires a patient to be referred by a local GP.

Sperm washing for couples affected by HIV Services are available in Liverpool. This service requires a patient to be referred by a HIV consultant (you would be referred to a HIV Consultant by the local GP).

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3 MANCHESTER DEMOGRAPHICS BY WARD

Manchester has a very diverse population which varies considerably across its different wards. The following tables, graphs and maps present the differences in the Manchester ward populations with regards to age, ethnicity, religion and socio-economic factors. 3.1 Age

The population of the Manchester wards vary from 22,562 in Cheetham to 12,455 in Didsbury West. The average age of each ward population ranges from 39 years in Moston to 27.4 years in the City Centre ward. 3 Figure 2 shows the age distribution for the population of Manchester which has the highest number of people in the age range 20-29.

Figure 2:Age distribution for the population of Manchester 4

3.2 Ethnicity

The following graphs present the ethnic diversity of Manchester. Figure 3 shows that the largest ethnic group in Manchester are those of a White ethnicity, representing just under three quarters of the Manchester population; the second largest ethnic group is Asian/Asian British which represents 17% of the Manchester population.

Figure 3:Ethnic diversity of Manchester 5

3 Office for National Statistics - 2011 Census data 4 Source: Office for National Statistics - 2011 Census data 5 Source: Office for National Statistics - 2011 Census data

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Figure 4 shows that among the ethnic minority groups, the largest group is Asian/Asian British and the second largest is Black/Black British. The other minority ethnic groups have far smaller populations.

Figure 4:Population of minority groups in Manchester 6

Figure 5 shows that among the Asian/Asian British population (excluding Chinese), the largest ethnic group is Asian/Asian British; Pakistani which is considerably larger than the other Asian ethnicities.

Figure 5: Asian/Asian British population in Manchester 7

6 Source: Office for National Statistics - 2011 Census data 7 Source: Office for National Statistics - 2011 Census data

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With regards to the Black/Black British population, Figure 6 shows that the largest ethnic group is Black/African/Caribbean/Black British; African. This group is far larger than the other Black/Black British ethnic groups.

Figure 6:Black/Black British population in Manchester 8

The following graphs present the distribution of different ethnic groups across Manchester by wards. Figures 7 and 8 show that Manchester’s Asian/Asian British population largely live in Cheetham, Longsight, Rusholme, Ardwick, Crumpsall and Whalley Range.

Figure 7:Wards with highest Asian/Asian British population in Manchester 9

8 Source: Office for National Statistics - 2011 Census data 9 Source: Office for National Statistics - 2011 Census data

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Figure 8:Number of Asian/Asian British in Manchester 10

Number of Asian/ Asian British 5,000 to 9,430 1,720 to 5,000 1,030 to 1,720 540 to 1,030

Figures 9 and 10 show that the Black/Black British population is concentrated in the Moss Side ward of Manchester; Ardwick, Harpurhey, Hulme, Bradford and Gorton North also have comparatively high numbers of Black/Black British residents.

Figure 9:Wards with highest Black/Black British population in Manchester 11

10 Source: Office for National Statistics - 2011 Census data 11 Source: Office for National Statistics - 2011 Census data

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Figure 10:Number of Black/Black British in Manchester 12

Number of Black/Black British 2,400 to 6,520 (7) 1,200 to 2,400 (5) 580 to 1,200 (11) 210 to 580 (9)

Figures 11 and 12 show that people who are Chinese or another ethnic group mainly live in the central wards of Ardwick, Hulme and Bradford.

Figure 11:Wards with highest Asian/Asian British; Chinese population in Manchester 13

12 Source: Office for National Statistics - 2011 Census data 13 Source: Office for National Statistics - 2011 Census data

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Figure 12:Number of Chinese/Chinese British in Manchester 14

Number of Chinese/ Chinese British 1,790 to 2,370 1,220 to 1,790 650 to 1,220 80 to 650

14 Source: Office for National Statistics - 2011 Census data

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3.3 Religion

The following graphs and tables present the diversity in religious belief among the Manchester population. Figure 13 shows that almost half of the population of Manchester identify themselves as Christian. There are also large proportions of the population which have no religion or are Muslim. Far smaller numbers of people identify themselves as Buddhist, Jewish, Sikh, Hindu or of another religion.

Figure 13:Religious diversity in Manchester 15

Figures 14 to 16 show which wards have the highest numbers of people practising a particular religion. Harpurhey is the ward with the highest number of Christians; Cheetham has the highest number of Muslims; and Ardwick has the highest number of Hindus.

15 Source: Office for National Statistics - 2011 Census data

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Figure 14:Number of Christians per ward in Manchester 16

Number of Christians per ward 8,500 to 11,200 6,000 to 8,500 2,000 to 6,000 0 to 2,000

16 Source: Office for National Statistics - 2011 Census data

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Figure 15:Number of Muslims per ward in Manchester 17

Number of Muslims per ward 5,000 to 9,780 1,470 to 5,000 630 to 1,470 330 to 630

17 Source: Office for National Statistics - 2011 Census data

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Figure 16:Number of Hindus per ward in Manchester 18

Number of Hindus per ward 300 to 467 (5) 200 to 300 (6) 100 to 200 (9) 0 to 100 (12)

18 Source: Office for National Statistics - 2011 Census data

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3.4 Socio-economic indicators

The following maps present the difference in socio-economic indicators across the Manchester wards .

Figure 17 shows the number of people in each lower super output area who are claiming Income Support. Areas to the north and south of Manchester have considerably higher numbers of people receiving Income Support than more affluent areas south of the City Centre.

Figure 17:Number of Income Support claimants in each lower super output area in Manchester 19

Number of income support claimants 317 to 420 200 to 300 100 to 200 0 to 100

19 Source: Office for National Statistics - 2011 Census data

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Figure 18 shows the percentage of households in each ward which are experiencing three or four dimensions of deprivation. The north east wards and the southernmost wards have the highest levels of serious deprivation.

Figure 18:Percentage of households in each ward experiencing three or four dimensions of deprivation in Manchester 20

Percentage of households with 3 or 4 dimensions of deprivation

11.5 to 16.4

8.5 to 11.5

5 to 8.5

1.5 to 5

20 Source: Office for National Statistics - 2011 Census data

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Figure 19 shows the percentage of people in each ward who are over the age of 16 and have no qualifications. The areas with the highest numbers of people with no qualifications are found in the north east of Manchester.

Figure 19:Percentage of people in Manchester over sixteen with no qualifications 21

% of people over 16 with no qualifications 34 to 42 26 to 34 16 to 26 2 to 16

21 Source: Office for National Statistics - 2011 Census data

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Figure 20 shows the number of economically inactive people in each ward who are unemployed.

Figure 20:Number of economically inactive people in Manchester who are unemployed 22

Number of people unemployed 865 to 1,084 681 to 865 552 to 681 314 to 552

22 Source: Office for National Statistics - 2011 Census data

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Figure 21 shows the Index of Multiple Deprivation scores for the lower super output areas across Manchester. The areas shown to be experiencing the highest levels of deprivation are mainly located in north and east Manchester.

Figure 21:Index of Multiple Deprivation scores for lower super output areas across Manchester 23

Index of Multiple Deprivation Score 63 to 82 (32) 44 to 63 (89) 25 to 44 (78) 6 to 25 (60)

23 Source: Office for National Statistics - 2011 Census data

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4 TERMINATION OF PREGNANCY IN MANCHESTER

The following data presents the number of terminations of pregnancy recorded in Manchester between 2007 and 2009. The data is analysed with respect to the age, ward and ethnicity of the women using termination services. Figure 22 shows that among the black and minority ethnic groups, termination of pregnancy was most common among women of Black/Black British ethnicity.

Figure 22:Number of terminations of pregnancy in Manchester between 2007 and 2009 24

When Manchester’s ethnic profile is compared to the percentage of terminations in Manchester per ethnic group (Figure 23), it is clear that the Black/Black British ethnic group and the Chinese/other ethnic group are experiencing higher rates of terminations than other ethnicities.

Figure 23:Termination of pregnancy compared to population 25

24 Source: NHS Manchester, Health Equity Audit: Termination of Pregnancy in Manchester 2007- 2009. The dataset is grouped using ONS ethnicity categories, White, Asian and Asian British, (A&AB), Black and Black British, (B&BB), Chinese and other ethnicity, (C&OE) and mixed. NB: Ethnicity was only recorded for 71% of the recorded terminations between 2007 and 2009 and some cases were recorded using outdated codes and so were re-coded using ONS ethnicity codes. Therefore caution should be applied when interpreting this data 25 Source: NHS Manchester, Health Equity Audit: Termination of Pregnancy in Manchester 2007-2009

Manchester BME Network Termination of pregnancy in Manchester: BME community engagement and consultation 31

Figure 24 shows the termination trend by ethnicity and age. The data shows that the number of terminations among White women decreases with age from the age of 18, whereas the number of terminations for Asian/Asian British women and Black/Black British women increases with age.

Figure 24:Termination trend by ethnicity and age 26

Table 1 shows the peak age for termination of pregnancy for the different ethnic groups.

Table 1:Peak age for termination of pregnancy for different ethnic groups

Most common age for Ethnicity termination of pregnancy White <18 Asian/Asian British 35+ Black/Black British 25- 35+ Chinese/other 20-29 Mixed 18 -19

Tables 2 to 4 show the wards with the highest number of terminations per ethnic group, as well as the total number of terminations for each ethnic group during 2007 to 2009. These figures only include the terminations for wards where ethnicity was recorded by the service provider.

26 Source: NHS Manchester, Health Equity Audit: Termination of Pregnancy in Manchester 2007-2009

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Table 2:Number of terminations by Black/Black British women 27

Number of terminations by Area Black/Black British women Manchester total 1016 Ardwick 85 Harpurhey 71 Bradford 67 Gorton South 63 Moss Side 63 Cheetham 60 Gorton North 59 Hulme 59 Longsight 46

Table 3:Number of terminations by Asian/Asian British women 28

Number of terminations by Area Asian/Asian British women Manchester total 458 Cheetham 43 Longsight 37 Levenshulme 29 Ardwick 28 Burnage 26 Moss Side 25 Rusholme 22 Crumpsall 19

Table 4:Number of terminations by Chinese, Mixed and Other White women 29

Number of terminations by Area Chinese, Mixed and Other White women Manchester total 675 Hulme 53 Ardwick 51 Moss Side 45 Cheetham 40 Gorton South 37 Ancoats and Clayton 34 Harpurhey 32

27 Source: NHS Manchester 28 Source: NHS Manchester 29 Source: NHS Manchester

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5 FOCUS ON SIX HOTSPOT WARDS

5.1 Introduction

Having analysed the latest BME termination data presented earlier, this study focuses on the following six wards: Ardwick; Harpurhey; Cheetham; Longsight; Hulme; and Moss Side. These wards have been chosen because they have the top two wards with the highest number of terminations of pregnancy for the three target ethnic groups.

Table 5:Top two wards for each BME group

BME group Ward Black/Black British Ardwick and Harpurhey Asian/Asian British Women Cheetham and Longsight Chinese, Mixed & Other Hulme and Moss Side 30

This section provides a profile of each of the six selected wards in terms of:

ward demographics (age, ethnicity, religion and socio-economic indicators); termination of pregnancy data in the ward; contraception and termination support services in the ward; women’s support groups and BME community groups in the ward.

5.2 Ardwick

5.2.1 Ward demographics

Age

Figure 25:Age distribution of Ardwick population 31

30 Ardwick is the ward with the second highest number of T.O.P.s among the Chinese, Mixed and Other ethnic group but in order to avoid repetition, Moss Side was chosen. Moss Side comes 3 rd in the table for the number of Chinese terminations and 5 th for Black and Black British terminations 31 Source: ONS Census Data 2011

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Ethnicity Figure 26:Ethnicity of Ardwick 32

Religion

Figure 27:Religious diversity of Ardwick 33

32 Source: ONS Census Data 2011 33 Source: ONS Census Data 2011

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Socio-economic indicators Figure 28:Unemployment and economic inactivity in Ardwick 34

Figure 29:Percentage of households in three or four dimensions of deprivation in Ardwick 35

34 Source: ONS Census Data 2011 35 Source: ONS Census Data 2011

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Figure 30:Percentage of Ardwick population with no qualifications 36

5.2.2 Termination of pregnancy data in Ardwick

Figure 31:Terminations of pregnancy in Ardwick 2007-2009 37

36 Source: ONS Census Data 2011 37 Source: NHS Manchester

Manchester BME Network Termination of pregnancy in Manchester: BME community engagement and consultation 37

5.2.3 Contraception and termination support services in Ardwick

Local sexual health, contraception and termination services:

GU Manchester Centre, Manchester Centre for Sexual Health , Hathersage Centre, 280 Upper Brook Street, Manchester, M13 0FH. T: 0161 276 5200. W: www.manchestersexualhealth.org .

The nearest termination of pregnancy clinic is the Whitworth Clinic, Gynaecology Outpatient Department, Ground Floor, Saint Mary's Hospital, Oxford Road, Manchester, M13 9WL. W: http://www.cmft.nhs.uk/saint-marys/our-services/gynaecology/whitworth-clinic.aspx . For appointments you need to call the Central Booking Service on 0845 365 0565 where appointments are made for all termination of pregnancy clinics.

Pharmacy and GP offering additional sexual health services: The Vallance Centre, Brunswick Street, Ardwick, Manchester, M13 9UJ. T: 0161 273 1327. The GP can provide implants and IUDs; the pharmacist can prescribe emergency hormonal contraception free of charge.

5.2.4 Women’s support groups and BME community groups in Ardwick

Manchester Women's Empowerment Group, 124 Stockport Road, Ardwick, Manchester, M13 9DZ. E: [email protected] . Assists women to empower themselves in areas such as employment, socialising, and improving general wellbeing.

The Pankhurst Centre, 60-62 Nelson Street, Chorlton-on-Medlock, Manchester, M13 9WP. T: 0161 273 5673. E: [email protected] . W: www.thepankhurstcentre.org.uk . Women's community centre combined with heritage project commemorating the Pankhurst family and the Suffragette movement. Classes, workshops, signposting, and drop in group for women.

Umbrella support groups covering all of Manchester: • Manchester BME Network; • Manchester Community Central; • Black Health Agency; • Manchester Race and Health Forum. See Appendix 2 for contact details.

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5.3 Harpurhey

5.3.1 Ward demographics

Age

Figure 32:Age distribution of Harpurhey population 38

Ethnicity

Figure 33:Ethnicity of Harpurhey 39

38 Source: ONS Census Data 2011 39 Source: ONS Census Data 2011

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Religion

Figure 34:Religious diversity of Harpurhey 40

Socio-economic indicators

Figure 35:Unemployment and economic inactivity in Harpurhey 41

40 Source: ONS Census Data 2011 41 Source: ONS Census Data 2011

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Figure 36:Percentage of households in three or four dimensions of deprivation in Harpurhey 42

Figure 37:Percentage of Harpurhey population with no qualifications 43

42 Source: ONS Census Data 2011 43 Source: ONS Census Data 2011

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5.3.2 Termination of pregnancy data in Harpurhey

Figure 38:Terminations of pregnancy in Harpurhey 2007-2009 44

5.3.3 Contraception and termination support services in Harpurhey

Local sexual health, contraception and termination services:

Harpurhey (Palantine and Fresh clinics), Harpurhey Health Centre, Church Lane, Harpurhey, Manchester, M9 4BE. T: 0161 861 2400. GP offering additional sexual health services (implants only). For appointments for termination of pregnancy call the central booking line on 0845 365 0565 for all termination of pregnancy clinics in Manchester.

Simpson Medical Practice, 361 Moston Lane, Harpurhey, Manchester, M40 9NB. T: 0161 203 5550.

Pharmacy offering additional sexual health services: Asda Pharmacy, Harpurhey District Centre, Harpurhey, Manchester, M8 4QS. T: 0161 839 7001. The pharmacist can prescribe Emergency Hormonal Contraception (EHC) free of charge.

Pharmacy offering additional sexual health services: Lloyds Pharmacy, Harpurhey District Centre, Harpurhey, Manchester, M9 4DH. T: 0161 205 2164. The pharmacist can prescribe the contraceptive pill, Emergency Hormonal Contraception (EHC), and test for Chlamydia.

5.3.4 Women’s support groups and BME community groups in Harpurhey.

It was difficult to identify support groups in Harpurhey with a specific focus on women and BME communities. There are community groups in Harpurhey that provide a wide range of support and services, including issues related to health and wellbeing:

The Factory Youth Zone, 931 Rochdale Road, Harpurhey, M9 8AE. T: 0161 203 5333. E: [email protected] . This organisation is focused on support for young people and includes information and support on sexual health issues.

Harpurhey Neighbourhood Project, Carisbrook Street, Harpurhey, M9 5UX. T: 0161 205 5143. W: www.harpurhey.org . They also run the Harpurhey Community First and are a good source of information on local groups and support available in the area.

44 Source: NHS Manchester

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Umbrella support groups covering all of Manchester:

• Manchester BME Network; • Manchester Community Central; • Black Health Agency; • Manchester Race and Health Forum. See Appendix 2 for contact details.

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5.4 Cheetham

5.4.1 Ward demographics

Age

Figure 39:Age distribution of Cheetham population 45

Ethnicity

Figure 40:Ethnicity of Cheetham 46

45 Source: ONS Census Data 2011 46 Source: ONS Census Data 2011

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Religion

Figure 41:Religious diversity of Cheetham 47

Socio-economic indicators

Figure 42:Unemployment and economic inactivity in Cheetham 48

47 Source: ONS Census Data 2011 48 Source: ONS Census Data 2011

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Figure 43:Percentage of households in three or four dimensions of deprivation in Cheetham 49

Figure 44:Percentage of Cheetham population with no qualifications 50

49 Source: ONS Census Data 2011 50 Source: ONS Census Data 2011

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5.4.2 Termination of pregnancy data in Cheetham

Figure 45:Terminations of pregnancy in Cheetham 2007-2009 51

5.4.3 Contraception and termination support services in Cheetham

Local sexual health, contraception and termination services:

Cheetham Hill Primary Care Centre, 244 Cheetham Hill Road, Cheetham Hill, Manchester, M8 8UP. T: 0161 202 8750. For appointments and consultation for termination of pregnancy call the central booking service on 0845 365 0565.

GP offering addition sexual health services (implants and IUDs): Collegiate Medical Centre, 407 Cheetham Hill Road, Cheetham Hill, Manchester, M8 0DA. T: 0161 205 4364.

Pharmacy offering additional sexual health services: Tesco Pharmacy, Cheetham Hill Road, Cheetham Hill, Manchester, M8 5DP. T: 0161 251 7547. The pharmacist can prescribe the contraceptive pill, Emergency Hormonal Contraception (EHC) and test for Chlamydia.

Pharmacy offering additional sexual health services: Boots the Chemist, Manchester Fort Retail Park, Cheetham Hill Road, Cheetham Hill, Manchester, M8 8EP. T: 0161 832 6623. The pharmacist can prescribe Emergency Hormonal Contraception (EHC) free of charge.

5.4.4 Women’s support groups and BME community groups in Cheetham

Awaaz, 464 Cheetham Hill Road, Cheetham Hill, Manchester, M8 9JW. T: 0161 720 5959. E: [email protected] . W: www.awaaz.co.uk . Provides a one-stop service to support Asian people in Manchester. A range of services are provided, including advice and support on healthcare, education, training and employment.

Cheetham Al-Hilal Community Project, 425 Cheetham Hill Road, Cheetham Hill, Manchester, M8 0PF. T: 0161 205 6662. E: [email protected]/[email protected] .

Neesa Well Women Drop in Project, Woodville Resource Centre, Shirley Road, Manchester, M8 7NE. T: 0161 740 2995/0161 795 9400. E: [email protected] . Health and wellbeing support for Asian women, library service, home visits, luncheon club and leisure services (e.g. coffee morning).

51 Source: NHS Manchester

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Umbrella support groups covering all of Manchester:

• Manchester BME Network; • Manchester Community Central; • Black Health Agency; • Manchester Race and Health Forum. See Appendix 2 for contact details.

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5.5 Longsight

5.5.1 Ward demographics

Age

Figure 46:Age distribution of Longsight population 52

Ethnicity

Figure 47:Ethnicity of Longsight 53

52 Source: ONS Census Data 2011 53 Source: ONS Census Data 2011

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Religion

Figure 48:Religious diversity of Longsight 54

Socio-economic indicators

Figure 49:Unemployment and economic inactivity in Longsight 55

54 Source: ONS Census Data 2011 55 Source: ONS Census Data 2011

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Figure 50:Percentage of households in three or four dimensions of deprivation in Longsight 56

Figure 51:Percentage of Longsight population with no qualifications 57

56 Source: ONS Census Data 2011 57 Source: ONS Census Data 2011

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5.5.2 Termination of pregnancy data in Longsight

Figure 52:Terminations of pregnancy in Longsight 2007-2009 58

5.5.3 Contraception and termination support services in Longsight

Local sexual health, contraception and termination services:

Pharmacy offering additional sexual health services: Wise Pharmacy , 372-374 Dickenson Road, Longsight, Manchester, M13 0WQ . T: 0161 224 7747. The pharmacist can prescribe Emergency Hormonal Contraception (EHC) free of charge.

Termination of pregnancy central booking service 0845 365 0565 for appointments at any clinic across Manchester. 5.5.4 Women’s support groups and BME community groups in Longsight

Himmat Support Group, Slade Lane Neighbourhood Centre, 642 Stockport Road, Longsight, Manchester, M13 0RZ. T: 0161 248 0425. E: [email protected] . W: www.himmat.org.uk . Centre for Asian parents and families of children and adults with physical or learning disabilities. The centre provides emotional support (one-to-one and group); help with form filling for benefits, housing and education; and referrals from care managers, community nurses, health visitors, education services, GPs and hospitals.

Manchester Bangladeshi Women's Organisation, 360 Dickenson Road, Longsight, Manchester, M13 0NG. T: 0161 257 3867, 2122. E: [email protected] . Advice, information and support for Bangladeshi women. Subjects covered include welfare rights, housing, health, education and training, employment and immigration, and nationality. Well woman sessions, mental health project, English classes, sewing and dressmaking classes (with a crèche), and mother and toddler group.

St Luke's Church Drop-in, Stockport Road, Longsight, Manchester, M13 9AB. T: 0161 273 1538. E: [email protected] . W: www.stlukeslongsight.co.uk . Drop-in support for people with long term and enduring mental health problems. Services include counselling, complementary therapies, art groups, advocacy, welfare rights advice, and housing related legal advice.

58 Source: NHS Manchester

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The Roby: South Asian Women's Group, 307 Dickenson Road, Longsight, Manchester, M13 0NG. T: 0161 257 2653. E: [email protected] . W: www.theroby.org.uk . A social inclusion space specifically for 30-40 South Asian Women with a focus on preventing mental ill health through raising awareness of wellbeing activities (e.g. exercise, nutritional food).

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5.6 Hulme

5.6.1 Ward demographics

Age

Figure 53:Age distribution of Hulme population 59

Ethnicity

Figure 54:Ethnicity of Harpurhey 60

59 Source: ONS Census Data 2011 60 Source: ONS Census Data 2011

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Religion

Figure 55:Religious diversity of Hulme 61

Socio-economic indicators

Figure 56:Unemployment and economic inactivity in Hulme 62

61 Source: ONS Census Data 2011 62 Source: ONS Census Data 2011

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Figure 57:Percentage of households in three or four dimensions of deprivation in Hulme 63

Figure 58:Percentage of Hulme population with no qualifications 64

63 Source: ONS Census Data 2011 64 Source: ONS Census Data 2011

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5.6.2 Termination of pregnancy data in Hulme

Figure 59:Terminations of pregnancy in Hulme 2007-2009 65

5.6.3 Contraception and termination support services in Hulme

Local sexual health, contraception and termination services:

GP offering additional sexual health services (implants and IUDs): Arch Medical Practice , Hulme Medical Centre, 175 Royce Road, Hulme, Manchester, M15 5TJ. T: 0161 226 0606.

GP offering additional sexual health services (implants and IUDs): Boundary Medical Centre , 63 Booth Street West, Hulme, Manchester, M15 6PR. T: 0161 227 9785.

GP offering additional sexual health services (implants and IUDs): City Road Surgery , 204 City Road, Hulme, Manchester, M15 4EA. T: 0161 872 8129.

Pharmacy offering additional sexual health services: Faith Pharmacy , 59 Booth Street West, Hulme, Manchester, M15 6PQ. T: 0161 232 8044. The pharmacist can prescribe the contraceptive pill, Emergency Hormonal Contraception (EHC) and test for Chlamydia.

Termination of pregnancy central booking service 0845 365 0565 for all appointments to any clinic across Manchester.

5.6.4 Women’s support groups and BME community groups in Hulme

Manchester Women’s Aid (Cameo Women’s Group), Kathe Locke Centre, 123 Moss Lane East, Hulme, Manchester, M15 5DD. T: 0161 820 8407/07432 719 770. E: [email protected] . W: www.manchesterwomensaid.org . Supporting BME women who have experienced abuse or forced marriage.

65 Source: NHS Manchester

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5.7 Moss Side

5.7.1 Ward demographics

Age

Figure 60:Age distribution of Moss Side population 66

Ethnicity

Figure 61:Ethnicity of Moss Side 67

66 Source: ONS Census Data 2011 67 Source: ONS Census Data 2011

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Religion

Figure 62:Religious diversity of Moss Side 68

Socio-economic indicators

Figure 63:Unemployment and economic inactivity in Moss Side 69

68 Source: ONS Census Data 2011 69 Source: ONS Census Data 2011

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Figure 64:Percentage of households in three or four dimensions of deprivation in Moss Side 70

Figure 65:Percentage of Moss Side households with no qualifications 71

70 Source: ONS Census Data 2011 71 Source: ONS Census Data 2011

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5.7.2 Termination of pregnancy data in Moss Side

Figure 66:Terminations of pregnancy in Moss Side 2007-2009 72

5.7.3 Contraception and termination support services in Moss Side

Local sexual health, contraception and termination services:

GP offering additional sexual health services (implants and IUDs): The Range Medical Centre, 121 Withington Road, Moss Side, Manchester, M16 8EE. T: 0844 499 6977.

Termination of pregnancy central booking service. T: 0845 365 9565 for all appointments to any clinic across Manchester. 5.7.4 Women’s support groups and BME community groups in Moss Side

Nigerian Women's Group Manchester, 4 Westernly Way, Moss Side, Manchester, M16 7EA. T: 0161 226 8090. W: www.nigerianwomengroupmanchester.co.uk .

Hosla Outreach Service (Savera Group), Sure Start Centre, Moss Side, Off Alexandra Road, Manchester, M16 7UH. T: 0161 636 7560/7551. E: [email protected] . W: www.saheli.org.uk . A health and wellbeing group for BME women in the community, providing advice, support and information, and link up with professionals and advice workers. Umbrella support groups covering all of Manchester: • Manchester BME Network; • Manchester Community Central; • Black Health Agency; • Manchester Race and Health Forum. See Appendix 2 for contact details.

72 Source: NHS Manchester

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6 SUPPORTING BME WOMEN TO ACCESS SEXUAL HEALTH SERVICES: CHALLENGES AND OPPORTUNITIES

The NHS Health Equity Audit: Termination of Pregnancy report (2007-2009) showed two areas of concern as regards high termination rates:

geographical – hotspot wards across the City; thematic – ethnic groups and age.

Our consultation therefore focused on women from specific ethnic backgrounds living in the hotspot areas of: Ardwick; Harpurhey; Cheetham; Longsight; Hulme; and Moss Side.

Table 6:Consultation

No. of Ethnic groups Age groups Hotspot wards interviews Asian/Asian British: Indian; Pakistani; and Cheetham 30-35+ years old 20 Bangladeshi origins Longsight Black/Black British: African; and Ardwick 20-35+ years old 20 Caribbean origins Harpurhey Chinese: Vietnamese; Malaysian; and Hulme 20-29 years old 20 Afro-Asian origins Moss Side

Interviewees were selected using a purposive sampling technique, in which paid community researchers and community based organisations working with women from diverse ethnic backgrounds, chose who should be interviewed. In total, 60 women 73 took part in the face-to-face interviewing process and six focus groups were held, one in each of the locations identified. This section of the toolkit reflects the findings of our consultation with women from a variety of ethnic backgrounds, and provides a qualitative account of the ‘service experience’.

Figure 67:Experience of sexual health service

The following sections reflect the views and experiences women from different ethnic backgrounds face in accessing contraception and termination services.

73 The Black and Black British, Caribbean origins sample included 10 women between 23 to 46 years of age (three between 23 and 28 years of age; four 40 years old or above and three mid to late 30s)

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7 SEXUAL HEALTH

7.1 Introduction

This section covers BME women’s views as regards sexual health services, with a particular focus on contraception. The section covers the following:

information and advice about sexual health; accessibility of sexual health services (contraception); barriers in accessing local services; suggestions to improve contraception services.

7.2 Information and advice about sexual health

Overall, all the women consulted felt they were well informed as regards sexual health and knew how to protect themselves from STIs (e.g. HIV and Chlamydia). The use of condoms is widely considered by the women as the best way to protect against STIs, together with regular health check-ups.

Generally, the first port of call for information on sexual health for women from all ethnic groups is the internet. The women tend to use search engines like Google or use the NHS Direct website to look for information. Visiting the GP is also a very common option to get advice on sexual health issues, particularly when more accurate information is needed. In many cases however, women tend to consult a pharmacist for advice regarding minor concerns. Among the younger women (particularly Chinese women between 20 and 29 years of age), university and/or college are considered a source of information and advice on sexual health issues. However, among the City’s universities, only the University of Manchester offers an Occupational Health Service. 7.3 Knowledge and use of contraception methods

Across all ethnic groups, there is good knowledge of the variety of contraceptive methods available. Aside from the women who are sexually inactive or trying for a baby, all the respondents used some form of contraception. The most popular methods reported are implants (often the coil), the contraceptive pill and condoms. The latter tend to be more popular among younger groups (particularly Chinese women and Black British; African women from 20 to 29 years of age) whilst women aged over 30 are more likely to use the contraceptive pill.

Depending on the type of contraception methods chosen, participants were aware of the possibility to purchase them in shops and supermarkets, as well as obtaining them free of charge in many health centres. Most of the participants go to their GPs or clinics for contraception, since they provide professional advice, however pharmacies are also used. 7.4 Accessibility of sexual health services (contraception)

Across all ethnic groups contraceptive methods are considered easily accessible in their local areas. Every locality has on average three or four pharmacies; and women are aware of the clinics where they can receive a more specialist service. Although clinics are not necessarily based in the neighbourhood where women live, there is widespread awareness of their location and knowledge of the services offered.

Generally, all women are registered with a GP 74 and feel they can trust their doctor with matters such as sexual health. Depending on the type of contraception method chosen, the GP surgeries appear to refer women to specialist clinics or to female nurses dealing with sexual health.

74 Only four out of the 60 women interviewed were not registered with a GP. Two from the Chinese group sampled stated it was for VISA issue (i.e. the visa had expired). The other two from the Asian group had moved recently to the area

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7.5 Barriers in accessing services (contraception)

Although it is recognised that there is ample availability of sexual health services in the local areas (i.e. pharmacies and GP surgeries) as well as across the City (i.e. private clinics such as Pall Mall and GUM clinics), three issues have emerged as main barriers 75 to accessing contraceptive services:

language and communication; gender of sexual healthcare professionals (e.g. GP); anonymity and confidentiality.

7.5.1 Language and communication barriers

Overall, women from all ethnic backgrounds felt the main barrier to accessing contraception and other sexual health services is communication. The reasons for this are twofold; limited English language skills; and cultural differences in terminology and attitude. Foreign nationals often do not speak English sufficiently well to express themselves, or understand the literature available on sexual health services. Whilst information on sexual health and contraception is widely available, if someone does not speak, or indeed read English, they cannot understand the content of leaflets or posters. Moreover, it was noted that due to limited English language skills, particularly among Chinese women, they may lack ‘the ability to express oneself’ correctly.

Although it is recognised that interpretation services are available, these are not perceived as effective. Chinese and Asian respondents in particular felt that whilst there are interpretation services, their accessibility is patchy and can sometimes be a barrier because women are not always ‘comfortable speaking about this topic’ with someone who is not a health professional. The private and personal nature of the topic means that women may find using an interpreter awkward.

Moreover, women who have just arrived in the UK are unlikely to understand how the health system works. Many examples were provided of women who had difficulty accessing contraception when they first arrived in the country, as they had little information on where to go and resorted to paying for contraception or the morning after pill. Other examples included women being unaware of the existence of walk in centres, and that many types of contraceptive methods are available free of charge.

The effectiveness of communication with health professionals, particularly GPs, can be a barrier to accessing contraception. Many British born women highlighted this issue, as the following quotation indicates:

‘Sometimes the GP doesn’t get where I’m coming from or my point of view, so sometimes I have to go along with what they say or suggest. For example if I feel a certain way I might think I know the reason why, but when I try to explain it to my GP, I feel as if what I say is not taken seriously.’ 76

Whilst this concern may reflect wider anxieties about the quality of service received in some GP practices, women from all ethnic groups expressed the need for better information and guidance on the choice of contraceptive methods (e.g. many women lamented the lack of monitoring after being prescribed the contraceptive pill, which later affected their health since their hormone levels had not been checked regularly). Women felt they were not given sufficient guidance to make an informed choice and were moved from one method to another, as the following quotation indicates:

‘Doctors don’t share all information with you or discuss the risks attached; I ended up trying four different forms of contraception. They only discuss other forms and make other suggestions after you’ve had a bad side effect.’ 77

75 Only two people among the 60 interviews specifically mentioned that their religious belief 76 Interviewee, Ardwick, 32 Asian/African, Muslim 77 Focus group participant, Moss Side, Black British and Black Caribbean

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7.5.2 Gender of sexual healthcare professional

Overall, women feel they can trust doctors with matters like sexual health and contraceptive methods; however there were mixed feelings about approaching GPs. The gender of the GP is often crucial in enabling women to disclose matters which are personal and confidential. Indeed, women who felt more at ease with their doctor also noted that they were female and thus better understood their needs. It was also recognised that many GP practices have a specialist nurse dealing with sexual health issues which was beneficial, particularly when the GP is male. However, since the GP is recognised as the most specialised, the presence of dedicated female doctors was accepted as a way to improve accessibility to contraceptive services.

7.5.3 Anonymity and confidentiality

Since sexual health in general is viewed as very personal and confidential, it is felt that a further barrier in accessing appropriate contraception is fear of disclosure. If a clinic or pharmacy is in the local area, some women fear that ‘someone might see or know them’; this is a common issue, particularly among Chinese, Black British and Black African groups. It is less of a problem with health professionals, since they are perceived to be bound by confidentiality. 7.6 Suggestions to improve contraception services

A number of suggestions were brought forward on how to improve sexual health and contraception services, in particular:

better information to newcomers; simpler language; sensitivity to cultural needs; community provision; reaching foreign students.

7.6.1 Better information to newcomers

The lack of information for new arrivals should be tackled by providing more information on how the system works, indicating what services are available, where, and that most are free of charge. Some information could be provided in the language spoken by the new migrants or by using ‘visual art to overcome language barriers’.

7.6.2 Simpler language

Since sexual health and contraception is a personal and private matter, it is important that women feel at ease talking about it and that sufficient information is provided to guide their choice. It was suggested that simple literature and promotion should be used, using options such as the advertising for Greater Manchester against domestic abuse, for which posters were used. This allows most women to understand the information, independent of the language they speak and their language skills.

7.6.3 Sensitivity to cultural needs

Whilst there was no obvious indication of differences among ethnic groups as regards contraception methods chosen, it was suggested that sexual health would be more effective if explained by someone of the same culture. Generally speaking, contraception is still perceived as a taboo subject, it is therefore best addressed by people from the same ethnic background, using the language that is more effective for that group. It was also noted that young people (particularly among the Black British and Black Caribbean groups) have a different vocabulary when it comes to sexual health, thus a generational sensitivity is also required if the service is to work effectively.

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7.6.4 Community provision

Overall, there was agreement that community based approaches to sexual health and contraception information, education and support, would be the most appropriate. This could be achieved through regular sessions with professionals in the community, offering space for women to discuss their issues, and for the health professionals to talk about the services available, distributing leaflets and free material. This would also enable newcomers to the UK to access support from people of their culture.

Community support could be delivered as a group through awareness raising sessions in different settings (e.g. mother and toddler groups), or through private discussion in a comfortable setting with someone from their community who understands their language. Most felt that this would make a difference in the way contraception is viewed, mainly because it would render the issue less formal and more social, as one focus group participant noted:

‘Women from different communities would be more inclined to attend as it would not be seen as a bad place to be seen.’ 78

7.6.5 Reaching foreign students

At the beginning of each academic year, the Occupational Health Service at the University of Manchester invites local GPs to present their practices and encourage new students to register with a GP. However, there is not a similar service at Manchester Metropolitan University and this is a serious concern. Many young women studying at the universities are foreign nationals who have come to the UK for the first time and may need to use sexual health services whilst they are here. It is therefore suggested that Manchester City Council and NHS sexual health services strengthen their links with higher and further education institutions in order to ensure that information about sexual health services is disseminated as widely as possible.

The sexual health services could work closely with educational institutions in Manchester to enable the free distribution of condoms and leaflets across the various university sites (e.g. student unions). This is particularly important since the University of Manchester’s health services budget has been reduced and the service now focuses on signposting and supporting students, rather than providing services directly.

78 Ardwick focus group participant (mixed ethnicities): East African (3); Botswana (1); Somalia (4); Pakistani (1) and East African Asian (1)

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8 TERMINATION OF PREGNANCY

This section of the toolkit reviews BME women’s experiences and perceptions of termination of pregnancy services. The section covers the following:

perceptions of termination of pregnancy; reasons for having a termination; experience of termination services; suggestions of how termination services may be improved.

8.1 Perceptions of termination of pregnancy

In general, women from all three ethnic groups express hesitancy about whether termination of pregnancy is morally permissible. Their main concerns with termination relate to their religious belief, but many women acknowledge that termination could be appropriate in extreme cases, such as if the woman’s health is at risk or if the pregnancy was caused by rape. It is also widely acknowledged that women must be able to access termination services to prevent them trying to terminate a pregnancy themselves, such as by drinking alcohol or other dangerous methods. Very few women are completely against termination in any circumstances, and feel that women must be able to choose. Overall, there is a strong feeling that women should not let allow themselves to become pregnant by accident, and that using contraception and behaving responsibly is important. 8.1.1 Religious beliefs

Religion is the main reason for women to be against termination of pregnancy. Women who are from Asian, African and Caribbean ethnicities often have strong religious beliefs and believe that termination is not allowed under Islam or Christianity, and that only God should decide over life and death. Women who are Muslim often express the strongest disapproval of terminating a pregnancy because they feel it is explicitly forbidden in Islam. Women of Chinese ethnicity are less likely to be religious and are generally less opposed to terminating a pregnancy. However, many still express strong concern that termination is not a morally right choice because it involves taking a life. Among young Chinese women, there seems to be less concern over the moral permissibility of termination and far more concern for the right of a woman to be able to terminate a pregnancy. 8.1.2 Family and partner’s influence

Across all the ethnic groups, many women mention the influence of their parents and partner over their decision to have a termination. For younger women, the role of their parents is usually significant in either pushing them to have a termination because they are considered to be too young; or persuading them not to have a termination because the parents consider it to be morally wrong. For students, the attitude of their parents’ is likely to be as influential as the student’s religion when considering a termination. Women from different ethnicities may not feel able to discuss having a termination with their friends or family because it would be too shameful, and they may not want to discuss termination in a community group setting because the subject is too private. The most common factor influencing a woman’s decision appears to be their partner. Many women describe how a woman’s partner may force her to have an abortion, perhaps because the man is married to another woman, or because he does not want to be responsible for a child. 8.1.3 Stigmatism

In general, termination of pregnancy is a taboo subject for women from all ethnicities. Women of an Afro-Caribbean ethnicity are usually more open and willing to discuss their opinions of termination; while women of Asian and Chinese ethnicities are far less willing to discuss the issue. Asian women often have far less knowledge of the termination services available, or of other women who have experienced a termination; this indicates a strong stigma attached to termination in the Asian community, and that Asian women who have experienced a termination were unlikely to discuss it with their friends.

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Privacy regarding termination of pregnancy may be particularly important for Chinese women, who are far less likely to discuss their experience of termination. Many Chinese women do not wish to talk about termination because it is too private and personal. 8.2 Reasons for having a termination

There are various reasons why women from black and minority ethnic groups choose to have a termination, and these are not necessarily related to their ethnicity.

8.2.1 Age

A common reason for terminating a pregnancy is because the woman and her partner are young and do not want to marry and raise a child together. For female students, discovering they are pregnant is usually very upsetting because they feel it will disrupt their education and career. There are also feelings of shame related to taking a break from studying to raise a child.

International students in particular are likely to choose termination because they are often very concerned about achieving academic excellence and not disappointing or angering their parents or sponsors who are supporting them through university. Chinese students are more likely to know of a peer who has had a termination, which suggests that termination is more common among this group. In general, Chinese students take comparatively less time in deciding whether to have a termination; this may be due to China’s one child policy, which may leave a Chinese woman feeling that ‘this is not the right time’ to have their only child. The lack of parental influence over students’ behaviour whilst they are abroad may also mean that students take less precaution and are more likely to have an unwanted pregnancy.

8.2.2 Religion and culture

Some women choose to have a termination because the pregnancy occurred outside of marriage which is considered wrong in Islam and Christianity. A woman may decide to have a termination rather than bear the shame and disapproval of her family and community of being an unmarried mother; marrying her partner may not be an option if her family did not approve of the relationship. This may be the case among Chinese women, where it can be important for the social class of the partner to match that of the woman. Likewise, in other ethnic groups, parents may also wish their daughter to only marry someone of the same religion and ethnicity, and thus may push their daughter to terminate an ‘inappropriate’ pregnancy.

8.2.3 Health

Women of all ethnicities may decide to have a termination due to pregnancy posing a serious risk to their health or because their child may be born with a severe disability. Some women with strong religious beliefs feel it is better to not intervene in pregnancy and to leave their health and pregnancy in God’s hands. 8.3 Experience of termination services

Women from black and minority ethnic groups have differing experiences of termination services. Most women described taking a pill to terminate a pregnancy as unpleasant and painful; others described the procedure as straightforward and not very invasive. Generally, termination services were described as being professional, and that the women were well informed about the medical aspects of the procedure. However, some women still felt unsure about the possible side effects of terminating a pregnancy, especially in relation to the effect on fertility and how many terminations a woman can have.

8.3.1 Emotional support

Many women, especially those who are religious, are unhappy about the lack of emotional guidance and aftercare. They feel the procedure is too medical and were too upset at the time to make the correct decision over whether to have a termination. Women who have strong religious beliefs may be most likely to suffer feelings of guilt and regret for many years after a termination, and feel that talking to a woman of their own religion would be helpful before and after a termination.

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For many women having a termination is shameful and, as such, they would not want to talk to their friends and family about the experience. Not having access to emotional aftercare or counselling may mean that these women do not have anyone they can turn to for emotional support before or after a termination.

There is concern that some religious student groups, such as Catholic Advisory Support, offer emotional support to students who are considering a termination; however the groups are strongly opposed to the termination of pregnancy. Furthermore, these groups may hold demonstrations outside of termination clinics which may upset women who are using these services.

8.3.2 Privacy

Among the student population, termination is generally considered shameful; thus University of Manchester students often choose to use termination services in Hazel Grove to avoid being seen by fellow students or teaching staff who may be studying or teaching at a Manchester hospital. The Brooks clinic is often used by students because it is perceived to be non-judgmental and provides aftercare support.

Chinese students are less likely to use NHS sexual health services due to language barriers and not wanting to register with a GP. Difficulty in communicating with doctors is a substantial concern for Chinese students when accessing sexual health services, including termination. Rather than using NHS sexual health services, Chinese students may use the private Pall Mall medical clinic in Central Manchester. For these students, paying for a private termination may feel more confidential and easier than trying to negotiate the NHS system. Chinese students may also be afraid of seeing a Chinese doctor who may be from their community. 8.4 Suggestions of how termination services may be improved

Improvements to termination services for women from black and minority ethnic groups concern two key issues: aftercare support; and information.

8.4.1 Aftercare support

Providing good counselling services and other emotional support to women before and after a termination is important for women to be able to cope with their decision. The person providing the support must understand different religious and cultural attitudes to termination, and women should be able to talk to a counsellor of their own faith and culture if they prefer.

Being able to use an interpreter and a female GP of the same religion and ethnicity is important for some women from black and minority ethnic groups, especially those with strong Christian or Muslim beliefs.

8.4.2 Information and awareness

Due to the stigma attached to termination of pregnancy, many women do not know what services are available or how to access them. More information needs to be provided about:

available termination services; how to access the termination central booking service; interpretation services and rules regarding termination; possible costs; procedures and possible complications; where services are located.

This information should be available in community venues and student residences, in GP surgeries and via leaflet drops. Information on termination should be presented positively and avoid negative language, such as the word ‘abortion’.

Language Language is a significant barrier to accessing information on termination services, especially because women may find it very embarrassing to ask someone to translate information about termination for them. Information about termination must be available in different languages.

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Community workers Some women would prefer to talk to someone about termination services rather than read a leaflet. Having a female community worker who visits people’s homes to discuss termination and contraception with women could be very helpful. Similarly, having community workers who visit community groups, in particular mother and toddler groups, could be an effective way of providing women with information on termination services.

Privacy Other women, especially women of Chinese ethnicity, find termination to be a very private subject and do not want to discuss it in a community group. They would prefer to have more opportunities to discuss it privately and to be able to access a website with information on termination services.

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9 MONITORING CHANGE IN BME WOMEN’S SEXUAL HEALTH NEEDS

9.1 Ethnic diversity

Compared to London, Manchester has greater ethnic diversity, in the sense that no one ethnic group exceeds 10% of the overall population. The 2011 Census allowed respondents to identify their ethnicity using eighteen different classifications, in addition to asking for their country of birth. According to the Commission for the New Economy, the Census results on ethnicity confirm that the main drivers for the overall population growth in Greater Manchester were immigration and births to mothers from non-White British backgrounds.

White British (which includes English, Welsh, Scottish and Northern Irish) is, by some distance, the largest ethnic group within Greater Manchester, with 80% of Greater Manchester residents (2.14 million) identifying themselves in this category. A further 541,000 Greater Manchester residents belong to a non-White British ethnic group. Of these, the Pakistani population (which includes people of Asian British heritage) is the next most numerous at 4.8%. Seven other ethnic groups account for at least 1% of Greater Manchester’s population:

1) Other White (2.6%, i.e. non-White British); 2) Indian (2.0% including Asian British heritage); 3) African (1.7% including Black British heritage); 4) Irish (1.3%); 5) Bangladeshi (1.3%, including Asian British heritages); 6) Other Asian (1.1%, including Asian British heritage); 7) Chinese (1%, including Asian British heritage).

Greater Manchester’s population has become more ethnically diverse since 2001. In 2001, the three most populous groups accounted for 93% of Greater Manchester’s population compared to 87% in 2011; however the growth in Greater Manchester’s ethnic population has become increasingly concentrated in Manchester (38% of Greater Manchester’s ethnic population in 2011 compared to 34% in 2001). 9.2 What has driven this change?

Absolute declines in Greater Manchester’s historic largest ethnic groups has resulted in the White British count decreasing by 41,000 (-2%), combined with a large percentage decrease in Greater Manchester’s White Irish (-8,000/-19.1%) population. At the same time, there have been large increases in the Pakistani (55,000, +73%) and Black African (34,000, +336%) populations. The doubling of the Other White group has occurred mainly since the EU enlargement in 2004 and 2008.

These results confirm that Greater Manchester’s overall population growth of 6.6% has been driven by immigration and births to mothers from ethnic minority backgrounds that tend to have larger families than mothers from the White British ethnic group. 9.3 What is the balance between migration and births?

Slightly skewed (60/40) to in-migration, nationally the skew is stronger (66/33), with Greater Manchester’s non-UK born residents more likely than UK migrants to have children after arriving in the country. 9.4 Issues with monitoring and reporting

9.4.1 Unreported language diversity (Census 2011)

Yaron Matras from the University of Manchester’s Multilingual Manchester Project, calls the Census data about linguistic diversity in Manchester ‘woefully inaccurate’. The project's own research shows that the Census under represented both languages spoken and the numbers of people who speak them:

‘We identified that our City boasts of at least 153 languages, making it one of the world’s most diverse places. It is very likely to be top of the list in Europe, certainly when compared to other cities of its size, perhaps only outflanked by London and Paris.’

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The languages whose populations the Census data under represents include: Yiddish; Romani; and Cantonese. One reason could be that respondents themselves have under reported their use of languages, either due to a lack of awareness or fear of stigmatisation. Another reason may be the different possible interpretations of the Census question, which asked about ‘main language’ rather than ‘home language’.

Matras and his colleagues are piloting a new method of surveying home languages which they hope will yield much better results. The first results are expected to be published later this year.

Overall, the non-White British population across Greater Manchester has increased by 80%. Most of this diversity is concentrated in the City Centre, with 40% of the non-White British population living there, compared to totals of 7-8% in the districts.

9.4.2 Monitoring ethnicity

The NHS has a central monitoring system in place for everyone entering the system which captures data on ethnicity. For Central Manchester, this is a green form entitled ‘registration details’ which every patient is asked to complete so that their details are kept on a central system. In addition to the contact and next of kin details, it also asks for details on ethnicity and religion. It is therefore possible to understand the diversity of people accessing NHS services in terms of gender, postcode, country of birth, ethnic group, and religion.

9.4.3 Termination of pregnancy services

Providers of termination of pregnancy services also capture data at the clinic level through an initial questionnaire which captures information including: ethnicity for under 18’s; postcode; need for interpreters; current contraception practice; and history. It is clear that within the NHS and the termination of pregnancy services, there is a lot of data that is currently collected. It is less clear whether the detailed data collected at the service level is the same across all service providers. 9.5 Future developments

The following areas of discussion can be pursued at the provider level to better understand the current data and its compatibility across providers. Areas for further discussion at provider level should include:

Census; self-definition (how would you define your ethnic group?); your first language; your country of origin; religion.

Manchester BME Network Appendix 1: Sexual health and contraception services i

APPENDIX 1 Sexual health and contraception services

Manchester BME Network Appendix 1: Sexual health and contraception services ii

SEXUAL HEALTH AND CONTRACEPTION SERVICES

Palantine and Fresh clinics

• Central Manchester (Palantine and Fresh) The Hathersage Centre, 280 Upper Brook Street, City Centre, Manchester, M13 9TX T: 0161 701 1555

• Withington (Palantine only) Withington Community Hospital, Nell Lane, West Didsbury, Manchester, M20 2LR T: 0161 435 3509

• Wythenshawe (Palantine and Fresh) Forum Health, Simonsway, Wythenshawe, Manchester, M22 5RX T: 0161 435 3509

• Cheetham (Palantine only) Cheetham Hill Primary Care Centre, 244 Cheetham Hill Road, Cheetham Hill, Manchester, M8 8UP T: 0161 202 8750

• Newton Heath (Palantine and Fresh) Newton Heath Sure Start Centre, Great Newton Street, Newton Heath, Manchester, M40 1WT T: 0161 227 3517

• Harpurhey (Palantine and Fresh) Harpurhey Health Centre, Church Lane, Harpurhey, Manchester, M9 4BE T: 0161 861 2400

See http://www.anyplanstonight.co.uk for up-to-date contact details for these services.

Specialist GU clinics

• North Manchester GUM Department North Manchester General Hospital, Outpatients 'D', Delaunays Road, Crumpsall, Manchester, M8 5RB T: 0161 627 8753 W: http://www.pat.nhs.uk

• GU Manchester Centre Manchester Centre for Sexual Health, The Hathersage Centre, 280 Upper Brook Street, Manchester, M13 0FH T: 0161 276 5200 W: www.manchestersexualhealth.org

• GU South Manchester South Manchester Sexual Health Centre, Withington Community Hospital, Nell Lane, West Didsbury, Manchester, M20 2LR T: 0161 217 4939 W: www.uhns.nhs.uk

See http://www.anyplanstonight.co.uk for up-to-date contact details for these services.

Manchester BME Network Appendix 1: Sexual health and contraception services iii

GPs offering additional services

See http://www.anyplanstonight.co.uk for up-to-date contact details for these services.

GPs in North Manchester

• Collegiate Medical Centre (implants and IUDs) 407 Cheetham Hill Road, Cheetham Hill, Manchester, M8 0DA Tel: 0161 205 4364

• Simpson Medical Practice (implants only) 361 Moston Lane, Harpurhey, Manchester, M40 9NB T: 0161 203 5550

• Wellfield Medical Centre (implants and IUDs) 53-55 Crescent Road, Crumpsall, Manchester, M8 9JT T: 0161 740 2213

• Urban Village Medical Centre (implants and IUDs) Ancoats Primary Care Centre, Old Mill Street, Manchester, M4 6EE T: 0161 272 5656

GPs in Central and East Manchester

• Arch Medical Practice (implants and IUDs) Hulme Medical Centre, 175 Royce Road, Hulme, Manchester, M15 5TJ T: 0161 226 0606

• Bodey Medical Centre (IUDs only) 28 Ladybarn Lane, Fallowfield, Manchester, M14 6WP T: 0161 248 6644

• Boundary Medical Centre (implants and IUDs) 63 Booth Street West, Hulme, Manchester, M15 6PR T: 0161 227 9785

• City Road Surgery (implants and IUDs) 204 City Road, Hulme, Manchester, M15 4EA T: 0161 872 8129

• Mount Road Surgery (implants and IUDs) 110 Mount Road, Gorton, Manchester, M18 7BQ T: 0161 231 4997

• The Range Medical Centre (implants and IUDs) 121 Withington Road, Moss Side, Manchester, M16 8EE T: 0844 499 6977

• The Vallance Centre (implants and IUDs) Brunswick Street, Ardwick, Manchester, M13 9UJ T: 0161 274 1500

• Ashville Surgery (implants only) 171 Upper Chorlton Road, Whalley Range, Manchester, M16 6RT T: 0161 881 4293

Manchester BME Network Appendix 1: Sexual health and contraception services iv

GPs in south Manchester and Wythenshawe

• Benchill Medical Practice (IUDs only) Brownley Green Health Centre, 171 Brownley Road, Benchill, Manchester, M22 9UH T: 0161 493 9101

• Bowland Medical Practice (implants and IUDs) 52 Bowland Road, Baguley, Manchester, M23 1JX T: 0161 998 2014

• Cornishway Group Practice (implants and IUDs) Forum Health, Simonsway, Wythenshawe, Manchester, M22 5RX T: 0161 490 2293

Clinics providing termination of pregnancy services

The Central Booking Service for appointments for all clinics is 0845 365 0565

• Whitworth Clinic Saint Mary's Hospital, Oxford Road (access from Hathersage Road), Manchester, M13 9WL

• Marie Stopes International 5 Wynnstay Grove, Fallowfield, Manchester, M14 6XG (Services provided: contraception; emergency contraception; pregnancy testing; unplanned pregnancy consultations; early medical termination of pregnancy; termination of pregnancy; vasectomy; Chlamydia testing; and HIV testing).

• Marie Stopes International (Early Medical Unit) Alexandra Buildings, 28 Queens Street, Deansgate, Manchester, M2 5HX (Services provided: pregnancy testing; unplanned pregnancy consultations; early medical termination of pregnancy; counselling; and STI testing and treatment).

• South Manchester Private Clinic and Pregnancy Advisory Service Fraterdrive Manchester Pregnancy Advisory Service, 32 Lever Street, Manchester, M1 1DE (Services provided: abortion information and consultation; early medical termination of pregnancy (termination pill); free pregnancy testing; full contraception service; and free walk-in Chlamydia testing for under 25s )

See http://www.anyplanstonight.co.uk for up-to-date contact details for these services.

In addition there are many other pregnancy and terminations services close to the Manchester area. Manchester residents are free to access pregnancy and termination services located outside of the Manchester area if they prefer. These can be found using the NHS Choices website: http://www.nhs.uk/Pages/HomePage.aspx .

Termination of pregnancy services in surrounding areas include:

••• Bolton Pregnancy Advisory Service 4th & 5th floor, Nelson House, Nelson Square, Bolton BL1 1JT (Services provided: abortion information and consultation; early medical abortion; free pregnancy testing; full contraception service; free walk-in Chlamydia testing for under 25s)

••• Salford Pregnancy Advisory Service Energise Centre, 3 Douglas Green, Charlestown, Salford M6 6ES (Services provided: abortion information and consultation; early medical abortion; free pregnancy testing; full contraception service; free walk-in Chlamydia testing for under 25s)

Manchester BME Network Appendix 1: Sexual health and contraception services v

••• Marie Stopes International - Avenham Primary Healthcare Clinic Avenham Lane, Avenham, Preston, PR1 3RG , (Services provided: Pregnancy testing, unplanned pregnancy consultations, early medical abortion)

••• Merseyside Clinic & Consultation Centre 32 Parkfield Road, Liverpool, L17 8UJ (Services provided: early medical abortion, surgical abortion, vasectomy, post abortion counselling, consultation)

Manchester BME Network Appendix 2: Umbrella support groups in Manchester vi

APPENDIX 2 Umbrella support groups in Manchester

Manchester BME Network Appendix 2: Umbrella support groups in Manchester vii

UMBRELLA SUPPORT GROUPS COVERING ALL OF MANCHESTER

• Manchester BME Network London Scottish House 24 Mount St Manchester M2 3NN T: 07811 531160 or 0161 257 0213 http://www.manchesterbmenetwork.co.uk/page10.html

• Manchester Community Central Swan Buildings, 20 Swan Street, Ancoats Manchester M4 5JW T: 0161 834 9823 http://www.macc.org.uk/

• BHA Democracy House, 609 Stretford Road, Old Trafford Manchester M16 0QA T: 0845 450 4247 http://www.thebha.org.uk/

• Manchester Race and Health Forum Contact via BHA.

Manchester BME Network