Sexual and reproductive health

Sexual health

The World Health Organization (WHO) defines sexual health as the physical, emotional, mental, and social wellbeing related to sexuality. While needs vary by age, gender, and orientation, core needs include access to high-quality information, education, services, and treatment. Poor sexual health can have serious consequences, including unplanned pregnancies, HIV transmission, and psychological harm.

A Herefordshire sexual health needs assessment (see related documents) was completed in 2023 to provide an overview of sexual health services and outcomes for the population. Its main findings were:

• Outcomes were mixed with some indicators above and others below national averages.
• Sexually transmitted infection (STI) testing rates were rising but remained below the national average.
• Low proportions of STI tests were positive (called ‘test positivity rates’), which may have indicated lower prevalence but only if there were fair and equitable access and uptake of testing, particularly for high-risk groups.
• Treatments have improved prognosis for individuals living with HIV nationally. However, Herefordshire had low HIV testing rates and a higher percentage of late diagnoses.
• Rurality poses challenges in accessing sexual health services, especially for young and high-risk groups. Equitable healthcare access remains a priority.
• Evidence-based primary preventative interventions should be prioritised to help improve sexual behaviours and sexual health outcomes across all ages.
• Multi-agency collaboration through the sexual health forum is essential for addressing local needs effectively.

Diagnosis rates for sexually transmitted diseases are significantly lower in Herefordshire than regionally and nationally:

• In 2024, the crude rate for syphilis diagnosis in Herefordshire was 7.4 per 100,000, significantly lower than in England (16.5) and the West Midlands (13.8).
• The gonorrhoea diagnostic rate per 100,000 in 2024 was also significantly lower than in England and the West Midlands region (59 per 100,000 compared to 124 and 84 respectively and was the lowest amongst comparable West Midlands local authorities.
• The chlamydia detection rate per 100,000 females aged 15 to 24 years in Herefordshire was 1,033, significantly lower than England (1,589) and similar to the West Midlands (1,290). In 2024, 15.2% of the female population aged 15 to 24 years were screened for chlamydia in Herefordshire, significantly lower than in England (18.0%) but significantly higher than in the West Midlands (13.5%).
• The crude rate new STI diagnoses (excluding chlamydia aged 24 years and under) per 100,000 in Herefordshire was 180 in 2024, significantly lower than in England (482) and the West Midlands (330).
• The all-HIV diagnoses rate in Herefordshire was 8 per 100,000 in 2024, significantly lower than in England (9.0) and similar to the West Midlands (7.5). The crude HIV diagnosed prevalence rate per 1,000 people aged 15 to 59 years in Herefordshire was 0.99 in 2024, significantly lower than in England (2.40) and the West Midlands (1.96).

The adolescent Human papillomavirus (HPV) immunisation programme vaccination coverage: for one dose (12- to 13-year-old) in Herefordshire was 89.0% in 2023-24, within the government target and significantly better than in England (72.9%) and the West Midlands (70.8%).

Reproductive health

Reproductive health is a state of complete physical, mental, and social well-being regarding the reproductive system, functions, and processes at all life stages. It implies the ability to have a safe, satisfying sex life, the capability to reproduce, and the freedom to decide if, when, and how often to do so.

Similar to regionally and nationally:

• The under-18 conception rate in Herefordshire was 14.1 per 1,000 in 2022, similar to the West Midlands (15.9) and England (13.9).   The rate has been falling for several years and in 2022 was almost two thirds lower than in 2007 (38.1).
• In 2021, 19 under-18s in Herefordshire had an abortion, representing a crude rate of 6.6 per thousand, similar to the West Midlands (7.3%) and England (6.5%).

Sexual offences

Sexual offences are defined in UK law as any non-consensual sexual activity, including rape, sexual assault, and exploitation.

Herefordshire has lower rates of sexual offending than regionally and nationally:

• In 2024-25 there were 531 sexual offences recorded in Herefordshire, representing a rate of 2.8 per 1,000, compared to 3.2 per 1,000 in the West Midlands and 3.1 per 1,000 in England.