It looks like it is going to be a long hard winter. The media have already been reporting restrictions on referrals and rising waiting times. It is likely that things can only get worse given the pressures on primary care trusts and local authorities. At times of economic stringency, women’s sexual and reproductive health can seem an easy target. But this is short-sighted and probably not costeffective given the UK’s high rates of teenage pregnancy and sexually transmitted infections. It is time for an approach to service configuration that goes beyond knee-jerk slash and burn.