Comment Writer Anya Desai considers the possibility of the contraceptive pill being accessible in pharmacies, arguing that whilst the decision would be accompanied by notable risks, improved accessibility would be a step in the right direction for female health

Written by Anya Desai
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Images by Korng Sok

The contraceptive pill became available through the NHS sixty years ago, initially only available to married women. Because of the efficiency and bodily autonomy it granted people, it is now the most commonly prescribed method of contraception. Currently, despite its ubiquity, the pill, in any form, can only be accessed by prescription from a doctor, arguably unnecessarily restricting its accessibility. Yet, underfunding and COVID induced strain on the NHS which make getting GP appointments much more difficult have prompted pharmaceutical companies Maxwellia and HRA Pharma to appeal to the Medicines and Healthcare products Regulatory Agency (MHRA) to change the status two progestogen-only pills from prescription only medicine to pharmacy medicine, allowing it to be sold over the counter. As such, the government has launched a public consultation aimed at medical groups and women’s organisations to see whether the reclassification of these contraceptives is a good idea. 

Whilst the pill revolutionised women’s health and can undeniably be credited in aiding female sexual liberation, there still exist barriers to its accessibility. In 2019, the All Party Parliamentary Group on Sexual and Reproductive Health found that women in England are finding it increasingly difficult to access contraception, especially underserved groups such as ethnic minority groups, young women and women from poorer communities.’ Hence, there appears to be a need to make the pill even more readily and universally obtainable. Over-the-counter access would eliminate the need to go through the increasingly arduous task of getting a GP appointment, for which waiting times can now be over two weeks. It would also better accommodate people who find it hard to get appointments because they may work during normal surgery opening hours. Indeed, countries in which the pill can be purchased in pharmacies found an improved uptake in oral contraception and, in turn, a reduction in unwanted pregnancies. Additionally, increased accessibility on the pill may decrease dangerous reliance on the morning after pill as emergency contraception, since people would not have to worry about running out of the pill before they had time to procure their next prescription. Since progestogen-only pills are easy to take and become effective within two days, improved accessibility to them would encourage people to engage in safer sex. 

As well as being a public health issue, the pill’s accessibility could, vitally, begin to remedy the stigma attached to female sexuality. Whilst any man can go to Tesco and purchase condoms, this degree of sexual freedom is denied to women who must jump over hurdles to be afforded the same right to contraception over which they have full control. As long as this is the case, it will continue to reinforce the idea that female sexuality is taboo. For this reason, selling the pill in pharmacies appears to be a necessary step in the correct direction towards modernising contraception. 

The pill’s accessibility could, vitally, begin to remedy the stigma attached to female sexuality

However, some people may reasonably worry about the risks that might accompany bypassing a medical consultation before obtaining the pill. It is true that pharmacies would presumably do important checks before prescribing it, such as checking blood pressure, BMI, and pre-existing medical conditions. Yet, perhaps for first time users, the severity of the side effects and risks caused to users of the pill warrant a more thorough medical consultation where their options with contraception can be explored. For instance, the side effects and risks listed for mini-pill Lovima, which are similar to those associated with most forms of oral contraception, include a slightly increased risk of breast cancer, thrombosis, ectopic pregnancies, high blood pressure and an increased propensity to psychiatric disorders such as depression and anxiety. Hence, since the pill gives rise to these significant risks, arguably its procurement should require more than some perfunctory pharmacy questions. 

When I asked people around me for their thoughts on over-the-counter contraception, the main concerns about increasing accessibility to the pill centred around bad experiences they, or people they knew, had had with it. This is really understandable. For many, myself included, the adverse side effects of certain pills can be enough to make them stop taking it, especially with regards to the mental health problems it can cause. I think this speaks to wider issues surrounding women’s health and the information – or lack thereof – we receive about our contraceptive options and the effects of ingesting hormones everyday. It has been demonstrated time and time again that women’s health issues are not treated with enough gravity and can be swayed by outside forces. We saw in 2019, for example, that NHS given advice about taking 7-day breaks from the combined contraceptive pill had no basis in science but was instead a means of appeasing the Vatican, demonstrating that greater care and attention needs to be taken when it comes to oral contraceptives. Perhaps, then, pharmacy accessibility for the pill would be a step in the wrong direction.  

It has been demonstrated time and time again that women’s health issues are not treated with enough gravity

Ultimately, improved understanding and advice surrounding the pill is vital, but in the meantime, and despite the risks involved, improving accessibility to it is still very necessary. Allowing the pill to be bought over the counter is likely to increase the autonomy of women further, whilst decreasing practical risks that may stop those taking it from having to take pill breaks, which can lead to unwanted pregnancies and circulation issues. Yet, whilst I think making Hana and Lovima available in pharmacies is a step in the right direction, if the government wants to take this decision they should ensure the prescription process for first time users is as in depth as one with a sexual health nurse would be. The pill is an essential part of lots of people’s lives – not just those who take it – meaning ultimately its accessibility and safety should be a priority.

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