More About the Campaign
It is now 15 years since the progestogen-only emergency contraceptive Levonelle (now also sold as Boots Emergency Contraceptive and Consilient) was first made available to women to buy from behind the counter in pharmacies after a consultation with a pharmacist. The price was set high and a mandatory consultation introduced to prevent women from using it as a regular method of contraception. British women can today pay up to £30 for a pill (which costs a fraction of that to produce) and have to endure a clinically superfluous consultation, at their own expense. In essence women are paying the ultimate sexist surcharge on their sex lives. This is neither right nor fair.
While EC is available for free from GPs and sexual health clinics, appointments can be hard to obtain in the timeframe needed, particularly as services become more restricted. Some pharmacies take part in NHS-funded schemes to provide EC free of charge, but this is often only available to young women, and even then, only from specific pharmacies, when the pharmacist is on site. This leaves many women with no choice but to purchase it, at considerable personal expense.
Most women in the UK rely on pills and condoms, and need swift access to emergency contraception when their method fails or is forgotten. It is no surprise that use of EC has barely changed in this country since pharmacy access was introduced, as the combination of cost and embarrassing consultation have acted as significant barriers to its use. Around a third of British women have had an episode of unprotected sex in the last 12 months, but in the vast majority of cases have not used EC afterwards.
How does this compare with other countries?
Progestogen-only emergency contraception is more expensive in the UK than any other European country except Ireland. In France, it costs in the region of 7 euros to buy without a prescription from a pharmacy. In other European countries, including Sweden, Norway and the Netherlands, it is also available on the shelf for women to self-select and not kept behind the pharmacy counter. It is even available on the shelf and without consultation in the United States, where issues surrounding women’s reproductive health are far more politicised. We need to ask ourselves why in other countries in North America and Europe – where drug safety protocols are no less rigorous than our own – women are sufficiently trusted to pick this product off the shelf and use it safely and sensibly without a mandatory discussion with a healthcare professional.
What needs to happen?
Bpas is calling on all those involved in the supply and sale of EC in the UK to act in good conscience and give women access to a more affordable product. We believe the Department of Health needs to intervene, and in particular, we would like the Medicines & Healthcare products Regulatory Agency (MHRA) to grant emergency contraception General Sales List (GSL) status, so it can be sold from the shelf without consultation. While this may not be the total solution, we believe this could go some way to reducing the cost of emergency contraception, and would also remove one of the key barriers to women accessing EC as the consultation is often seen as embarrassing and shaming.
Would this be safe?
Absolutely and completely. Emergency contraception meets all the criteria to be classified as a medication that can be sold directly off the shelf without consultation, as it is in other countries. There are no known health risks associated with the use of progestogen-based EC. No deaths or serious complications have been causally linked to its this product, and the World Health Organisation classifies it as a Level One medication – indicating there should be no restrictions on its use. There are no women for whom EC is not safe, including women who are breastfeeding. EC cannot disrupt an existing pregnancy and there is no evidence it causes any congenital malformations or any other pregnancy complications, so it can be taken by a woman who does not know she is pregnant. The relevant drug interactions relate to liver enzyme inducing drugs, and the issue here is one of reduced efficacy of EC. This could be clearly stated in the Patient Information Leaflet.
EC is considerably safer than many medications currently available to purchase from the shelf without consultation, including Nicotine Replacement Therapies, which can be fatal if ingested by young children and enzyme inhibitors such as Nexium, which can mask serious underlying gastric conditions such as cancer, and the long term use of which is associated with the sometimes fatal c.difficile infection. Placing products on the shelf does not mean people cannot consult with their pharmacist about the most appropriate product for them and how to use it, it simply means that such a consultation is not mandatory. There is nothing that a pharmacist asks a woman requesting Emergency Contraception which would preclude her from taking it.
What can I do?
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