Contraception at your convenience?

Contraception at your convenience?

With a small news headline on the front page proclaiming ‘Prescription not needed for Pill’, Wednesday’s Metro newspaper (10.12.2008) caught my attention as I made my way in to work. According to the small front page summary; ‘The contraceptive pill will be given out at pharmacies without a prescription from next year. Women will be able to bypass the doctor’s surgery and have a consultation with a pharmacist before obtaining it free’

My first reaction was to welcome the news, as I thought back to the inconvenience of arranging my last doctor’s appointment to renew my Pill prescription. Once I had eventually been able to make an appointment that wasn’t completely inconvenient as far as work was concerned, all that was required of me was to have my blood pressure measured before being given, as usual, the all clear and the all important slip of green paper.

With time to kill on my tube journey, I settled down to read the rest of the story over on page 7. Knowing that the Metro paper can, like many of the tabloid-style free papers, be a teensy bit alarmist I was interested to see how long it would take before this simple story about making contraception more accessible would veer off course and start predicting the end of the world as we know it.

The unfounded speculation came even sooner than I thought, with the 3rd sentence stating; ‘Pharmacists could eventually be granted the right to give the Pill to girls under 16 without their parent’s consent, something GPs can already do’. With the seeds of fear firmly planted that this move will further enable under-age girls to have sex behind their parent’s backs, the report then went on to state that ‘Family planners warned there was no evidence that making the Pill available from chemists would cut unplanned pregnancies, and said it could lead to more sexually transmitted infections’. Who these ‘Family planners’ are exactly is never divulged, so whether we should take their word as gospel is highly suspect.

Following on from this point, Norman Wells of the group Family and Youth Concern (whose seasonal bulletins carry reports under headlines such as ‘Dismantling the altar of ‘safe sex’’ and ‘Sexual orientation regulations seek to force public approval of homosexual practice’) is quoted in the Metro report as saying “As far as young people are concerned, this is promoting a casual approach to sex. It will result in more teenage pregnancies, more abortions and more sexually transmitted infections.’ Well, if that’s not scare-mongering I’m not sure what is. I would love to know how Mr Wells arrived at the conclusion that improved access to contraceptives will result in more unwanted pregnancies and, therefore, abortions. Of course the contraceptive pill is no substitute for sex education, but no one is saying that pharmacies will be handing out Pill packets willy-nilly and saying ‘just get on with it!’ One would hope that pharmacists would discuss the Pill properly with new users, as well as discussing the importance of barrier methods as a preventative measure against the passing on of STIs. If that was all done, I’m not sure how Wells could be proved right. Perhaps Wells imagines that younger women will be unable to take their medication properly due to the supposed sloppy-ness of youth?

The Guardian, reporting on the same story, might have managed to assuage Well’s fears with their statement; ‘Any woman getting the pill in this way would have to go through the same procedure as she would if she visited the GP. That would involve a questionnaire about her health and other medication she might be taking. It could also mean that the pharmacist would take her blood pressure.Pharmacists will also be given extra training. “We will work with the pharmacy profession to ensure robust standard-setting and appropriate training to ensure pharmacists are competent to safely provide this service,” the department said.’

Reading this story in the Metro, I was left wondering what had become of the many women who take the pill who are not in this highly suspicious and unsavoury bracket of ‘teenage’ or, god-forbid, ‘underage’ who are all, by default, into daisy chaining parties and casual sex behind bike sheds. If the pill is ‘used by 4 million women’, then what of the majority who, whether in relationships or not, simply want control over if and when they might want to conceive. But, hang on, wouldn’t that be pretty much every woman who has taken the decision to take the contraceptive pill? In this country, every woman has the right to free contraception, no matter how old they are or what their sexual lifestyle consists of. This seems to have been forgotten in this report.

If the Metro had not overlooked this truth, perhaps it could have had the foresight to get it’s knickers in a twist about other issues that this plan (if eventually carried out next year) could bring up for women.

In it’s October 2008 issue Company Magazine published the results to their ‘Your Voice Your Choice’ survey that said; ‘more than a third of you are unhappy with your contraception and one in five of you haven’t even had different forms of contraception discussed with you’. With readers complaining that GPs tended only to talk about contraception in terms of the Pill or Condoms, Company concluded that it was unfair that 20% of primary care trusts refuse younger women Long Acting Reversible Contraception (the coil, implant and injections). The Pill might not be the right choice for women, who smoke, have diabetes or a high blood pressure . If the Pill does become available for free over the counter, will this make it even more difficult for women to pursue other options?

Also, with women suffering from side effects such as mood swings and migraines from some Pill brands it is important that women be able to ’shop around’ for the right pill for them. Microgynon is the cheapest pill on the market, at about 80p a packet, which means it is dished out to most women. This is because the NHS tries to cut costs where it can and has a responsibilty to be as cost effective as possible. So, this begs the question, of all the 26 brands of the pill which might be the one made freely available from pharmacies? And, more importantly, will pharmacies be happy to let women try out as many other brands as they feel they might need to in search of the right Pill for them?

In reality, free contraceptive Pills over the counter at pharmacies seem a rather distant dream. Apparently the plan will only be implemented in two London Primary care trusts (Lewisham and Southwark) next year to see whether the scheme would be suitable for the rest of England. In the mean time, I’ll be keeping an eye out to see how the story will be reported.

By: Sarah Barnes, 12.12.2008 | Comments (1)
Comments
  • Gareth Thomas
    January 16th, 2009
    3:37 am

    As a pharmacist I read this article with great interest. It is encouraging to hear positive comment on the benefits of increased access to healthcare taking in to account the feelings of the majority of people who might access such a service.
    I imagine that the metro article failed to mention that emergency hormonal contraception (ehc) aka the “morning after pill” has now been available in pharmacies to buy over the counter for several years, probably because the fabric of our society still remains in tact.
    To answer a couple of questions:
    It is unlikely that the oral contraceptive (oc) is that distant a dream. Yes there will be a trial but there was for the eoc and the treatment for chlamydia.
    There probably won’t be much choice, at least to start off with. Either it will be available to buy(1), like the ehc, Levonelle one step, which means that one pharmaceutical company will step up and prove to the MHRA that their product is, with correct questioning and counseling, safe to sell off prescription. The alternative is that each PCT sets up a patient group directive (PGD)(2). Think of it as a pre-signed prescription so a prescription medicine could be supplied after correct questioning and counseling by a pharmacist to a patient. The contraceptive would then be free again. Each PCT would have to decide whether there is a need for this service beyond the existing structure, as they’d have to pay for it, and would choose the most cost effective contraceptive to be supplied…..microgynon.
    This is also where age could become a factor. Choice 1 would probably be for 16 yrs or over but choice 2 could cover all ages. If there was a need, one example being high teenage pregnancy rates, a PCT could include under 16’s. PGD’s are currently the only way under 16’s can obtain ehc from pharmacies.
    The uptake by pharmacies would probably be lower to join a PGD The uptake by the women would be lower if the contraceptive had to be paid for as it is unlikely that the 80p price (for microgynon) to the NHS would be passed on to the consumer by the pharmaceutical company.

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