There are few products on sale in our pharmacies that have a greater mark-up than emergency contraception. While the pills can now be purchased for under £4 from online retailers, women are still paying four times that for an equivalent product in places such as Boots.
Emergency contraception is not an impulse or luxury buy. It is an essential purchase for women of all ages – where regular methods failed or were unavailable – and is time sensitive. It is effective but its efficacy declines as the clock ticks. We can’t shop around or wait a couple of days for a package to arrive from a cheaper online provider.
It matters at a practical level that women can access it swiftly – and that means affordably. Of course it can be obtained for “free” from GPs, sexual health clinics and some pharmacies which participate in an NHS-funded scheme – although that doesn’t mean it is actually free; the cost in time both for the woman who has to make the appointment or the GP who needs to write the prescription, the fact that the time that takes can also reduce efficacy and result in unwanted pregnancy.
So retail access is important and pharmacies need to discharge this responsibility responsibly. That’s why the British Pregnancy Advisory Service, where I am chief executive, has been supporting the call from a group of women MPs for Boots to permanently keep progestogen-only pills at £8 – the 50 per cent off price it introduced as a Black Friday deal. In France it costs between three and seven euros to buy from a pharmacy while in the UK it can be bought for as little as £3.39 online.
There is a whole history to unpack within the packaging of this little white overpriced pill.
Many women are unable to attend a sexual health clinic or GPs to obtain free emergency contraception.
85% of people live within 10 mins of a @BootsUK. This is why it is so important they do not double the cost. - @RoseStokes
Sign the petition https://t.co/MDVggfy8MF pic.twitter.com/rg6WrIJIQ3
— BPAS (@BPAS1968) November 30, 2021
The product available today was originally conceived of as a medicine for women who were having more irregular sex to use on a fairly regular basis – as often as four times per month. The idea was to provide an alternative for women who did not want to take a daily contraceptive pill which they did not necessarily need, or caused them side-effects, at a time when fears about thrombosis were high. At one point it was sold in Europe by the manufacturer in packs of 10 – clearly underlining this as a method of choice, not a rarity. But that approach changed over time to the “only in emergency” framing we see today.
This framing has had a number of negative consequences for access. The first retail version was originally set at a high price when it was launched in the UK the early-Noughties to discourage women from regular use – even though there are no clinical issues with using the pill as often as needed.
It positioned the women who use it as somehow problematic. The mandatory consultation was conceived of as providing the requisite supervision of these women. Even when the cost of the actual medicine came down the price of in pharmacies remained high, as women were expected to pay for the privilege of this discussion. The consultation has frequently been used to justify the high price tag, even if it is little more than ticking a few boxes as pharmacists know how safe this is. There are no clinical contraindications to the use of the progestogen-only pill and the benefits of taking it even when a woman has a very low chance of conception clearly outweigh any mild side-effects.
The framework we see today – continued high prices, mandatory consultations – remains underpinned by a particular view of women and female sexuality. It’s salutary to compare this with the sale of Viagra, which also requires a consultation. Viagra is safe, effective and undoubtedly an important medication but its risks are significantly higher than those of emergency contraception, and erectile dysfunction can indicate other underlying problems. Yet its cost to buy from a pharmacy is substantially lower. There is not the same interest in policing men’s desire for sex with a woman’s wish to avert unwanted pregnancy.
Emergency contraception is not just safe in and of itself. It’s not a “nice to have”. It’s an essential medicine. Many pharmacists provide excellent support to women, but the time has come to take this out from behind the counter, to ditch the consultation and cut the price, and sell it from the shelves of a wide range of outlets. It can’t work if women can’t use it.