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The morning-after-pill should be available over the counter - and here's why

The story of the regulation of emergency contraception is the story of the regulation of women’s bodies, writes Clare Murphy
The story of the regulation of emergency contraception is the story of the regulation of women’s bodies, writes Clare Murphy Credit: IAN HOOTON/SPL 

It's a cry that has been gaining momentum for some time: women should be able to buy the morning-after-pill over the counter, without the need for a consultation. 

Now a new report by the Royal College of Obstetricians and Gynaecologists has joined many of us in recommending just that. It says that emergency contraception should, just like condoms and pregnancy tests, "be sold straight off the shelf" - without the need from a grilling by the pharmacist, which can make women and girls feel "uncomfortable, embarrassed or judged" and deter some from attempting to get the pill at all. 

The Better for Women report also points out that there are currently too many barriers to women accessing basic health services in the UK, suggesting that they should be allowed to take abortion pills at home, and be able to have consultations for early abortion over the phone - not to mention having clinics where women can have all their sexual and reproductive healthcare needs met in one place. We can but dream.

When it comes to the morning-after-pill, in particular, we continue to punish women at their time of greatest need. Price is a serious factor here - a row has exploded again in advance of the Christmas season, as online retailer Dr Fox is selling emergency contraceptive pills for £3, so that women can have them at home if they need them.

Cue “outrage” from the moral crusaders at Society for the Protection of Unborn Children (SPUC - the ones who believe gay marriage causes abortion), so no surprises there.

But the real moral outrage should be directed at a system that peddles pills at vastly inflated prices and restricts access only to those who submit to a consultation. That isn’t very moral at all.

Emergency hormonal contraception is not a silver bullet for unwanted pregnancy, but it is one of the best options we have when a regular method failed or was forgotten, when you miscalculated your cycle, or when things simply didn’t turn out as planned.

It is a source of huge frustration for us at the British Pregnancy Advisory Service (bpas) that a method which gives women a second chance has so many barriers. Less than a third of women use the morning-after-pill after an episode of unprotected sex, so it is absolutely an under-utilised resource.

Indeed the price of the pill was set high from the outset to act as a deterrent to regular use – well done – the upshot is women don’t use it nearly as regularly as they should.

In 2017, following a campaign by bpas, the sky high price of the progestogen-based for of EHC came down. It is now widely available for between £13 and £16, which still means it has a massive mark-up on it. And some pharmacies don’t offer women a cheaper version at all - Lloyd’s for example charges £26 for a pill you order online and pick up in store.

Presumably, it believes women will bear the price premium in order to avoid that awkward face-to-face conversation with the pharmacist - I’ll leave you to make of that what you will. It was also the same chemists whose pharmacist refused to dispense said pill once a woman had ordered it online - citing conscienscious objection and sending the woman to another town altogether.

The best way to get the morning-after-pill into women’s hands at a more affordable price would be to reclassify progestogen-based emergency contraception to a General Sales List medication, which means it could be sold straight from the shelf from a variety of locations, just like condoms and pregnancy tests.

In North America and many European countries, women do not have to undergo a consultation in order to obtain this product, indeed in the US it is now increasingly available from vending machines. Getting it into these kind of spaces not only means women can access it more easily, it also destigmatises this medicine, which for so long has been wrapped up in shame and secrecy.

Indeed, the story of the regulation of emergency contraception is the story of the regulation of women’s bodies, sexuality, and a lack of trust in their ability to use this product.

Any woman buying emergency contraception should be able to seek advice if she needs it, but we should not make access contingent on her receiving that advice. A good example is the way in which we regulate nicotine replacement therapies – these are widely available for sale in a variety of locations on the basis that there are no circumstances where it is safer to smoke than to use them.

People needing them are trusted to seek further advice if they need it, and onward referrals, but we don’t force them into doing so. The same should be true of emergency contraception: there are simply no circumstances where it is safer to be pregnant than to take emergency contraception – the individual and public health benefits of helping women avoid unwanted pregnancy are huge.

Women agree with us. Polling we conducted with 1,000 women last year found 64 per cent did not think the consultation should be mandatory, and shared their experiences of interactions obtaining emergency contraception – the good, the bad, the ugly: “Judged”, "Made to feel like a whore” and “Slightly slutty”.  

Bpas undertook its own mystery shop of 30 pharmacies in 2018 and found while many pharmacists provided a kind, swift and non-judgmental service, there were some examples of appalling care – including women being asked to show ID, take a pregnancy test and even being sold the wrong product. Consultations were often held on the shop floor, and little information was provided about STIs or other forms of contraception... advice which is used to justify the need for the consultation in the first place.

Emergency contraception works best when it is taken as soon as possible after unprotected sex. We owe it to women to give them the best possible chance of this method working for them – and we will keep campaigning until we’ve got it into women’s hands, where it belongs.

Do you think the morning-after-pill should be available over the counter? Or should there still be a consultation? Tell us where you stand on this debate in the comments section below.