Is over the counter contraception the answer to an existing lack of access?
A public consultation led by the MHRA will be collecting public opinion on the potential reclassification of two progestogen-only pill types: Lovima 75 microgram film-coated tablets and Hana 75 microgram film-coated tablets.
Both products are currently only available with a prescription following a medical consultation. If reclassification is approved, the two pill types could be sold over the counter at pharmacies, in what would be a UK first.
A consumer healthcare association quoted in a recent Guardian article labelled the move a ‘positive step’ and at face value, it is.
We know access to contraception has been increasingly challenging for women over recent years. A 2019 Inquiry into Access to Contraception conducted by the All Party Parliamentary Group on Sexual and Reproductive Health (APPG SRH) highlighted that ‘women in England are facing increasing difficulty in accessing contraception which suits their needs’ (1).
We also know that the issue of inadequate access to contraception disproportionally impacts marginalised women, with the Inquiry also noting that there ‘is an urgent need to structure care around the needs of women, especially underserved groups such as ethnic minorities, young women and women from poorer communities’ (2).
Sadly, Covid-19 exacerbated the issue, forcing many GPs and clinics to limit provision of contraception, including routine long-acting reversible contraceptive (LARC). During the pandemic, fittings of LARC were ‘almost universally suspended, with 54% of SRH service providers ending or limiting the provision of emergency LARC and 39% ending or limiting provision for LARC complications’ (3).
Funding is another factor making access to contraception and sexual health services problematic. The local authority public health budget was cut by £700 million in real terms between 2014/15 and 2019/20. This reduced sexual health service budgets by 25%, despite rising rates of STIs and a 15% increase in demand for services (4).
The solution isn’t to sell daily contraceptive pills over the counter. Not in isolation, at least. Any meaningful solution must consider the bigger picture and come up with workable strategies that promote enhanced access to services, while working under the constraints of a shrinking financial envelope.
While the pandemic has undoubtedly compounded access in many areas, it has also acted as a catalyst for much needed innovation in others. For example, more healthcare providers than ever before turned to digital services, remote consultations and telemedicine during the pandemic – ‘improving access to services for some underserved and isolated individuals, including women in rural areas and women living with abusive partners’ (5).
What if we used this as a starting point to redesign the way we approach the delivery of sexual health? What if, with improved access as the primary objective, we empowered patients to take control of their sexual health and contraception needs? A digital front door for patients where they can communicate with providers, book appointments, order contraception and complete remote testing for STIs with autonomy and convenience…. Now, wouldn’t that be wonderful?
(1) https://www.fsrh.org/policy-and-media/all-party-parliamentary-group-on-sexual-and-reproductive-health/
(2) https://www.fsrh.org/policy-and-media/all-party-parliamentary-group-on-sexual-and-reproductive-health/
(3) https://www.fsrh.org/policy-and-media/all-party-parliamentary-group-on-sexual-and-reproductive-health/
(4) https://www.tht.org.uk/our-work/our-campaigns/funding-hiv-and-sexual-health-services
(5) https://www.fsrh.org/documents/womens-lives-womens-rights-executive-summary/
