Calls for more contraception access in England as pill goes over-the-counter | Contraception and family planning

A move to make contraceptive pills more accessible in England has been welcomed by experts, but they say provision of other, highly effective, methods as well as counselling must also increase to ensure women’s needs are met.

The pills are to be made available on the NHS via high street pharmacies from next month.

Earlier this year Prof Lesley Regan, a leading gynaecologist and women’s health ambassador for England, warned that women’s access to contraception had been getting worse, resulting in a rise in unplanned pregnancies.

Some contraceptives also help with gynaecological issues, including heavy periods, and the menopause, meaning poor access can have wider ramifications for women’s health.

The move, announced on Thursday, goes further than a previous step made in 2021, that made it possible for women to buy progestogen-only pills (POP) over the counter: not only does the new announcement mean provision is free, but it also covers oestrogen-containing pills.

Dr Janet Barter, president of the Faculty of Sexual and Reproductive Healthcare, said the organisation was thrilled by the announcement.

“Pharmacists are experts in medicines and well placed to provide high-quality care and advice on contraception,” she said.

“These changes will increase access and make it easier to access essential contraception at a time and place that is convenient to them, giving women more autonomy over their lives, allowing them to decide if and when they would like to get pregnant.”

But more needed to be done, she said.

“The pill is just one form of contraception, and it is really important that we now look to increase access to all the other forms of contraception. In particular to long-acting reversible contraceptives [Larcs] like the coil and the implant, which are the most effective contraceptives available,” she said.

“We believe that women should have access to the full range of contraceptive methods in the location of their choosing irrespective of where they live in the UK.”

Dr Jenny Hall, a clinical associate professor of reproductive health at University College London, agreed. “Making the pills available at pharmacies will not reduce the need for Larcs and providing these services needs to be prioritised, too,” she said.

One issue is that many Larcs require a trained healthcare provider to fit, and many GPs do not offer the service. “It costs GPs more money to fit a coil than the practice is paid to do it,” said Hall.

As a result, women desiring such methods must typically visit a sexual health clinic, and often experience long waiting times. According to Herefordshire & Worcestershire Health and Care NHS Trust: “As of October 2023, the current waitlist for a routine coil or implant fitting is eight weeks to be contacted and then an appointment within four weeks of that.”

Experts have also stressed it is crucial women are given accurate information and counselling about the full range of contraceptives available so that they can find the right method for them: not everyone wishes to use hormonal contraception, while some experience unacceptable side effects. Even among hormonal methods, what works well for one person may not suit another.

“The pill is often the default option for women, and proper consideration of the range of options available may lead them to discover a method they would prefer,” said Hall. “Since pharmacists can’t offer the full range of options this discussion won’t happen and women may be on a less effective or less suitable method, or may experience side effects and stop taking it, and still be at risk of unplanned pregnancy.”

Dr Rebecca French, an associate professor of sexual and reproductive health research at the London School of Hygiene and Tropical Medicine, said it was important pharmacies received adequate funding and support to provide the enhanced service, noting it was also crucial that women were given the opportunity to return and discuss alternative options if they had side effects or other difficulties with the oral contraceptives.

Kate Muir, author of the forthcoming book Everything You Need to Know About the Pill, said one concern is the link between some oral contraceptives and conditions such as depression, particularly in young women.

“When they put out the announcement they should have put out a caveat at the same time which said: ‘Women who don’t know what they want should still go and see the GP or a sexual health clinic. You deserve information and proper counselling on contraception,’” she said. “People go on the pill as teenagers basically out of school and they should get a real proper consultation on what they’re doing.”

Hall said a more holistic approach was needed around provision of contraception.

“Properly funding that service, with adequate staff and training so that women have access to counselling and a range of contraceptive options at a time and place convenient to them, including digitally, would actually be more cost-effective and acceptable to women and healthcare professionals,” she said.

An NHS spokesperson said: “Pharmacists are qualified to offer women advice about the most suitable choice of contraception for them. As well-trained clinicians, pharmacists understand when to advise women to speak to their GP or another NHS service, based on clinical need. The NHS’ decision to expand oral contraception services to pharmacies is good news for women and offers them more choice in how they access care.”

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