If women are having to pay £45 for fast access to emergency contraception free from humiliation, the system is truly broken and in need of complete overhaul.
In many ways we absolutely applaud the new initiative from EllaOne, the newest and most effective form of emergency hormonal contraception. Women can go online, answer a few very straightforward questions, and, if they live in London, the pill can be couriered to them within three hours. For £44.94. Outside of London a next day service is available.
The delivery service initiative, which in itself isn’t new, been developed in response to the long held knowledge that women find the process of obtaining emergency contraception awkward and embarrassing, and having to answer intimate questions posed by a pharmacist often on the middle of the shop floor is at best not the most enticing way to spend ones lunch break, and at worst an absolute barrier to women obtaining it.
A mystery shop of phamacies by Bpas published last year found many pharmacies did not have a private space for consultation. While many pharmacists provided a swift and non-judgmental services, there were some appalling examples of care, including being told to take a pregnancy test before sale, show ID and be tested on your date of birth, and lectured on it not being a regular form of contraception. Women we polled as part of the research also described their experience own as “made to feel like a whore” and “quizzed and made to feel slightly slutty”.
EllaOne’s own findings that nearly half of women had had an episode of unprotected sex in the last year but of those only a quarter had used emergency contraception is very credible. The in person consultation acts as a barrier to use, as does the phenomenally high price of the product.
In 2017 Bpas launched a national campaign to reduce the price of levonorgestrel-based emergency contraception, the older sister of EllaOne, and a product that has been available to buy after consultation from a pharmacist since 2002.
It became apparent to us that the price women were being asked to pay for levonorgestrel, in the region of £30, bore no relation to the price of the product. When we asked Boots to reduce the price we were told by their chief pharmacist that they wouldn’t do so on the basis that it might “incentivise inappropriate use”.
After national outcry over this position Boots did start selling a cheaper generic levonorgestrel product for £15.99 (still steep for what it is), joining Superdrug and supermarket pharmacy chains in Tesco, Asda and Morrisons who were stocking it for £13.50.
But the fact that emergency contraception, safer and with fewer side effects than many products available to buy straight from the pharmacy shelf, is still kept hidden behind the pharmacy counter, available only after consultation is a problem.
The EllaOne delivery service may get round this – but only at a high price for women in need.
When EllaOne is sold to pharmacies for around £14 it is perplexing why women are paying £20 on top of this to buy it direct, and a further £10 to have it delivered.
EllaOne should be applauded for their campaign to destigmatise the use of emergency contraception, #mymorningafter, to make clear it is a product women should feel able to use when they need it, but the price bracket they’ve set it at positions it as product only for exceptions – and feels a little exploitative of the very women it is purporting to champion in their time of need.
Instead of tinkering at the edges with different ways of delivery, we need a through overhaul of the framework around emergency contraception, so it can be sold straight from the shelf without consultation, with further sources of information and advice available to women who request it – not delivered via a mandatory interaction with a healthcare professional.
Our medicines watchdog the MHRA approved the sale of nicotine replacement therapies (NRTs) straight from the shelf and to all groups, even where they may be some risks attached, on the basis that there were simply no circumstances where it was safer to smoke than to use NRTs.
There are very few risks associated with EllaOne and next to none with levonorgestrel (the biggest risk is that it won’t work). What puts women at risk? Pregnancy. There are no circumstances where it is safer to be pregnant than take emergency contraception.
How dare we put barriers in the way of women trying to avoid a pregnancy that may risk their life, health and mental wellbeing.
Emergency contraception, whether EllaOne or levonorgestrel, is most effective when it is taken as soon as possible after unprotected sex.
Swift, shame-free access shouldn’t mean delivered to your door in secret packaging for £45. It should be available to pick up off the shelf at your pharmacy or supermarket, without inquisition (or demands you take a pregnancy test), for less than a tenner.