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.