Andrea Butcher

A bitter pill

From Socialist Review, No. 178, September 1994.
Copyright © Socialist Review.
Copied with thanks from the Socialist Review Archive.
Marked up by Einde O’Callaghan for ETOL.

Government plans to make contraception available over the counter may seem like a welcome expansion of provision. But, as Andrea Butcher explains, the Tories’ interest in the big business of contraception has to be looked at with suspicion

It may soon be possible to buy the contraceptive pill or the ‘morning after pill’ over the counter in chemists without a prescription.

As prescription charges get higher and higher people are being encouraged to buy the products they need directly from the chemist and cut out a visit to the doctor.

But ‘over the counter’ (OTC) provision raises many issues which are causing fierce debate within the healthcare community and society in general.

The Family Planning Association is supporting moves for wider availability of emergency contraception (the morning after pill) which has to be taken within 72 hours of unprotected sex. Many women find that they are currently unable to get an appointment with their local GP or family planning clinic in time. Others, especially young women, are too embarrassed to ask their family doctor for help and risk an unwanted pregnancy.

Anti-abortion groups like LIFE and SPUC are totally opposed to OTC provision. Despite claiming to want to reduce the number of unwanted pregnancies, they are scared to death by the thought of women, especially those under 16, gaining easier access to the morning-after pill.

Pharmacists are also in favour of making emergency contraception easier to get. Every pharmacy has at least one trained health professional on site at all times and all pharmacists are more than adequately qualified to give help and advice on the use of the morning after pill.

However, the Family Planning Association has been quick to make the point that providing emergency contraception OTC must not mean that women can no longer choose to get treatment free of charge via the NHS. There is a real fear that the government wants to use OTC provision as yet another cost cutting exercise.

The Tories have already attempted to get certain contraceptive pills removed from NHS prescription lists. Labour MPs Glenda Jackson and Dawn Primarolo sponsored a motion to prevent the blacklisting. The two pills the government wanted to block both contain the new progesterone gestodene and are among the most expensive. A spokeswoman for Schering Healthcare, the company which produces the pills, said, ‘Surely they have the right to the most modern progesterone. Why should they be denied the choice?’

In fact the pills the government wants to be restricted are some of the most suitable for young women starting oral contraception. At a time when the government professes to be concerned about the level of teenage pregnancies, a certain hint of hypocrisy can be detected.

Any decision to make either the pill or emergency contraception available for sale via pharmacists without prescription has to go hand in hand with protecting free NHS provision. There is nothing the Tories would like more than to force women to pay for the contraceptive care they currently receive free of charge.

At any given time nearly 25 percent of sexually active women in Britain are using the contraceptive pill. This is a massive potential market and a massive source of potential savings within the NHS.

All along the line people are making huge profits. We don’t yet know what sort of prices would be charged for emergency contraception if it were available over the counter but charity clinics such as Marie Stopes and the British Pregnancy Advisory Service already charge their clients between £15 and £30. The actual cost to buy a dose of the morning-after pill from the manufacturers is around £1.40.

The experience of OTC availability in America doesn’t support the argument that costs will always fall. When Monistat-7, a vaginal medication, was granted OTC status, prices rose for clinics and customers alike. Some doctors have even argued that women would value the pill more if they had to pay for it.

Globally, there is a huge need to address the issue of safe and effective contraception. Every day there are 910,000 conceptions, 150,000 abortions and over 500 maternal deaths – the equivalent of a jumbo jet crashing each day of the year. Of the maternal deaths, 40 percent are due to unsafe abortions.

Research into new forms of contraception has virtually ground to a halt. Scientists are more than keen to do the job but the drug companies have taken away the funding.

The effect of the worldwide recession has been clear to see. Dennis Lincoln, director of the Medical Research Council’s reproductive biology unit in Edinburgh, said, ‘There has been a massive reduction over the past 15 years in research related to contraception.’

All over the world the health of women plays second fiddle to profits. In Indonesia drug companies paid incentives to doctors to fit the new contraceptive implant, Norplant. Norplant does have certain advantages for some women and, despite the way it has been used as a method of social control in America, it has a place in contraceptive healthcare. As a result of the incentives offered to doctors, over a million women in Indonesia are now walking around with contraceptive implants.

However, the manufacturers have offered no similar inducements to doctors to remove the implants should they prove unsuitable or after they cease to be effective.

Meanwhile in Britain women who want to use Norplant are being turned away because their cash starved GPs can’t afford to buy the drug.

In Pakistan a new procedure, quinacrine sterilisation, is causing controversy. Tim Black, director of Marie Stopes International who are using the new technique, has said, ‘It’s looking as if it’s very safe and effective. Certainly, the relative risk of having a baby in a rural area is much higher than anything quinacrine presents.’

But again many professionals are questioning why it always seems to be women in less developed countries who act as guinea pigs for new treatments and there is a worry that the ease and cheapness of quinacrine sterilisation might prove irresistible for governments looking to coerce women to give up their fertility.

There is no doubt that many millions of women want access to reliable sterilisation. One of the advantages of quinacrine is that women can use it immediately after the birth of a child to prevent any more pregnancies. They can also do so without their husbands having to know any procedure has been performed.

Used in the right way it could be an enormous boon for women who want to control their fertility especially in cultures where women have little economic or social power.

The problem is, while working class men and women are denied real control over their lives, developments which might make all our lives more bearable are taken away and used against us.

What real use is over the counter provision of the pill if the Tories continue to cut sex education and close down more and more family planning clinics?

What does it mean if the morning after pill is for sale in the local chemist if you simply don’t have £15 to buy it?

How can you decide whether or not to use a new treatment if you have no confidence that adequate research has been done to ensure it is safe and effective?

We have to fight every inch of the way to protect whatever gains we have won in the past and to push for more control over technologies and developments that can help us in the future.

When the anti-abortion bigots plan another assault on Britain, fighting them off can be the first step in improving reproductive healthcare choices for us all.

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