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Access to emergency contraception “an avoidable mess”, BPAS warns, with women forced to risk their health, confidentiality, or an unplanned pregnancy during the pandemic.

  • One third of pharmacies are unable to provide emergency contraception in a confidential and COVID-secure way due to current licensing restrictions, research by the charity the British Pregnancy Advisory Service, BPAS, has found.
  • This could be solved by the Secretary of State reclassifying EHC as a General Sales List medication so it could be sold without a mandatory consultation as it is in other countries – and as a new poll shows most women would prefer.
  • A mystery shop exercise of pharmacies conducted by BPAS found that a lack of physical space in some pharmacies meant that women would have to undergo the consultation, which can include intimate questions about sexual activity, on the shop floor through a plexiglass screen.
  • The situation is particularly acute given concerns regarding women’s access to more regular methods of contraception as a result of the pandemic, with particular backlogs for LARC replacements and fittings.
  • BPAS are advising women to keep a supply of emergency contraception in their bathroom cabinet until the situation improves. EHC can be obtained in advance from the online pharmacy Chemist 4 U for the lowest available prices - £3 for the levonorgestrel product Ezinelle and £18.99 for Ella One.

Research published today by the British Pregnancy Advisory Service, BPAS, has found that one third of pharmacies are unable to provide emergency contraception in a confidential and COVID-secure way due to current licensing restrictions. The charity is calling for emergency contraception to be reclassified by the Secretary of State for Health as a general sales list (GSL) medication which would enable women to purchase this safe and effective medication directly from the shelf, without placing their health or confidentiality at risk during the pandemic. BPAS are concerned that if pharmacists are unable to provide a private, COVID-secure, consultation, women may be deterred from accessing EHC when needed.

In September, a BPAS mystery shopper contacted 34 pharmacies in England. Of these, two were out of stock of emergency contraception, and one pharmacy did not provide emergency contraception. Of the 31 pharmacies with emergency contraception in stock and available for sale, ten were unable to provide a confidential and COVID-secure consultation. Within this group:

  • In 2 pharmacies, the consultation rooms were closed due to COVID-19.
  • In 5 pharmacies, the consultation room was too small to observe social distancing.
  • In 2 pharmacies, the client was offered a verbal consultation using the screen at the shop floor counter.
  • In 1 pharmacy, the pharmacist offered to conduct part of the consultation via a written form followed by a verbal discussion on the shop floor.

The remainder had developed different ways to try to achieve a COVID-secure, confidential consultation, with varying levels of practicality. Less than half (14) pharmacies were able to use their consultation room after adopting measures such as plastic screens or full PPE.  However, within this group, 4 of the pharmacies stated that they had limited capacity to provide a consultation in private because this space was heavily booked for flu vaccination appointments.

Under the current regulatory framework, pharmacists must conduct a consultation with every woman requesting EHC. If EHC were reclassified as a GSL medication, it could be sold straight from the pharmacy shelf, without a consultation, as is the case in the USA, Canada and several European countries including France. Women would still be able to seek advice and assistance from a pharmacist, but the reclassification of EHC as a GSL medication would enable women to access it swiftly and safely at a time when it is essential to minimise social contact. A survey of over 1,000 women from across the UK found that more than half (55%) said they believe women should be able purchase EHC without undergoing a mandatory consultation, with 7% expressing no view, and 38% supporting the mandatory consultation.

There is precedent for the Secretary of State amending the regulatory framework for emergency contraception. In 2000, the-then Health Secretary reclassified Levonelle Emergency Contraception from a Prescription Only Medication (POM) to a Pharmacy Medication via a Statutory Instrument 

Clare Murphy, Deputy Chief Executive at the British Pregnancy Advisory Service, BPAS, said:

“Many pharmacists are doing their best to provide emergency contraception at this very difficult time.  However, our research has found that one third of pharmacists are limited by the space of their store and the current licensing requirements. The physical constraints that pharmacists are operating under cannot be changed – but the current regulatory framework, which places pharmacists under an obligation to undertake a consultation with every woman requesting EHC, can and should be. 

"At a time when many women are having trouble accessing their normal method of contraception, it is imperative that access to EHC is swift, safe, and convenient. Long-acting reversible contraceptive methods, such as the coil and the implant, which require insertion by a medical practitioner, are particularly difficult to access due to service closures and limited GP appointments. This may mean that more women will therefore be relying on condoms and daily pills, for which emergency contraception is an important back-up if these methods fail or are forgotten.

"Women should not be forced to risk their confidentiality or health to prevent an unplanned pregnancy. This is an entirely avoidable mess, which could be swiftly solved by the reclassification of emergency contraception by the Health Secretary. Until then, we urge women to keep a packet of emergency contraception at home as a back-up method.”

ENDS

For more information, please email press@bpas.org or call 07881 265276

Notes to Editors:

All figures, unless otherwise stated, are from Censuswide. Total sample size was 1,007 women aged 18-45. The survey was carried out online between 2nd – 7th September 2020.

About BPAS:

BPAS is a charity which sees almost 100,000 women a year for reproductive healthcare services including pregnancy counselling, abortion care, miscarriage management and contraception, at clinics across the UK. It supports and advocates for reproductive choice. BPAS also runs the Centre for Reproductive Research and Communication, which seeks to develop and deliver a research agenda that furthers women’s access to evidence-based reproductive healthcare, driven by an understanding of women’s perspectives and needs. You can find out more here.

BPAS intends to launch a not-for-profit fertility service in Spring 2021, to provide ethical, evidence based, person-centred care that supports patients. We intend to only charge what it costs to provide a safe, high-quality, and accessible service to patients who may be unable to access NHS funded care.