- Poll finds majority of UK women would like to buy EC without a mandatory consultation; women describe feeling “judged”, “like a whore” and “slightly slutty” during the interaction
- Mystery shop study also published by bpas today of 30 pharmacies found while majority of pharmacists provided a kind, non-judgemental interaction, there were notable exceptions with the shopper being asked to show ID or even take a pregnancy test before they would sell it
- Multiple people often had be asked before help could be offered, and lack of private rooms in some pharmacies meant private discussion about sexual activity took place near other customers
- bpas calls for EC to be reclassified as a General Sales List product and made available for women to purchase directly, seeking advice only if they need it, enabling pharmacists to focus their expertise on those requesting additional support
- The charity notes the pill is sold straight from the shelf without consultation in countries with robust medicines regulatory regimes such as Sweden and the US. There are no risks which outweigh its use and it is considerably safer than many medicines sold straight from the shelf in the UK.
Most women in the UK would prefer to buy emergency contraception without a mandatory consultation with a pharmacist, as is the case in North America and elsewhere in Europe, a poll commissioned by the British Pregnancy Advisory Service shows.
64% of women aged 18-45 polled said they believed the consultation should be optional, with 57% wanting to see it sold directly from the shelf. Women described mixed experiences of the consultation - ranging from: “Awful. Made to feel like a whore” and “Quizzed and made to feel slightly slutty,” to “informative, respectful and swift” and “easy and pain free”. Women also describe instances of being denied the medication they requested, including one case ending in unplanned pregnancy and abortion. The price was also described as “exploitative”.
Bpas today also publishes the results of a mystery shop of 30 pharmacies in England to better understand the provision of emergency contraception today. Nearly 2 decades after it was first made available in pharmacies, the progestogen-based pill still remains firmly behind the counter, available only after a consultation, while other medications with significantly riskier safety profiles are sold directly from the shelf.
The results from the mystery shop illustrate that current arrangements for the sale of emergency contraception can put women at risk of unwanted pregnancy by putting needless barriers in their way.
While many pharmacists provided a swift, non-judgmental service, there were notable exceptions: the 22-year-old shopper was asked to show ID and be tested on her date of birth, take a pregnancy test, and she was also refused progestogen-based emergency contraception because she said she had already used it once in that cycle. This refusal has no basis in evidence or guidance.
Emergency contraception was hidden from view in the vast majority of pharmacies, and only 17% of pharmacies visited had any indication on the shop floor or within the window that emergency contraception was available. No information was provided in the women’s health section. This is in sharp contrast to other products, which are often advertised in store (such as erectile dysfunction medication) or with placeholders for customers to take to the pharmacy counter.
Under current rules, emergency contraception can only be sold by a pharmacist, and not a pharmacy technician or assistant. In more than half of pharmacies (55%), our shopper had to speak to at least two members of staff before the pill could be sold – and on one occasion 4 different members of staff were involved in the sale.
Fewer than half (48%) of pharmacies visited offered a private room for consultation, so conversations about sexual activity were sometimes held near other pharmacy users, creating a significantly more awkward experience for the shopper.
Although the consultation is justified as necessary because women will be provided with advice about all forms of emergency contraception, other methods of contraception and STI testing, this was not provided in the pharmacies visited. Only 7% provided accurate clinical information about EllaOne, an alternative form of emergency contraception deemed to be slightly more effective, and none provided information about the most effective method of emergency contraception, an IUD, or where that could be obtained. It has also been suggested that the consultation is required to ensure that women are taking the medication in the right time frame – however research shows the number of women presenting outside of the timeframe is negligible.
The cost of exactly the same branded product varied from £11.49 to £24.99, and there was no relationship between the cost and the length or quality of the consultation. The online pharmacy Chemist4U has recently noted that women are being charged up to 650% of the cost price of EC.
Clare Murphy, Director of External Affairs at the British Pregnancy Advisory Service, said:
“The obligatory consultation is a barrier to access to this vital medicine. This is a medication with an impressive safety record, there are no contraindications to its use and it gives women a crucial second chance of avoiding an unwanted pregnancy. Pharmacists can be an excellent source of information, but most women know what they need and would like to see the end of a mandatory consultation, with further advice available only if they request it.
“Instead of emergency contraception being squirrelled away out of sight at the back of the pharmacy, many women would also like to see it on the shelves where it belongs, alongside other essentials. Nearly two decades after emergency contraception became available from pharmacies, it is still treated as a source of shame. It deserves to be on the shelves, at an affordable price, for women to use when they need it. Other countries have given women this access and the sky has not fallen in – we believe the UK should do the same.”
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Notes for editors
The poll of 1001 women aged 18-45 was carried out by Censuswide between 5/11/18 and 7/11/18. Regional breakdowns are also available on request.
The mystery shop of 30 pharmacies can be found here.
More information about emergency contraception can be found here.
bpas is a charity which sees more than 70,000 women a year and provides reproductive healthcare services including pregnancy counselling, abortion care, miscarriage management and contraception, at clinics across the UK. It supports and advocates for reproductive choice. More information can be found at bpas.org.