Posted by: Allyson | December 11, 2008

England to Begin Non-Prescription Birth Control Pilot Program

H/T to Daily Women’s Health Policy Report:

England plans to launch two pilot programs in the London area that will provide women with nonprescription access to birth control pills, the PA/Google.com reports. The pilot programs will begin next year in the Lambeth and Southwark primary care regions of England’s National Health Service, and the results will be used to determine whether the program should be expanded across England. Under the program, women seeking nonprescription oral contraception will undergo an interview with a qualified pharmacist. Strategic health authorities — which manage local health services under NHS — will be required to provide pharmacists with sets of instructions known as patient group directions, including special directions for girls younger than age 16, the PA/Google.com reports. According to the PA/Google.com, patient group directions are required by law to dispense medications without a doctor’s prescription and currently are used for administration of emergency contraception. The directions for dispensing EC to girls younger than 16 include a mental health assessment.

I think that any measure designed to help women have easier access to birth control is great, and I think it would be fantastic if birth control could be offered without a prescription.  On the other hand, though, I worry about the interview with the pharmacist (or nurse, as the case may be).  From personal experience, I have medical issues (family history of high blood pressure and certain cancers) that restrict the kinds of birth control pills I was/am able to take (I’m no longer on the Pill but have an IUD instead).  I felt more comfortable going through a more involved process, one that required me to go in for some minor, noninvasive tests after the first three months on the Pill to make sure it wasn’t doing major damage. 

Now, I assume that during the interview process, medical history will be taken into account and if a patient has health issues that prevent her from being on the Pill, the pharmacist or nurse will recognize that.  In the Daily Mail article, the author mentions that pro-life groups have criticized the plan because they don’t think the pharmacist’s interview will have the same safeguards.  However, I don’t think that’s really an issue.  When I was going on the pill for the first time, I had my vitals taken and was asked questions about my sexual health and family history.  I am sure a pharmacist could administer those checks just as well as a gynecologists.  However, I have concerns about what happens if a women who, for medical reasons, should not be on the Pill, decides to go ahead with it anyway?  My question is: what kind of safeguards will be in place to prevent women whose health issues prevent them from going on the Pill? 

I’m not saying I want to deny women the right to be on the Pill.  But speaking from my own experience, I had to switch pill brands when I went to graduate school, because my health center didn’t offer my original pills at a reduced rate.  The doctor I was seeing did not pay attention to my health history, and gave me pills that made my blood pressure go through the roof.  Now, I’m not inferring that those mistakes will happen during this pilot program (I mean, they might, but that’s not really my concern).  What were to happen if a woman had blood pressure issues was told to avoid the Pill, but wanted to take it anyway?  Would she be allowed to?  What if she got sick?  Who would be liable?  The pharmacist, or her?  I guess I’m kind of Libertarian in the sense that if a woman wants to do something that might make her blood pressure spike and possibly make herself sick, that’s her decision.  On the other hand, as I said, who would be responsible if she went against medical advice? 

I guess I need to have more confidence in people.  I mean, would a woman really want to risk endangering her own life just to be on the Pill?  I know I wouldn’t.  On the other hand, I’m lucky that I’ve had plenty of opportunity for contraception education and could afford the up-front expenses of an IUD – maybe there are women willing to take a risk just because they don’t know what else to do.  Although one hopes that a pharmacist would be able to give them Pill alternatives.

I genuinely hope that this pilot program will be successful, and I’m optimistic that it will work.  I am confident that the professionals running this program have taken all concerns into account.  I look forward to seeing how this program turns out, and hope that more comprehensive information about the pilot is released soon.

Crossposted at This is What a Feminist Blogs Like.

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Responses

  1. I don’t doubt that all women want what’s best for them. But I also don’t doubt that some women are too stupid to know about their medical family history. A pharmacist does not have access to medical journals, and if the woman does not know or can’t remember the exact names of her conditions and whatever medications she takes or once took and their effects. This will simply mean that she’ll need to go to her doctor to get a print of her medical journal to bring to the pharmacist – and why not go to the doctor in the first place anyway?

    Also: If birth control can be handled by a pharmacist, won’ that just mean that doctors are within their rights to charge (extra) for consultations about birth control – and that’ll harm those with a medical history.

    In any case, a pharmacist is NOT a doctor. It is required that you get a health check-up before birth control is prescribed as far as I know, and a pharmacist is not educated to do that nor is she/he educated to do a gynaecological exam. If anything I’d want my doctor who’s educated to do that and no one else, especially not someone who’s educated in phamocological stuff rather than medicinal stuff. I know they overlap in some areas… but uhhhh yeah.

    I think it’s great for birth control to be easily available to everyone. But let’s remember that it is a medication that affects the body’s hormone levels constantly – not just a one time gig – and sometimes drastically.

  2. Contraception is free in the UK. No woman sees a gynecologist to get contraception – most of it is handled by Family Planning nurses, the rest by their Genral Practitioner. Contraception is not a medical condition, and if a woman has medical issues that would prevent her from taking the pill, those would be just as likely to be missed by a doctor who didn’t know her medical conditions as a pharmacist. The attitude to contraception is simply different over here, and I find it hard to accept that someone would think it’s dangerous for a qualified pharmacist to dispense the pill to anyone who wants it. Women don’t need to be prevented from doing what they want ‘for their own good’.

  3. I believe oral contraceptive have to go over the counter. There is no other way to get them where they need to be (in women’s hands) more easily. Of course, there will be problems, but there are problems with aspirin and cough medicine too. If women like me, who do not cotton to MD’s stranglehold on their choices want O.C.s, they should have access. I know the health issues, but control of my fertility is more important than many of them.

  4. I think the idea of a pharmacist being able to give out the pill is great. Really, if you accept that a pharmacist should be able to give out emergency BC I can’t see any realistic argument against giving out the pill without a doctor’s prescription.

  5. I do believe that birth control should be easier to get hold of and think that to be able to get it from the pharmacy would make life easier for women. I had a (planned) baby back in February. It was my second child, I am married, have been on the pill for 10 years and I have no health complications at all. However for some reason my doctors surgery insists on seeing me every three months for a checkup.

    I have since found out that this is quite common in our area. I think that this is a ridiculous policy as I can easily imagine it causing problems for women, especially younger women still in school who may find it hard to keep attending these appointments. I can only imagine that it would increase the number of ‘accidents’ amoungst women who may then turn to the morning after pill which is available at the pharmacy. I cannot then understand why you would be unable to get this preventative medicine from the pharmacy as well.

    I also think that, from my experience, my pharmacist would be able to provide me personally with just as much medical support as my nurse who at my pill checks simply takes my blood pressure and weighs me. It takes less than 5 minutes although I’ve already had an hour wait in the surgery!

  6. I have a lot of faith in our pharmacists recomending us drugs available over the counter when we don’t always have the time to see our Doctor right away. Contraception is already free on the UK NHS, and over the counter we can already buy emergency contraception, but at a high price – around £20 – thats the price of three prescriptions.

    What we do find in the UK, is that many Doctors are over keen in prescribing the pill to regulate teenagers periods. But at the same time they are reluctent to prescribe contraception for birth control because of their religious faith. This was certainly true of the Doctor I had untill I was 25 who put me on the pill at 14 and who took me off it at 20 because I had developed ovarian cysts. The same Doctor refused me contraceptive injections when I was 25 after suffering miscarriage.

    I don’t agree with being on the pill for long periods of time. I certainly question my years on it and whether it contributed to the deterioration of my sexual health. However I am Pro-Choice for those who want to choose it as their preferred form of contraception.

    Having the choice of where you can get contraception is very important, especially for women who have Doctors who will not prescribe the pill for birth control on the grounds of their religious belief. This pilot scheme in London could prove to be highly successful for modern women on the move, but I feel there could be a greater need for a pilot like this to have taken place in a more rural setting where the religious attitude seems to be the norm.

    I’ll be interested to see what can be evaluated from the pilot and hopefully this will put into motion a change in how we get our contraception. Birth control will remain free on the NHS but looking at what we would pay for emergency contraception, I highly doubt that the contraceptive pill will be free from the pharmacy.

  7. I wouldn’t necessarily say that the women who don’t know their medical history are uniformly “stupid.” Perhaps many are wilfully ignorant, but I am willing to bet that many others lack the resources to be fully informed about family history. Furthermore, what about women who have been adopted? They do not always know the medical history of their biological families. Also, some young women who still live with their parents may feel uncomfortable asking about medical history for the sake of being informed. That’s something I had not considered until I read your comment. It’s not always possible to know your history, for a variety of reasons, and I shouldn’t necessarily assume that everyone is able to find out that information.

    Looking back on my first experience getting on the Pill, it felt like something a pharmacist could do, because all they did was take my vitals and ask me about my medical history. I am sure that if I told a pharmacist about the blood pressure issues in my family, she or he would have been able to make the proper decision about which kind of pill to take. Maybe there is something more complicated at play that I don’t realize because I am not involved in the medical profession.

    If birth control can be handled by a pharmacist, won’ that just mean that doctors are within their rights to charge (extra) for consultations about birth control – and that’ll harm those with a medical history.

    I never thought of that. That could definitely have a negative impact on birth control access or other healthcare. I’m not sure whether or not doctors would be within their rights to do that, but I’d say it’s likely they would. That definitely could open a whole different set of problems.

    What are your opinions about Plan B being offered over the counter in some countries? Are you more okay with that because Plan B is a one-time thing, or do you think it should be offered via prescription?

  8. In Spain you don’t need a prescription to purchase birth control, nor do you need to be interviewed by a pharmacist. It makes my life much easier and I wouldn’t have it any other way!

    I’m perfectly capable of making sure that birth control pills are okay for me without paying money and wasting time seeing a doctor or a pharmacist. In fact, I kinda think that forcing woman to meet with doctors and be prodded in the nether regions in order to get birth control (which makes absolutely NO sense, by the way) is just another way to control women’s sexuality.

    m

  9. We linked to this in a post at the CA NOW blog, “Reproductive Health News and Actions” http://www.canow.org/canoworg/2008/12/reproductive-health-news-and-actions.html

  10. Right, I can see I need to describe the situation in Denmark where I live and am on BC.

    When I was 16 I needed to get on the pill – not for birth control reasons but to control and lighten my periods which were heavy and too frequent. I had to see my doc to get a prescription. However, because I was still a virgin then there was no need for gynaecological exam, had I become sexually active I would’ve had one.

    Fair enough.

    I got a prescription which goes for a year’s supply of pills that I can just go and pick up for a relatively low cost at a pharmacy of my choosing. The prescription details the type of drug – a brand name in my case Marvelon – and at the pharmacy they are law-bound to inform me if there is a cheaper version of the same drug, with the same dosage of course. That means I don’t actually get Marvelon, but rather Desorelle which sells at about 2/3 the price.

    After a year, when I need my prescription renewed I call my doc’s office and have the nurse renew it. It’s a phone call I can make any time between 8 AM and 5 PM and it takes roughly 10 minutes, depending on whether it’s just before a holiday when oodles of people call in to have prescriptions renewed.

    I do not at all consider my access to reproductive health hampered. Not at all. If the clinic is closed I can get a 3 month prescription from another doc.

    Emergency Birth control is an over the counter drug here – as it should be. It’s a one time effect, as I said in my first post, and when in a situation where Plan B is needed the visit to the doc’s is not the first priority. Not getting pregnant is.

    Ordinary birth control isn’t a matter of getting it within hours or it’ll be too late. It’s a matter of being sure you get the right medication for you.

    Another difference between our national systems is that my medical records are listed with my social security number; something that is deeply private and shouldn’t be revealed to anyone (nevermind that I know half my family’s social sec numbers). It’s actually a citizen number. It’s used for taxes, unemployment benefits, medical records, etc etc all things state related. If you’re a Danish citizen you have a number to identify you in the records.

    This means that if I move to the other end of the country and therefore need to see a different doc from my usual, I can simply tell him/her my number and they’ll be able to read everything my old doctor wrote in my medical journal. Of course I do have the option of choosing not to disclose it upon changing medical consultant, but I can’t see why anyone would want to do that except in cases of a malpracticing doctor. For that reason (and other I just haven’t thought of) the option needs to be there – obviously.

    Anyhow, only doctors of medicine can access patient journals. My psychologist cannot access my medical journal, my psychiatrist can. My pharmacist can’t access my journal, but she is law bound to hand out the medicine on my prescription or a cheaper version thereof should I take the offer.

    Last time I needed penicillin it was just before my exams in December. It was my throat, it was bad. I could tell on my own that I needed penicillin, I called my doc, described every single symptom, she agreed penicillin might be a good idea, but before she’d prescribe it for me she’d need to know when I last took penicillin. It’s something about it not being very good for the body if you take it too often. But heck if I could remember when I’d last used penicillin. But lo, she got my number and checked my journal and could tell that it had been 10 years since last time, and wrote me a prescription without even wanting to see me in person.

    This phonecall took no more than 3 minutes all in all. Handled from the privacy of my home.

    Maybe it’s just the culture around here, but I do NOT EVER want to have to explain symptoms or issues to a pharmacist at the pharmacy in order to get advice on medication or whatever. Why? Because there’ll be at least 12 people standing within hearing range and it’s none of their fucking business what medication I’m getting and for what. As things are now I can go to the counter give them my number, tell them there’s a prescription for me in their system, and they can look it up, offer me a cheaper version, and I can be on my way without anything private ever being mentioned.

    And yes, I like it that way. I realise I come from a privileged background, I’ve always had the option of going to a doctor without any cost as long as it was necessary for me to see a doctor. If it would no longer be necessary for me to see a doctor for advice on my reproductive choices they can start charging me when I do need advice. Just like they’re allowed to charge me for the medical certificate that I’m healthy enough to be allowed to drive a car, and just like I had to pay for the medical attestation that I should be excused from certain things in gym class as it would ruin my joints. It is not a human right to get a driver’s license nor to be excused from classes, so I have to pay. It is a human right to stay healthy, and all advice health-wise is free and goes through doctors, anything non-major like simple pain killers, and anything emergency related like Plan B is non-prescription.

    However, when birth control becomes pharmacy stock on par with pain killers it will no longer be classified as medicine but as personal health and hygiene and thus you can no longer get a doctor’s advice for free – because it’s not about health it’s about comfort – just like moisturiser.

    So, considering I have to talk to my doc 5 minutes a year (unless I need changes in the medication – then it takes a little longer) I hardly find it restricts my reproductive freedom. I do know that if I suddenly had to pay for consulting a doc about my pills, I certainly never would have gotten them in the first place. And that’s what would likely happen here if BC became an OC drug.

    Monica wrote:
    “I’m perfectly capable of making sure that birth control pills are okay for me without paying money and wasting time seeing a doctor or a pharmacist.”

    I don’t doubt that anyone can tell whether the pills make them sick or not. But here is one who would even refuse the advice of a pharmacist.

    I know most women know their own bodies, but that doesn’t make any of us medical experts. It doesn’t make us doctors. I’m the expert on me, but I’m bloody well not the expert on how one artificially created hormone might affect my body compared to another hormone.

    I think, while we use our voices and take the authority and make the decisions that we haven’t been allowed for so long, we should be careful that we don’t start ignoring the experts. Being a woman doesn’t make me an expert on what might case venereal disease in my womanly body, a doctor is an expert on that.

    I scoff when my government says it doesn’t need the advice of experts to know what’s best e.g for the kids in our schools – they think that is common sense. What they forget is that ‘common sense’ is neither common nor sensical. It is highly coloured by background, and what is obviously sound to some is unthinkable to others. And where have our school system gone lately? To the dregs. Because they refuse to listen to educated experts who have studied this area.

    Am I going to be like the Danish government and refuse to listen to educated professionals (I’m not saying they’re always right, mind you) and think I know everything best myself? Hell no, I’m a linguist, not a doctor of medicine, and I’m not so arrogant to think I know everything about what goes on in my body. I know how my body feels, and I can tell when something changes, but that doesn’t make me an expert on human biology, physiology, medicine nor anatomy.

    But maybe I’m just spoiled rotten because we have a fairly well-functioning system of socialized medicine in this country. That may be it.

  11. Just stumbled this page and thought I would weigh in. In general I am in favor of the notion of OTC Birth Control, but I have two concerns.

    First I worry the availability will increase the likelihood of young girls being sexually abused. I had a family member who abused all of his four daughters from his first marriage, but stopped when they hit puberty. He was afraid of getting them knocked up or the doctor figuring out they were abused. He got busted doing the same thing to his youngest stepdaughter from his second marriage, because she expectantly got pregnant. Had the pill been available OTC he likely wouldn’t have been caught and the abuse would have continued not just with her, but her two younger sisters and the twin daughters his wife was pregnant with. While this isn’t a normal condition, far too many girls get abused and easy access birth control has the potential to let it continue or to increase the risk to some girls.

    My second OTC concern is the cost factor. Every time something goes OTC insurance quits paying for it and pharmacies shoot the price as high as possible. Several drugs me or my family members have been on in last several years went OTC and became unaffordable. We were told we could either pay full price out of pocket for these drugs (which had a retail price spikes of 25% to 150%) or we could use other drugs which in the case of our allergy meds didn’t work nearly as well and meant taking several pills instead of one.

    While many might be able to afford $20 or $25 a month for birth control even if it shoots up to $50 a month, many however who are currently paying $5 – $10 or getting it for free from government programs such as medicaid won’t be able to afford it. I simply wouldn’t feel good about birth control pills going OTC unless medicaid is required to continue picking up the tab.


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