A public consultation on whether two progestogen-only pills should be made available to purchase from pharmacies without a prescription draws to a close tomorrow (5 March).
The Government is proposing that pharmacists in England be allowed to issue a three-month supply of 75mg Lovima or Hana tablets – both desogestrel (DSG) progestogen-only pills – at initial consultation.
As it stands, the two pills are only available on prescription following a medical consultation.
This is the first time an application has been made for oral contraceptives to be a P medicine after several health bodies have asked the Government to make it more readily available to women.
There is also already parliamentary support for the move. In September 2020, the All-Party Parliamentary Group (APPG) on Sexual and Reproductive Health in the UK recommended that the progestogen-only pill be reclassified as an over-the-counter medicine (OTC).
The authors of the APPG report, Women’s Lives, Women’s Rights, said that there was an opportunity to expand the role of community pharmacists in supplying the pill.
But what does the sector make of the proposals? The Pharmacist spoke to pharmacy professionals and healthcare bodies to get their take on it.
Helping more women
Ade Williams, superintendent pharmacist at Bedminster Pharmacy, Bristol, saw the potential move as a ‘great opportunity for pharmacists to champion female reproductive health and champion wider gender-based inequalities’.
‘We will be able to use our clinical expertise to support the right choice, increasing confidence in our knowledge and expertise by making every care encounter sensitive and dignified,’ he added.
Reena Bari, who runs a community pharmacy in Sutton, London, also thought pharmacies were ‘well placed’ and ‘adequately trained’ to offer women the pill safely.
‘I think making the pill available in pharmacies will help more women — including women from different cultures who might not have gone to a GP before — have better access,’ she said.
‘A pharmacy is often somewhere convenient, close to where people work and offers people immediate access to a healthcare professional.’
She added that a lot of people have used their pharmacy first during the pandemic, ‘without needing to go to the GP’, and women would therefore really appreciate being able to get a supply of the medication from their pharmacy.
Pharmacist Thorrun Govind said that she is keen that ‘women are better supported with their sexual health’.
‘We need to appreciate that women have busy lives and they need access to contraception which supports that,’ she said.
She also highlighted that if the reclassification was to go through, we would need to make sure there were ‘proper review strategies in place.
‘If we are already offering emergency contraception over the counter, there should be scope for exploration of this, so I welcome the fact we are having this important consultation, we need to know what women want as a starting point for better care’ she added.
The consultation follows a study published in The Lancet in November, which revealed that community pharmacy intervention helps increase uptake of contraception among women.
The study concluded that having to attend a GP of sexual health clinical appointment ‘takes time’ and could mean women – who might otherwise have taken contraception – lose motivation to seek contraception and risk unintended pregnancy.
FiLiA, a women’s charity that aims to promote equality and diversity between men and women and eliminate gender discrimination, told the Pharmacist they also believed that requiring women to get a GP prescription for the progesterone-only pill constitutes an ‘unnecessary barrier’ in being provided with a ‘safe and effective form of contraception’.
They added: ‘We would warmly welcome the reclassification of this medicine to pharmacy product, to allow women and girls easier access to basic reproductive healthcare.’
Other organisations, including the Royal College of Obstetricians and Gynaecologists (RCOG) also said they supported the move.
Dr Edward Morris, president of the RCOG said: ‘The RCOG has long called for easier access to a wide range of contraception for girls and women, and included a recommendation in our Better for women report 2020 for the progestogen-only oral contraceptive pill (POP) to be reclassified from prescription-only to pharmacy product.
‘Given the long safety track-record of the progestogen-only oral contraceptive pill, we are delighted that our call has started to become a reality.’
He added: ‘We know too many girls and women were struggling to access basic women’s health services, including contraception, even before the pandemic. The past year has added further barriers to women and girls getting the support they need.’
Dr Morris said that the consequences of these barriers include ‘an increase in the number of unplanned pregnancies, which can result in poorer outcomes for women and their babies, and a rise in requests for abortion’.
‘A move like this would give women and girls more control over their reproductive health – which can only be a good thing,’ he added.
Make it ‘an affordable price’
Clare Murphy, chief executive of the British Pregnancy Advisory Service (BPA) told the Pharmacist she thought the reclassification was an ‘uncontroversial move’ but called for the pills to be made available at an affordable price and any consultation for supply to be ‘swift and straightforward’.
‘We should learn the lessons from the transition of emergency contraception to a pharmacy medication in the early 2000s, in which the price of the pill was set high and the consultation overly intrusive, and ensure the provision of these pills is as accessible and affordable for as many women as possible,’ she said.
Ms Murphy added that the move should ‘improve access to an extremely safe method of contraception, and give women another option if they cannot access their GP, or prefer a walk-in service’.