Popping the Pill in pharmacies everywhere
The Pill gives women control over their bodies, time and sex lives. Getting hold of it should be made much easier.
A pilot scheme allowing women to get the contraceptive pill without a doctor’s prescription will begin next year in two south London primary care trusts, Southwark and Lewisham (1). First introduced in the UK in 1961 for married women only, today the Pill is used by one in four women aged 16 to 49 (2). Hailed by many as one of the greatest medical advances of the twentieth century, the Pill has effectively liberated women from the bounds of biology.
The UK government has invested £26.8million in improving access to contraceptives, and if this pilot scheme is successful, the Pill could be handed out by pharmacies in the same way that the ‘morning-after’ pill currently is. This initiative should be welcomed enthusiastically, since it would make life easier for at least 3.5million British women who rely on the Pill for birth control: it would cut the need for women to plan ahead, schedule doctor’s appointments, and take time off from work to make trips to their GP surgery.
The Pill was developed in the US in the 1950s by the American biologist Dr Gregory Pincus. Its history has been dogged by controversy and health scares, but it is also, of course, linked with the history of women’s liberation and the free love spirit of the 1960s. Yet this history has not been invoked since the announcement of the UK government’s pilot scheme to get rid of the bureaucratic processes that make acquiring the Pill an inconvenient affair. These inconveniences don’t just have practical implications for women – they also perpetuate the idea that taking the Pill is a risky affair that requires careful, regular administration by, and consultation with, a GP.
Unfortunately, it is a rather debased view of women that has informed the government’s pharmacies scheme. For starters, the government was cautious in backing the scheme, with health minister Lord Darzi stressing that ‘at this stage there is no commitment to roll this out’ and that it would be wrong to suggest that the contraceptive pill should be made available over the counter (3). Rather than supporting the initiative outright, for further improving women’s reproductive freedoms, officials justified the pharmacies scheme on the grounds that it might help reduce Britain’s teenage pregnancy rate.
Predictably, this mealy-mouthed defence of the scheme was seized upon by critics of widening access to the Pill, such as the Family Education Trust. The FET moralised that the government was ‘more interested in getting young people to use contraception’ than it was in ‘discouraging them from engaging in sexual activity in the first place’. The FET rather dubiously added that ‘there is no evidence to show that increasing young people’s access to contraception results in lower teenage conception rates or reduces abortion rates’. However, Professor Alan Maryon-Davis, president of the UK Faculty of Public Health, retorted: ‘Teen pregnancies are at their lowest for 20 years, and studies show that this is largely due to much easier access to contraception for young people.’ (4)
It is probably true that, if rolled out nationally, this initiative would make it easier for teenagers to get the Pill without making embarrassing calls to the family doctor – but rather than defending it in the name of reducing the teenage pregnancy toll, the scheme should be welcomed as a good thing for all women and not merely as a way of realising government policy aims.
As Julie Bentley, chief executive of the Family Planning Association, rightly points out: ‘Women want to get their contraception from a health professional, at a time and a place that’s convenient to them and without unnecessary delays.’ (5) It makes sense for pharmacies to play an increased role in the provision of the Pill and other sexual health services, because they are easily accessible and have convenient opening hours. Pharmacists have all the necessary competence to do the relevant medical checks (blood pressure, every six months) and to dispense the key info: take the Pill as prescribed, see the doctor if you suffer any unwanted side-effects, keep smoking to a minimum, and make sure to use a condom if you vomit, have diarrhoea or take antibiotics (6).
The Society for the Protection of Unborn Children avoided making an outright moral argument against widening access to the Pill, warning instead that ‘the government’s policy, like its policy on the morning-after pill, puts women’s health at risk’ (7). This isn’t the first time that the anti-choice lobby has hidden behind ‘the evidence’ on health risks in order to advance its moralistic agenda (8), and it certainly isn’t the first time that the Pill has been subject to unwarranted health scares. According to the US Food and Drug Administration, more studies have been done on the potential side effects of the Pill than for any other medicine (9).
In the 1980s in the US, uptake of the Pill fell from 10million to 8.4million due to concerns over possible links to breast cancer, strokes, heart attacks and blood clots. In 1995, a health scare over thrombosis caused a ‘blip’ in UK usage – accompanied by an increase in abortions and pregnancies (10).
But while it is true that the Pill is associated with an increased risk of breast cancer, with some studies also suggesting a possible link with cervical cancer, these have to be balanced against evidence of the much reduced risk for pill users of developing cancer of the ovary, uterus and colon. Indeed, when all cancers are grouped together, the risk of developing a cancer in Pill users is reduced overall (11).
Myths about the Pill causing women to gain weight, become depressed, and infertile have also been dispelled (12). There are 32 different types of contraceptive pills available today, and it only takes a couple of trials to get women on the Pill suited for their specific needs. While the risks are few and far between, the Pill’s advantages are numerous and well-documented.
The Pill works by tricking the body into thinking that it’s already pregnant; a wondrous little thing, it stops ovulation and as a back-up also thickens the cervical lining so that even in the unlikely case of fertilisation, eggs cannot implant in the womb. Because it’s so easy to use, doesn’t interfere with sex and is almost 100 per cent effective if taken correctly, it comes as little surprise that, today, contraceptive pills are used by over 3.5million women in the UK alone and by more than 100million women worldwide (13).
Critics have railed through the years that the Pill encourages promiscuity and doesn’t guard against sexually transmitted diseases, but this wonder of modern medical science has effectively liberated women from slavery to biology. Not just an effective contraceptive, it also has many other positive ‘side-effects’ which are enough to get it prescribed even if you aren’t ‘getting any’. The Pill can clear the skin, make breasts bigger and, above all, it gives women lighter and shorter periods and the choice of when to have them, if at all.
It is rather telling that, today, reverence for biology over science is still the main cause for the Pill’s only slightly less than perfect efficacy rate. Indeed, it is an interesting and little known fact that the Pill wasn’t developed to consist of 21 days of pill-taking followed by a seven-day pill-free interval (where rapid decline in hormones results in an artificial period) for physiological reasons, but simply because doctors in all their wisdom felt that women needed periods to feel ‘normal’ (14). The Pill-free interval has been described as the ‘Achilles heel’ of the Pill. In the words of one expert: ‘When you think about it we have here a bizarre contraceptive: one that we providers actually instruct the users not to use – for 25 per cent of the time.’ (15) In light of this fact, many GPs now choose to inform women that it’s safe to take subsequent pill-packs and not to have these artificial ‘periods’ at all. Women, hail the wonders of science!
The Pill has liberated women all over the world from slavery to nature and advanced their freedom from unnecessary biological burdens. Widening access to contraceptives should be defended as a moral good for women, rather than justified on the grounds of narrow utilitarian calculations for reducing teenage pregnancy. The government should quit all the hand-wringing and start rolling out that wondrous little pill.
Maria Grasso is a lecturer in politics at St Hugh’s College, Oxford.
Rob Johnston celebrated the oral contraceptive pill as the best of medicine. Jennie Bristow explained how the condom became a metaphor for caution. Rob Lyons defended spontaneity in everything from food to sex. Anne Furedi questioned the fuss about ‘do-it-yourself’ abortions. Or read more at spiked issue Love and sex.
(1) Pill to be given out by chemists, BBC News, 10 December 2008
(2) A short history of the pill, BBC News, 7 January 1999
(3) Women may get “pill” without prescription, Reuters, 13 December 2008
(4) Pill to be given out by chemists, BBC News, 10 December 2008
(5) Pill to be given out by chemists, BBC News, 10 December 2008
(6) Combined Oral Contraceptive Pill, Patient UK, 19 March 2008
(7) Women may get “pill” without prescription, Reuters, 13 December 2008
(8) The de-moralisation of a woman’s right to choose, by Ellie Lee, 16 October 2008
(9) A short history of the pill, BBC News, 7 January 1999
(10) A short history of the pill, BBC News, 7 January 1999
(11) Combined Oral Contraceptive Pill, Patient UK, 19 March 2008
(12) The Pill: Myths and Misconceptions, Women’s Health, 31 September 2008
(13) A short history of the pill, BBC News, 7 January 1999
(14) The Pill: Myths and Misconceptions, Women’s Health, 31 September 2008
(15) Contraception Your Questions Answered (third edition), J Guillebaud, Churchill Livingstone, 1999
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