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Should the Pill be available over the counter? 

Dr Max Pemberton (pictured) argues the pharmaceutical industry shouldn’t be able to push public health policy

NO

By Dr Max Pemberton 

We all want things to be more con-venient and easier. What’s more, many women have had problems accessing contraception during the Covid-19 pandemic.

But I fear that these proposals to allow some forms of the Pill to be sold over-the-counter without a prescription at pharmacies, while appearing to be in women’s best interests, are quite the opposite.

In the race for profits — the proposal has come, after all, from the companies who make the pills — women’s health may be compromised. If they plump for an over-the-counter service, they will lose out on a medical consultation to fully explore their options.

I am also concerned that this is a slippery slope. At the moment, only the progestogen-only Pill is being considered. But if this is approved, the makers of the combined oral contraceptive Pill (which also contains oestrogen) will surely push for the same, and this worries me.

Of course, there are some who will say that, despite being a doctor, as a man it’s none of my business. I understand this — medicine has an inglorious history of men trying to police and control women’s bodies. But the reason I feel so strongly about this is that, years ago, my mother nearly died from a blood clot — one of the rare side-effects of the combined contraceptive Pill. Thankfully, she had been warned about the risk by her doctor so knew to get medical help when she developed symptoms.

It’s true that the progestogen-only Pill is usually well tolerated. But it needs to be taken at the same time each day, and other medications can interact with it to make it less effective. So it is estimated that, as a result, 13 women out of 100 using it will get pregnant in a year. Will that be explained to them and compared to other forms of contraception?

We must not let drug firms drive health policy 

The link between the progestogen-only Pill and breast and ovarian cancer is still unclear and it increases the risk of ectopic pregnancy. I worry women will take it without being fully risk-assessed or knowing the alternatives.

Should we really be allowing the pharmaceutical industry to push public health policy in this way? I’d much rather see pressure to make it easier to get GP appointments and better sexual health services so women can discuss contraceptives with their doctor.

This isn’t about trying to limit or control women’s access to the Pill — this is simply about acknowledging that it has side-effects, that risks should be minimised and other options explored so they can make an informed decision.

Dr Shahzadi Harper (pictured) argues the service could save on unwanted pregnancies

Dr Shahzadi Harper (pictured) argues the service could save on unwanted pregnancies

YES

By Dr Shahzadi Harper 

The progestogen-only Pill (pop) is a safe and highly effective form of contraception. Commonly used by women over the age of 35 or those with a high risk of breast cancer or blood clots, it is 99 per cent effective at preventing pregnancy if taken correctly.

Yes, as with every Pill, there are potential side-effects such as poor menstrual cycle control, and some women report mood changes and lack of libido.

It should also be taken with care by those on certain medications, for example anti-epilepsy medication.

But POPs are safe to use for women with high blood pressure, those who are breastfeeding and for most women up until the age of 55.

So what’s the problem? There is potentially very little that could go wrong as long as the right questions are asked by the pharmacist.

The advantages of non-prescription access are huge by comparison. It could save on unwanted pregnancies, and stop some women relying on emergency contraception such as the morning-after pill. Many women have struggled to get contraception in the past year with some GP appointments limited and family planning clinics often shut.

You can buy Viagra, so why can’t women take control 

So it makes sense to free up a chemist service without prescription. After all, Viagra is available to men over the counter, yet the side-effects and potential for recreational abuse are far higher with this drug.

Yet again, it seems to me, society has decided to take ownership of women’s reproductive systems. For some women in abusive relationships or from cultures where using contraception is frowned upon or seen as a family decision, an over-the-counter service would give women vital choice and freedom.

I know this better than most. I had an arranged marriage when I was young, and after my daughter was born, my midwife smuggled a pack of the progestogen-only Pill in for me with a starter kit of nappies.

The relief was huge as I didn’t want to get pregnant again straight away, but she had to give it to me when my mother-in-law wasn’t looking. Oh, how much more relieved would I have been not to have to rely on such an act of kindness?

For most women, a trip to the chemist would be a huge advantage over reliance on a GP. All we are asking for is control over our bodies. This proposal is a positive first step.


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