How can we avoid making emergency contraception into a panic?

Emergency contraception made the headlines this week as newspapers revealed that the morning after pill is being sold on eBay for as little as £5. Although the coverage is welcomed, it fails to explore the complexities behind a woman’s decision to use this risky solution. It also neglects to discuss alternative, safer options for access to emergency contraception.

Access is challenging

Last year, we began scoping what an online emergency contraception service would look like; what clinical information do we need to be able to safely issue the medicine? How do we communicate that to users? What do people who need emergency contraception need to know to feel confident in taking it? Do they even want to order emergency contraception online?

I needed to go and get a morning after pill and I went to a clinic and they said the wait was 2.5 hours long, so I just went home and made myself a nice dinner

We spoke to 11 groups of women in clinics, at our office and other locations around London. Many women have told us that it can be virtually impossible to get a GP appointment and especially at short notice. Similarly, when sexual health clinics are operating at capacity (which many are, and will continue to do in an environment of financial pressure), some women can find themselves turned away. Having taken the time out of work or college to get to the clinic and then being unable to get the drug is extremely stressful.

Overwhelmingly, they told us they would definitely order online if the service had:

  1. Clinical assurance
  2. Guaranteed delivery within the window to take the medication effectively

We also conducted a twitter poll which had over 150 responses. Again, people would be happy to order emergency contraception online so long as it reached them within the required time.

In our recent service user survey, 43% of respondents wanted emergency hormonal contraception to be added to our service offer.

This, coupled with the latest news about people buying the morning after pill illegally from eBay demonstrates there is a clear need for emergency contraception to be made more accessible, safely.

While there is a huge element of risk in taking drugs supplied from unregulated sources via the internet, for some women, the convenience, and seeming lack of other options can be enough of a reason to take the gamble against an unwanted pregnancy.

Over-the-counter is costly

Women are paying 4x more than women in other European countries for over-the-counter emergency contraception

Women that can’t get to their GP or sexual health clinic may choose to go to a pharmacy to buy emergency contraception over-the-counter. There are also online pharmacies that can process same day delivery providing they receive the order by a certain time. However, this is a costly solution - the drug can cost around £30 to buy over-the-counter. This means that only women who can afford the cost can access it. A recent petition by 38Degrees exposed that British women are paying around 5x more than women in other European countries for over-the-counter emergency contraception (in other countries it’s as little as £6). The medication is sold at a huge mark-up and women have also complained that pharmacists' consultations can feel ‘embarrassing and intrusive’. One young woman also told us that a pharmacist demanded she take the drug there and then, which made her feel judged too irresponsible to take it on her own terms. Women under 25 are able to get free emergency contraception over-the-counter at many pharmacies, but this is often under-promoted so they may also end up paying.

Safe online emergency contraception delivery is possible

We took a thorough approach to safeguarding in the development of our prototype emergency contraception service. We have made clear in the user journey why we need certain information and what impact an incorrect answer could have on the use of the medication. Our service would, when commissioned, also be overseen by a qualified clinician.

There is some fear around making emergency contraception more accessible, that women will use it too often, however, there’s no evidence as yet that using emergency contraception on multiple occasions is harmful. Of course, the better outcome would be to use this as an opportunity to give women more information about longer-lasting or more suitable contraception. Women we spoke to told us that they would like to receive more information about contraception when they accessed an online emergency contraception service.

These opportunities for health promotion won’t be available if we ignore the causes of the problem and leave women in a situation where they feel compelled to use cheap and unregulated medication from eBay. An online sexual and reproductive health service that works in partnership with the NHS can deliver health interventions quickly and remotely and bridge people into clinic where needed.

At present we are also developing an oral contraception service and talking to commissioners about how we may be able to start delivering the combined pill and progestogen only pill. Emergency contraception can be delivered safely online and also at a reduced cost to NHS CCGs and local authorities, saving valuable GP and clinician time. We welcome the media attention on emergency contraception’s availability online this week and say it’s time to widen the conversation about how online tools can be used to safely make emergency contraception more accessible to women.

We’d love to hear what you think, should contraception be available online?

Should clinically regulated contraception be available, free, online?
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