ENGLAND – Emergency contraception: overcoming limits on pharmacy access during Covid-19

In their recent inquiry, ‘Women’s Lives, Women’s Rights: Strengthening Access to Contraception Beyond the Pandemic’, the UK All-Party Parliamentary Group on Sexual and Reproductive Health found that women in England were facing real difficulties in accessing contraception, which has been exacerbated during the Covid-19 pandemic by already existing reductions in contraception services. This makes access to both emergency contraception (EC) and safe abortion even more important than ever.

Community-based pharmacies are a main source of emergency contraceptive pills. These pharmacies have received guidance on safety in providing medicines for customers during Covid-19. The guidance calls for physical distancing of 2 metres, and/or use of personal protective equipment (PPE) for a consultation, and not to use a consultation room if it is too small, as is the case in many pharmacies. However, to get EC pills from a community pharmacy, a confidential consultation with a pharmacist is required by regulation.

The British Pregnancy Advisory Service (Bpas), who also pioneered telemedicine for early medical abortion in Britain, were concerned that the Covid-19 regulations might make it difficult for pharmacists to provide EC pills in a safe, confidential manner during Covid-19. Indeed, retail data from March to April 2020, from the start of the first lockdown, showed that sales of EC fell by 50%, while National Health Service prescriptions for EC pills declined by around 20% in the same period.

In September 2020, Bpas undertook a mystery shopper survey by phone to ascertain whether and how UK pharmacies were carrying out the mandatory consultation for EC during the pandemic and assess how safely and easily women could access EC pills from pharmacies without compromising on physical distancing practices or confidentiality. They called 34 pharmacies in England that were a mixture of chain shops, independent shops and supermarket pharmacies, each in a different local government area, all selected at random.

Two were out of stock of EC and one did not carry EC. In quite a lot of the remaining 31 pharmacies, the consultation room could not be used because of the pandemic or because it was being used only for influenza jabs. Only nine pharmacies had big enough consultation rooms for physical distancing, while five either used a plastic screen or the pharmacist wore PPE. Of the rest, three offered the consultation over the phone, two said they would use a written questionnaire, one could only do the consultation in the main shop area, and one offered to close the shop temporarily in order to do the consultation. Overall, a third of the pharmacies who offered EC were unable to provide a safe, private consultation, which they regretted but could do nothing about.

There are only three ways in Britain that medicines can be supplied: by prescription, via a consultation with a pharmacist, or over the counter. To resolve this current problem, the Secretary of State for Health could reclassify EC as an over-the-counter medicine. Arguing that EC has been around for many years and has proven to be very safe, Bpas are calling for provision of EC pills over the counter, at least during the pandemic, in order to ensure that access is not substantially reduced. They are also advising women to keep a supply of EC pills until and unless the situation improves. If the pills cannot be obtained from a local pharmacy, they recommend the online pharmacy Chemist 4 U, where pills can be ordered in advance of need (but must be paid for).

SOURCES: BPAS Report ; BPAS press release, 23 October 2020; VISUAL, by Yeji Kim