Over the Counter, Under the Carpet: Why Nonprescription Birth Control is Widening the Gender Health Gap
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As I left the chemist clutching three month’s supply of progesterone-only contraceptive, I pondered how far society had come since 1961. That was the year ‘the pill’ was first introduced to the UK on the NHS. Prescribed exclusively to married women, it would be another six years before Dr Gregory Pincus’ wonder-drug was made available to the unwed. Finally, in 1974 family-planning clinics were licensed to prescribe the pill, removing the need for a GP visit. After millennia of being at the mercy of our own biology women finally controlled their reproduction, with monumental social, economic and sexual repercussions. Now, in 2021 I can just stock up on over the counter (OTC) contraception at my local pharmacy or order it online. This is true liberation.
Or is it? I had just paid £21.99 for synthetic hormones to trick my body into thinking it’s pregnant, disrupting my cycle and altering my body’s chemistry. But from the pharmacist’s conduct I may as well have been picking up some Strepsils. There are fewer risks associated with the mini-pill than the combined oestrogen and progesterone pill, but side-effects can still include migraines, water retention and depression. But apparently this doesn’t warrant a medical once-over. As if the gender health gap wasn’t wide enough. When Hana (the brand name for this pill) was first marketed in July, the literature stated patrons need only answer three questions before purchase. These were: are you over 18, are you pregnant and do you have issues like spotting? The only question I was asked was: “Cash or card?”
Even Hana’s £5 million ad campaign showcasing confident, industrious pill-poppers can’t hide the fact that the OTC pill is less about freedom and more about profit. If even a fraction of England’s three million pill-takers switch to Hana, there will be a healthy boosts to manufacturer HRA Pharma’s annual €253.8 million group revenue. Then there’s the NHS’ savings, as a year’s supply of the pill costs the public body up to £127 per person. Ideally any newfound reserves would be channeled into women’s health as less than 2.5% of publicly funded research is dedicated solely to this area. However, with COVID-19 having cost the NHS an additional £63 billion in 2020, female health is even less of a priority. In fact, this year the UK cut 85% of its contributions to the United Nations Population Fund due to COVID-19 related expenses.
In the wake of a global pandemic it’s easy to feel like any non-deadly ailment should be borne with a stiff upper lip. But this has been the societal approach to female health for generations, despite the fact that one in three UK women will suffer from a gynaecological or reproductive health problem. There is a normalisation of extreme pain and physical complications for women and commodifying the pill is an extension of this lackadaisical attitude towards female health.
It is important to remember the pill is not only used for contraception. I was 14 when I was prescribed Ovranette for crippling stomach pain assumed to be my polycystic ovaries. It was over a year before yet another visit to casualty doubled over led to a kidney stone diagnosis.
All too often, prescribing the pill is a placating quick fix and I dread to think how many people will self-medicate. This one-pill-cures-all approach continued during my early twenties when I experienced an almost constant period for three years. None of the four different pills I was prescribed helped and despite my pleas, no tests or scans were ever run. Eventually I was recommended a coil which left me in agony for over three months (apparently not abnormal) before it came out of its own accord one night. Plus-side, my constant menstruation did improve afterwards.
My experience with the pill has been that it is used as a go-to for any issue occurring in a woman under 50’s midsection. Making it OTC reinforces this idea that female health is a physical process rather than a medical concern. Of course, periods, pregnancy, labour and menopause are all pain-riddled experiences and nothing can alter this physical reality. But if an exceptionally painful period means you can’t function this should be investigated. Furthermore, greater research and funding into female-specific-issues such as fibroids and vulvodynia could make so many female health issues more manageable. At present, erectile dysfunction which affects 19% of men receives five times the funding of premenstrual syndrome which affects 90% of women.
For all of my issues with making the pill available OTC, I was grateful for the option. With so few sexual health clinics accepting walk-ins, trying to get through during their active phoneline hours was second only in difficulty to getting a GP appointment. The adverts for Hana focus on this convenience, depicting bustling career women, busy mothers and lustful ladies all confirming that Hana is “for women like us.” When I revisited ordering Hana online, I noticed the checklist had increased to 8 questions with certain answers resulting in a “We’re afraid Hana may not be suitable for you” block. However, you can simply restart the checklist and adjust your responses accordingly. Covering all bases, Hana’s website also links to a handy prescription-free morning after pill, Ellaone which you can order for £34.95.
I foresee a few things emerging from an OTC pill. More women will buy it as an attempt to ease various issues without any research into what is causing their problems. More teenage girls (and probably younger females) will buy the pill and not take it correctly resulting in unwanted pregnancies and likely more STIs as condoms will be abandoned. Finally, I think trans girls and trans women who are awaiting medical treatment will experiment with the pill, hoping it will have a feminising effect and likely hurt themselves in the process.
I remain eternally grateful that I live in a country where contraception is readily available and not taboo. But just like we shouldn’t brush off extreme cramps or severe mood swings as ‘just something women go through,’ we also shouldn’t be blasé about taking the pill. Our health system shouldn’t be obtuse about female health either and any OTC pill needs to be regulated accordingly. It’s true that getting the pill without prescription is more convenient, but as it comes with a price tag, it is definitely not more accessible.
by Gillian Fisher
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