PJ view: For pharmacy, providing oral contraception should be just the beginning

If the reclassification of two progestogen-only contraceptive pills to pharmacy medicines goes ahead, then there is a case for expanding the contraceptive options pharmacies provide without a prescription.
PJ view: For pharmacy, providing oral contraception should be just the beginning

In February 2021, the Medicines and Healthcare products Regulatory Agency (MHRA) launched consultations on the reclassification of two progestogen-only contraceptive pills — Lovima 75 microgram film-coated tablets and Hana 75 microgram film-coated tablets — from prescription-only medicines (POMs) to pharmacy (P) medicines.

If approved, this will be the first time the contraceptive pill has been available from pharmacies without a prescription and would mark a major expansion in women’s access to birth control.

It comes at an important time. Funding cuts and fragmentation of sexual health services have meant that women have had reduced access to contraceptive services.

The Advisory Group on Contraception found that almost half of councils in England have closed sites providing contraceptive services since 2015, and Public Health England states that one-third of women are not able to access contraception from their preferred provider. And this was reported before the COVID-19 pandemic, which has further reduced access.

After a number of years of stability, abortion rates have risen to the highest level ever recorded

This is having consequences. After a number of years of stability, abortion rates have risen to the highest level ever recorded, with the age-standardised abortion rate in England and Wales reaching 18.0 per 1,000 women aged 15–44 years in England and Wales in 2019. The previous peak was in 2007 with 17.9 abortions per 1,000 women.

And perhaps this explains why the MHRA consultation has been so positively received.

The Faculty of Sexual and Reproductive Healthcare, the Royal College of Obstetricians and Gynaecologists and the Royal Pharmaceutical Society fully support the proposals to make it easier for women to obtain the progestogen-only contraceptive pill in pharmacies.

The British Medical Association also says it is “in favour”, although it raised concerns around safeguarding and recommended that pharmacists provide in-depth counselling and advice to women on the risks and benefits of different choices.

The MHRA has yet to confirm the result of the consultation, but if the reclassification goes ahead, there may also be a case for further expansion of the contraceptive options that community pharmacies provide without a prescription.

Making the contraceptive pill available in pharmacies is supported by evidence that it does not result in lower continuation rates or contraindicated use.

In 2020, Professor David Taylor from University College London School of Pharmacy made a powerful case in The Pharmaceutical Journal that community pharmacy should be initiating and monitoring combined hormonal contraceptives — including pills, patches and vaginal rings — in order to free up GP practices to increase rates of prescribing for long-acting reversible contraception, such as coil fitting or injections, which are flatlining.

It makes sense that in a setting where women are able to access emergency contraception, pharmacists are able to signpost to convenient contraceptive options that will work long-term. Ideally, this would be offered without charges to maximise uptake.

For too long, women’s health has been an afterthought: as we emerge from of the pandemic, it makes sense to use community pharmacy to widen access to contraception. The approval of Lovima and Hana should be just the start. PJ

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Citation
The Pharmaceutical Journal, PJ, April 2021, Vol 306, No 7948;306(7948)::DOI:10.1211/PJ.2021.1.80598