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Contraceptive pills from your pharmacist? Looking beyond the media hype

December 16th, 2009

Dr Petra

pill advert

Over this weekend the story broke that pharmacies were going to give teenagers the pill – as a means of tackling teenage pregnancy.

News coverage included:
Teenage girls offered contraceptive pill over the counter in a drive to cut pregnancies – Daily Telegraph

Teenagers to get pill without prescription – Independent

Girls get the pill on demand: now teenagers can get the contraceptive without prescription

Teenage girls to get contraceptive pill in pilot scheme

You’ve got to love these ‘girls get the pill on demand’ style headlines – which kind of ignore the fact that contraception is free and available within the UK – and yes you can ‘demand’ it if you like!

From the press it sounds like girls across the UK are going to get the pill from the pharmacy – is that really the case? Well, before we get to that, let’s look at what we do know about providing contraception via pharmacies.

What’s the evidence?
The papers have not clearly indicated this is a pilot scheme, perhaps in their hurry to promote a shock/horror response they overlooked this. They also seemed to overlook the wider evidence base about oral contraceptive provision, and managing teenager pregnancy.

So what do we know about this issue? Well, we do know our teenage pregnancy rates in the UK are high. Most of those pregnancies are terminated, but the prevalence of termination (particularly repeat terminations) are of concern to healthcare providers. As a result there’s been a push within reproductive/sexual healthcare over the past decade to rethink how contraceptive services are delivered – and how teenage pregnancy rates can be reduced.

There is already an established evidence base that pharmacies can provide some forms of contraception and sexual health support – for example condom sales, testing for Chlamydia and providing emergency contraception (morning after pill).

Here the pharmacy becomes an additional service for providing contraception/sexual health support, alongside existing reproductive health/family planning clinics or GPs.

Young people are frequently blocked from accessing services due to unclear signposting of services (so young people don’t know where they are); restricted opening times which often don’t fit with young people’s timetables; problems with location; uncertainty over what happens in a clinic; worries about confidentiality; or just basic information (many young people still wrongly think you have to pay to get contraceptives).

Add to this problems with sex education and general problems around poverty and social exclusion, there are understandable reasons why young people get pregnant. Culturally we’re often quick to blame them without appreciating the lack of access to information and contraception that affect some teenagers. You can read more about how poverty, lack of education and healthcare barriers contribute to sexual and reproductive health problems here (with an ongoing investigation into the issue reported here)

Part of a response to our current sexual health crisis been a shift to making sexual health less clinical and more about self management. This has been suggested to reduce strain on services and make aspects of care that can be managed in other settings more effective. So pharmacies can be one additional place to deliver care, as might school nurses, or even cafes and nightclubs. More choices and more places to get advice and services are a step to reduce teenage pregnancy and termination rates.

There is no evidence that making sexual health services more accessible increases teenage pregnancy (as some media reports have claimed). Although it’s worth noting that many of the schemes trying to reduce teen pregnancy are being rolled out in areas where teen conception is already very high.

What’s actually happening?
This is a pilot scheme being run in a deprived area of London with a high prevalence
of teen pregnancy. You can read about the area’s history on this issue here. This borough has received charitable trust funding to modernise a variety of services, including sexual health. You can read an independent evaluation of that work here.

Within this modernisation work, practitioners have already investigated delivering sexual health services within community settings, including assessing whether community pharmacies were suitable locations for Chlamydia testing.

This latest pilot is part of an ongoing project looking to modernise, improve and make more accessible sexual and reproductive health services for a resource poor community. All activities have been based upon evidence and completed in consultation with the community.

So rather than the pill being given to all teenagers across the UK, this is simply a pilot scheme to see whether providing the pill to younger people within community pharmacy settings is feasible – and works to reduce teen conceptions. If it does, then the scheme will be rolled out to other pharmacies. If it doesn’t work then alternative approaches will be considered.

Why do we need to be cautious?

My first question about this story is ‘is this really news?’. It created a widespread splash in the papers, but it was actually launched to the press last year, and there was some coverage of the proposed scheme in August 2009 too.

We need to discuss why this story got back into the papers. It isn’t clear. But what is clear is the majority of coverage was judgemental or negative, and has discussed a pilot scheme within the press before it has even really got started. That’s a problem as it can scupper a pilot and mean we never get to see if it can work or not. It can lead to people interfering with the delivery of a service – particularly those who’ve been led by the media to see such a pilot in negative ways.

We don’t know if this will work – that’s the point of a pilot. To investigate and explore. So media coverage should really only happen when a study has been completed – not speculation before it starts, or during any study.

We’ve seen similar problems with the media outing interventions to reduce teen pregnancy in the past. You could be forgiven for believing some media outlets simply don’t want us to tackle the problems we’re experiencing with teenage pregnancy and sexual health.

Generally health evaluations work better if left undisturbed and can be reported faithfully whether they work or not. We really do need to challenge this practice of reporting on pilots until they are finished. Particularly in the restrictive way the media approaches this which is to find a practitioner (usually from a faith based group) to say how such a scheme will inevitably make things worse. What may help more would be to put such schemes within the context of wider evidence, and if you want a debate to talk about whether other approaches – like better sex education, tackling poverty or increasing aspirations for young people – might be equally or more effective.

For the record this pilot scheme does not mean all teenagers are going to be offered the pill. It’s a pilot taking place in a specific part of South London. Even within the pharmacies in the pilot it doesn’t mean that pharmacists will be pouncing on all young women entering their stores and giving them oral contraceptives. Any young woman requesting oral contraception will have consultation and be assessed for competence and the pharmacist can refer to other services if needs be.

Parents don’t need to worry that pharmacists will be slipping the pill to their daughters behind their backs. Even if some journalists have misled them that this will be the case.

For now, all we can do is wait and see if this pilot works. And in the meantime additional focus will continue to address ways for reducing teen pregnancy in
poor/deprived boroughs.

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