In the summer of this year, I was researching for a feature for Easy Living magazine on the potential side effects of the birth control pill and when searching for a news hook for the piece, I found out about the preparation of a NHS scheme which would allow oral contraceptives to be distributed from pharmacies without a prescription. At that time, all of the doctors I interviewed expressed concerns about this development, even the most conservative GPs who stubbornly dismissed my concerns about side effects.
Then last week it hit British newspapers that this scheme had recently launched in the areas of London that have the highest rates of teenage pregnancy. Bold, bright posters in the style of laundry soap adverts exclaiming that the Pill is now available without prescription are up in pharmacy windows of Lambeth and Southwark. According to the news reports the pharmacists involved were given three weeks of training in order to provide consultations for young women looking to start taking oral contraceptives or wanting to move from the Pill to long acting methods like the injection, the implant or the hormonal IUS. The implication was also there that if young women came to the pharmacy for the emergency contraceptive pill then their consultation would involve the suggestion that they start on the Pill or a long-acting method.
The British government can't seem to figure out how to handle their teenage pregnancy problem. They are looking for a quick, effective, wide-reaching fix that doesn't cost much - certainly not as much as working with individual teenage girls to discuss their attitudes towards relationships and definitely not as much as providing holistic sex education that covers both the technical and emotional aspects. The NHS as a countrywide health service can be brilliant at organizing awareness campaigns - such as their quit smoking scheme - but providing the Pill without prescription is a step in the wrong direction.
Aside from the fact that this proposal will, without a doubt, devalue the Pill as a drug, a medication, and thus make it appear harmless, and therefore keep women ignorant of its potential impact on their health and wellbeing and prevent them from seeing the signs of side effects - any 'consultations' provided by pharmacists are very unlikely to be comprehensive or cautious. We already know how most doctors deal with doling out the Pill - many simply do not tell the truth about how it works, and do not talk about the potential problems it might cause, particularly in terms of mood and emotions.
The pharmacists have probably been told to check the teenagers weight and blood pressure on their first visit - but what about scheduling follow up appointments? Will the teenage girl go back every six months and check in with the pharmacist for another consultation? How many packets of the Pill will they be given to start? It can be assumed busy pharmacies aren't going to want to have a constant round of check ups and would be more inclined to hand out Pills literally over-the-counter after an initial talk. This goes against even the loose policies presently in place for obtaining prescriptions. Women must return to their GP every three or six months to check for problems such as the increased blood pressure, migraines or breathing difficulties that might suggest a blood clot formation.
Most women get the Pill from their GP, but often family planning clinics are much more interested, at least in the UK, in the side effects a woman might suffer from on different brands. This new scheme appears to stem from the root idea that teenage girls are secretive about taking the Pill and therefore want to avoid their family GP. The spokespeople for the scheme have said teenagers go into, say, the Boots pharmacy to buy cosmetics, so they can pick up the Pill easily and inconspicuously. It seems very doubtful that teenage girls really have this problem with people knowing they are on the Pill. Would these consultations, like those available at a family planning clinic, involve discussion of condoms and the necessity that they are used for casual sex at all times? If teenage girls are using condoms properly then they wouldn't need to take the Pill, and they definitely need to use condoms to prevent getting or passing on STIs.
President Obama is putting money into a research project to investigate why men don't like using condoms and how this problem might be helped. He is backing education on the proper use of condoms, and research on the design and marketing issues that stop men using them as often as they should. This seems like an excellent move. Condoms are very effective when used correctly and diligently and even more effective if used with spermicide. Studies have shown far lower rates of unwanted pregnancy amongst young women using condoms and spermicide than those using the Pill alone. Teenage girls could also be encouraged to buy condoms with their cosmetics at Boots pharmacy. Many young women don't use condoms because they don't want to bring the subject up, and neither does the NHS it appears.
Maybe money should also be put into getting the one-size-fits-all diaphragms now designed and ready through FDA approval and out on the market as soon as possible. Then money could be put into educating women about this original, truly liberating contraceptive method. Then teenagers could buy diaphragms with their cosmetics.
The pill encourages the kind of thinking about sex and attitude towards relationships that likely causes the UK’s higher rates of teenage pregnancy. Keeping contraception invisible, unobtrusive and solely the girl’s responsibility encourages a skewed perspective on sex and relationships. This outlook separates the idea of sex from reproduction - and of course sex should not have to lead to reproduction - but it also completely ignores how a woman's body works.
I'm not a moralist, or a right wing Christian, but the action of having to stop for a moment and put a diaphragm in or stop and put a condom on could actually be helpful in more ways than just the preventing of pregnancy and the transmission of STIs. This pause makes a person consider the partnership, the other person, the situation and their feelings about that. It puts sex, however casual, into a context. Actively promoting a contraception - the Pill - that perpetuates a silence about sex, our bodies and our relationships is not the solution.
Barrier contraceptive methods involve conversation, discussion and pause. Where do teenage boys factor in this NHS scheme? Perhaps the possibility of a resulting pregnancy is one thing that stops some teenage unprotected sex from happening. But if all the girls in Lambeth are on the Pill, then perhaps there will be more unprotected sex happening, not less, and therefore more STIs spreading. These STIs might cause a few hundred teenage girls to become infertile - but perhaps that is what the British government would like. The creation of the Pill has foundations in eugenics studies.
The part of the scheme concerning moving women from the Pill to the injection and the implant is obviously part of the general British government drive to get women on to long-acting methods. These methods will further divorce thinking about sex from any reality, and promote silence and ignorance. They aren't piloting this scheme in the affluent areas of Knightsbridge or Hampstead in London. We can assume there is a link being made between poverty and teenage pregnancy rates. If we can assume this, then the scheme smacks of the crusade to stop the 'wrong' kinds of people having children.
There is research that shows how important it is to let young women's menstrual cycles mature and settle - a process which can take four or so years. The Pill will be available to teenagers that are sixteen years-old and up. These girls are developing a sense of self and sexuality and the Pill will distort that experience dramatically for some of them. Who is this scheme for?
Weight, blood pressure or genetic predispositions will probably not be discussed properly, so there will almost certainly be an increased risk of physical problems developing. The mood changing effects of the Pill will not be discussed in the pharmacy consultation room. If the young women experience low libido as a result, that will be considered a triumph! As it was handed to them at the local Boots along with their lip gloss what's the likelihood that the teenagers will consider the Pill might be the cause behind their panic attacks, their suicidal thoughts or even their severe headaches?
President Obama's decision is more progressive. Much is said about the American government's unsupportive attitude towards the birth control pill - such as the Pill not being covered by medical insurers and abstinence-only sex education. Perhaps somehow out of all that religious, moralist, conservative talk of the last Presidency around the issues of contraception, and the subsequent suspicion of the Pill, there has finally formed something useful and sensible. The British government appears wholesale fanatical about the Pill in comparison. Their attitude holds just as much ignorance, just as strong an agenda and just as little respect for women as the Religious Right has displayed at its worst.