Health

Why It's Bad That the Morning After Pill Isn't Free in the UK

Just because you might have gotten it for free, doesn't mean everybody can.
Hannah Ewens
London, United Kingdom
December 6, 2016, 12:31pm

Last week, I went to Paris and back to buy the morning after pill. The point of this was not to spread the "feminist agenda," as some commenters bizarrely suggested, but to make a serious joke about the fact the morning after pill is both expensive in the UK (up to £36 [$46]) and difficult to procure (an embarrassing one-on-one consultation is necessary and can involve traveling around different pharmacies). Whereas, in France, it's just £6 [$8] and very easy to get your hands on.

All of this made lots of people very angry. And of course it did. This simple argument crosses over sensitive points for many—of NHS and public funding, of women's control over their bodies and lives, and of reproductive rights. Yet, in almost every case, the commenters—both men and women—were wrong in their responses to the story.

Many commented that the pill was free in the UK—that women who couldn't get hold of it were stupid. That's not true. The pill is free at sexual health clinics and doctors' offices, but to be seen in either of those you'd most likely have to take time off work, and that's if you even manage to get an appointment within the window you need for the pill to be effective. It's not free at pharmacies if you have a consultation; it varies from place to place in a zip code lottery.

According to an NHS spokesperson, some pharmacies aren't commissioned by a local authority public health team to provide emergency contraception free of charge, and a large number follow schemes that have age restrictions, such as only the morning after pill being free if you're under 21 or under 25. Those variables mean the morning after pill is not free for all, or even a majority.

It's also clear that an overwhelming number of people believe that, if you're using the morning after pill, you haven't sorted out your contraception and you're irresponsible. That's just not true. The person in question could have missed a contraceptive pill, or a few. They could have run out of their pill and be waiting for a doctor's appointment. People might not be on contraception for plenty of reasons: They might react badly to different types of contraception, meaning depression, mood swings, or migraines, to name a few common side effects—or maybe they don't have sex often, so it's not worth using a long-term method of contraception. Or, of course, the condom could have split.

Natalie, a 25-year-old student from Cheltenham, was one of a number of people I spoke to who explained how they were caught out by the age restriction on free morning after pills in their local Boots. "If I'd been three days earlier [the day before her 25th birthday], I'd have got it for free, as they didn't charge at 24," she said. "I almost went elsewhere to lie about my age. I was like, 'OK, so now I'm 25 I can somehow afford £28 [$36] for the privilege of not producing offspring?' But it's '25 and you're paying,' regardless of circumstance."

The author after buying a morning after pill in Paris

The experience of trying to get a morning after pill can often be one of extreme high stress under time constraints. "It's being broke and the sheer panic of trying to find somewhere that will give it to you. I just thought, Why the fuck am I made to feel like I've done something wrong here?" said Ash, 28, from London. "It's baffling and shameful. I even looked up websites, but they charged, too. I think there was a catchment area for a government scheme, which guaranteed it for free, but it's like jumping through hoops."

Some commenters argued that you shouldn't be able to get the morning after pill for free over-the-counter because the one-on-one consultation is important for your health. Thing is, not only do other countries not demand that you have a consultation, but the morning after pill is considered extremely safe: The NHS says it has no serious side effects. It can also be bypassed if you buy the pill online by ticking whatever boxes allow you to get it, indicating very clearly that the consultation is not perhaps wholly necessary.

A spokesman from the Family Education Trust, when talking about the failings of the consultation, highlights what is really the concern with giving women easy access to emergency contraception: "With no questions asked about previous medical history or previous use of the drug, there is a very real danger that it could be misused or overused." Bottom line: Women aren't trusted to take control of their bodies. In fact, the British Pregnancy Advisory Service argues that the mandatory consultation may be part of the reason it is so costly in the UK, compared with other countries where such consultations are not required.

In addition, commenters said that if women felt patronized or humiliated by the consultation it was their own fault for getting themselves into the situation in the first place—and doubted that many actually felt this way. Yet a large 2014 study found that nearly a third (31 percent) of women in European countries of those who used emergency contraception reported feeling uncomfortable, stigmatized, lectured, or judged by the prescribing healthcare professional, with those rates far higher in the UK.

Alice, 22, from the northeast said, "I feel judged when the pharmacist suggests all the different forms of contraception [I should be on] before handing over the pill. I'm aware of all of them and have my own reasons for not being on anything. It's so hypocritical when, if I chose to pay the £30 or so, they wouldn't bother with any questions or advice, which you have to sit through in the consultation room in case they decide not to give you the pill otherwise."

Grace, 25, from north London went to get the morning after pill last Saturday and had a similar experience of being made to feel uncomfortable (as well as traveling around town to find somewhere to get it from). "Two chemists said the pharmacist wasn't in and said I could only get it if I bought it. The third place, which I eventually got it from, would only let me have it once I'd done a chlamydia test, so added an extra barrier. They were really bad at confidentiality and did everything on the shop floor. They wrote my name onto a form in front of me which had other women's names and dates of birth on who'd got the pill, but I didn't want to call them out because I was so relieved to finally find somewhere that would give it to me."

It's not just a case of it being a humiliating and stressful experience that women can grin and bear. Of the study sample in the UK, 11 percent of women—twice the figure of the other European countries studied—had not taken the emergency contraception when they needed it because they were too embarrassed to ask, meaning they'd risked unwanted pregnancy rather than going through the process. Worse still, the fact that it's not easy to obtain means that the stakes are just as high, even if you do put yourself through the "embarrassment."

Sarah, a 25-year-old from London, couldn't get the morning after pill a few years ago, which led to her having a medical abortion. "I'd just moved to London for an internship, didn't know anyone, had zero money, and hadn't got a doctor yet. I went to get the morning after pill, and they insisted I give them doctor details. I didn't have any as I hadn't registered anywhere yet, but as only certain NHS organizations and areas give it for free, they wouldn't let me have it. They sent me to my local hospital pharmacy, but that had closed for the weekend. I went to a different pharmacy closer to home, and they insisted on referring me to a doctor… which I didn't have. By the time I found somewhere that would give it to me, teary-eyed, stumbling upon Boots on Oxford Street like an oasis in a desert, the pharmacist realized it was too late. I ended up registering with a doctor, which took two weeks to get an appointment, and I was in fact pregnant, so had to get the pills for an abortion. This took another three weeks for an appointment to come through."

Why should anyone other than women care? Why is this so much more than pushing a "feminist agenda"—which, in this instance, is just women wanting equal rights over their body, by the way? To get the morning pill sorted out, it's a case of researching pharmacies and sexual health clinics, going around town, getting turned away, traveling to other ones, sitting in a waiting room all day. Women often have to take time off work, school, or college and pretend to be ill to get it, which has obvious knock-on effects. If women have to see their doctor to try to get it for free because they can't at their pharmacy, they're using up an emergency appointment, which could be used for someone who actually needs that time. In many cases, with doctors ridiculously overworked, that's not even possible. If a woman with kids who cannot afford to pay for the emergency contraception has to pay for it, that deficit puts her children at risk of going without.

On a wider scale, the cost of abortions or unwanted pregnancies is far greater to the state and taxpayer than giving someone a free pill. There's the added stress and associated burdens that come as a result of those two circumstances. Presumably, many of the men who commented on the original article wouldn't want to deal with the burden of an unwanted pregnancy?

The reason people commented so angrily on that article is in part the same reason women are frantically having to travel around their city to find anywhere that'll give the morning after pill to them for free: because there's a lack of standardization. How is it right that one lucky woman can get free access to the morning after pill, if every factor (pharmacists being in, pharmacies being open, being able to take a sick day and so on) aligns, but other women elsewhere have to risk unwanted pregnancy? There are far too many obstacles in place that prevent it from being accessible. To say that we have free contraception in the UK—something that's taken as a given with the NHS—is not true, and it won't be true until the morning after pill is free behind the counter for every woman who needs it.

Follow Hannah Ewens on Twitter.