With the UK experiencing “catastrophic” shortages of key contraceptives, three major organisations are now calling on the government to take action. It couldn’t come soon enough – but, says Moya Crockett, this isn’t the only problem affecting contraceptive access in the UK.
Last summer, after a particularly brutal string of experiences trying to access basic contraception, I posted an angry, exhausted thread on Twitter. It blew up. Within the space of 24 hours, I’d been contacted by hundreds of women saying that they, too, were finding it almost impossible to get hold of various different brands of contraceptive pill through their GP or pharmacist.
It wasn’t just the pill that women were struggling with. Women in their 20s and 30s messaged me stories of waiting months to get the coil fitted. Others, who were going through the menopause, spoke of suffering as a result of being denied hormone replacement therapy (HRT). My unexpected virality made me realise that my experience wasn’t unique or unlucky. On the contrary, it is now completely normal for women in the UK to be thwarted when trying to access medication that’s essential to their reproductive and sexual health.
Now, major public health bodies are urging Boris Johnson’s government to take action to tackle shortages of contraception and HRT across the UK. The Royal College of Obstetricians and Gynaecologists (RCOG), Faculty of Sexual and Reproductive Healthcare (FSRH) and British Menopause Society (BMS) say that thousands of women and girls have been affected by contraception and HRT shortages.
The organisations have written to health secretary Matt Hancock, denouncing the shortages as “unacceptable” and calling on him to set up a working group to address ongoing supply issues.
“It remains unclear why there is a shortage in the first place or when the normal supply of the products might resume,” says Dr Edward Morris, president of RCOG. “The lack of transparency around why these shortages have occurred is extremely frustrating.”
While investigating contraception shortages last year, I spoke at length with Dr Asha Kasliwal, president of FSRH and one of the co-signatories of the letter to the health secretary. Kasliwal now says that many FSRH members – all of whom work in the sexual and reproductive health field – have contacted her organisation to say they’re finding it increasingly difficult to prescribe contraceptives.
“We are aware that women are sent away with prescriptions for unavailable products and end up lost in a system that is frustrating to navigate. This is causing utter chaos for patients, clinicians and pharmacists,” she says.
We talk a lot about the potential effect of hormonal contraceptives on our emotions, but the distress and anxiety caused by being unable t
“I had been on Cilest since I was 18 and it was perfect for me,” Abboud says. But when she went to collect her usual prescription last summer, she was told Cilest wasn’t available. “I took the morning off work to traipse to four more different pharmacies, only for them all to tell me they had none in stock and didn’t know when it would be back in.”
Abboud was shocked that nobody had warned her that her pill was due to be discontinued. “We need to know in advance so we can mentally prepare for a change in contraception,” she says. “I also can’t afford to take time off work to track down medication; I’m a young professional working in an all-male team. The worst thing is, I don’t know who I should be complaining to, or who would actually listen.”
Kaytee Johnson had a similar experience. The 28-year-old trainee solicitor from Liverpool started taking Loestrin 20 – the same pill I relied on until last year – in 2017 after experiencing “awful” side effects on another oral contraceptive. Johnson only learned that Loestrin 20 had been discontinued when she went to collect her regular prescription, and was told her GP had put her on an alternative pill.
“The man in the pharmacy had the nerve to tell me ‘they’re all the same anyway,’” Johnson says. Of course, this isn’t true: not only do many women experience extremely unpleasant side effects as a result of hormonal birth control, Johnson was unable to take the new pill she’d been prescribed due to an existing health condition. After taking time off work to attend yet another doctor’s appointment, she was eventually prescribed a new progesterone-only pill called Zeletta.
“People need to be aware of how much of an issue this is,” she says. “I went through weeks of hell on Zeletta until my body got used to it – my skin was like sandpaper, I felt nauseous and the mood swings were atrocious.
“The whole thing was just exhausting from start to finish. On top of having to deal with massive change in my hormones, I’m dealing with the stress of going from pharmacy to pharmacy and taking time off work. I just felt so hopeless and low. Something as simple as birth control should not be such a headache.”
The demand for the government to investigate shortages of contraceptives and HRT has been backed by women’s reproductive healthcare charities including the British Pregnancy Advisory Service (bpas) and Marie Stopes UK. Bpas is also asking the health secretary to consider reclassifying emergency contraception, so it can sold “straight from the shelf at a more affordable price” to those who need it.
“We know some women have been struggling to access their preferred pill, and others have also experienced issues obtaining the contraceptive injection,” says Clare Murphy, director of external affairs at bpas.
“It can take women a long time to find a pill that suits them and they may find it hard to tolerate the side effects they report on the others, including abdominal pain, headaches and irregular bleeding.
“Combined with the fact that emergency contraception is increasingly hard to obtain for free in England, it is not surprising that we are seeing unplanned pregnancies as a result.”
Individual GPs, nurses and pharmacists are not to blame for medication shortages. Neither are experiences like Johnson’s, Abboud’s and my own caused solely by issues in the supply chain. When we talk about problems with contraception access, we can’t ignore the fact that our sexual and reproductive health services have had their budgets slashed dramatically by successive governments over the last decade.
According to the Local Government Association, local authorities faced cuts of nearly £16 billion between 2010 and 2020. Since local councils were made responsible for running contraceptive services in 2013, this means there is a direct correlation between austerity and stripped-back sexual health provision.
Half of councils in England had cut or planned to reduce the number of sites providing contraception services between 2015 and 2019, according to a BBC investigation, while recent research by FSRH shows that nearly four in 10 women in the UK are unable to access local contraception services.
Julia Hogan, Marie Stopes UK’s contraceptive and sexual health nurse, says that staff at her charity’s clinics regularly speak to women who have experienced difficulties accessing birth control. She emphasises that the problem is bigger than pharmaceutical scarcity. “Not only have many services been shut down, but when women do manage to find a clinic many are being denied the full range of contraception, including some of the most effective long acting methods.”
The Department of Health and Social Care has confirmed that there are currently ongoing supply issues with some HRT products and contraceptives, notably Synphase, Noriday, Norimin and the Sayana Press injection. It offered no comment on the multiple forms of oral contraceptive that have been discontinued in recent months, including Cilest and Loestrin 20.
In a statement, a spokesperson said the government was working closely with suppliers and stakeholders to resolve the problem as soon as possible. “We understand how distressing medicine shortages are,” the spokesperson said. “We want to reassure patients we are doing everything we can to help them access treatments as soon as possible.”
But if the government is serious about ensuring that everyone in the UK has access to the contraception they need, they need to do more than just tackle medication shortages. We also, at the bare minimum, need proper funding for reproductive and sexual health services within the NHS. Were Boris Johnson to make this a priority, it would offer much-needed evidence that his government genuinely cares about women’s physical and emotional wellbeing.
As it stands, the progress the UK has made on women’s reproductive healthcare is currently under threat.
“Unless action is taken, it is the most vulnerable who will be worst affected,” says Hogan. “It’s vital that we give women the contraceptive services they deserve.”
If you would like to write to health secretary Matt Hancock to share your experiences of being unable to access contraception in the UK, you can do so here.
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