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Impact on contraceptive practice of making emergency hormonal contraception available over the counter in Great Britain: repeated cross sectional surveys

BMJ 2005; 331 doi: https://doi.org/10.1136/bmj.38519.440266.8F (Published 28 July 2005) Cite this as: BMJ 2005;331:271

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The 'golden standard' or the exception

According to Marston et al. (2005) the use of emergency contraception
(EC) in the UK has not increased due to its new over-the-counter status. I
do not know whether this finding corresponds with EC sales in Britain. In
other countries however, EC sales increase significantly after becoming
available over-the-counter. Although it's still early to draw conclusions,
EC sales in the Netherlands seem to have increased by approximately 50%
since it became available without prescription in January of this year.
Similar increases have been reported in other countries as well. This
poses some interesting questions:

- Is the conclusion that EC use in the UK did not change accurate?
Have EC sales not gone up?

- If they have, is an omnibus study (like the one in the UK)
sensitive to these changes, i.e. is the sample appropriate? If not, how
then should we interpret their other findings, i.e. that contraceptive
behaviour is not affected?

- If EC sales actually did not change, it would be interesting to
understand why the situation in the UK is different from other Western
countries where EC became available over-the-counter.

These questions need to be answered in order to be able to understand
whether the British findings can be generalised to other countries. This
issue is especially interesting, because most research on EC has been done
in the UK. It's important to know whether the British situation is the
'golden standard' as is often assumed, or that it is actually an
exception.

Finally, the overall tone of news items on the aforementioned study
is one of relief. As if it's a good thing when EC use does not increase,
like it's a good thing when people don't have unsafe sex because of EC.
However, I would think it's the other way around. If sales did not
increase due to a status change, the status change proved to be redundant.
EC can only prevent unwanted pregnancies and abortions if it is used, and
if it is used properly.

Charles Picavet

Rutgers Nisso Groep, The Netherlands

c.picavet@rng.nl

Competing interests:
None declared

Competing interests: No competing interests

12 September 2005
Charles Picavet
Researcher
Rutgers Nisso Groep, PO Box 9022, 3506GA Utrecht, The Netherlands

abortion rates climb despite OTC morning after pill

Whilst Marston et al make interesting observations , it only comments
in passing on the failure of OTC emergency contraception to reduce
unwanted pregnancy. OTC emergency contraception was introduced to try and
reduce unwanted pregnancies by improving access (1). However the latest
abortion statistics from the DoH (2) sadly show a further increase in
abortions for 2004 (up to 184,000), and in this respect the introduction
of OTC emergency contraception can be said to have failed in its purpose.

The UK strategy to prevent unwanted pregnancies continues to be
woefully inadequate. This isn't surprising however, as current policies
continue to promote "safer sex" and fail to recognise that a society which
condones and even encourages promiscuous sexual behaviour is inevitably
going to have high rates of unwanted pregnacy and STDs. Sadly pointing out
that promiscuity is an unhealthy way to behave is seen as intolerant and
politically incorrect. Interestingly smoking is (rightly) criticised with
no concerns about intolerance.

Chris Wayte GP, Bath

1. BMJ 2001 vol 322 p 186
2. Department of Health website 27.7.05

Competing interests:
None declared

Competing interests: No competing interests

31 July 2005
Chris Wayte
GP
Bath BA2 3JZ
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