As the threat of a no-deal Brexit looms over the nation, a growing proportion of British citizens are starting to stockpile food and medicines. Drug prices have begun to rise in anticipation of border delays due to customs formalities, with some increasing as much as six-fold in just a few months. Some medicines have already become difficult to access. The Secretary of State for Health has even chartered planes to airlift urgent medicines and has invested in refrigerators to store them.
What has not yet been reported is what will happen to the UK’s supply of contraceptives – including condoms, birth control pills, and coils – if the government is unable to reach a trade agreement before the Article 50 clock runs out on 29 March.
The NHS became one of the first health systems in the world to provide free contraception subsequent to the National Health Service (Family Planning) Act of 1967 and NHS Reorganisation Act of 1974. The ability to have control over fertility, no matter one’s income, is one of the most important factors contributing to the emancipation of women: contraception reduces teen pregnancy rates, allowing women to complete their education.
Many women use hormonal contraception for medical reasons. Barrier methods have also been helpful in reducing the risk of passing on sexually transmitted infections. Contraceptives are an essential part of modern life – two-thirds of women aged 20–24 use the contraceptive pill in the UK.
So how will access to contraception be affected if the UK leaves the European Union without a trade agreement? Suppliers and manufacturers of contraceptives are now mostly international companies, with other countries forming either the base for headquarters or the site of manufacturing.
For example, Durex, the most popular condom brand in the UK, started out as the London Rubber Company and is now owned by the British company Reckitt Benckiser, but production is entirely in China, India, and Thailand. The biggest supplier of contraceptive pills, including the “morning after” pill, is Bayer. The German company released a statement announcing that they would be stockpiling supplies in the UK for the periods immediately prior to and after 29 March 2019. Boots, one of the leading British dispensers of condoms and contraceptive medicines, stated that it was closely monitoring the situation and is arranging six weeks of additional stock of medicines and medical products to be held by marketing authorisation holders, and reviewing transport routes for medicines. It is also introducing the ability to implement protocols that can aid with serious shortages of medicines.
Contraceptives are not currently included among the medical products that were put on a list of price concessions by the Pharmaceutical Services Negotiating Committee, the supplier of NHS pharmacies. (Tadalafil, a medication for erectile dysfunction, does appear on this list.) But there is a very real risk that, in the event of a no-deal Brexit, access to these vital medications will be limited as stockpiles run low.
It is also worth remembering that these medications and devices all have expiry dates. In December, reports emerged that pharmacies may be given emergency powers to block or substitute alternative prescriptions in the event of medication shortages. The result may be that patients have to switch to different types of contraceptive pill. If these measures fail, Britons may be faced with empty shelves in the family planning aisles.
Predicting the effects of a shortage of contraception on the population requires little imagination: less safe sex, and more unplanned pregnancies. Other possibilities would be individuals resorting to alternative methods of contraception, such as sterilisation.
There are parallels in recent history. Last month, New Zealand suffered a shortage of prescription condoms and of the combined oral contraceptive Levlen ED, with doctors instructed to ration the contraceptives. When Donald Trump was elected president of the United States, there was concern about future access to contraception and women’s health services. Faced with losing control over their autonomy and fertility, women began stockpiling Plan B, an emergency contraceptive, and there was a 19 per cent rise in consultations for coil insertions. Twitter was flooded with good Samaritans offering to ship emergency contraception across the country to women at risk of losing access to it.
Whether British women will start thinking along the same lines as the UK hurtles closer towards the abyss of a no-deal exit from the EU remains to be seen.
Dr Rebecca Grossman is a specialist registrar in general surgery, working in the NHS.