More than 50 years since it became widely available in the UK, the pill remains the most popular form of prescribed contraceptive among women in England, research by the Guardian shows.
A flurry of articles have claimed that many women are shunning oral contraceptives, as studies have emerged warning of links to everything from depression to difficulties reading the emotions of others. Meanwhile, the rise in use of fertility apps and period trackers suggests women are keen for a hormone-free form of birth control.
But despite the negative press, rumours of the pill’s demise appear to have been greatly exaggerated, according to new data that shows little evidence of a backlash against the contraception.
Figures obtained by the Guardian under the Freedom of Information Act show almost nine in 10 women who receive contraception from the GP or pharmacies take either the combined pill or “mini pill” – a total of more than 3.1 million women in England in 2017-18 – with the proportion remaining similar for the past three years.
But experts say the findings raise concerns that women might be missing out on the latest contraceptive options.
Julia Hogan, a contraception and sexual health nurse who works for the charity Marie Stopes, said: “That so many women are being given the pill makes me think that they are not being given information about all the methods,” adding it was likely that women were asking for the pill and were given it without clinicians checking whether a different type of contraception might have suited them better.
The data reveals only a fraction of women were prescribed long-acting reversible contraceptives, or Larcs, the most effective forms of contraception, which last for months or years without further intervention. Just over 10% of women were prescribed contraceptive injections, while 3.7% were prescribed the implant and 4.4% were prescribed a hormone-free intrauterine device (known as the “coil” or IUD), or a hormone-containing intrauterine system (IUS).
Research from the Family Planning Association released in December 2016 revealed that only 2% of GPs offer the full range of contraceptives, with a fifth saying they didn’t offer the IUD or IUS and a quarter saying they didn’t offer the implant.
The IUD, IUS and implant are all more than 99% effective once fitted and, unlike the pill, are not subject to user error. By contrast, oral contraceptives are only 91% effective if taken in a typical fashion – with about 9 in 100 women using the pill getting pregnant in a given year. Unlike the case of the pill, if a woman wants to become pregnant, she will need an appointment to have the IUD, IUS or implant removed.
According to the data obtained by the Guardian, there has been a slight drop in women receiving the implant through GP or other community prescriptions over the past three years, and a small rise in those receiving the IUS and IUD – although the reasons are unclear. Nonetheless, uptake remains low.
Dr Rebecca French, associate professor of sexual and reproductive health at the London School of Hygiene and Tropical Medicine said it was not surprising the pill was more commonly prescribed than other methods, because doctors needed specialised training to fit uterus-based gadgets or the implant, and that consultation times were short.
Long-term data previously released by the NHS reveals that the number of prescriptions of Larc methods by sources including doctors and pharmacies rose from 2009 but fell from 2014 – with signs that they have now plateaued.
French said financial incentives to encourage doctors to discuss the full range of contraceptives were scrapped in 2014. According to the Clinical Advisory Group, half of local authorities in England reduced spending on contraceptive services in 2017-18.
The upshot, she said, was a “perfect storm” that could leave women with little choice. “You are getting GPs that may not be incentivised to provide a full range, and you are getting pressures on sexual health services, and therefore women may not be getting the long acting reversible contraceptives that route, particularly if there are waiting times,” she said.
Prof Helen Stokes-Lampard, chair of the Royal College of GPs, called for an increase in funding to GP practises to ensure women were able to access the full range of contraception. “We are concerned about the large-scale cuts – or plans to cut – contraceptive services in England, meaning that many GP practices running Larc-fitting clinics are no longer being adequately funded to do so,” she said, adding that funding for appropriate training for staff was “patchy”.
French said funding contraception was a “no brainer”, adding that a report from Public Health England published last year showed that, for every £1 invested in contraception from the public purse, £9 would be saved across the public sector over 10 years, assuming couples would move from buying cheap short-term methods, such as condoms and pills, to more effective methods of birth control.
“We do change what contraceptive method suits us in terms of what is going on in our lives, or past experiences with methods, or whether we are planning to have kids soon or not, so different methods will be suited to different points in time,” French said. “I think there is still a lack of knowledge about what different methods are available to people and to help women to make informed choices.”
Data note/methodology
The Guardian analysed data from NHS Business Services Authority, which manages dispensing contractors across England. The data captures the number of individuals of all ages who were prescribed contraceptives between 2015-2016 and 2017-2018 in community settings – which includes GP surgeries and pharmacies but excludes sexual health clinics. Individuals could be prescribed more than one method of contraception in a year, however the percentage share for each contraceptive is calculated as a proportion of unique patients. Condoms and over-the-counter methods are not included, or the use of “natural” family planning or apps. Some women would have been prescribed contraceptives for purposes other than pregnancy prevention, such as managing bleeding.
