The Great Morning After Pill Rip-Off

The high street giant Boots faces a backlash after putting emergency contraception (or the morning after pill) on offer for Black Friday. Instead of charging £15.99 for levonorgestrel, Boots listed it at £8 for the duration of the offer. 

It was like something from feminist dystopian fiction: Buy up the morning after pill today while you can, ladies. It’s half price! Black Friday is the epitome of consumerism. It is a shopping event which sees consumers race to buy things they often don’t need while they’re discounted. The entire concept exposes a farce: that almost every product we purchase is at an inflated price because of retailers’ profit margins. To apply Black Friday 'offers' to essential medicine felt poisonous. It was bitter to swallow, fizzing like pineapple chunks left too long in the fridge. 

The very same medication – levonorgestrel – is available from online pharmacy Chemist4U for £3.39. This fact has led the British Pregnancy Advisory Service (BPAS) and a coalition of MPs led by Labour’s Dame Diana Johnson to condemn Boots and ask it to reconsider its pricing. 

They have written to Sebastian James, the managing director of Boots, imploring the company to keep the price low "and demonstrate a clear commitment to improving women’s reproductive health and wellbeing". BPAS has also launched an online petition for people to sign, calling on Boots to "do the right thing" and remove financial barriers to this essential medication. 

The fact that emergency contraception is available over the counter ought to be good. It ought to signal progress and accessibility but instead this is the story of the quiet privatisation of contraception in England. It is about how women’s needs have been neglected due to government cuts, allowing private companies to step in and profit. 

When Britain’s National Health Service (NHS) was founded by an act of parliament in 1946, one of its founding principles was the delivery of healthcare which was "free at the point of use". In 1961, when contraception became available on the NHS (initially for married women only), it was no different. 

Today, both contraception and emergency contraception are still available for free via the NHS. However, in recent years, cuts to public health funding in England mean that some women are not able to access it as readily as they would like or, indeed, need to. 

According to the Advisory Group on Contraception (AGC), the government has made cuts to contraception spending power of nearly a fifth since 2015, despite the soaring demand for these services. The AGC analysed the government’s contraception figures for 2018/19 and found that closures of services have continued to escalate, from 9% in 2015/16 to 26% in three years. The AGC's audit also found that prescriptions for the most effective contraception in primary care have continued to fall, based on Public Health England's data.

In 2020 the All Party Parliamentary Group (APPG) on Sexual and Reproductive Health issued a similar warning, saying that the coronavirus pandemic had made a "difficult situation even worse" for women trying to access contraception. They conducted an inquiry and found that patients "have to navigate a complex system just to receive basic healthcare".

And so, while emergency contraception is available for free from GPs and sexual health clinics, for many women this is not a practical option. Appointments can be hard to obtain, particularly during the pandemic, and services increasingly restricted amid cuts to public spending. ‎As a result, pharmacy provision will be many women's only option to access this important method of back-up contraception when their usual method fails. But the high cost of emergency contraception can be a major barrier to women accessing it when they need to, leading to unplanned and unwanted pregnancies.

It is against this backdrop of prolonged waiting times and sexual health clinic closures that people have turned to buying emergency contraception privately. 

Katherine O'Brien, associate director at BPAS, explains: "Contraception should be free at the point of use. It is an essential aspect of healthcare, yet years of chronic underfunding has meant that NHS-funded services have become less accessible." 

It is not only emergency contraception that can now be purchased privately online or on the high street. Hormonal contraception such as the combined oral contraceptive pill and progestogen-only pill can be, too. 

"This will of course be a swift and convenient option for some women," Katherine continues. "However, the option to purchase contraception does not negate the need to provide it for free. We need affordable options in pharmacies but contraception should not become a privatised service. The ongoing battle regarding emergency contraception demonstrates how vital it is that our NHS continues to provide the reproductive healthcare that women need."

This isn’t the first time Boots has found itself in hot water over emergency contraception. In 2017, following a BPAS campaign, Superdrug reduced the price of emergency contraception to £13.50 and other high street pharmacies followed suit. Boots, however, initially refused to lower the cost, keeping it at £28.25 in the belief that doing otherwise would "encourage inappropriate use". It only changed its position after an intervention by Labour MPs. 

Today, Boots stocks three kinds of emergency contraception: Levonelle (£28.25), EllaOne (£34.95) and levonorgestrel (£15.99). 

"This Black Friday promotion that ran on our Online Doctor hub was 50% off all men’s and women’s private healthcare services. We sometimes offer short term promotions in order to raise awareness of certain services but it is not usually possible to sustain significant discounts in the long term. Our pricing model takes into account the expert clinical advice and consultation that we give with these services and the prices are in line with other high street pharmacies. The morning after pill is available for free in many NHS settings, including in Boots pharmacies that have been commissioned by local NHS CCGs to provide such a service."

"It is extremely disappointing that high-street giants continue to impose a sexist surcharge on emergency contraception. Boots has an opportunity to lead the way and demonstrate a clear commitment to improving women’s reproductive health and wellbeing. Alongside the women of the Parliamentary Labour Party, I implore Boots to do so."

"At BPAS, we regularly see women experiencing an unplanned pregnancy who were deterred from using emergency contraception because of the obstacles to access, including the price.

"The current offer from Boots, and the fact a much smaller online retailer is able to sell the same medication for less than £4, shows that it is entirely possible for big pharmacy chains to make emergency contraception much more affordable. 

"It is wrong that a woman in need of emergency contraception this time next week will be forced to pay double the price compared with a woman who needs this medication today. This essential medication should be available, affordable, and accessible for everyone who needs it. We urge Boots to do the right thing and not double the cost once their arbitrary 'Black Friday' discount expires."

The Department for Health declined to comment because emergency contraception remains free on the NHS. It is a matter for pharmacies to determine the price at which a pharmacy product is sold.