A Complicated History

Today, questions of access around contraception are particularly pertinent, since 17 March 2021 marks 100 years since Marie Stopes—along with her philanthropist husband, Humphrey Verdon Roe—opened the first birth control centre in the British Empire, in North London.

In some ways, the centre was revolutionary: many married women were able to access early forms of contraception legitimately for the first time, including the cervical cap and types of spermicide made from oil. But Stopes’ legacy is far from straightforward.

To support the clinic, Stopes had founded the Society for Constructive Birth Control and Racial Progress the year before. She was a fervent eugenicist who condemned interracial relationships, an advocate of compulsory sterilisation for those deemed ‘unfit’ for parenthood, including mixed-race people and the ‘lower orders’, and reportedly an admirer of Hitler. Her early cervical caps were called ‘prorace’ caps.

As Mark and Neil Sutherland write in their book Exterminating Poverty, the clinic sought above all to create ‘a race of well-formed, well-endowed, beautiful men and women’. In response to 2020’s Black Lives Matter movement, Marie Stopes International changed its name to MSI Reproductive Choices.

In the century since, contraception provision in Britain has moved to centre the autonomy of those who use it, rather than Stopes’ often more sinister ends. However, new challenges have arisen over the availability of contraception on a severely underfunded NHS – challenges which, like all the consequences of austerity, affect some groups more than others.

Many of the present problems date back to 2013, following changes introduced via the Health and Social Care Act 2012 which meant the commissioning of sexual health services in England were siphoned off from NHS to the local authority. According to Sim Sesane, a nurse from MSI Reproductive Choices, sexual healthcare was turned into a ‘postcode lottery’, with local authorities themselves facing cuts that they have to pass on; abortion rates, meanwhile, reached a record high in 2020, indicating that many are not able to access the resources they need to avoid unwanted pregnancies.

The Present Challenge

Many women speak of particular challenges accessing emergency contraception, or the ‘morning after pill’. Daisy from Bristol says she has more than once found herself walking up and down high streets and going in and out of pharmacies, unsure where she can and can’t get it for free. ‘It’s humiliating and demoralising having to go up to so many desks,’ she says.

Others have been told that free emergency contraception is only available to residents of a certain area, or have been forced to travel miles from rural locations for services.

Like with all healthcare, the consequences of long waiting lists and a lack of information can be serious. Ellie from Hull has had her implant for close to eight years—making it overdue for removal—despite having repeatedly asked for it to be taken out. Every time she tries to make an appointment, she says, she is met with refusal due to a lack of trained staff.

Along with irregular periods, Ellie now suffers from severe hormonal spikes, which leave her emotions ‘on a rollercoaster’. ‘I feel I’ve been forgotten about. I’ve just been left with this object in my arm without any concern or follow up after lots and lots of attempts to get help,’ she adds.

Dr Jane Dickinson, a consultant in sexual and reproductive healthcare at Aneurin Bevan University Hospital, points out that there are several inverse care laws that affect how easily one can access contraceptives.

‘If you’re in a violent relationship you’re going to find it difficult to get out, and you’re going to find it difficult to use a telephone to access telephone services,’ she says. ‘The same goes for if English isn’t your first language. If you live in a rural area and you don’t have money, you might not be able to use public transport to access services.’

During the pandemic, there has also been a reported ‘drop’ in the number of young BAME people requesting contraception services, suggesting that marginalised groups have been most affected by limited access to care.

Reduced waiting times and flexibility around work have both been called for as solutions with the introduction of e-consultations since the pandemic hit. ‘But there’s a danger that people see digital telemedicine as a panacea,’ says Lisa Hallgarten, head of policy and public affairs at Brook, who would caution against that edict.

Questions of funding are indicative of what a government does and does not value: a change in technique cannot make up for a funding shortfall, or for a government that does not value reproductive independence.

100 years on from the opening of the UK’s first contraception clinic, contraception services are under a new and different kind of threat – but implicit is the fact that the question of sexual healthcare access all too often remains an ideological one.