Sat 17 April 2021

The news that under-30s will be offered an alternative to the Oxford/AstraZeneca jab has sparked a debate about women’s reproductive and contraceptive healthcare, reports Sian Norris

The UK’s medicines regulator, the MHRA, has announced that under-30s will be offered an alternative to the Oxford/Astra-Zeneca COVID-19 vaccine after concerns were raised about blood clot risks. 

The policy shift comes after 79 people – two-thirds of them women – developed blood clots following the vaccine, although it is not confirmed that there is a causal link between the two. This translates to a four in one million chance of developing a blood clot. 

The MHRA is clear that the benefits of the vaccine outweigh the risks and that everyone who is offered a vaccine should get one because the vaccine programme is breaking the link between COVID-19 infection and deaths.

But, with concerns around a potential link between the vaccine and blood clots making the headlines, women have been asking questions about the lack of attention paid to the side-effects of the contraceptive pill – including the risk of developing blood clots. 

There is five times as much research into erectile dysfunction than into premenstrual syndrome. The former impacts 19% of men, with the latter affecting 90% of women

Referring to the contraceptive pill, Labour MP and Shadow Minister for Domestic Violence and Safeguarding Jess Philips tweeted yesterday: “I developed a blood clot caused by medication women are prescribed every single day. Let’s make sure we are careful to properly understand the rare nature of what is being reported.”

The risk of blood clots to women taking a combined hormonal contraceptive that contains levonorgestrel, norethisterone or norgestimate is between five to seven in 10,000 in a year. This increases to nine to 12 women in 10,000 when taking a combined hormonal contraceptive that contains drospirenone. For women who take no hormonal contraceptive at all, the risk of a blood clot is two in 10,000 a year. 

The risk remains very low and blood clots do not have to be life-threatening. The European Medicines Agency estimates that if 10,000 women receive the contraceptive pill for a year, they expect to see four excess blood clots.

Emancipation and Side-Effects

The introduction of the contraceptive pill in the 1960s was a vital step forward for women’s rights – giving women the opportunity to control their own fertility in an unprecedented manner. 

Women’s increased bodily autonomy enabled by the pill caused what former chair of the Federal Reserve Janet Yellen called a “biological shock”, as more and more women were able to choose if and when to have children and to enter the workforce in record-high numbers. 

In recent years, however, a new generation of young women have raised concerns about the impact of the side-effects on their health and wellbeing – with journalist Stephanie Boland asking in the New Statesman: “Why are female contraceptives still so rubbish?”

Those side-effects include blood clots, migraines, low sex drive and depression. A 2016 study of more than a million women aged 15-34 found that those taking a combined contraceptive pill are 23% more likely to use anti-depressants than those who do not. The number was higher for adolescents – those using combined oral contraceptives are 80% more likely to take anti-depressants.

Plans for a contraceptive pill for men have tended to run aground against adverse side-effects. A paper in the British Medical Journal explained that “the potential risks of the contraceptive were deemed to outweigh the potential benefits, leading to the trial’s discontinuation. In female contraceptive trials, adverse events are also seen, but deemed acceptable compared to risks of pregnancy”. 

Side-effects identified in the male pill included reduced sex drive, depression, weight gain and headaches – all familiar to women on hormonal contraception. 

A Lack of Research

The development of the pill was almost prevented by a lack of funding into women’s health. In the end, it was funded by a wealthy benefactor, Katharine McCormick, who was interested in birth control.

Today, research into contraceptive options still struggles to get funding. Quoted in inews, researcher Professor Øjvind Lidegaard explained that it can be difficult to secure funding for research which looks at the negative effects of hormonal contraception: “I think it’s true that the companies who produce these pills are very willing to support proving that there are benefits to taking hormonal contraception. It is much more difficult to get support to study the negative reactions and demonstrate the adverse effects.”

Less than 2.5% of publicly-funded research is dedicated solely to reproductive health despite the fact that one in three women will suffer from a reproductive or gynaecological health problem in their lifetime. There is five times as much research into erectile dysfunction than into premenstrual syndrome. The former impacts 19% of men, with the latter affecting 90% of women.

A lack of sex-aggregated data can also lead to problems in identifying risks to women’s and men’s health. The Government was criticised last year for failing to collect sex-based information in its Coronavirus data tool. Global Health 50/50, an initiative to advance gender equality in global health, explained why sex-disaggregated data was needed, with evidence suggesting that sex and gender are “important drivers of risk and response to infection and disease”.

This has now been emphasised by the potentially gendered reaction to the Oxford/AstraZeneca vaccine. An openness about any identified sex differences in how people respond both to the virus and the vaccine will be important in maintaining confidence in the weeks and months to come.

While the benefits to getting the vaccine to keep oneself and others safe from the Coronavirus outweigh any risks, young women who are on the pill need to understand if they face a greater risk than their male peers, and whether the risks of blood clots on the pill interact in any way with the potential risk of the vaccine. 

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