Does Big Pharma Believe in Autonomy?
Sex sells—but only when industry chooses to market to women. The FDA first approved the birth control pill in 1957 as a treatment for severe menstrual disorders. That precipitated a sudden spike in the incidence of severe menstrual disorders. When the FDA approved the pill as contraception in 1960, American women readily took advantage of the freedom to conveniently separate their sex lives from pregnancy. By 1962, 1.2 million American women were taking the pill, rising to 2.3 million in 1963. In 1964, the manufacturer, Searle, took in a $24 million profit. That is equivalent to around $1.8 billion today, making the pill a “blockbuster drug.”
A blockbuster is typically defined as a drug that treats a common, recurring medical problem and generates annual sales of more than $1 billion. For obvious reasons, pharmaceutical companies typically love blockbuster drugs. But despite the popularity of the pill, unintended pregnancy remains a common problem. Approximately half of all pregnancies in the United States are unintended, around 3 million per year. Worldwide, it is estimated that around 40 percent of pregnancies are unintended, which amounts to 85 million per year. Clearly, there is still considerable potential for large monetary gains by filling gaps in the contraceptive market.
One need waiting to be filled is occupied by women who would like a contraceptive pill that they take around the time of having sex—either just before or just after. Market research indicates that such a pill, known as the pericoital contraception pill, is desired by women who have sex infrequently (around six times per month or less) and who do not want to become pregnant but also do not want to take a pill every day. Some women who have sex infrequently already use emergency contraception (EC) in a similar fashion to the proposed pericoital pill. Indeed, a leading contender for the pericoital market is levonorgestrel, a currently approved EC marketed as “Plan B” in the United States.
Given that there is significant potential demand for an already developed drug, it might be expected that pharmaceutical companies would be falling over each other to develop and aggressively market levonorgestrel as a new pericoital contraceptive. Pharmaceutical companies are typically not shy when it comes to reformulating an old drug for a new purpose. Such reformulations are relatively cheap, and they generate new, patented monopolies with associated easy profits from marketing campaigns directed to the consumer.
Enthusiasm for making and marketing contraceptives, however, has waned dramatically since the 1960s. From 1999 through 2004, a tiny company called Women’s Capital Corporation marketed Plan B. After 2004, Barr Pharmaceuticals acquired Plan B, and TEVA Pharmaceuticals subsequently acquired Barr in 2008. Barr did not spend heavily on advertising the drug and, despite Plan B becoming available over the counter (OTC) in 2013, TEVA has also not spent heavily on promoting it.
Pharmaceutical companies prefer to keep a useful, and lucrative, contraceptive product out of the hands of women because developing and marketing this kind of contraception would require allowing women to make their own sexual choices.
Schering marketed the first UK version of EC, but it engaged in barely any promotion at all, not even bothering to change the name from the technical moniker PC4 to something more commercial. Remarkably, Schering actively blocked the product from becoming OTC in the UK until 2001, preferring that it be provided only on prescription from a health professional. Providing PC4 only on prescription obviously undermined access and sales and countered the very logic of an emergency product intended for rapid use.
Why such reluctance to enter, and exploit, a seemingly lucrative market? The only likely explanation is that pharmaceutical companies are afraid of the moral implications. Contraception, broadly speaking, is now understood to be part of a morally responsible attitude to sex and family planning. It is accepted that women in long-term relationships use contraception to control their fertility and space out their pregnancies as they see fit. But pericoital contraception enters a morally disputed area of women’s sexuality.
Pericoital contraception can appeal to women who have sex spontaneously, without planning and without protection. An enormous number of women (and men) find such sexual activity tremendous fun, which is why they do it. But for sexual and reproductive health officials, such sexual activity is reckless, risky and irresponsible and must be condemned. Marketing a pericoital pill, therefore, becomes a tricky balance of selling the pill to the “right” people who will use it responsibly, without encouraging anyone to swerve over the line of accepted sexual morality.
No marketing team is going to relish promoting a new pericoital contraceptive on those terms. To properly promote any product, it has to be accepted that consumers will integrate the product into their life choices. But when it comes to pericoital contraception, there is discomfort with those potential life choices. Pericoital contraception will facilitate women’s sexual autonomy, which is not welcomed because such autonomy must include the possibility of unplanned sex. Pharmaceutical companies prefer to keep a useful, and lucrative, contraceptive product out of the hands of women because developing and marketing this kind of contraception would require allowing women to make their own sexual choices. Women pay the price for this discomfort with their sexual autonomy, and industry doesn’t reap the profits.