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Contraception Market Assessment
Key Note Publications Ltd, Jan 2000
The UK contraceptives market is a mix of prescription only contraceptive products and OTC products. Thus it falls into two broad categories, as both a consumer market and a controlled drug/pharmacy market. One of the key trends in contraception over the last few years has been the expansion of different options open to men and women. Changes in society have meant that women are having children later in life and second families are also becoming more common, as the divorce rate continues to rise. People are increasingly using a range of different forms of contraception at different stages in their life to suit their particular circumstances at the time. In addition, many women are now opting to use dual methods of contraception, ie the pill combined with the use of a condom by the man, in order to offer protection both against pregnancy and STIs.
The contraceptives market in the UK is highly dependent on population trends and the decline in the number of women in the 16-49 age group, that is set to continue over the next few years, is likely to restrict growth. At the other end of the scale, however, young women are having their first sexual encounters earlier than in previous generations, so there is likely to be growth in demand for contraception among 16-19 year olds in particular. Girls under the legal age of consent are also more likely to have had intercourse, although this sector is not covered by the scope of this report as official figures do not include those who are underage. While there are fewer people in the key childbearing age groups, the trend for having children later will mean that contraception is being used for longer than in the past.
In the most recent General Household Survey of Great Britain (for 1997) of women in the 16-49 age group, results showed that 82% used at least one method of contraception, up by eight percentage points since 1991. There was a corresponding decline in the proportion not using contraception, to 25% of women. Reasons for non-use range from a desire to have children to lack of a partner. The oral contraceptive pill remains the most popular method among women aged 16-49, used by 26%, up slightly since 1995. The condom was the preferred method for 21% and the same proportion used male/female sterilisation as a permanent method of contraception.
Market Assessment commissioned independent and exclusive research from National Opinion Poll Solutions (NOP) in January 2000 into consumer attitudes towards contraception. For this research, a representative sample of all adults aged 16-55 were surveyed, to gain an insight into attitudes in general, not just those of women. Respondents were asked various questions relating to their use of contraception and their views on the issue. Findings show that nearly a half (47%) of respondents use contraception primarily to avoid unwanted pregnancy, with this being the most popular of all responses. Only a fifth (19%) use contraception primarily to protect against STIs or HIV/Aids. Just 4% of respondents were non-users because they were planning to start a family, but perhaps more worryingly there were 7% of respondents who simply do not bother about using contraception and 2% who do not always use, because they forget. Furthermore, only 15% of respondents were very worried about the risk of contracting HIV/Aids from unprotected sex.
In terms of attitudes, a high proportion (39%) consider that women have a more responsible attitude to contraception than men, perhaps a predictable response. Nearly a third of respondents (32%) also consider that contraceptives should be easier for those aged under 16 to get hold of, without parental knowledge. This reflects growing concerns about teenage pregnancies and the number of teenagers having unprotected sex through ignorance or fear of going to a family doctor to obtain contraceptives. Media publicity over mothers as young as 12 years old have given a higher profile to this problem in the last year, with the UK having the highest rate of teenage pregnancy in Europe.
Other significant findings of this research were that 18% of people were concerned about the long term health risks of methods of contraception, such as the pill, and a further 7% had given up the pill because of these concerns. On a positive note, 13% of respondents would consider using a male contraceptive pill.
A total of around 3.6 million women used the contraceptive pill as their main form of contraception in 1997, with around 80% of these visiting their family GPs. This figure shows a slight fall, of 1%, since 1992, due mainly to the pill scare, in 1995-1996, that caused some women to switch to other methods. There has also been a steady decline in the number of women in the relevant age groups. In terms of family planning clinics, the most frequently prescribed oral contraceptive is the combined pill, accounting for 89% of all prescriptions. It is estimated that around three-quarters of all pill users are on the combined pill, although the mini pill is likely to increase in popularity as it is often recommended for older women. As the population is ageing, it is therefore likely that it will be more widely prescribed in the next few years.
The use of family planning clinics has declined, between 1992 and 1998, as opening hours have been cut due to NHS cutbacks. As a result, there has been a 14% decline in the number of women attending clinics who have been prescribed the pill, over this period, to stand at 0.4m. In contrast, around 2.5m attended GP's surgeries for pill prescriptions, in 1998, with doctors writing out an estimated 7 million prescriptions. Although there is not a retail value to this sector, the average cost of an annual pill prescription is around £12, so this suggests a total market worth £43.2m per annum.
It is not possible to obtain any drug-based contraceptives over the counter and so the distribution differs from other consumer markets. As such, consumers have less choice and are more dependent on the advice and recommendations of their doctor or clinic. The most popular brands of contraceptive pill in 1999 remain, as in previous years, Microgynon and Ovranette, made by Schering Healthcare and Wyeth respectively. Other leading suppliers, of both combined and progestogen only pills, are Organon Laboratories, Parke Davies, Janssen-Cilag and Searle.
The use of contraceptive injections has increased steadily over the last five years, as women perceive them to be more convenient and reliable than the pill. In 1997-1998, there were around 52,000 women using this form of contraception (or implants), a fourfold increase since 1992. There are only two contraceptive injectable products currently licensed in the UK, namely Depo-Provera and Noristerat, with Depo-Provera being more commonly prescribed. The only contraceptive implant on the UK market, Norplant, was withdrawn in 1998, due to poor sales, although there is still potential for this product as a reliable long term form of contraception.
Use of the emergency contraceptive pill has increased in the last five years and in 1997 had been used by 9% of women aged 16-49 in the previous two years, compared to 7% in 1995. Usage is much more common among single women, as might be expected, with 16% having used this form of contraception, up by three percentage points. The combined pill is the most commonly recommended form of emergency contraception, used by around 97%, although an IUD can also be used, but is only suitable for those who have already had a child. There are plans to introduce a progestogen only emergency pill as well in 2000. There is currently only one brand of emergency pill, Stirring's PC4, although the same company is planning to launch Levonelle-2, a progestogen only alternative, in Spring 2000.
Barrier contraceptives are the male and female condom, caps and diaphragms and are preferred by those who do not wish to use hormone-based methods, or find these methods more suitable for their needs. Only condoms offer protection against STIs and HIV/Aids, however, and are by far the largest sector, used by 21% of all women (and their partners) aged 16-49. This market was valued at £64m in 1999, an increase of 36% since 1994, while volume sales increased by 8% over the same period, to reach 173 million units. Regular health education campaigns regarding the importance of using condoms for safe sex, to protect against infection, have ensured continued popularity of this method. There has, however, been a worrying decline in overall use, between 1991 and 1997, of 60%, suggesting that young people, in particular, are becoming complacent about the risks of contracting Aids or other STIs.
The condom sector is heavily dominated by one brand, Durex, which accounts for around 80% of sales, by value, in the UK. The brand was formerly part of the London International Group which, in 1999, merged with healthcare group Seton Scholl to form a new company, Seton Scholl London (SSL) International Group plc. The company spent £2.2m on main media advertising in 1999, a fourfold increase compared to 1994. There are a few other brands in this sector of note, namely Mates and Condomania. The Jiffy brand has been phased out since 1998, after no buyer could be found for the brand when it was disposed of by former owners, Sime Derby. Boots offer a range of own label condoms, as well as branded products. While condoms can be purchased in retail outlets, it is still possible to obtain supplies free from family planning clinics and GP's as well. In terms of the retail distribution, pharmacies dominate, taking 60% of sales (Boots alone taking 30%), while the supermarkets account for just under a fifth of sales.
The cap or diaphragm is used by 2% of women aged 16-49 and the number of new users has fallen over the last 10 years. The products are generally perceived as messy and difficult to use. The same can be said of the only female condom on the market, Femidom, which also has low levels of usage, with less than 1% of women using it in 1997. The product was launched in 1993, but has failed to make significant inroads into the barrier contraception sector and is therefore likely to remain a minority product.
The IUD has been used for many years but is also in decline with around 4% of women using this method in 1997. The product has suffered adverse publicity about the risks of PID and ectopic pregnancy and the fact that it can cause heavier, and more painful, periods. The more recently introduced IUS is smaller and also uses slow release progestogens in order to provide dual protection. They also cause periods to be shorter, lighter, or non-existent and are thought to offer fewer health risks than the IUD. The problem is that the product, Mirena is the only brand currently available, is much more expensive than conventional IUDs. A newer, smaller IUD has also been introduced in the last couple of years, Gynefix, and this may help stimulate renewed interest in the sector.
Sterilisation is the chosen method of contraception of 21% of people, although the actual numbers dropped between 1992 and 1998. There were around 80,000 male and female sterilisations carried out in 1998, split fairly evenly between the genders. There has been a 24% decline in the numbers of female sterilisations, between 1992 and 1998, while the number of vasectomies has also fallen by 16%. All female sterilisations take place in hospital, whereas 24% of male vasectomies take place in clinics. The popularity of permanent methods, such as these, has fallen, as there is more uncertainty in relationships and rising divorce rates mean that some people choose to have a second family, if they remarry or enter a new relationship.
A very small proportion of adults, around 6% in total, uses natural methods of contraception (NFP). These tend to be more unreliable as they are so dependent on being used correctly. They are, however, the only option for those with strong religious beliefs and can, if used diligently, be very effective. The main device on the market that uses natural methods (measuring changes in hormone content during the monthly cycle) is Unipath's Persona electronic monitoring system. This product was launched in 1996 and faced some early criticism of its high failure rate, but is still the only such product on the market and is also used by couples wanting to predict fertile periods in order to conceive. As such, it is not just a contraceptive device, more a fertility awareness product.
Future developments in the contraceptives market are likely to include the development of a contraceptive vaccine and the male pill. The only problem with such products is that there is a long period from developing the product in the laboratory to it appearing on the market, as any new drug has to be extensively tested and subject to clinical trials before it can gain a license for use. It will also be necessary to continue to warn people about the need to use condoms to protect against STIs, as complacency and ignorance among young people appear to be on the increase once again.
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