Breaking barriers to emergency contraception

sad woman

Pharmacists and women alike need more education about the supply of Emergency Contraception, also known as the Morning After Pill, in order to improve access to the medicine.

So says Dr Safeera Hussainy, from Monash University’s Centre for Medicine Use and Safety, who with colleagues is conducting research exploring access to EC from community pharmacy, and how it could be improved. Her work was highlighted by Monash today as part of International Women’s Day.

In 2008-10, Dr Hussainy and her team implemented a national survey of pharmacists to find out what they knew about EC, and what their attitudes were.

“Their knowledge was good, however their attitudes and practices were sub-optimal,” she told the AJP.

“Some of them had quite paternalistic attitudes towards supplying it, they acted as gatekeepers and they had the belief that EC acts as an abortifacient, rather than emergency contraception, when it simply isn’t. This prompted a revision of the most commonly-used guidelines, the PSA guidelines, at the time.”

Three major changes in provision were warranted, Dr Hussainy says: regarding the time frame the medicine is supplied, supply to under-16s and advance supply.

“Emergency contraception can be used up to four days, effectively up to 96 hours after unprotected sex – the literature says 72, but later evidence says 96 and possibly we’re seeing now a little longer,” she says.

“We were finding a lot of pharmacists weren’t supplying it after 72 hours.

“We also included in the guidelines the fact that you can supply to women who are under the age of 16 as long as they meet certain criteria – we followed guidance from the UK around that.

“It’s also possible for women to have EC on hand for future use. If women come to the pharmacy and say, ‘I’m going on holiday, I’d like to have a packet on hand,’ or just wanting a packet on hand anyway, that’s legitimate.”

The evidence shows “no real medical reasons or contraindications” for not supplying EC, she says.

Attitudes and knowledge have improved in the years since, Dr Hussainy says, but could improve further.

She is now working on ACCESS: a qualitative study exploring barriers and facilitators to accessing the emergency contraceptive pill from community pharmacies in Australia.

The results, which include telephone interview data from a large sample of women and pharmacists, are not yet analysed but Dr Hussainy says that her observations so far point to a need for greater education for women, many of whom remain unaware that EC is available over the counter.

“The aim is to explore what barriers there are to accessing this important drug, because it’s a time-sensitive drug and not contraindicated, its supply should be relatively straightforward and yet women are still having difficulty getting it,” she says.

“Some are having to go to a doctor when a doctor’s visit is not usually necessary, unless the pharmacist suspects sexual abuse or something else untoward, or it’s outside the time frame.

“A major finding is that many women still don’t know it’s available OTC. That’s something we really need to work on, and advertising is a problem because it’s S3, so addressing that could take years. We could also look at how it’s promoted within pharmacies, which could work as it’s not really an advertised product, but you could advertise the professional service in pharmacy.

“We’re looking at strategies to make the entire process more woman-friendly and less judgemental. Our next steps are to take these ideas and propose a pilot for them this year.

“My hope is that women, not just in Australia but all around the world – because we know that in both developed and developing countries, there are issues with accessing this life-saving commodity – will be able to access emergency contraception with ease and without judgement, and that where referral is necessary, that it happens.”

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