Lack of consistency hurts women’s health

New data has found considerable variation in access to contraceptives across the Gippsland area – meaning women and girls cannot be confident they can get the emergency contraceptive pill from a pharmacy, the authors say

In the survey, Gippsland Women’s Health aimed to gather information from pharmacies across the region about which sexual and reproductive health pharmaceuticals they supply.

The researchers aimed to gather information about access to these pharmaceuticals – including the ECP and medical termination of pregnancy – in Gippsland, and to identify where access was limited or non-existent, and if so, why.

They contacted 68 pharmacies, and received 48 responses: a 70.5% response rate.

The survey found that long-acting reversible contraception (LARC) such as Implanon, Depo-Provera and IUDs, were readily available from most pharmacies: Implanon at 89.4%; Depo-Provera at 100% of pharmacies and IUDs at 87.5%.

However, in cases where the pharmacies did not actually stock the product, women faced a potential delay of up to three days while the product was ordered in.

The emergency contraceptive pill was available from 97% of the pharmacies who responded, but many of these placed age restrictions on supply of the medicine.

More than a quarter – 28.5% – restricted supply to those aged under 16 years, while 7% restricted supply to those aged under 18 years.

Another 11% of pharmacies restricted supply with conditions such as “after counselling or discussion with the patient;” “considerations for patient’s medical conditions, time from last intercourse;” “if someone else comes in to pick up the pill, other than the intended user;” and “available elsewhere – would usually get it from hospital ED”.

The authors said the inconsistency in restrictions of the medication due to age is a concern, “and highlights the need for standardised practice to be established and communicated to pharmacists.

“Clear guidelines would improve access for young women who are most at risk of being disadvantaged by an unintended pregnancy or the potential need to travel to metropolitan areas for a MToP (Medical Termination of Pregnancy) or SToP (Surgical Termination of Pregnancy).”

As for medical termination of pregnancy, only 41% of the pharmacies supplied this; and half did not keep it in stock, meaning they had to order it in with waiting times estimated at one to three days.

Reasons for not supplying these medicines included conscientious objection, a lack of the required training, that doctors weren’t receptive, or a perception that there was not demand for the product.

“The number of pharmacies that supply MToP medication (41%) is encouraging however the fact that many of these did not stock the medication and there was a delay of 1-3 days to order the medication in, could be problematic due to the time sensitivity surrounding its use,” the authors write.

“This situation could be improved with open conversations between doctors and pharmacists about providing MToP in the region and developing a clear referral pathway.”

Only one of the 48 pharmacies supplied dental dams.

Most of the pharmacies – 91.7% – provided a private space to discuss use of contraceptive medication.

“Women in Gippsland are not only limited by the services provided by medical clinics (2018, Gippsland Sexual and Reproductive Health Alliance) but also by the availability of, or restriction to sexual and reproductive pharmaceuticals necessary for a woman to exercise choice about theirown reproductive health,” the authors wrote.

Gippsland Women’s Health’s Selena Gillham told the AJP that the lack of consistency in provision of the ECP is detrimental to women’s health, as it is a time sensitive medication and any delay in provision will reduce its effectiveness.

“If the delay is too long and the woman does become pregnant and decides that she wants to have a termination there is added expense and difficulty in accessing an abortion,” she warned.

“I would encourage pharmacists to ensure that the full suite of reproductive medication is readily available from their pharmacies including contraceptives, long acting reversible contraceptives, EC and MTOP medication.

“It can be difficult enough for women to navigate the system without limited access to pharmaceuticals making it harder.

“If there seems to be a lack of demand for the medication it would be good to speak to the GP practices, primary health networks and women’s health services to ensure that there are trained providers in their region.”

A second survey by Gippsland Women’s Health looked at access to sexual and reproductive health services via GPs.

This survey provided quantitative evidence that women’s access to the full suite of sexual and reproductive services, including pregnancy options, in Gippsland is limited.

This results in many GPs referring women to Melbourne, the authors wrote.

“This lack of services not only increases the financial and time cost to women and their families, but leads to poorer health outcomes for women in Gippsland compared to women living in Metropolitan areas.”

Gippsland Women’s Health also suggested that pharmacists in Victoria become familiar with 1800myoptions,  a Victorian Statewide helpline for information about contraception, pregnancy options and sexual health. 

Pharmacies can register and state which sexual and reproductive health services they provide with the service. More details are available here.

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  1. Vicki Dyson

    I had a young girl present for emergency contraception (accompanied by an older woman, possibly a teacher). Postinor was appropriate but she was taking carbamazepine. Would fellow pharmacists be comfortable encouraging a double dose. It was late in the afternoon and a doctor visit would probably be delayed until the next day.

  2. Jarrod McMaugh

    The authors of the study don’t seem to acknowledge the cost of ranging some of these products.

    Low demand items like IUDs and MToP are often expensive to have available “just in case” – a 1-3 day wait in this situation is rarely unreasonable.

    My pharmacy had an agreement with a local service to keep MToP. We agreed to keep 3 in stock after the first few weeks of receiving referrals.

    Then the referrals stopped – no explanation. That’s an expensive outcome.

    Perhaps in the Gippsland area, the authors may decide to pay for 1 of each item to be available to dispense in each pharmacy

    • Notachemist

      Jarrod it would be interesting to ask why the referrals stopped. Did someone decide to refer elsewhere? Did they decide to stock it themselves? Was price an issue for their clients?

      In regard to the research I suspect that those undertaking this type of research do not understand that community pharmacy is a small business with relatively low margins to cover stock which expires before use. Also Gippsland is an area with many families having a low socioeconomic status who are more likely to access services through public hospitals.

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