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Pharmacists' concerns a barrier to emergency contraception

Obstetrics and gynaecology

Obstetrics and gynaecology

A small, qualitative study has found that a lack of understanding among some pharmacists about emergency contraception (EC) is preventing women receiving treatment.

Levonorgestrel, the single dose progestogen-only postcoital oral contraceptive, is available as a pharmacy medicine, which means a pharmacist may sell the product without the need for a prescription. However, they are not obliged to do so and some pharmacists decline for ethical reasons.

Twenty-three pharmacists were interviewed about ethical matters in general and EC in particular. Sixteen were happy to sell it, three declined to do so for ethical or religious reasons and four would sell EC depending on their judgment of the situation.

The four pharmacists who only sold EC under certain circumstances appeared to base decisions on age and social class. Younger, poorer women were viewed as being less deserving, and one pharmacist expressed concern that supplying EC to women under 25 risked encouraging its use as a future regular method. Older women were perceived to be ‘more genuine'. Another pharmacist felt manipulated by the Government into being a pawn of a social policy to reduce unplanned pregnancies.

The researchers also explored the pharmacists' understanding of EC. Worryingly, EC was frequently called ‘the morning after pill', despite its 72-hour postcoital therapeutic window. One pharmacist felt uncomfortable dispensing ‘massive doses' of hormones to young women. Several pharmacists, including two of those who did not sell EC, believed it to be a form of abortion even though it is actually prevents conception (implantation of the fertilised oocyte).

Several pharmacists mentioned that having a uniform policy in any one location was difficult, as locums and stand-ins may take a different view on selling EC. One proprietor declined to sell it at all in order to ensure a consistent approach.

A significant proportion of women requesting termination of pregnancy could have used EC. Any obstacle to its provision risks increasing unplanned pregnancies. The change to out of hours service provision cannot have improved EC availability. If this study is representative of pharmacists across the UK, it suggests that they may not be filling the gap in provision.

Cooper RJ, Bissell P, Wingfield J. Ethical, religious and factual beliefs about the supply of emergency hormonal contraception by UK community pharmacists. J Fam Plann Reprod Health Care 2008;34:47-50

Reviewer

Dr Chris Barclay
GP, Sheffield

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