Introduction The UK's unwanted pregnancy and medical termination rate has been highlighted by several governmental publications as causing public health concern.1,2 Evidence suggests that the majority of women who present for termination in the UK would have used emergency contraceptive services if they were more aware of its existence.3 But despite efforts to widen the availability of hEC, the overall number of unwanted pregnancies does not appear in decline. One proposed strategy to increase the accessibility of hEC is to deregulate it from prescription only (PoM) to pharmacy only (P) status. This would allow women to purchase hEC over the counter in registered pharmacies.4 This study aimed to examine pharmacists' perceptions of the problems and benefits associated with such a public health manoeuvre.
Methods A sample of 3,999 pharmacists drawn from the Royal Pharmaceutical Society of Great Britain's (RPSGB's) database were mailed with a questionnaire which ascertained basic demographic details together with specific questions relating to the issues surrounding emergency contraception and contraception in general. No exclusion criteria were applied, barring an individual's registration with the RPSGB for the year 1997 to 1998.
Results In total 3,999 questionnaires were administered, of which 1,543 replies (38.6 per cent) were received and analysed. All responses were included in analyses including 33 (2.1 per cent) blank forms and 1 (0.06 per cent) spoilt questionnaire. The mean (SEM) age of respondents was 43.4 (0.4) (n=1,497), with males showing a greater mean age than females (p<0.01). Six hundred and seventy-four (43.7 per cent) of the respondents were male, with 48 (3.2 per cent) failing to indicate gender. Of the total, 968 (62.7 per cent) were identified as community pharmacists and 235 (12.2 per cent) as hospital pharmacists, proportions similar to the RPSGB's manpower survey.
Overall, 1,165 (75.5 per cent) respondents stated that they would be willing to supply hEC over the counter if it were to become available, with 549 (35.6 per cent) considering themselves both willing and competent to supply hEC without further education and training. Of those pharmacists not willing to supply hEC the proportion of males was similar to that observed in the overall sample (37.9 per cent), and the mean ages of both males and females not willing to supply hEC were not significantly different from those who were willing to supply (p>0.05). Of the 456 categorised comments explaining pharmacists' objections to the supply of hEC over the counter, 241 (52.9 per cent) could be categorised as safety or training concerns. Moral and ethical concerns were included in 71 (15.6 per cent) explanatory comments. For those pharmacists most likely to be involved in the supply of hEC, notably hospital and community pharmacists, the proportion willing to supply was almost identical, 79.2 per cent for community compared with 79.1 per cent for hospital pharmacists.
Discussion The results of this survey suggest that the majority of pharmacists would be willing to supply hEC over the counter if it were deregulated to P status. There are no obvious demographic differences that allow differentiation of those who would be prepared to supply compared with those who have an objection to deregulation. Despite moral and ethical objections being raised in this survey, they are voiced relatively infrequently and appear to be secondary to concerns relating to safety issues. Over one third of pharmacists state that they are both willing and competent to supply hEC over the counter without further training.
Conclusion The results suggest that if hEC was deregulated from its current POM status the majority of pharmacists would be prepared to be involved in its supply. Most pharmacists articulate the need for further specific training if deregulation were to be a successful public health strategy.
School of health sciences, University of Sunderland; *Durham and Teesside pharmacy practice unit, Hartlepool General Hospital