|
Ellie Levenson, is founder of www.womenarenotstupid.co.uk,
a website campaign for better access to emergency contraception
|
The Broad spectrum feature is
open to any reader. Contributions of around 1,100 words commenting
on topical issues
may be posted to Graeme Smith, managing editor, or
e-mailed to graeme.smith@pharmj.org.uk for consideration
|
According to the Royal Pharmaceutical Society’s “Practice
guidance on the supply of emergency hormonal contraception as a pharmacy
medicine” (PDF 140K),
only in exceptional circumstances should pharmacists supply the product
to a person other than the patient.
In
practice, exceptional
circumstances are few and far between. Work, school or other commitments
are not usually deemed exceptional enough. This means that if my boyfriend
and I have an accident with a condom, I cannot send him out to get emergency
contraception for me.
If a teenage girl has unprotected sex and seeks
to rectify the situation quickly but has commitments at school, her mother
cannot go and buy it for her. If a friend cannot get out of work commitments,
I cannot go to the pharmacist and pick it up for her, dropping it off
in her lunch hour.
If a women with multiple caring roles, perhaps looking
after young children and elderly parents, cannot leave her charges unattended,
she cannot ask anyone else to get her emergency contraception. Given
that emergency contraception is 95 per cent effective within 24 hours
of unprotected sex, and just 58 per cent effective after 72 hours, putting
barriers in the way of women’s access to it seems ludicrous.
One way around the problem would be to encourage advance provision. If
I could keep emergency contraception in my home, I could take it as soon
as I realised my normal contraception had not worked thus minimising
the chances of an unwanted pregnancy and, potentially, lowering the number
of abortions.
I believe that women are clever enough to take responsibility for self-diagnosing
their need for emergency contraception and reading instructions to work
out whether they would benefit from it. That is why I have set up a website
(womenarenotstupid.co.uk) to campaign for better provision of emergency
contraception. It links to an e-petition on the Downing Street website
calling for everybody to be able to buy it and to be able to do so at
any time, not just at the point of need.
I do not think women would use easier access to be irresponsible in the
use of emergency contraception, after all I keep powerful painkillers
in my home and regulate the use of these myself. Neither do I buy into
arguments that easier access leads to greater promiscuity — but
even if it did, so what?
In fact in 2005, JAMA published a study of more than 2,000 women aged
15 to 24 who wished to avoid pregnancy and found that women who had advanced
access to emergency contraception were no more likely to have unprotected
sex than the other groups but, when they did, they were twice as likely
to use emergency
contraception.
In theory the Society is not against advanced provision. In December
2006 following announcements from Marie Stopes International and the
British Pregnancy Advisory Service (BPAS) supporting the advance provision
of emergency contraception, it issued a statement saying that it is not
against advance supply of EHC in principle.
The statement said: “If
faced with a request for an advanced supply of EHC, pharmacists should
use their professional judgement to consider the clinical appropriateness
of the supply.”
But just as pharmacists are allowed to give emergency
contraception to someone other than the user in exceptional circumstances
but rarely do, anecdotal evidence suggests that pharmacists also do not
usually allow people to buy it in advance.
This means that if I were
to go on holiday to a country where emergency contraception is difficult
to obtain, or even illegal, and I have an accident with a condom, or
perhaps have diarrhoea and cannot count on the effectiveness of the contraceptive
pill, I would not have been able to get emergency contraception from
my pharmacist to carry with me in my suitcase just in case.
It is true that family planning clinics and GPs can give advance prescriptions
for emergency contraception, but these are not always practical for people
to get to. And given that last month’s White Paper “Pharmacy
in England: building on strengths — delivering the future”,
seeks to increase the role of community pharmacists and give them a key
role in being a first port of call for people’s minor ailments,
it seems sensible and timely to take this opportunity to modernise their
approach to emergency contraception.
Remember, too, that pharmacists can still choose not to supply emergency
contraception on the grounds of religious or moral belief. If we make
emergency contraception more easily available, we not only make women’s
lives easier but we take away the opportunity for pharmacists to let
their own moral views get in the way of doing the best for their customers.
I do not believe women are stupid. I do not believe men are stupid either,
which is why I would like men to be able to buy emergency contraception
in advance to keep at home thus allowing them also to take responsibility
for any contraception accidents. This would help to encourage the idea
that contraception is the responsibility of both sexes.
Not only are women not stupid, but we are smart enough to learn quickly
how to play the game and get what we need. I had to buy emergency contraception
recently for a friend who, for various reasons, could not get to the
doctor or pharmacist in time. I did not want to lie because, as a responsible
adult, I do not believe that I should have to. But since the first two
pharmacists I asked refused to give EHC to me, in the third pharmacy
I lied. I said that I had had sex the night before and that I was in
the middle of my cycle.
Not only did the pharmacist ask me questions about this in the main shop
and not offer me the chance for a confidential consultation as Society
guidelines recommend, but neither was I asked about my general state
of health, whether I was already pregnant or whether any other contraindications
were present. In fact the pharmacist did nothing that I could not have
done myself, asking no questions that could not have been self-administered
by reading a simple information leaflet.
If pharmacists really are to be at the forefront of community health
care, they need to concentrate on conditions where their knowledge and
training really is used; they must let us self-diagnose and self-prescribe
for everything else, especially for something like emergency contraception.
In this case, the fact that someone is seeking out emergency contraception
in an attempt to rectify mistakes and accidents demonstrates a sense
of responsibility in itself. |
The
Pharmaceutical Journal