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Contraceptive agents

More than half of women think emergency contraception should switch to OTC, poll reveals

The British Pregnancy Advisory Service has reinforced its call for the levonorgestrel 1.5mg pill to be made available over the counter.

Emergency contraception should be made available over the counter without the need for a pharmacist consultation, the British Pregnancy Advisory Service (BPAS) has said.

The charity polled 1,001 women aged 18–45 years and found that 57% would support the levonorgestrel 1.5mg pill switching from a pharmacy (P) medicine to a general sale list (GSL) drug.

Of the women polled, 64% said they wanted the emergency contraceptive consultation — currently mandatory when seeking levonorgestrel, owing to its P status — to be made optional.

The charity also carried out a mystery shopper exercise involving 30 community pharmacies in England at a variety of locations, including supermarkets, high street chains and small independents.

While the BPAS acknowledged that most community pharmacists provide a “kind, swift and nonjudgmental” service when approached for emergency contraception, there were some “notable exceptions.”

One pharmacist asked the mystery shopper for ID while another quizzed her about her date of birth. The 22-year old mystery shopper was also asked to take a pregnancy test on one occasion and another pharmacist refused to supply the product on the grounds that she had already used it once before in the same menstrual cycle.

In 15 of the 20 cases, the mystery shopper had to ask at least two members of the pharmacy team before being seen by the pharmacist and in two cases, the shopper was turned away or told to come back later.

A minority of pharmacists offered the additional support expected when supplying the emergency contraception, the BPAS found. Only six provided details about the most effective form of emergency contraception and none offered any information about future contraceptive options or offered the chance for testing for sexually transmitted infections.

Less than 50% had a private consultation room which, according to the BPAS, “made the consultation awkward for the shopper” and limited the likelihood of a full consultation.

In the poll, carried out by Censuswide, some women described the pharmacy consultation as “awful”, and complained they were made to feel “slutty” or “like a whore”. Others said the experience was “informative and respectful,” fast and “pain-free”.

The BPAS said the mystery shopper and poll findings reinforce its call for levonorgestrel 1.5mg — which switched from a prescription-only medicine to a P medicine in 2000 — to be changed to a GSL and made available over the counter, as it is in other countries such as Sweden and the United States.

It said: “In other countries, women are allowed to buy Levonorgestrel 1.5mg directly from the shelf and ask for further information only if they need it. In the UK, this has been resisted on the basis that the consultation provides an important opportunity to provide further information on other methods of contraception, [sexually transmitted infection] testing, and answer other sexual health questions.

“However our mystery shop makes clear that this information is in any event not being provided. The opportunity to ask further questions, should a woman wish, is also compromised by the lack of private space to do so.”

 

 

Citation: The Pharmaceutical Journal DOI: 10.1211/PJ.2018.20205941

Readers' comments (2)

  • I agree with the condition of it to be sold by competent staffs only to make sure there is no abuse use of the medicine.

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  • Given that there are approximately 11700 pharmacies in England, the mystery shopper exercise carried out by BPAS in 30 pharmacies cannot be considered a representative sample. Nevertheless, the exercise does throw up some anomalies and issues for concern that could at the very least be followed up by the RPS and/or the GPhC. Whilst the mystery shopper exercise and poll could be considered in the overall assessment of whether to switch levonorgestrel 1.5mg from P to GSL, neither exercise in itself provides the robust evidence that would be required for such a switch. The article provides the reasons why the switch is being resisted in the UK and the reasoning is sound. A larger and more representative countrywide survey could be performed to help better understand whether the service provided by pharmacies and pharmacists meets the required standards. There is no reason why an application(s) with the appropriate evidence for the switch from P to GSL cannot be submitted to the UK MHRA for consideration.

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