Posted by: Connie Pringle15 DEC 2011
Dishing out free emergency hormonal contraception (EHC) in advance of the Christmas season is, unequivocally, a bad idea. Apparently, uptake of the latest British Pregnancy Advisory Service (BPAS) initiative has been astounding, with 1000 women requesting packs in the first two days alone! You can read more about the service here.
The BPAS champions the service as a solution to barriers sometimes associated with obtaining Levonorgestrel (the ‘morning after’ pill). Fair enough, I suppose. Presumably the seasonal closure of community pharmacies can indeed cause grief for women seeking EHC, and with the added complication of the ongoing conscience clause conundrum, a legitimate case for stocking up on stand-by EHC could potentially be made.
However, even whilst setting aside the cost factors and ethical dilemmas involved, I’m entirely unconvinced that we should be encouraging people to expect emergencies in the contraception department over christmas. Sure enough, patients want peace of mind in terms of access to medication if the need arises, but this scheme seems far-fetched. Taking the ‘emergency’ out of ‘emergency hormonal contraception’ is an expensive solution to problems which, on the whole, can be best managed by encouraging people to take long-term responsibility for managing contraception.
We must assess why uptake of the service has been so great. Aside from practical concerns about seasonal pharmacy/surgery closures, The BPAS’ statement more than hints that women have been keen to participate in the service because of worries regarding staff attitudes towards supplying EHC.
"From what women are saying, they have found it stressful or difficult obtaining the pill in the past . . . because women don’t always know how their request is going to be viewed by a doctor or a pharmacist, they appreciate talking to someone who they know does not think they are doing something wrong."
If this is true, then we have a problem – for so many obvious reasons! The BPAS seem to be saying that women don’t have confidence in doctors and pharmacists to supply the morning after pill alongside impartial, non-judgemental advice. I wonder if women really do have this negative perception of health professionals in this area, and if they do, I wonder if it is justified. If it is, perhaps the conscious clause debate has a point after all. Moreover, if women really are concerned about the ‘judgement face’ of pharmacists supplying EHC, perhaps its CPD time for the whole profession.
I think there’s more to this issue than initially meets the eye. If I wasn’t up to my own eyeballs in exam revision and essay writing (whilst trying to squeeze in time to celebrate Christmas) I’d love to find out more about the factors which have really been influencing the involvement of women with this new service
One might suggest that alternative reasons for the overwhelming uptake of non-emergency-EHC could simply include the commonly held natural desire to ‘get something for nothing’. Equally, whilst the packs may be handy to have ‘just in case’, sceptics might suggest that more women will rationalise the use of EHC as a replacement for, or an excuse for compromising the use of regular contraception methods.
They say that prevention is better than cure. Call me idealistic but I feel the most cost-effective, long term patient friendly solution is avoiding the need for emergency contraception rather than predicting, (and in some cases even prompting?) its inevitable necessity. Although all this may sound heartless, I do know the importance of supporting women who are anxious about access to emergency contraception, and ensuring that, wherever physically possible, it is available to them, if and when required. But what is there to say that with effectively managed regular contraception, the need for EHC should be any greater at Christmas than any other bank holiday. In the long term, I think a bit of support, a smile and assurance about the efficacy of properly managed regular contraception might go a long way.
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