Emergency contraception checklist dropped

Women buying emergency contraception no longer have to undergo an invasive and off-putting checklist

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Women purchasing emergency contraception at a pharmacy should no longer have to undergo an invasive and off-putting checklist, as long as their pharmacist uses newly updated guidelines.

Prior to February, the Pharmaceutical Society of Australia recommended pharmacists use their written checklist, which asked questions about sexual assault and STIs, prior to dispensing emergency contraception.

Now, women’s health experts have welcomed new guidelines, a series of steps for the pharmacist to consider rather than a form for patients, developed in response to the scheduling of a second over-the-counter emergency contraception, ulipristal.

Under the previous system, women could be asked to fill in a form to help the pharmacist “ensure the emergency contraception medicine is safe and suitable for you”.

Questions included the woman’s name, age, their usual means of contraception, STI symptoms, medical conditions and their reason for needing emergency contraception.

In giving their reasons for needing emergency contraception, women were given a choice of: contraceptive failure (e.g. split condom), missed pill(s), or recent episode of diarrhoea or vomiting, sexual assault and contraception not used.

No details were provided about the privacy systems in place for the document, other than that their answers would “be treated with the utmost privacy”.

Dr Rosemary Isaacs, medical director of the sexual assault service at Sydney LHD, said the question about sexual assault was very concerning.

“Generally speaking, it doesn’t help to ask about something unless you can respond in an appropriate way,” she said. “It’s actually confronting and distressing to people, particularly when filling in a form with their name on it.”

While it was great for pharmacists to want to address sexual assault, this method was unhelpful and probably counterproductive.

“Is it possible to have a private conversation about such an intimate thing as sexual assault in a pharmacy?” she said. “Just filling in a form, someone might see it.”

“There are pros and cons of having [emergency contraception] available in a pharmacy and not on prescription,” she said. “But I think the main pro is access, and if you are going to ask people confronting questions, and they are concerned about privacy, it might actually reduce access.”

Whether a woman had experienced a sexual assault was not relevant to whether it was a “safe and suitable” medicine for them, she said.

The question could also cause unnecessary distress to women in the community who had previously been sexually assaulted, but required emergency contraception for another reason in this instance, she said.

Uptake of the checklist varied for pharmacies across the country, but one 2013 study found around 83% of pharmacies in Western Australia used it for women seeking emergency contraception.

However, the study found the checklist did not improve the advice pharmacists gave when dispensing the pill.

A study of Sydney pharmacies, published in 2010, found that one in 10 pharmacies asked a simulated patient to complete the checklist.

While the form has never been mandatory, TMR understands some women say they’ve been told it was a requirement to purchasing the pill, and were pushed to complete all the sections.

One woman also reported that a pharmacist used the checklist as a reason not to dispense the emergency contraception to her male partner, despite there being no legal restrictions on buying the medicine for somebody else.

Associate Professor Deborah Bateson, medical director at Family Planning NSW, welcomed the move away from the checklist and said Family Planning had been working with the pharmacy society on the updated guidelines.

“We certainly don’t want barriers which make it off-putting for people to go to a pharmacy,” Professor Bateson said. “There’s no need to record those details.”

While some of the questions about Crohn’s disease and malabsorption in the previous form could influence the pharmacist’s decision, it also included a number of clinically irrelevant questions, she added.

Asking about medical conditions such as breast cancer, or information about the woman’s cycle, should not affect the pharmacist’s decision to give emergency contraception, she said.