Our bod­ies, our­selves

Women are fi­nally be­ing trusted to take con­trol of their fer­til­ity by be­ing able to sim­ply pick up the morn­ing-af­ter pill at the chemist, writes Áilín Quin­lan

Irish Examiner - Feelgood - - Feature -

GET­TING the morn­ing-af­ter-pill has never been eas­ier. Only a few months af­ter the Govern­ment de­cided med­i­cal card hold­ers should be able to get it free of charge with­out a pre­scrip­tion (pre­vi­ously a pre­scrip­tion was re­quired), women are vot­ing with their feet in phar­ma­cies around the coun­try.

Phar­ma­cists say there has been an in­crease in up­take through the na­tional General Med­i­cal Ser­vices scheme since July when the emer­gency con­tra­cep­tion be­came di­rectly avail­able to med­i­cal card hold­ers with­out pre­scrip­tion.

It’s a sign of the times that women are fi­nally be­ing trusted to do what they feel is best for their own bod­ies by be­ing able to sim­ply pick up the pill at the chemist, with­out, for ex­am­ple, first hav­ing to make an ap­point­ment with the GP or with a women’s health or­gan­i­sa­tion such as the Well Woman Cen­tre or the Ir­ish Fam­ily Plan­ning As­so­ci­a­tion.

Up to July 1, many fe­male med­i­cal card hold­ers were pay­ing the phar­ma­cist pri­vately for the emer­gency con­tra­cep­tion, be­cause they hadn’t ac­cessed their GP to get a pre­scrip­tion in or­der to get it for free, points out Dar­ragh O’Lough­lin, sec­re­tary general of the Ir­ish Phar­ma­ceu­ti­cal Union.

The med­i­ca­tion works as an emer­gency con­tra­cep­tive by pre­vent­ing or de­lay­ing ovu­la­tion. It may also stop sperm from fer­til­is­ing an egg or pre­vent the egg from im­plant­ing in the uterus.

As a re­sult of the changes around ac­cess to the pill — it first be­came avail­able over­the-counter in 2011 — the de­mand for emer­gency con­tra­cep­tion from or­gan­i­sa­tions such as Dublin’s Well Woman Cen­tre, or the Ir­ish Fam­ily Plan­ning Agency, for ex­am­ple, has fallen dra­mat­i­cally, says Well Woman Cen­tre’s med­i­cal direc­tor, Dr Shirley McQuade.

“Be­fore it went OTC we would have seen about 4,000 women per year for emer­gency con­tra­cep­tion — they were all ages but mostly [in the] 20-30 age group,” she says.

Th­ese days, says McQuade, the num­ber of women ac­cess­ing the or­gan­i­sa­tion to avail of emer­gency con­tra­cep­tion is only a frac­tion of that. “Now if we see 500 a year, it’s a lot.”

How­ever, she re­minds women that the cop­per coil, which must be put in by a spe­cially trained doc­tor, can be used as a very ef­fec­tive emer­gency con­tra­cep­tion.

“The main ac­tiv­ity is that it stops the move­ment mech­a­nisms of the egg and sperm but it can also stop im­plan­ta­tion of a fer­tilised egg in the uterus,” she says, adding that it also can be used as a woman’s long-term con­tra­cep­tive.

Even though emer­gency con­tra­cep­tion is now di­rectly avail­able over the counter, women must still have a one-to-one con­sul­ta­tion with the phar­ma­cist, in a process sim­i­lar to that in Bri­tain and Canada.

“The con­sul­ta­tion takes place in a pri­vate con­sul­ta­tion room and it is a reg­u­lated, manda­tory re­quire­ment of the pro­vi­sion of the emer­gency con­tra­cep­tion ser­vice,” says Caoimhe McAu­ley, direc­tor of phar­macy at Boots. “It’s de­signed to sup­port the pa­tient in avail­ing of the ad­vice, sup­port and med­i­ca­tion to meet her unique needs.”

She says emer­gency con­tra­cep­tion may not be suitable for ev­ery­one and a con­sul­ta­tion fo­cus­ing on as­cer­tain­ing the suit­abil­ity of the med­i­ca­tion for the in­di­vid­ual is con­ducted in all cases.

Guide­lines for com­mu­nity phar­ma­cis­tled emer­gency con­tra­cep­tion ser­vices are set out by the IPU, says McAu­ley, adding that the phar­ma­cist will con­duct a con­sul­ta­tion with the woman to pro­vide her with the rel­e­vant ad­vice, sup­port, and emer­gency con­tra­cep­tion to meet her needs.

“This con­sul­ta­tion also al­lows the op- por­tu­nity to dis­cuss risks as­so­ci­ated with un­pro­tected sex­ual in­ter­course such as sex­u­ally trans­mit­ted in­fec­tions as well as op­tions for reg­u­lar on­go­ing con­tra­cep­tion and re­fer­ral to the GP where ap­pro­pri­ate,” she says.

In the mean­time, pro­vid­ing eas­ier ac­cess to the morn­ing-af­ter pill is un­likely to lead to more peo­ple en­gag­ing in risky sex, be­lieves O Lough­lin.

First, he says, al­though it is of­ten as­sumed that it is 18-25-year-olds seek­ing emer­gency con­tra­cep­tion, the re­al­ity is dif­fer­ent. O’Lough­lin points to re­search car­ried out in this coun­try in 2016 which showed that it is more likely to be older women who avail of emer­gency con­tra­cep­tion. In fact, 55% of women be­tween the ages of 25 and 34 and 61% of 35-49-year-olds had taken the med­i­ca­tion, com­pared to 36% of 18-25-year-olds.

“Peo­ple al­ways as­sume that it will be teens and twenty-some­things, but we see more peo­ple in the 25-35 age group than the 18-25 age group,” he ex­plains.

“We think that the peo­ple in the lat­ter cat­e­gory are more likely to be in re­la­tion­ships, have had sex and may be more cau­tious, or may al­ready have chil­dren and don’t want to be­come preg­nant again.

“I have no rea­son to be­lieve that mak­ing this con­tra­cep­tion avail­able leads to more risky sex,” he says, adding that it has been proven that putting bar­ri­ers in the way of con­tra­cep­tion re­sults in more cri­sis preg­nan­cies.

Phar­ma­cists don’t ask peo­ple why they need the morn­ing-af­ter pill.

“We sim­ply check their med­i­cal back­ground and ask them when the un­pro­tected sex oc­curred so we know that they are within the time pe­riod for the med­i­ca­tion to be ef­fec­tive,” he says.

There’s no obligation for women to take the pill in the phar­macy, says O’Lough­lin, adding that most phar­ma­cies will of­fer a glass of wa­ter to help the pa­tient take the pill im­me­di­ately as that is what they of­ten want to do — the sooner the med­i­ca­tion is taken, the more ef­fec­tive it is.

There is no le­gal age limit for us­ing it, he says, though McAu­ley says the Boots Ire­land ser­vice is avail­able to women over the age of 17.

“Women at­tend­ing for an EHC con­sul­ta­tion pro­vide their date of birth to the phar­ma­cist as part of the con­sul­ta­tion,” she ex­plains.

“While an ID check is not manda­tory, as health­care pro­fes­sion­als our phar­ma­cists will use their pro­fes­sional judg­ment to en­sure that any ad­vice/ser­vices of­fered meet the needs of the pre­sent­ing pa­tient,” she says.

“This may in­volve sign­post­ing to other ser­vices where ap­pro­pri­ate.”

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