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
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.”