Pregnant in clinic oversight

Terrie Caldow wasn’t warned morning after pill unreliable for above averagesized women, writes Hannah Martin.

Clinics and pharmacists prescribing the morning-after pill are too embarrassed to warn it is unlikely to work for any woman of above-average weight.

In May last year, Terrie Caldow, 33, had no idea her weight would mean the emergency contraceptive pill (ECP) would not prevent an unwanted pregnancy when she went to a sexual health clinic in Tauranga.

Weighing over 70kg at the time, Caldow says she was not told her weight was a risk factor. The pill didn’t work – she now has a fivemonth-old daughter.

Despite a warning issued by Medsafe in 2014, pharmacies are failing to warn women their weight could render the ECP ineffective.

Pharmacies visited by three women journalists, all more than 70kg and asking for the ECP, failed to follow dispensing guidelines telling them to refer women of above-average body-mass index to a doctor. Other women report weight was never mentioned in their consultations.

The Medsafe warning was issued after research revealed the most popular type of morning-after pill made from Levonorgestrel was ineffective for women over 80kg, and became increasingly ineffective in women over 70kg.

The Pharmacy Council of New Zealand then issued its own guidelines showing the risk of pregnancy was three times higher for women with a body mass index (BMI) of 30 or more, than those who were smaller.

Figures from a 2011 survey show the average New Zealand female over the age of 15 weighs 72.6kg.

Despite national best practice guidelines stating the ECP would be of ‘‘no advantage’’ to women with a BMI of more than 30, pharmacists still aren’t warning women of the risks, and there is no legal obligation for them to do so.

The Pharmacy Council’s best

I love and adore my daughter . . . but I took the ECP to prevent a pregnancy. Terrie Caldow

practice guidelines say women should be referred to a doctor or family planning clinic if there are any concerns with the ECP.

Medsafe general manager Chris James said the agency decided that although conclusive evidence was lacking, women should be told that Levonorgestrel may not be effective for bigger women.

Weight is a ‘‘delicate’’ subject, said Bob Buckham, chief pharmacist adviser for the Pharmaceutical Society.

But a 36-year-old woman, who said she weighed around 94kg when she asked for the ECP last year, said she wouldn’t have been offended if the pharmacist had mentioned weight: ‘‘It’s more awkward telling a stranger that you’ve had sex and need the ECP.’’

The manners factor made no sense to Terrie Caldow. She would still have taken ECP, but might have asked for a double dose.

‘‘I love, and adore, and idolise my daughter, and in hindsight, I am so glad the pill did not work, but I took the ECP to prevent a pregnancy.’’