Emergency Hormonal Contraception.

Although now more than a third of all EHC has been dispensed in pharmacies, some people still think that EHC should only be a prescription-only medicine (POM) because pharmacists do not have access to clients’ medical records. But it has been well documented that GP’s reluctance to issue emergency contraception has been barriers to wider emergency contraceptive use. Because the efficacy of EHC decreases with time, improved access and improved awareness for women is essential in preventing unwanted pregnancies.

For the following reasons I believe that pharmacists are well positioned to play a major role in increasing women’s access to emergency contraception and in providing counselling about contraceptive methods:

• Pharmacists are highly respected drug experts. Pharmacists are well trained in pharmacology and pharmacotherapy and greatly contribute to the health care system by working with patients to ensure that their health goals are achieved by drug therapy; by assessing positive or negative responses to medications from patients; by providing education to patients on proper use of medications and medical services and by ensuring safe and effective distribution of medications.
• Pharmacists are also the most accessible health-care professional.

1. If a woman has to go to her GP to obtain emergency contraception that takes too long (doctors say that they need at least 20 minutes counselling time) and can be off-putting
2. Many pharmacies across the UK are open during evenings and on weekends, when the emergency contraception service is most needed, whereas access to other health professionals may be limited

To make EHC as a general sales licence (GSL) product is obviously not appropriate since although it needs to be quickly accessible to women who need it, it also needs to be supplied in the right setting where expert health advice is always available.

After comparing and contrasting all the information I gathered I think that women should benefit from over-the-counter sales of EHC as a pharmacy medicine. However I do feel that there is a strong need that a programme should also be incorporated into teenagers’ sex education lessons to give information on emergency contraception and how to prevent unwanted pregnancies.

Almost all women can safely use EHC. There are no known long-term side effects associated with emergency contraception but some women may experience short-term side effects depending on what method is used:

• Progestrogen-only pills may cause a slight deterioration in glucose tolerance level in some users; therefore diabetic women are advised to have their blood sugar closely monitored when they are taking EHC.
• Adverse drug reactions are possible though very rare (in the UK, where over four million prescriptions for EHC have been written there are only six reported adverse reactions possibly related to their use).  But women should be reassured that EHC would do no harm to the foetus if it is inadvertently used during pregnancy.
• Emergency contraception does not appear to increase either the absolute risk of ectopic pregnancy or the chance that a pregnancy following the use of emergency contraception will be ectopic. Emergency contraception providers need to be aware that a history of ectopic pregnancy is considered to be a contraindication of using the treatment.  
• No increased risk of birth defects is found in women who inadvertently took emergency hormonal contraceptive pills during pregnant. It can be explained that emergency contraceptive pills are taken long before organogenesis starts, so that there would not be a teratogenic effect.

Since over-the-counter sale of EHC is unlicensed for use to women under 16 years of age so a 14-year-old female would not get supply. However advice should be given as to where to obtain EHC on prescription as POM product does not have this age restriction.  

Supply of EHC to third parties is not recommended in PGDs as there is a concern of abuse use. However supply can be considered in exceptional circumstances for example if the woman concerned is house bound. In such cases the third party (in this case the 28-year-old male) should be told that telephone calls would be made to the woman to check that treatment is appropriate and provide advice.

After checking that a woman (in this case the 28-year-old female) meets the requirements in a PGD, a supply of EHC should be made on request. However the client should be made fully aware of the side effects and warned that EHC is not suitable for repeatedly use and that methods of future contraception should be advised. Information on mode of action, failure rate, and where to get help should the treatment failed should also be provided.  

I believe that it is reasonable to charge £20 for two tablets although which, in real terms, may cost less than 20p for the following reasons: firstly, to enable pharmacists to provide better emergency contraception services, appropriate training, together with space and privacy in pharmacies for appropriate consultation would be important. Finances would be needed to make all the above available. Therefore the fee should reflect the investment of time and space needed. Secondly, pharmacists need to spend time on consulting with patients, as would doctors, to determine weather emergency contraception is appropriate, therefore they should be properly paid for their professional services during this consultation. Thirdly, charging £20 for this service also comes from the need to make it accessible to all without making it appear to be an ‘easy’ choice, i.e. if people have to pay they will be more careful.  

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