Recently, a close friend messaged me after she visited a pharmacist and was made to shout her request for oral emergency contraception (OEC) in front of a lengthy queue of customers. She described asking for OEC at an audible volume but the older, male pharmacist repeatedly claimed not to have heard until she was practically shouting in the middle of the shop. She called me, upset, feeling that the pharmacist was deliberately trying to shame her – a married women, in her thirties for being too busy to pick up her regular contraception tablets and now requiring OEC.
As a sexual health doctor, it’s a story I’ve heard many times and I can only imagine how much worse this encounter is when you’re a nervous teenager, or worse still, someone who’s just been assaulted.
Luckily, my friend is located in a large city with multiple pharmacists close by – she got her OEC and is currently free from the worry of an unplanned pregnancy. However, this could have been a very different story if the individual requesting emergency contraception was more vulnerable or located in a more rural location. Stories of people experiencing shame and embarrassment when accessing emergency contraception are all too common – a recent Twitter thread about a women’s experience in a Lloyd’s pharmacist in Lewes struck a chord with many. The twitter thread describes how, after ordering OEC online, she was denied collection of the tablet by a pharmacist on account of "personal reasons".
Given that OEC has a finite window for effectiveness (up to 120 hours if using Ulipristal Acetate or 72 hours for Levongesterol) and its effectiveness declines over time, such incidences are deeply concerning. It is unethical to be pushing people from pharmacy to pharmacy when they know exactly what they need and rarely is any additional information being provided.
The General Pharmaceutical Council have clear guidance on how their members should behave in response to requests to medication like OEC if they have a moral objection including that: “If a pharmacy professional is unwilling to provide a certain service, they should take steps to make sure the person asking for care is at the centre of their decision-making, so they can access the service they need in a timely manner and without hindrance.” Yet, there are still too many women having deeply concerning experiences which are delaying their care and could be resulting in an unwanted pregnancy.
The National Survey of Attitudes and Lifestyles (NATSAL) data showed that the most common users of OEC are black women who also experience higher rates of domestic violence and socio-economic deprivation than their white counterparts; socio-economic issues may affect their ability to travel to a different pharmacist for OEC . Whilst a face-to-face interaction may provide an additional opportunity to discuss other sexual health issues or offer women the more effective copper intrauterine device, there is evidence that easily accessible, over the counter OEC does not increase its use or encourage unprotected sex.
A minority of pharmacists may object to providing OEC due to the myth that it causes an abortion, despite the tablets working to delay ovulation and acting on the menstrual cycle in a similar way to routine oral contraception pills. Others seemingly object to pre-marital sex or are simply too embarrassed to provide the relevant sexual health information suggested by the Faculty of Sexual & Reproductive Health prior to dispensing the medication.
Whilst people have a right to their own beliefs, as a health provider your judgement should never be felt or adversely impact those in need of your care, as it could compromise their independent decision making. It is time we stopped allowing those with moral objections to block access to OEC and that we trusted those in need of it to make their own decisions – by giving them the opportunity to pick OEC off the shelf and take it to the till, like you can do for so many other medications.
When approached for comment, a representative from Lloyds Pharmacy said:
"We are very sorry for the distress and frustration caused to one of our patients following their experience at one of our pharmacies. Our professional standards team are investigating the incident to better understand what has happened. We have also asked the patient to contact our customer service team so that we can make sure they have the care and support they need. We take this complaint very seriously.
Our priority is always the health and wellbeing of our patients. We adhere to the GPhC guidelines which allow pharmacists to refuse to dispense medication that goes against their personal beliefs if there is adequate alternative care available for the patient. As part of our own guidance, we encourage our pharmacists to use their professional judgement, but they must always put the patient first. In this case, the pharmacist was a locum pharmacist, not a full time employee. However, we will be communicating to our colleagues to remind them of this guidance.
If a pharmacist refuses to dispense a particular product, they should contact the local NHS Patient Advisory Team so that an alternate pharmacy can be found as a matter of urgency. On this occasion we contacted the customer with details of another local pharmacy where the product would be made available."