Sexual Health

Emergency contraception

Since January 12 emergency contraception has been available over the counter from pharmacies across the country. The controversial decision caused a stir in the medical world and although it was considered to be an “exciting” development in Ireland, questions continue to arise as to whether the new over-the-counter policy maintains the same level of privacy and care that a patient can be ensured at the medical centre or family planning clinic.

It was one of the UK’s most popular chemists; Boots that initially began supplying the drug under what were called “patient group directions” in January. However, the chain was told by the Irish Medicines Board (IMB) that it was breaking the law by making the morning-after pill available without prescription under the protocol drawn up by its medical director. However, after much consideration the IMB gave pharmacies across Ireland the go-ahead to sell the French – made contraceptive pill NorLevo without prescription. There are only two emergency contraceptive pills available to Irish women, NorLevo and Levonelle, which is manufactured in Germany. Levonelle can be obtained with a prescription from the doctor.

Emergency contraception (EC) has been available in Ireland since 2001 and is recommended by doctors only as an occasional method. According to the Medicines Information Online (MIO) it should in no instance replace a regular contraceptive method. The NorLevo drug which is currently being sold over the counter is 95% effective if taken within the first 24 hours. This drops to 85% between 25 and 48 hours and 58% if taken between 49 and 72 hours. Efficiency after 72 hours is unknown.

Medical expert working at the clinic in Dublin Institute of Technolgy, Dr. Brendan Clune said that “the emergency contraceptive is not 100% reliable; people should know that, women assume that they can be sexually active and that emergency contraceptives are going to protect them automatically.” He added that contraception is as effective as the time of the month when the accident takes place, “so if the emergency contraceptive is taken whilst you’re ovulating the effectiveness rate is a lot less than if you were at the end of your cycle or at the beginning,” he said. He added that every year, one person within the student population falls pregnant despite taking the morning after pill. When asked about the dangers of taking the morning after pill more than once he replied, “you can take it more than once but every time a person goes on the regular pill, the risk of blood clotting increases, it is the same with EC, recent studies show that a person who takes EC is at a higher risk of blood clotting then someone who is staying on the pill for a regular amount of time.” In a chemist there is no way for the pharmacist to keep a record. They must rely on the trust between themselves and the patient. Chain-store Boots assured that “healthcare is based on trust. Usage of contraception, including emergency contraception, will be discussed as part of the consultation to ensure that the patient gets the best service and outcome possible.”

As with all medicine there are side effects and dangers to consider when taking the morning – after pill. If someone has a history of blood clotting or thrombolis they cannot have the MAP as it will make it worse. According to the Irish Pharmaceutical Society of Ireland, the drug sold over the counter should not be supplied to patients with the rare hereditary problems of galactose intolerance, the Lapp lactase deficiency or glucose-galactose malabsorption. The pharmacy regulator also states that Norlevo is not recommended for patients with a history of infection of the fallopian tubes (salpingitis), ectopic pregnancy or severe hepatic dysfunction.

A short survey was carried out amongst eleven Irish women aged between 20 and 30. They were asked whether they thought selling emergency contraception over the counter was a good idea. Out of the total asked, 60 per cent agreed that yes, it is a good idea, the other 40 per cent of the women disagreed. When asked why, the reasons varied.

Eleanor, aged 22 said; “The previous method of obtaining the morning after pill was more stressful and in some cases (relating to unhelpful/judgemental doctors) embarrassing and demeaning to women who had the need for it.”

“I think girls would be careless with contraception knowing that they can just take the ‘quick fix’ the next morning,” said Carmel, 20 years old.
“I think it’s a good idea because let’s face it as long as unplanned pregnancy is prevented who cares how and where the contraception is provided. Also this makes it readily available to everyone as it would be less costly,” stated Aisling, 26 years old.

The survey proved that there is an alarming sense of uncertainty about the selling of the MAP over the counter. Some women felt that going to the medical centre or family planning centre would be safer than buying the pill at the chemist. The majority of women asked said that they would prefer the doctor because of privacy.

“The pharmacist seems like the easier option, but I would probably go to the doctor to be safer,” said Michelle who has never had the morning – after pill.

Sharon, aged 29 said, “I’d rather go to the doctor as I would be able to talk about it with them in a more private place. Boots and other pharmacies are very public places and I would feel a bit embarrassed if there were many other customers about as they told me about it. In saying this, I probably would have chosen to get it in a pharmacy if I needed it a few years ago as when I was younger, I would have been less comfortable to visit the doctor on my own for this sort of thing.”

“If I was going to take it I would go to a doctor it is much more confidential and the medical advice would probably be better., admitted 24 year old Niamh.
However, there was a general viewpoint that although the pharmacist might be more “impersonal” than a doctor, this could be a good thing.

One woman who received the pill over the counter said the entire consultation took place “over the counter.” I felt “very awkward.”

The Pharmaceutical Society of Ireland (PSI) introduced an interim guidance on safe supply to patients of the NorLevo drug. The PSI states that “consultations between the pharmacist and the patient should take place in the pharmacy’s patient consultation area and due consideration must be given to the patient’s right to privacy and confidentiality.” The society outlines that a pharmacist must ask the patient about medical history and background.