27 Jul Trial is breaking down contraception barriers to empower all women
One-third of Australian women experience an unintended pregnancy in their lifetime, writes Danielle Mazza, with rates of unintended pregnancy higher among the socio-demographically disadvantaged, and those living in rural areas.
One in three of these unintended pregnancies results in abortion, with almost half of women who seek an abortion having a history of previous abortions.
What this means is that some five decades after the contraceptive pill was first developed, we remain woefully poor in ensuring women have access to contraception that suits them. Many women aren’t aware of all contraceptive options available or hold misconceptions about the various types. Availability does not always equate to access or uptake.
While tapping the resource or the local pharmacy has been successfully used in a number of public health initiatives, such as smoking cessation, diabetes and cardiovascular screening and care, there’s been little focus on the provision of contraceptive counselling.
Our recently-announced ALLIANCE trial, or Quality Family Planning Services and Referrals in Community Pharmacy: Expanding Pharmacists’ Scope of Practice, uses pharmacists to provide contraception information to women seeking emergency contraception. The trial received $2.5 million funding from the federal government.
The trial was recently misrepresented by some as mandating counselling prior to women being able to receive emergency contraception (formerly known as the morning-after pill) or medical abortion medication.
The reality is quite different.
Instead, the ALLIANCE trial will provide women with the opportunity to receive evidence-based information about all of their contraceptive options in a private consulting room in the pharmacy from a specially trained pharmacist. This offer will be made after the woman purchases emergency contraception (ECP) or fills their medical abortion prescription.
Should the woman decide she wishes to pursue the contraceptive pill or an IUD or implant, the pharmacist will refer her to either her GP or other local services where these contraceptives can be obtained.
Turning up to a pharmacy for either the ECP, which has been available over the counter in pharmacies since 2004, or medical abortion medication, which requires a prescription from a GP or other provider, is stressful.
The ALLIANCE trial will use methods such as providing women with written information about the availability of the service, or informing them about it through signage in the pharmacy to maintain confidentiality and to reduce any stress associated with the visit as much as possible.
Sexually active women who want to avoid pregnancy need to adopt an effective contraceptive method after using either the ECP or undergoing a medical abortion in order to prevent unintended pregnancy. Emergency contraception and medical abortion can, however, also be sought by women after unwanted sexual intercourse or rape.
Clearly, the trial is not seeking to offer information on ongoing contraception in this scenario, but it will educate pharmacists about the support services they can link women with if so desired.
Pharmacies are trusted by the public
There are about 5700 community pharmacies nationally, and they’re rightly seen by the Australian public as a trusted and valued part of the Australian healthcare system. Some 42% of young people have visited a pharmacy in the past six months.
Additionally, while many people in rural and regional Australia may struggle to see a doctor, some 65% of Australians in regional areas live within 2.5km of a pharmacy.
While tapping the resource of the local pharmacy has been successfully used in a number of public health initiatives, such as smoking cessation, diabetes and cardiovascular screening and care, there’s been little focus on the provision of contraceptive counselling.
The ALLIANCE trial will look at ways to use this untapped resource as a way to ensure Australian women everywhere know what is available to assist them in preventing unwanted pregnancy – in the same way that we’re embracing the expertise of, and the trust we have in, our pharmacists for providing us with our influenza vaccinations.
Our trial is not a barrier to women’s access to contraception, but rather a way to empower those of us, particularly in rural and regional areas, who to date have struggled to gain informed knowledge of, and access to, all the contraceptive choices available to make us truly in charge of our own bodies.
Danielle Mazza is the Professor, General Practice, Monash University