‘A justified and winnable campaign’
Re(al)-Productive Health has seven primary campaign aims;
- To remove the conscientious objection clause
- To make the consultation process optional
- To ensure a standard price for emergency contraception
- To ensure that pharmacies in rural areas operate a Sunday rota system
- To ensure pharmacists are properly trained to dispense emergency contraception in a non-judgemental, understanding manner
- To work towards advance provision of emergency contraception
- To ensure emergency contraception is available to all genders/sexes
1. To remove the conscientious objection clause:
Despite being available without a prescription in Ireland since 2011, under Principle One of the Pharmaceutical Society of Ireland’s (PSI) Code of Conduct for pharmacists, as outlined in the PSI’s guidance on the supply of NorLevo by pharmacists, pharmacists may refuse to dispense the morning after pill if it lies in contradiction with his or her moral standards;
‘if supply to a patient is likely to be affected by the personal moral standards of a pharmacist’ (PSI, 2015)
The same is true of guidelines regarding the supply of ellaOne, made available without prescription in 2015 in Ireland.
Though the pharmacist is required to refer you to another pharmacy this is often physically and financially impossible. Furthermore it is totally unacceptable to turn individuals away from receiving this legal, safe and often essential drug. A decision to access emergency contraception should not be dependent on the value system, religious beliefs or moral philosophy of any other individual. We believe that this is an extremely vulnerable and degrading position to put individuals in and that it exploits the power and influence of medical professionals. We believe that moral judgements held by medical professionals should not impact on their role in providing safe, legal and requested health care. We believe we are fully capable of making decisions about their reproductive health.
Our campaign aims to amend Principle One of the current PSI Code of Conduct.
We seek to replace this conscientious objection clause with one which ensures provision of this medication on request- irrespective of a pharmacist’s moral judgements. We have re-drafted this principle which you can read here
Please read, share and campaign with us for this essential amendment!
2. To make the consultation process optional:
A detailed consultation process, according to the PSI guidance on NorLevo is ‘required’ when accessing emergency contraception over the counter. Such a process is described as required in order to ‘determine the appropriateness of the supply and provide an opportunity to meet the appropriate patient counselling requirements’ (PSI, 2015). This process is certainly useful in terms of providing comprehensive information on the potential risks and effects associated with the drug.
The same is true of guidelines regarding the supply of ellaOne, made available without prescription in 2015 in Ireland.
Nonetheless, with such a consultation largely based on a questioning approach, it may represent a source of intimidation, frustration or embarrassment. Thus, in order to provide accurate, comprehensive information on NorLevo, whilst also acknowledging the potentiality of such negative emotions, an information giving approach would perhaps be more appropriate. Indeed, with NorLevo widely regarded as ‘safer than Aspirin’ (Grimes, 2002: 1536), it is difficult to see why there exists such a variation in the process of access.
On the other hand, for many, accessing emergency contraception, in line with common perceptions of the drug, may be a rather daunting experience itself. Some may actually favour the questioning approach of the present consultation process.
Thus, rendering the consultation process optional, whilst all the while providing comprehensive information on the drug in all cases, would, according to Re(al)-Productive Health, offer real autonomy in terms of accessing this drug.
3. To ensure a standard price for emergency contraception:
(a) The cost of the morning after pill is unregulated and varies hugely throughout counties, cities, towns and pharmacy chains in Ireland. Getting the morning after pill can set you back anywhere from €10 to €45 or higher.
We feel that a standard, maximum price should be set for the morning after pill, to ensure awareness of how much the drug will cost them irrespective of where they live. We feel that emergency contraception is a right and that economic resources should not influence access. The morning after pill is a drug which must be taken within a very short time frame and so financial alternatives such as borrowing from a friend, accessing post office/credit union or other savings accounts are not always an option. Furthermore, depending on age range, living situation and refugee status, having access to money may be greatly constrained.
We feel that as a reproductive right, access to emergency contraception should be have free (socially subsidised). We intend to campaign further on this right. As a short term goal however, we feel that setting a maximum, standard price of the drug would be fairer and more accessible than the current, unregulated system.
(b) In addition, the lack of inclusion of emergency hormonal contraception under the Irish medical card scheme is very concerning. In the current situation, though reimbursed for emergency hormonal contraception when accessing it with a prescription in pharmacies, one is not reimbursed when accessing emergency contraception without a prescription. With a recent survey conducted by the Irish Pharmacy Union indicating that 18% of those with a medical card chose to get their emergency contraception from a pharmacy as opposed to getting it free on prescription from their GP, the issue certainly requires resolution. With seasonal flu vaccinations, among many other drugs, available free of charge in pharmacies under the medical card, it is difficult to understand why there exists such a difference in terms of provision of emergency hormonal contraception. The IPU have already called for action on this. Re(al)-Productive Health are in full agreement with such a position – it is time to place public pressure on the HSE to include emergency hormonal contraception within the medical card scheme.
4. To ensure that pharmacies in rural areas operate a Sunday rota system:
Accessing the morning after pill can be especially difficult for those living in rural areas where there may be just one pharmacy or where some travel is required to access a pharmacy in a nearby town. As such access to and availability of the drug are particularly important in these cases. In order to ensure the availability in all chemists of the morning after pill, we must stress the importance of rural pharmacies operating a rota system on Sundays to ensure access to the drug on weekends. With such a short time frame required for effective use of the pill, it is not fair or in many cases possible to travel substantial distances in order to find an open pharmacy, which may still conscientiously object to provision of the drug.
Sunday rota systems already operate in many towns around Ireland, reflecting the unique importance of the services which pharmacies provide. We feel that such a system should be operated in every area, particularly rural parts of Ireland, in order to ensure safe, effective and consistent access to services, including access to the morning after pill.
5. To ensure pharmacists are properly trained to dispense emergency contraception in a non-judgmental, understanding manner:
In addition, we also feel pharmacists could benefit from additional training. At present, the Irish Pharmacy Union offer a module on emergency contraception on IPU NET, a web based application. The IPU NET Emergency Contraception module is a ‘clinical decision support tool’ designed to assist ‘community pharmacists in providing safe and effective access to emergency hormonal contraception in a community pharmacy’ (Duggan, 2012). Such a facility may indeed be useful in educating pharmacists on provision of emergency contraception over the counter.
Nonetheless, a rather more comprehensive training programme would be welcome. Indeed, by way of comparison, in the UK, pharmacists must have completed ‘three CPPE open learning/e-assessment packages’, ‘Emergency Contraception; Contraception; and Child Protection – A Guide for the Pharmacy’ in order to be accredited for supply of levonorgestrel over the counter. The difference is, however, that online training is supplemented by ‘two required training sessions’ (NHS, 2013: 4). Such training sessions may serve to deepen and consolidate information in a manner beyond the capacity of an online programme.
Indeed, a study undertaken on a pilot training session in the UK in 2003 found such training to have been of great value to pharmacists, in terms of a ‘team-building exercise, enabling the participants, the project manager and community trust pharmacists, and the clinicians who would be offering support to get to know each other and work as an effective unit’ (Bacon et al., 2003: 21)
In order to reduce the stigma surrounding emergency contraception in Ireland, potential training sessions in Ireland could seek to, along with information on contraception and reproductive health, focus upon improving experiences of accessing emergency contraception. A focus on awareness of potential embarrassment and shame of those seeking to access ‘NorLevo’, awareness on the positive and negative impact of aspects such as body language and language, as well as portraying easy access to emergency contraception as an equality issue, would be highly beneficial in this regard.
In addition, specific emphasis on the safety of emergency contraception would be extremely valuable, in order to seek to counter the commonly-held myth that use and repeated use of emergency contraception is particularly dangerous in comparison to other drugs.
With access of emergency contraception often a sensitive issue, it is something for which we feel pharmacists should be extremely well-trained.
6. To work towards advance provision of emergency contraception
The World Health Organisation (WHO) state that advanced provision of emergency contraception is “not associated with increased frequency of unprotected intercourse”but rather “leads to increased use of the method”(WHO, 2010). Dr Stephanie O’Keeferesearcher and policy manager with the HSE crisis Pregnancy Programme has stated that taking the morning after pill does not impact on primary use of regular contraception(IFPA, 21/01/2012). Re(al)-Productive Health feel that providing access to advancedprovision of emergency contraception in Ireland would give D greater access andautonomy over reproductive health choices. Access to emergency contraception fromhome, from one’s own medical storage would be undoubtedly beneficial to those requiringthe time sensitive drug during anti-social hours or those with restricted access to finance.In line with our proposal of an alteration to the consultation process for those requiringimmediate access to emergency contraception, we suggest a similar process in terms of advance provision; the provision of a standardized information leaflet, alongside anoptional opportunity to consult with the pharmacist in a private setting.Advanced provision of the morning after pill is already available in many countries, such asCanada, Denmark, Sweden, Portugal and the United States of America (InternationalConsortium for Emergency Contraception, 2013). In these countries, as already stated, the drug is available over the counter without having to ‘go through’a pharmacist.
7.To ensure clarity on availability of emergency contraception to all genders/sexes
At present, there is no strong reference to gender or sex in relation to access of emergencycontraception. There appears to be no policy-related barrier in relation to this (i.e. within PSI guidelines). Nonetheless, greater clarity on this is extremely important, for tworeasons. Firstly, and most vitally, it is essential that those with the ability to bear children (e.g. trans men, genderqueer and intersex individuals) never be refused access to emergency contraception. Pharmacists, in line with our calls for specialised training, must be aware of and sensitive to the existence and specific needs of all those along the gender and sex spectrum. In addition, it is vital that partners and/or friends should be in a position to accessemergency contraception for others – in the case of fear or stigma regarding access, or lack of ability. This call for great clarity regarding gender and sex coincides with our calls to remove the mandatory consultation process.
Why this campaign?
We believe the elements of our campaign are justifiable and necessary. We believe we should be in a position to avail of the best possible treatment in accessing this vital drug in pharmacies. The outlining of tangible, viable aims is key to any attempt to effect social change.
‘Power concedes nothing without a demand. It never did and it never will’
Pop over here to find out how you can join us in our demands.
Pharmaceutical Society of Ireland (PSI) (2015) Guidance for Pharmacists on the Safe Supply of Non-Prescription Levonorgestrel 1500mcg for Emergency Hormonal Contraception Available at: http:// www.thepsi.ie/Libraries/Practice_Guidance/NorLevo_1_5mg_Interim_Guidance-1.sflb.ashx Accessed on: 16 June 2013
Pharmaceutical Society of Ireland (PSI) (2015) Guidance for Pharmacists on the Safe Supply of Non-Prescription Ulipristal Acetate 30mg (ellaOne®). Available at: http://www.thepsi.ie/Libraries/Practice_Guidance/Guidance_for_Pharmacists_on_the_Safe_Supply_of_Non-Prescription_Ulipristal_Acetate_30mg_ellaOne_for_Emergency_Hormonal_Contraception.sflb.ashx
Grimes, D. (2002) ‘Emergency contraception and fire extinguishers: a prevention paradox’ American Journal of Obstetrics and Gynecology 187(6):1536-8
Kelly, P. (2012) ‘New educational campaign on emergency contraception is launched’ The Irish Medical Times. 29 June. Available at: http://www.imt.ie/clinical/2012/06/new-educational- campaign-on-emergency-contraception-is-launched.html Accessed on: 23 June 2013
Guiry, R. (2013) E-mail to Fiona Dunkin. 25 July
Duggan, B. (2012) ‘Interview with CPC Chairman, Bernard Duggan’ IPU Review. July. Irish Pharmacy Union
Bacon et al. (2003) ‘Training and supporting pharmacists to supply progestogen-only emergency contraception’ Journal of Family Planning and Reproductive Health Care 29 (2): 17-22
Douglass, F. (1857) ‘Two Speeches by Frederick Douglass’. Rochester