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Moving forward on contraception

Recent news that the ‘morning-after pill’ is to become available without prescription to women with a medical card was widely welcomed.

The general consensus is that this will remove any existing barriers to women in accessing timely and reliable emergency contraception, ending what Minister for Health Simon Harris described as an “unfair anomaly” in prescribing practices.

Of course, like any change to prescribing regulation, I’m sure there will be varying reactions among health professionals and no doubt this will pop-up in GP education sessions for further discussion.

I remember being asked my opinion, years ago, during a GP scheme interview, on the morning-after pill as an ‘over-the-counter’ medicine, when it first became available without prescription for private patients. I think, in my naiveté, I exclaimed enthusiastically that it was “a great thing”. The conversation and the (unsuccessful) interview subsequently came to a stuttering halt.

When’s the last time you prescribed the morning-after pill or any form of emergency contraception for a patient? What age was she? What was the context? Did she get ‘caught out’ with her postnatal contraception, forgetting to take her pill in between on-demand feeding and nappy changes? Was she a teenager who may not have been on any contraception at all prior to attending your surgery, maybe alone or with a sheepish-looking boyfriend in tow? Was she a woman in her late 40s who felt that she shouldn’t have to be worrying about this stuff’? Was she the victim of a sexual assault?

These women represent a spectrum of the emergency consultations that we, as GPs, have with our patients on a daily basis. It can often be a quick visit, or a potential opportunity to discuss contraception in a more comprehensive, long-term context. We may, during this type of consultation, realise that this woman may not have the means to access regular contraception, be it from lack of finances, education or logistical issues such as living in temporary accommodation and lack of access to a regular GP, etc.

She may be sitting in front of you in an out-of-hours setting, panicked and uneasy because she was too embarrassed to attend her regular GP or because her GP was flat-out and booked up for the day and there were no appointments left in the diary.

When it comes to sexual education as a wider issue, a recent survey of college students in NUI Galway revealed that a staggering 76 per cent of participants said that the sex education they received in school was inadequate. On another reason why a woman may require emergency contraception (the issue of reliability of a form of contraception), it is interesting that the British Pregnancy Advisory Service (BPAS) recently released figures relating to more than 14,000 women who used their service in 2016, which showed that one-in-four women who had an abortion had been using the pill or a long-acting contraceptive method.

Of course, we know that no form of contraception is 100 per cent effective. I feel proper advice and access to emergency contraception is a requisite part of any family planning or sexual health consultation. We know that timely access to emergency contraception when existing methods have failed is vital and helps prevent unwanted or crisis pregnancies. So, on the one hand, a measure that widens access to this is obviously positive, but it should also be weighted with our duties as prescribers and health educators to provide a holistic framework of care to women who attend in any of the aforementioned scenarios.

It is not our role alone, as GPs, to provide high-quality reproductive healthcare to women; it needs to be a responsibility shared by society and other health professionals with regard to accurate school-based sex education programmes, and at home and in hospital clinics, where a woman’s contraceptive prescription should not be regarded as anything other than part of her essential daily medication.

Will the new prescribing regulations reduce the amount of consultations we are providing to these women? Possibly. But we should still be proud of our role as GPs who are trusted by our patients to provide continual advice, guidance and expertise for women. When it comes to reliable contraception in any of its forms, be it pill, patch, coil, implant, barrier etc, this should be viewed as part of a woman’s basic healthcare rights, independent of her age, status, education or financial means.

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