$2.5m trial where pharmacists offer birth control counselling ‘misrepresented’ | Health


The creator of a new federally-funded trial that will see pharmacists offer counselling on birth control options to people who purchase emergency contraception says the program has been “misrepresented as a barrier” to reproductive choice, when its real aim is to increase access and affordability.

On Saturday, the Daily Telegraph published an article stating that “pharmacists would offer private birth control counselling to young women who turn up” requesting emergency contraception or the medical abortion pill. While this is true, the program’s creator said the headline in print – “Talk before birth control: pharmacists to offer counselling” – seriously misinterpreted the study, leading to a wave of outrage from women online.

“The perception was that this trial would put an additional barrier up for women at a time where they were feeling stressed,” Prof Danielle Mazza, the chair of general practice at Monash University and a women’s health expert, said. “What the trial is actually doing is training pharmacists to be able to offer optional services to improve women’s understanding of the contraceptive options available to them.”

The emergency contraception pill, commonly known as “plan B” or “the morning after pill”, taken after unprotected penetrative sex, aims to prevent fertilisation of the egg and is available over the counter. A medical abortion pill is a heavily regulated prescription drug that is taken by a newly pregnant person to induce termination without the need for invasive surgery.

One in four women in Australia will have an unwanted pregnancy, with a third of this group requiring an abortion. This program intends to address one of the key causes for these high unwanted pregnancy rates: education.

After handing over medication, pharmacists participating in the trial would ask the purchaser if they would like to take part in a private-room counselling session, which would lay out information on available birth control options and refer the purchaser to a clinic.

The federal government has put $2.5m towards the trial, developed by Monash University, with plans to test the program across 21 pharmacies in New South Wales, Victoria and the Northern Territory.

Mazza said the trial includes comprehensive training for pharmacists, and counselling would not include any moral component, only information on possible birth control options.

“It’s not mandatory. It’s after [the purchase],” Mazza said. “You purchase, the offer is given to you, and you can decline.”

After reading the print version of the article, the Victorian minister for women, Gabrielle Williams, tweeted that it was pushing the federal government’s “not-so-subtle pro-life agenda”.

She later clarified that she “fully supports any measures to ensure women and girls have the information they need to effectively use contraception and understand their contraceptive options”.

“My concern is that having these conversations at a time of potential crisis may leave women and girls feeling judged rather than informed, and be a deterrent to seeking future help,” she said in a statement to Guardian Australia. “This needs to be considered in the study.”

Mazza rejected the suggestion the trial was in any way aligned with the pro-life movement, saying these concerns were being carefully considered.

“I have spent my entire professional career advocating for the rights of women in relation to women’s health and contraception and abortion, I feels sad that the trial was misrepresented and misunderstood.”

It’s understood the government is frustrated at the public condemnation of the trial and its interpretation as anti-choice.

“This is an independent and peer-reviewed process which is focused on giving people more choice and more information on the full range of contraceptive options for women,” a spokesperson for the health minister said.

The president of the Pharmacy Guild of Australia, Anthony Tassone, said confusion around the program may be due to a misunderstanding of the term “counselling” in a healthcare context.

“Some readers of initial media reports have questioned and perhaps misunderstood the term ‘counselling’ and whether it is appropriate that pharmacists do this,” he said. “In the context of a pharmacist’s practice, ‘counselling’ refers to the provision of medicines information and other advice to suit the needs and enquiries of the patient.

“I’ve lost count of the times speaking with a patient they weren’t aware of other contraceptive options … as pharmacists we are not part of any not-so-subtle ‘pro-life agenda’, we are pro-patient, informed-choice and pro-evidence-based.”

However some in the field are still concerned the model misses the key issues leading to unwanted pregnancies.

The managing director of the reproductive health provider Marie Stopes Australia, Jamal Hakim, said while he was happy this was on the government’s radar, this trial would have to be very carefully considered and structured.

“It’s really critical that we don’t over medicalise things in a way that means people’s choices are being hindered,” he said.

“It has to be age-appropriate. It has to be culturally appropriate for the entire lifespan. It has to be trauma-informed so that people … who are experiencing more complex situations, such as sexual assault, such as domestic violence, aren’t inadvertently then pushed into a conversation that they’re not comfortable with.”

Mazza said training for pharmacists around trauma would be included.

Hakim said he was concerned the government funding did not address one of the key reasons people who can fall pregnant don’t have access to reliable birth control, which is cost.

“If we want to increase access, we need to be able to change the way we deliver contraception,” he said.

Hakim said that if someone who can get pregnant was not practising safe sex because they could not afford contraception, then these counselling sessions would not solve the problem.

“We have a ‘choice fund’, used to support women and pregnant people who can’t afford abortion or contraception care … we currently have no money in that fund,” he said.

“It shouldn’t be down to nonprofits to have to raise internal funds to support Australians who can’t afford access to contraception. That really should be part of universal healthcare, and we should be providing it for every single person who wants it.”

He suggested a better area of focus for the federal government would be to increase subsidies on the copper IUD, which can provide hormone-free birth control for up to 10 years, but incurs significant upfront costs.

Mazza said the pharmacist counselling trial could help increase IUD uptake, which is low in Australia, and cut costs for some by providing alternatives to the pill.

“[The] pill is actually quite a high-cost option because you need to pay for regular prescriptions … and see a doctor to get those prescriptions,” she said.

“If you’re worried about the costs for women, then I’d be working towards increasing women’s awareness about the availability of long-acting reversible contraception which has no ongoing costs and advocating for free contraception,” she said.

“This isn’t government policy. This is a research trial where we try to actually see what works out in the field in practice … we’re going to try it out, see if it works and if women want to talk to take up this offer.

“If it works we can promote it and we can extend it … if it doesn’t, it doesn’t. But that’s why you do trials. That’s why you do research.”

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