health

Nicola needed the morning-after pill. She was handed a questionnaire about her sex life.

Nicola walked into the pharmacy with her husband and her six-month-old daughter. The 32-year-old was there to pick up the morning-after pill

Upon approaching a pharmacist and requesting the pill, she was handed a form.

"Confused, I asked him why I had to fill it out. The pharmacist said it was to better determine which treatment I needed, asking that I put my full name and address on the form, too," Nicola tells Mamamia.

"I nodded my head, thinking it would be basic questions around perhaps possible side effects - but when I looked at the form, it was a questionnaire with multiple-choice questions about my intimate life."

Watch: How to compare combination birth control pills. Post continues below.


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"When I said I wasn't comfortable filling out this form, he said it was their procedure and that they wouldn't sell it to me without the form completed."

"I pushed back and said that I didn't understand how the questions would impact the treatment. The young male pharmacist shrugged his shoulders."

Embarrassed and angry, Nicola turned to find her husband, realising a queue had formed behind her. Everyone was listening to her conversation with the pharmacist. 

"I pushed the form away and walked out," she said.

When she went into another pharmacy, Nicola was asked to answer the same series of questions - this time, in person. Out on the pharmacy floor.

"They said I would need to fill out a form, but they had run out of them. The lady pharmacist very uncomfortably proceeded to ask me the same questions."

"But this time she looked over to see that I had a husband with me and a young baby which seemed to satisfy her reasons for why I may want the pill - being that I wasn't a single woman - so she gave me it."

Emergency contraception may be easier to access than ever before - however, the surrounding stigma is still thriving.

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While we've come a long way from pre-2004, when women were required to have a prescription from their GP to access the pill, there are still many hurdles for women when it comes to emergency contraception.

It could be the fact that a pharmacist can still refuse to distribute the pill on 'moral ground' - referring you to another supplier. It seems outrageous, but the fact is that religious beliefs can still interfere with a women's reproductive rights.

Or it could be the cost of emergency contraception - especially for younger women. The morning-after pill can be expensive, depending on the type and brand, and it's not something that's covered by health care.

Then, of course, there's the drastic misunderstanding of how emergency contraception works and who can use it. The term ‘morning-after pill’ continues to be problematic, as it suggests the medicine relates to casual sex and that it must be used ‘the morning after’ or within 24 hours of unprotected sex.

Another massive barrier? The culture of shaming. 

At the very crux of it, the 'interview process'. The unpleasant pharmacy Q&A acts like a guard dog upon requesting the morning-after pill. 

There's a number of women who tell Mamamia that they’ve been lectured, patronised, and humiliated during the questioning process.

"NOT that it matters, but as a married woman with a six-month-old baby, I felt shamed in this process and I think that women in various situations would feel the same," said Nicola.

Image: Getty 

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There's still very much an underlying stigma surrounding the pill - and it's women who take it on.

An overwhelming number of women reported feeling anxious and on edge for having to explain themselves for something that's not only often an accident, but something that resulted from two people's actions - not just one.

One woman writes: "The last time I got it several years back they took a photocopy of my license. The pharmacist was awful, suggesting it [must be] “for a friend” and being disparaging of my age. My male partner has purchased another for me since with zero paperwork and a pat on the back for being a good guy."

Another woman said: "When I purchased it for the first time I was told they had to take a copy of my license to "check I wasn’t using it too often". I was 18-years-old."

Like Nicola, many Aussie women said they felt judged, ashamed, and belittled when trying to purchase the morning-after pill. These women expressed concern about their lack of privacy. The irrelevant and ambiguous questions they're asked. And how, in 2021, they still had to justify making their own choice around unwanted and ill-timed pregnancies.

Women still face a number of barriers when it comes to emergency contraception - and it's even harder for young women to navigate them. Meaning? It could very well prevent young girls from being able to access completely safe and legal medication in time.

What is the morning-after pill?

The morning-after pill is used to prevent pregnancy after unprotected sex. There are currently two types, and until 2004, these had to be purchased with a prescription.

It wasn't until over seven years of vigorous campaigning by the National Health and Medical Research Council that it became available over the counter - much to the dismay of anti-choice advocates who fought against it.

To give you a brief rundown, the morning-after pill is a drug that falls under the Therapeutic Goods Administration (TGA) and is to be used within three days of unprotected sex - however, there's research out there that suggests its effective for up to four days.

Either way - the sooner the emergency contraception pill is taken, the more effective it is in preventing pregnancy.

Available in the form of a tablet, the morning-after pill is a 'Pharmacist Only' medicine. That is, a medicine that “safe use of which requires professional advice but which should be available to the public from a pharmacist without a prescription.” 

What are the regulations around distributing the morning-after pill?

Under Australian law, pharmacists are required to personally deliver or supervise the delivery of these types of medications, as well as give directions for their use. 

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This entails a pharmacist asking the customer questions about any current medical issues, past medical history, and the medications he or she is taking. 

Most pharmacies use the Pharmaceutical Society of Australia’s (PSA) written protocol to guide their supply and distribution of the emergency contraceptive pill. 

Under this guideline, pharmacists are to consider their professional standards, assess the patient's needs, confirm the therapy is appropriate, supply the morning-after pill, and provide written information on how to use it.

A recent study on the provision of the emergency contraceptive pill has found that most Australian pharmacists tend to follow the protocol for dispensing the pill quite strictly, with stronger, more conservative attitudes than overseas pharmacists. 

Take, for example, the checklist that many women are asked to fill out. According to the pharmaceutical board, this is not actually a mandatory form.

As the emergency contraception pill is not dangerous under any known circumstances or in women with any particular conditions, the PSA said this is an outdated practice.

"The checklist is outdated and is no longer recommended by PSA for use. PSA stopped recommending the use of this checklist almost ten years ago," said a spokesperson for the PSA.

"The checklist was developed around 20 years ago, in partnership with Family Planning Australia when emergency contraception first changed from a Prescription Only Medicine to a Pharmacist Only Medicine."

"At the time, this checklist was developed following extensive stakeholder consultation, as a tool to support pharmacists in facilitating the safe supply of emergency contraception."

"As both the population and pharmacists have become more familiar with the supply of this medicine without a prescription, the use of such a checklist has no place in current practice." 

However, since a pharmacist must determine the safety and appropriateness of each medicine they supply, it is, therefore, a legal requirement that they ask a version of these health questions - whether it be in person or on paper.

What kind of health questions can a pharmacist ask when you request the morning-after pill?

To supply this medicine, Australian pharmacists are required to know who it is for, why they need to take it, how long it has been post-intercourse, details about if they have had previous unprotected intercourse this month, and details about the patient’s menstrual cycle. 

According to experts, this is all to do with the appropriateness and safety profile of the medicine without a consulting doctor. As mentioned prior, pharmacists have a legal obligation to ensure you are receiving the correct drug.

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However, as can be inferred from numerous women's experiences, some of the questions asked are undeniably prying and seemingly off-topic in reference to the safety, effectiveness, and side effects of the medicine - such as probing into the customer's relationship status and their reasons for wanting the pill. 

But this is where it becomes tricky.

Similar to other Schedule 3 medicines, if a person does not wish to disclose relevant health information, a pharmacist is required by law to decline the supply of the medicine.

"Emergency contraception is a Pharmacist Only Medicine, meaning pharmacists have both legal and professional obligations to establish the therapeutic need for the product and to provide support for its safe and effective use," a spokesperson from the PSA explains.

"The same obligations exist for other Pharmacist Only Medicines, including treatments for migraine-inducted nausea, some cold and flu medicines, and sedating antihistamines."

"In order to establish therapeutic need, pharmacists must have conversations with patients, which may require them to ask questions that may otherwise seem intrusive. This should be done in the private area or consultation room wherever possible."

"Pharmacists should continue to have appropriate, respectful, and culturally safe conversations with patients to enable the supply of this very safe medicine," said the PSA spokesperson.

While some pharmacists prefer to have a conversation with the patient in a private area, a paper form can be a discreet and private option for some pharmacies. Either way, the choice of how the information is found is up to each individual pharmacist and their preferences/counselling technique.

However, for many women who spoke to Mamamia, this is the issue. Many women said it's not just about the medical process and the intimate questions - it's about the execution. 

Often women are not directed to a private room to discuss their personal details. Sometimes there isn't a discreet conversation. Sometimes it happens right there on the pharmacy floor.

Image: Getty 

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As Risha*, 35, tells us, "I have needed the morning-after pill in my 20s as a not-too-responsible person, and in my 30s as somebody in a committed relationship. I was never asked to fill in a form previously, just asked if I’d had it before and told about the side effects, when to take it and the next one, etc."

"The last time that I had it, I was required to answer all the questions. I had to say when my last period was, what day I was in my cycle and why I needed it (i.e. condom broke etc). I then had to speak to a pharmacist. I wasn’t bothered by the questions so much, as I understand why they need to know when your last period was and where you were in your cycle - but the pharmacy assistant asking me why I needed it in the main area of the pharmacy was a bit mortifying," she shares.

For women and girls at risk of assault or abuse, this is significant.

"I think [there is] sensitivity surrounding the questions [and this] needs to be done in a separate area and more discretely. If I had been sexually assaulted I imagine the whole conversation and interaction could have been very stressful."

While pharmacists have guidelines on how to take sexual exploitation and abuse into account when supplying the morning-after pill, stories like this highlight a glaring problem.

"As with all health care professionals, should a pharmacist become aware of the possibility of sexual assault, they have a duty-of-care to offer support to the person, including onward referral to designated services."

"Pharmacists also have an ethical obligation to respect a person's autonomy, including a decision to decline this support (unless mandatory reporter obligations apply, for example, with minors)," said the PSA spokesperson.

"Sadly, sexual assault and abuse continue to occur in our community. As pharmacists are Australia’s most accessible health professionals, they can sometimes be the first person people turn to when they are seeking help. It is important that pharmacists are equipped to provide the correct support and referrals."

Why do you need to provide identification for the morning-after pill?

As with all other Pharmacist Only Medicines, it is also a common practice for pharmacists to request identification when providing the morning-after pill.

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"This may be to help identify any potential medicine interactions within dispensing software," explains the PSA.

"This is particularly useful where there is confusion about which medicines a person is taking (for example, which oral contraceptive a person may have recently used, or identifying medicines that may significantly interact with the emergency contraceptive pill)."

In some states, it is also a legal requirement for pharmacists to label Pharmacist Only Medicines with the patient’s name, and directions for use.

But what happens to this information? And is it purely used for medical purposes?

"All information that a pharmacist collects is protected by the pharmacist’s professional obligations, the pharmacy’s accreditation standards, and the Privacy Act," said the PSA.

"Where a person does not wish to disclose identifying personal information, pharmacists should find other ways to gather relevant information needed for the safe and effective supply of emergency contraception."

The issue with the morning-after pill system.

At present, the system of requesting the morning-after pill – the process used and whether the medication is dispensed to a customer or not – is confusing.

Judging by the numerous experiences shared with Mamamia, there needs to be a more unified process in place. One that is a more respectful and discreet experience for women when seeking treatment.

"It's daunting as it is under the best of circumstances to ask the pharmacist for the morning-after pill, and this current system means that some women may be deterred from accessing the appropriate treatment and support," said Nicola. 

"If a chemist needs to ask the customer some questions, I think there should be standard questions asked and [it should] be done discreetly, and that at most the potential side effects need to be communicated. No woman should have to leave untreated, because the risk of an unwanted pregnancy is not worth it."

Image: Getty 

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Put it like this: if the current process is offputting and uncomfortable enough for older women, it's even worse for younger women.

According to the PSA, where a pharmacy chooses to use a paper form, people can request not to use the checklist, and can equally request a private consultation space for discussion should it not have already been offered. 

However, in cases such as Nicola's, a second option is not always on offer: "When I refused to fill out the form, they refused to help me buy it. It was fill it out or go without," she shares.

Experiences such as this highlight the need for a revised set of standards that will help pharmacists ensure that women can access and use this pill effectively, safely, and easily.

According to the PSA, a lot of these experiences simply come down to poor practice by individual pharmacies.

"Pharmacists want to provide patients with the best possible experience when seeking access to medicines they need. There is no one factor that clearly explains the different experiences – some of these examples are undeniably poor practice."

"However, we hope these experiences are becoming less frequent and do know for many women that the improved, timely access to this medicine, and the care and advice provided by pharmacists is exemplary."  

For Nicola, the stigma attached to the morning-after pill is something that needs to be brought to light. 

"I can't believe that in 2021, women are still being subjected to methods to control their choices and rights," she tells Mamamia.

"I can't imagine that this process was dreamed up by a woman - it reeks of a man in an office who has never had to justify his choices."

* Name changed for privacy reasons.

Feature image: Getty/Mamamia.

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