When the morning-after pill was introduced in Malta in 2016, it was decided that it could be sold over the counter in pharmacies, without a doctor’s prescription. One of the main reasons given at the time was that the potential delay in finding a doctor to write a prescription could hinder the efficacy of emergency contraception.
It was also highlighted that this was an acceptable method, as pharmacists feel well qualified to ensure that emergency contraceptive pills are sold correctly.
Women who request the morning-after pill over the counter are asked certain questions by pharmacists to ensure that it is taken correctly. But some women are now complaining that the questions are at times too personal or even unnecessary. They say they have felt ‘shamed’ and ‘judged’.
The Chamber of Pharmacists insists, however, that pharmacists should follow their guidelines, which are based on international standards. These guidelines tackle confidentiality and patient safety, among others.
They are intended to safeguard women’s health and not to make access to emergency contraception difficult. They help the pharmacist ensure medicine is dispensed properly.
The administrators of the Facebook group ‘Women for Women’ have written to the chamber asking for their guidelines, and the recommended set of questions asked to women requesting the pill, to be made available to all.
Wanting to know what to expect is reasonable. But even if it is possible to have a more rigid or standardised set of questions, some would always need to be of a personal nature, especially given the type of pill in question.
One problem here could be that, while patients tend to choose their doctor and enter into a private exchange based on confidentiality and trust, women may not have made the same considered choice in the case of the pharmacist they meet behind a counter when seeking emergency contraception. They may never have been to that outlet before, as not all pharmacies sell the morning after pill.
The awkwardness of such a personal exchange can be exacerbated by an inappropriate environment. Some women have complained that they were asked these questions in a situation where they could readily have been seen and heard by other customers around them, and not in a private area like a consulting room.
This can make it uncomfortable both for the client and for the pharmacist trying to ensure that the medication is dispensed correctly.
In order to give women the privacy and respect they deserve when requesting emergency contraception, the right facilities should be provided by healthcare professionals. Most pharmacies have a private area or back room which could be used to ask questions of a personal or confidential nature.
At times these areas could, of course, be unavailable because they are being used by a doctor. In such a case, one option could perhaps be for the doctor to give advice to the woman on the correct use of the emergency contraceptive pill, instead of the pharmacist. No significant delay would be created if a doctor is present on site, and a more private space would thereby be offered.
Pharmacists are expected to follow the guidelines but informing women about what to expect in such situations might help avert embarrassment.
The right information, environment and facilities can be provided to preserve both the clients’ wellbeing and the professionalism of pharmacists.