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Column: What you don’t know about emergency contraception (and why it might hurt you)

Revelations that emergency contraceptives were bring sold without a warning that their effectiveness could be compromised in women of a certain weight underlines the lack of holistic education about contraception and sexual health, writes Alison Begas.

Alison Begas

WHEN EMERGENCY CONTRACEPTION was first licensed in Ireland in 2001, women seeking it had to first attend their GP or family planning clinic, after which a prescription would be issued.

Ten years later, a change in licensing regulations cleared the way for women to access one emergency contraceptive – NorLevo – over-the-counter from their community pharmacy.

This move to over-the-counter availability was hugely significant – women could now buy this medication directly from their local pharmacy, especially helpful at times of peak demand such as weekends, or in the Christmas party season.

So far, so good.

However, one of the downsides of the medication being available over-the-counter is that the majority of Irish women no longer see a doctor when they wish to avail of emergency contraception. Instead, they simply walk into their local pharmacy and make the purchase, thereby missing out on the holistic healthcare consultation which can only be delivered by a family planning doctor or GP.

A widening knowledge gap

There is increasing evidence that a widening knowledge gap is being created among the Irish population when it comes to sexual health education and awareness.

Last week, in an astonishing revelation, it emerged that the manufacturers of NorLevo had failed to include package information to tell women that if they weighed 80 kg (around 12 stone 8 lbs) or more, it would not be effective as an emergency contraceptive.

In fact, the effectiveness of NorLevo starts dropping in women weighing 75kg (11 stone 11 lbs) or more. As the average Irish woman now weighs around 11 stone, the form of emergency contraception that’s most readily available to her might not work, and many women might have got it from their local pharmacy, and may still have run the risk of becoming pregnant.

It’s all a bit Irish, isn’t it? Now, the Irish Medicines Board, the consumer watchdog that licenses medication for use, has weighed in (excuse the pun), and is requiring amended product information to be included with all NorLevo packaging, and the Irish Pharmacy Union has issued updated guidelines to all pharmacists.

It may be easier, and more affordable, to buy drugs over the counter at the pharmacy. But at the same time there is an important connection between accessing emergency contraception, and accessing holistic sexual healthcare.

There is no substitute for long-term contraception

Emergency contraception is a very safe form of medication, but it is no substitute for being on a more long-term form of contraception, such as the oral contraceptive pill, an injection, or a LARC (long-acting reversible contraceptive, a ‘Fit and Forget’ option which provides contraceptive cover for 3 – 10 years). There’s also a huge need to raise awareness around sexual health and STIs.

As part of the discussion on medical history, a doctor will always assess BMI (a calculation relating body-weight to height), and this is a factor in deciding what form of contraception, or emergency contraception, is appropriate for each individual woman. Equally important, the doctor will always use the consultation to discuss sexual health concerns with the patient.

For us in Well Woman, the knowledge gap over weight and NorLevo was a wake-up call as to the lack of awareness out there about emergency contraception. The good news is that women now have choice (not something traditionally in generous supply in Ireland as far as family planning or reproductive issues are concerned):

  • The post-coital coil – the most effective form of Emergency Contraception (99% +), it must be fitted by a family planning doctor or appropriately qualified GP, up to 5 days after unprotected sex. Apart from being the most effective option, it’s also the most expensive, and potentially the most painful as it’s an invasive procedure, but it is suitable for women above average weight.
  • ellaOne – an Emergency Contraceptive pill, which can be taken for up to 5 days after unprotected sex. It is as effective on Day 5 as on Day 1, and almost halves the risk of becoming pregnant, when compared to average efficacy rates in the over-the-counter offering, NorLevo. It requires a visit to a GP or family planning doctor, and is less expensive than a post-coital coil. It’s also more suitable for women of above average weight.
  • NorLevo – sold over-the-counter in pharmacies. It can be taken for up to 3 days after unprotected sex, and is approximately 95% effective on Day 1, 85% on Day 2, and 58% on Day 3. It’s the most affordable, but also the least effective, of the three options, and remember that weight will affect efficacy.

A HSE education campaign is urgently needed

Clinic statistics from the Dublin Well Woman Centre’s three Dublin locations in 2012 showed a 72% increase in the level of positive results for genital herpes in just 12 months. The figures also showed a 35% increase in the level of positive results for chlamydia in the same time frame, with the number of people diagnosed with chlamydia in Well Woman now at its second highest rate in the past ten years.

There is a credible argument to be made that women who are now accessing emergency contraception over-the-counter in community pharmacies are missing out on a holistic sexual health consultation and that this is contributing to a general ‘dumbing down’ when it comes to sexual education.

To address this knowledge deficit, we are calling for an urgent awareness and education campaign on emergency contraception to be rolled out by the HSE.

In the medium term, a nurse-supplied emergency contraception service as part of the National Sexual Health Strategy, would help provide a lower-cost sexual health consultation, which would fit well with the stated intention of the Minister for Health to provide healthcare services at the ‘lowest level of complexity’.

Ireland’s sexual health needs have changed. While many of these changes are positive, we need to constantly prioritise education and awareness of the options available so that people are informed enough to be able to make the best choices for themselves.

Alison Begas is Chief Executive of the Dublin Well Woman Centre, experts in sexual health and family planning for more than 35 years, see www.wellwomancentre.ie.

Read: The male contraceptive pill now a step closer

Column: Ireland’s reproductive revolution – are women now in control?

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Alison Begas

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