Women who seek emergency contraception from their pharmacist are wrongly being told they must fill in a form asking them to declare whether they were sexually assaulted or have STI symptoms before they can access the medication.
An investigation by the Medical Republic reveals that some chemists are telling customers they are “legally required” to fill out a checklist originally created by the Pharmaceutical Society of Australia (PSA) in 2013, even though the body has since distanced itself from the form.
The use of the outdated checklist has some experts worried that it could deter women from accessing the medication.
The document, which was never mandatory, was introduced when the medication first became available without a prescription in 2004, and may have been adapted by some pharmacies to their needs, says Dr Safeera Hussainy, an adjunct senior lecturer in the department of general practice at Monash University.
A 2013 version of the checklist developed by the PSA asks for the date, the customer’s name and age, their usual form of contraception, and detailed information about their menstrual cycle and last period. It asks customers to list the medications they are taking and say whether they have certain medical conditions.
It also has a section for the customer to state the reason for seeking emergency contraception, with one of the options being “sexual assault”. Another section asks if the customer has burning or pain when urinating, pain during or after sex, unusual vaginal discharge or irregular vaginal bleeding or spotting.
Pharmacists asking women sensitive questions about when they last had sex or if they were coerced could stigmatise and shame them, said Dr Deborah Bateson, the medical director of Family Planning New South Wales.
“Pharmacies don’t always have private areas,” Bateson said. She said such stigma was a particular issue for women in rural areas and small communities, and worried it could deter them from seeking the medical care needed to prevent an unintended pregnancy.
A PSA spokesperson said that the organisation does “not recommend the use of a checklist”, and that the 2013 document is out of date.
However, it appears some stores have been slow to catch up.
The Medical Republic called 15 stores from four major pharmacy chains across the country.
A Chemist Warehouse in Sydney’s northern beaches, which uses the 2013 document, told the Medical Republic that filling in a form was a legal requirement. Another in Melbourne’s St Kilda said it was company policy, adding that they would also need to see a driver’s licence.
An employee of a Priceline in St Kilda told this reporter she would need to complete the form in order to obtain the medication but would not need to write her name on it.
A TerryWhite Chemmart in the Brisbane CBD and another in Victoria’s Surrey Hills said the form was mandatory, while another in the Adelaide CBD said that only a name and address were needed.
Cincotta Discount Chemists in inner Sydney and Armidale, NSW both said there was a form that needed to be filled in, but when asked if it was compulsory said no. The first said it was “recommended” to make sure the medication was safe to take, while the other said it could be done over the phone.
Only three stores equivocally said that there was no need to fill in a form, while staff in the remaining stores were either not able to say whether the form was necessary, or said the checklist could probably be communicated verbally with the pharmacist.
Hussainy, a pharmacist and advocate for wider access to emergency contraception, said some questions on the checklist were clinically necessary to ensure women get the best care. For example, a woman with Crohn’s disease should be offered a copper IUD instead of the emergency contraception pill.
However, she believes that filling in a physical form could be a depersonalising experience for women. Instead, that same information could be obtained – just as it is with other medication – by speaking to the woman, she said.
Hussainy said the document may be used as a “safety net”, and a holdover from when it was first made available over-the-counter and there were fears of women suing due to continued pregnancies. She said the forms would typically be filed in a folder and kept on the pharmacy premises, being treated as confidential private data, and shredded after about a year.
Pharmacists can be a valuable source of information on topics such as ongoing contraception, referrals for STI checks or sexual assault services, Bateson said. “But we want to ensure there are not just routine questions being asked of everyone, because they can be a barrier.”
The use of such a form highlights the way reproductive health often has restrictions that other areas of medicine don’t, Bateson said. She added that the emergency contraceptive pill was a “very safe” medicine that was even dispensed in supermarkets and vending machines in some parts of the world.
Associate Prof Marie Bismark, a Melbourne public health physician and legal academic, said that customers may have grounds to complain about being told it is mandatory to fill in the form.
Australian Privacy Principles stipulate that organisations should explain why they are collecting information and whether it is required by law. Health information can be collected when it is “reasonably necessary” and when it is obtained by “lawful and fair means”. This means that the organisation is collecting the information without deception and in a way that is not unreasonably intrusive, Bismark said.
“I think those words ‘unreasonably intrusive’ are interesting. Asking for details about why somebody requires emergency contraception could potentially be an unreasonably intrusive question, unless the organisation can show the clinical relevance of those questions,” Bismark said.
Ideally a form would clearly state whether questions were mandatory or not, and explain why the information was being requested.
A customer could also complain to the regulator, the Pharmacy Board of Australia, if they believed a pharmacist was not adhering to professional standards.
A TerryWhite Chemmart spokesperson said: “We encourage all of our pharmacists to follow professional practice standards and fully support the PSA guidelines.”
The other pharmacies had not responded at the time of publication.
This story was published in conjunction with the Medical Republic