Dispense Emergency Contraception Research Articles

Pharmacist recommendations for emergency contraception in Belgium: a simulated user study

Background Emergency contraception reduces the risk of unintended pregnancy, after unprotected sexual intercourse or contraceptive failure. In Belgium, emergency contraception is available without a prescription and pharmacists play therefore a crucial role in dispensing emergency contraception. Aim This study assesses the dispensing practices of emergency contraception by pharmacists in two regions of Belgium. Method and design Simulated patient study, using a predefined scenario, evaluating a request for emergency contraception. The scenario involves a 25-year-old woman not using contraception, who had unprotected sexual intercourse 84 h (3.5 days) ago. Her last menstrual period was 10 days ago. Population 260 pharmacies were randomly selected. Principal outcome: proportion of pharmacists who deliver the adequate emergency contraception. We considered the following responses as adequate: Prescribing ulipristal acetate or redirecting to another pharmacy, in case of unavailability, or referring for a copper IUD Results We analysed the data obtained in 216 pharmacies (216/260 = 83.1%). In 64% of cases, adequate dispensing of emergency contraception (dispensing of ulipristal acetate or referral for intrauterine device insertion) occurred. There was an association between correct dispensing and asking appropriate questions, such as the date of the last menstrual period and the date of the risky sexual intercourse. Conclusion More than one-third of visited pharmacies did not distribute appropriate emergency contraception, underlining the need for improvement. We hypothesise that this may be achieved with appropriate training, use a dispensing checklist.

Objection or Obstacle: Applying Amartya Sen's Capability Approach to the Conscientious Refusal of Emergency Contraception.

The conscientious refusal to dispense emergency contraception (EC) is legally protected in fourteen states. While the ethical dimensions of these objections have been explored within moral and feminist philosophy, conscientious refusal to the over-the-counter sale of EC has not been significantly studied through an egalitarian lens, especially with attention to the existing reproductive healthcare landscape in which these refusals occur. This article argues, through Amartya Sen's capability approach, that conscientious refusal to EC creates a burdensome inequality for people wishing to prevent pregnancy that manifests within a background of historical injustices, elevating its importance in our weighing of capabilities.

Conscientious Objection to Emergency Contraception

Conscientious Objection to Emergency Contraception

Reproductive Health Services: Attitudes and Practice of Japanese Community Pharmacists.

The provision of sexual and reproductive health (SRH) services is an important part of a community pharmacist’s role in many countries. However, such services are not traditionally provided by pharmacists in Japan. We surveyed the practice and attitudes regarding the provision of SRH services among Japanese community pharmacists with a focus on reproductive health (RH) topics. The participants were asked about the provision of RH services, attitudes toward their role as SRH providers, and self-reported confidence in providing education to patients on RH topics. We obtained 534 effective responses. About half of the participants reported providing RH services, and only 21% were involved in dispensing emergency contraception pills. Although the proportion of pharmacists providing education on these topics was considerably lower, about 80% recognized the importance of their role as SRH advisors. Confidence in providing patient education about RH topics depended on their experience in providing such services. Most participants were interested in additional SRH training (80%). Our results suggest that training programs could help to expand Japanese community pharmacists’ roles as SRH providers and increase their confidence in the education of patients. This study provides useful insights to expand pharmacists’ roles in Japan as providers of comprehensive SRH services.

Pharmacies' Duty to Dispense Emergency Contraception: A Discussion of Religious Liberty.

In a recent battle between reproductive rights and religious freedom, the U.S. Supreme Court, by a five to three vote, declined to review an appeal in Stormans, Inc v Wiesman, a case brought by a Washington state pharmacy owner and two pharmacists who held religious objections to emergency contraception. These petitioners brought a constitutional challenge to Washington state regulations that required pharmacies to dispense all lawfully prescribed pharmaceuticals. In 2015, the Ninth Circuit Court of Appeals ruled that these regulations did not violate the Constitution. The Ninth Circuit confirmed that pharmacies must comply with state regulations requiring access to drugs even if the owners of the pharmacies hold religious objections to the provision of certain types of drugs-here, emergency contraception. The pharmacy owners appealed this ruling, and in 2016, the Supreme Court declined to review the case, effectively leaving the lower court ruling in place. This article analyzes the Stormans case, the difference between it and a seemingly similar case regarding contraceptive access decided by the Supreme Court in 2014, the effects of the Stormans ruling on emergency contraception access in Washington state as well as the ruling's potential implications for public health.

Evaluation of Pharmacists' Services for Dispensing Emergency Contraceptive Pills in Delhi, India: A Mystery Shopper Study.

Background:Although emergency contraceptive pills are available over the counter, the quality of consultation, including key areas of contraceptive counseling and prevention of sexually transmitted infections (STI), has not been well documented.Objective:To evaluate actual pharmacist services while dispensing emergency contraception through a mystery shopper technique.Material and Methods:This cross-sectional study was conducted in 81 pharmacies situated in Delhi by 4 trained mystery shoppers posed as customers over a period of 6 months.Results:None of the pharmacists asked about the time lapsed since last unprotected sexual intercourse or last menstrual period before deciding the eligibility of the customer. The majority were unclear about side effects associated with emergency contraception (78.57%) or with anticipated changes in menstrual flow (78.57%); 85.71% did not know whether subsequent unprotected intercourse would be protected. Only 15.71% counseled shoppers regarding risk of STI on asking leading questions and 88.5% did not provide any contraceptive advice.Conclusion:There is a huge gap in the technical knowledge and mindset of the pharmacists when it comes to checking for the eligibility of the client and providing advice regarding use of regular contraception and barrier for protection from STI, which needs to be addressed in order to realize the full benefit of making emergency contraceptive pills available over the counter.

Mechanism of Action, Efficacy and Safety of Emergency Hormonal Contraception (levonorgestrel and ulipristal acetate) and Attitudes of Pharmacists

Summary Emergency hormonal contraception is used to prevent unintended pregnancy postcoitally. The mechanism of action of the most frequently used hormonal preparations for emergency contraception, levonorgestrel (LNG) and ulipristal acetate (UPA), is still not fully known, but clinical trials indicate that they act by inhibiting or delaying ovulation. LNG has a long history of use for emergency contraception, proven safety and high efficacy if administered in the preovulation period. The newest emergency contraceptive, UPA, available only with a prescription, is indicated within this period of 120 hours after sexual intercourse and the data indicate that UPA does not lose efficacy within this period. Clinical trials showed its noninferiority versus LNG and its effect on the potentially occurring pregnancy is being additionally monitored. However, many misconceptions and controversial opinions about emergency contraception are still present, even among pharmacists. A search of Medline database identified 20 papers published from January 1993 to December 2012, on pharmacists’ knowledge, attitudes and practices related to emergency contraception. In these papers, the attitudes of pharmacists pertaining to the dispensing regime of emergency contraception were different. Research in Australia has shown that personal attitudes and religious convictions influence the practice of dispensing emergency contraception. In the research conducted in New Mexico, 30% of pharmacists were against prescribing emergency contraception for religious or moral reasons. There were no published data in regards to pharmacists’ knowledge, attitudes and dispensing practice in Serbia and such research is highly recommended.

The fox and the grapes: an Anglo-Irish perspective on conscientious objection to the supply of emergency hormonal contraception without prescription

Emergency hormonal contraception (EHC) has been available from pharmacies in the UK without prescription for 11 years. In the Republic of Ireland this service was made available in 2011. In...

Conscience and Emergency Contraception

This article examines the influence of religious beliefs on the law of emergency contraception. That influence is evident in two areas of the law. The first is conscience clause legislation, which allows health care providers to refuse participation in abortion, sterilization, contraception, or other medical procedures for religious and moral reasons. The second is the substantive content of health law and policy. The article first describes recent claims of conscience by pharmacists who refuse to dispense emergency contraception. It then reviews state and federal attempts to regulate the availability of emergency contraception. It also discusses the implications of the debates about contraception for the Religion Clauses of the First Amendment, concluding that legislative over-reliance on conscience clauses may violate the Establishment Clause.

Emergency Contraception and Conscientious Objection

abstractEmergency contraception — also known as the morning after pill — is marketed and sold, under various brand names, in over one hundred countries around the world. In some countries, customers can purchase the drug without a prescription. In others, a prescription must be presented to a licensed pharmacist. In virtually all of these countries, pharmacists are the last link in the chain of delivery. This article examines and ultimately rejects several standard moves in the bioethics literature on the right of pharmacists conscientiously to refuse to dispense emergency contraception. Its central thesis is that the standard ‘moderate’ solution to this problem is mistaken. Thus, when all publicly relevant interests are given their due, it is not acceptable to allow refusals in the big city, where pharmacies are plentiful, but forbid them in rural settings, where pharmacies are scarce. Rather, there should be strong public policy requiring that all pharmacists dispense emergency contraception to customers who request it, regardless of pharmacists' moral or religious objections.

Religion and conscientious objection: A survey of pharmacists’ willingness to dispense medications

Some US states allow pharmacists to refuse to dispense medications to which they have moral objections, and federal rules for all health care providers are in development. This study examines whether demographics such as age, religion, gender influence 668 Nevada pharmacists' willingness to dispense or transfer five potentially controversial medications to patients 18 years and older: emergency contraception, medical abortifacients, erectile dysfunction medications, oral contraceptives, and infertility medications. Almost 6% of pharmacists indicated that they would refuse to dispense and refuse to transfer at least one of these medications. Religious affiliation significantly predicted pharmacists' willingness to dispense emergency contraception and medical abortifacients, while age significantly predicted pharmacists' willingness to distribute infertility medications. Evangelical Protestants, Catholics and other-religious pharmacists were significantly more likely to refuse to dispense at least one medication in comparison to non-religious pharmacists in multinomial logistic regression analyses. Awareness of the influence of religion in the provision of pharmacy services should inform health care policies that appropriately balance the rights of patients, physicians, and pharmacists alike. The results from Nevada pharmacists may suggest similar tendencies among other health care workers, who may be given latitude to consider morality and value systems when making clinical decisions about care.

Negative and Positive Claims of Conscience

Discussions of appeals to conscience by healthcare professionals typically focus on situations in which they object to providing a legal and professionally permitted service, such as abortion, sterilization, prescribing or dispensing emergency contraception, and organ retrieval pursuant to donation after cardiac death. “Negative claims of conscience” will designate such appeals to conscience. When healthcare professionals advance a negative claim of conscience, they do so to secure an exemption from ethical, professional, institutional, and/or legal obligations or requirements to provide a healthcare service.

A Plan C for Plan B: A Feminist Legal Response to the Ways in Which Behind-the-Counter Emergency Contraception Fails Women

On August 24, 2006, the Food and Drug Administration approved Plan B, the brand-name drug sold for emergency contraception, for sale to pharmacy customers eighteen and over without a prescription. However, Plan B must be shelved behind the pharmacy counter; thus, a customer over the age of eighteen seeking this medication must ask a pharmacist for it. A pharmacist with a moral or religious objection to emergency contraception can, therefore, still pose a barrier to a customer seeking to obtain it. I use a feminist legal perspective to examine the regulation of behind-the-counter sale of emergency contraception to customers over the age of eighteen, addressing two problems with the regulation. First, because the regulation permits only behind-the-counter sale of Plan B, pharmacists are in a unique position to decide whether they think the customer should receive the requested medication - thus making pharmacist refusals possible. Second, the regulation surreptitiously adds an age requirement that was neither contemplated by the manufacturer nor medically justified, which hinders the access of young women and women without the required identification. I first map out a litigation strategy to challenge pharmacist refusals to dispense emergency contraception. Using New York law as a model, I discuss the various theories of relief upon which a refusing pharmacist could be sued, including professional causes of action and administrative causes of action. I further posit private causes of action - including sex discrimination, wrongful conception, and breach of fiduciary duty - as a way to hold refusing pharmacists accountable to customers seeking emergency contraception. I next discuss Tummino v. von Eschenbach, a lawsuit that challenges the regulation's age restriction. I argue that the age restriction privileges both age (adults) and gender (male purchasers/non-users) in ways that are unrelated to the use of the drug or its risks. This section applies a feminist legal perspective on the age restriction through use of constitutional theories supporting invalidation of the age restriction, in particular minors' right to decisional privacy.

Adjudicating rights or analyzing interests: ethicists’ role in the debate over conscience in clinical practice

The analysis of a dispute can focus on either interests, rights, or power. Commentators often frame the conflict over conscience in clinical practice as a dispute between a patient's right to legally available medical treatment and a clinician's right to refuse to provide interventions the clinician finds morally objectionable. Multiple sources of unresolvable moral disagreement make resolution in these terms unlikely. One should instead focus on the parties' interests and the different ways in which the health care delivery system can accommodate them. In the specific case of pharmacists refusing to dispense emergency contraception, alternative systems such as advanced prescription, pharmacist provision, and over-the-counter sales may better reconcile the client's interest in preventing unintended pregnancy and the pharmacist's interest in not contravening his or her conscience. Within such an analysis, the ethicist's role becomes identifying and clarifying the parties' morally relevant interests.

Emergency Contraception: Legal Consequences of Medical Classification

Pharmacists with religious or ethical objections to prescribing emergency contraception won the latest round in the fight over conscience clauses in a case that could have broader implications for attempts to restrict access to contraception. In Stormans, Inc. v. Selecky, a federal District Court in Washington State granted an injunction to block the enforcement of regulations that would have forbidden pharmacists to refuse to dispense emergency contraception on the grounds of religious or ethical objections. In its decision, the court applied Supreme Court abortion precedent without explicitly ruling whether emergency contraception should be legally categorized as a form of abortion or as contraception. However, the legal status of emergency contraception affects the strength of the defendants’ claims that the law was justified on the grounds of preventing sex discrimination. In neglecting to rule one way or the other, the court not only failed to adequately consider the sex discrimination claim but also may have opened the door to more restrictive regulation on contraceptives generally.

Pharmacy access to emergency contraception: Perspectives of pharmacists at a chain pharmacy in San Francisco

ObjectiveTo assess pharmacists' perception of their role in dispensing emergency contraception (EC) in San Francisco. DesignCross-sectional study. SettingCommunity chain pharmacies in San Francisco during summer 2002. Participants76 Walgreens community pharmacists. InterventionsSelf-administered survey mailed to all pharmacists (n = 122) working in all Walgreens units (n = 49) in San Francisco. Main outcome measuresPharmacists' attitudes regarding EC provision. Variations in sociodemographic, training, and practice characteristics were tested using chi-square statistics for categorical variables and Student t test for continuous variables. Results76 pharmacists (62%) responded to the survey (approximately 50% women and 74% Asian). Knowledge among the pharmacists was very high; most knew the timing of the first dose (95%), the adverse effect of nausea (99%), the effectiveness compared with oral hormonal contraception (92%), that EC offers no protection from sexually transmitted infections (99%), differences from medical abortion (100%), and that EC does not increase the risk of birth defects (100%). Most pharmacists (91%) reported that participation in a direct pharmacy-access program would make them feel more important in their pregnancy prevention role, and nearly all (99%) supported pharmacy-access legislation for EC. Knowledge and attitudes did not differ by highest degree earned, position, age, or sex. ConclusionAn assessment of pharmacist experiences in the San Francisco area showed high capability and support for an enhanced professional role regarding EC.

Emergency Contraception for Sexual Assault Victims in North Carolina Emergency Departments

One in 5 women is a victim of sexual assault. This study examines the administration of emergency contraception to victims of sexual assault in North Carolina hospital emergency departments. One hundred seventeen surveys were mailed to hospital emergency departments across the state to determine their emergency contraception practices for victims ofsexual assault. The survey contained 11 questions about emergency contraception practices for victims. Of the 117 surveys, 103 were returned revealing that just over 50% of the hospitals in North Carolina treated victims with emergency contraception without exception. Both dispensing emergency contraception and providing information about emergency contraception were significantly associated with having a sexual assault nurse examiner program. Results from this study demonstrate inconsistent provision of emergency contraception to victims of sexual assault; however, there is greater consistency of emergency contraception use by emergency departments using sexual assault nurse examiners.

Reasons and Healthcare Professionals' Claims of Conscience

Robert Card (2007) argues against even a limited conscience-based right to refuse to dispense emergency contraception (EC) on the grounds that there are no “reasonable or justified” reasons to supp...

Conscientious Objection and Emergency Contraception

This article argues that practitioners have a professional ethical obligation to dispense emergency contraception, even given conscientious objection to this treatment. This recent controversy affects all medical professionals, including physicians as well as pharmacists. This article begins by analyzing the option of referring the patient to another willing provider. Objecting professionals may conscientiously refuse because they consider emergency contraception to be equivalent to abortion or because they believe contraception itself is immoral. This article critically evaluates these reasons and concludes that they do not successfully support conscientious objection in this context. Contrary to the views of other thinkers, it is not possible to easily strike a respectful balance between the interests of objecting providers and patients in this case. As medical professionals, providers have an ethical duty to inform women of this option and provide emergency contraception when this treatment is requested.

The Pharmacist's Personal and Professional Integrity

The pharmacist's duty to dispense emergency contraception may be approached as a legal, policy, and regulatory issue; as an ethical issue; or as an empirical question. Card (2007) elects to analyze...