Emergency contraception from pharmacists misses opportunity

EDITOR—I hope that the predicted reduction in unplanned pregnancies and abortions will result from pharmacy access for emergency contraception, as described by Harrison-Woolrych et al in their editorial.1 The possibility of risk displacement, however, rendering this move ineffective in the same way as has been postulated for condom use2 makes this far from certain. What is certain is that the opportunity for detection of sexually transmitted diseases and reduction of risk has been missed.

A tunnel vision approach to reducing unplanned pregnancy may do nothing to reduce the risk of sexually transmitted diseases and can increase it.3 Many, if not most, women in need of emergency contraception will also be at risk of sexually transmitted diseases. If, in taking a history to explore the need for emergency contraception, a doctor did not also gently explore the risk of sexually transmitted diseases and advise the patient appropriately, I would consider it substandard practice and possibly even negligent. The website pharmacy training programme highlighted in the editorial mentions sexually transmitted diseases only in the context of emergency contraception, not in terms of providing any protection against them. No questions are advised to assess the risk of sexually transmitted diseases, and no information is to be provided on how to obtain further help on diagnosis and management. Even mandatory provision of a simple leaflet mentioning possible risk of sexually transmitted diseases and giving the details of the nearest departments for genitourinary medicine would be better than nothing.

As it is, a woman who obtains emergency contraception from a pharmacy is unlikely to be offered any chance whatsoever of having a concurrent sexually transmitted disease investigated and treated promptly. Rates of sexually transmitted diseases will continue to increase in the United Kingdom yet again as a predictable and direct result of a scheme introduced with insufficient planning and training for pharmacists. When concerns about sexually transmitted diseases were raised by some of those involved in the Manchester pilot scheme, they were simply ignored. The trauma of a diagnosis of chlamydia infection is clearly of little interest to those who want to make buying emergency contraception as easy as buying a toothbrush.4