Calls to fund the emergency contraceptive pill are missing the point, says an Auckland GP

“Only paying $40 or $50 in one hit seems like better value than $150 in one go for a LARC, which shows that the most effective contraception is still out of reach”

Demands to fund the emergency contraceptive pill in pharmacies skirt around the issue that the most effective forms of contraception are still out of reach, says Auckland specialist GP Orna McGinn.

A recent pilot programme run by Northland DHB fully funded consultations and dispensing of the emergency contraceptive pill (ECP) in three-quarters of the district’s pharmacies.

As reported by Pharmacy Today, the success of the pilot, which saw the pill dispensed for free nearly 3000 times, prompted calls for the ECP to be funded nationwide.

At most pharmacies across the country, it costs around $35 to $60 to access and is available at low cost, or sometimes for free, from GP and Family Planning clinics.

However, Dr McGinn, who is based at Pakuranga Medical Centre in South Auckland, says there has never been a single study that shows the ECP reduces abortions or unintended pregnancies.

There still needs to be a focus on making all forms of contraception, including long-acting reversible contraception (LARC) such as Mirena, fully funded, she adds.

While the cost may be prohibitive for some, Dr McGinn says she has seen a patient who has used the ECP twice this year because the cost is cheaper than accessing a LARC.

“Only paying $40 or $50 in one hit seems like better value than $150 in one go for a LARC, which shows that the most effective contraception is still out of reach.

“The rates of people using the ECP will be less if access to LARCs was better.”

What is needed is a visible network of trained providers that patients and professionals can easily access and navigate, says Dr McGinn.

She adds that the emergency copper intrauterine device can be a better option than the ECP anyway, depending on factors like weight or the length of time that has passed since unprotected sex occurred.

The emergency IUD has a 0.01 per cent failure rate and can be inserted up to five days after the egg is released, compared with the ECP which is 98 per cent effective for those of an average weight, when taken within four days of unprotected sex.

READ MORE:

• Hurdles in accessing contraception shown
• On the trail of the $6 million: Nine DHBs explain their spending on contraception
• GPs troubled by red tape, variability in DHB funding of contraceptive care

Family Planning national medical adviser Beth Messenger says the ECP is a safe but time-critical medication and expanding access with funding in pharmacies would help get the “best out of it”.

Coming from the UK originally, where all contraception is free, Dr Messenger adds it makes sense to look at removing another barrier here in New Zealand, but there are some issues that need to be addressed first.

“Free ECPs, yes, we would support that, but it’s not the only option.

“In some areas there is often a pharmacy when there are not other health services, but not all pharmacists are trained to provide the ECP.”

This is particularly true for rural areas, where services are affected by recruitment and retention issues, and also geography.

“What if the only pharmacist in town is a conscientious objector, and there’s no GP? That patient could be facing a long drive to someone who will dispense it, or ringing Family Planning and getting the medication, which is time critical, couriered.”

Ultimately, patients should be able to access the ECP in a range of different places and have awareness of what those different options are, says Dr Messenger.

This again raises the issue that health system’s approach to women’s health needs assessment, says Dr McGinn.

Women’s health is constantly treated as “single issues” and there are large variations in what is available in different areas across the country, she adds.

“There is not one team with a strategic view of women’s health – abortion is separate from contraception which is separate from maternity.”
“We now have the gold standard for cervical screening, it’s great that ACC has widened funding for birth injuries but these are always going to miss the point if we are not looking at this in a integrative and strategic way.”

The $6 million of Ministry of Health funding allocated in 2019 to improve access to contraception has also not had any determinable effect on abortion or pregnancy, and following last year’s law change, health professionals can now offer early medical abortions but still can’t offer funded LARCs.

The Bay of Plenty DHB service Protected&Proud, which provides women with information regarding contraception options and access to services, is a great example of best practice, says Dr McGinn.

But there has been no movement from the ministry to roll it out nationally, she says.

Given the upcoming health reforms, if New Zealand doesn’t end up with more integrated and effective women’s health services, it will be a “failed experiment”, Dr McGinn says.

“This is the intent, and it has taken years to get to this point for them to tell us the system is fragmented and doesn’t serve patients’ needs.”