New pharmacy trial seeks to break down barriers to contraception

When Professor Danielle Mazza set out to promote her pharmacy trial, aimed at educating women about their contraceptive options, the last thing she expected was to find herself embroiled in an online backlash.
 
A photo of the headline ‘Talk before birth control’ published in the Daily Telegraph was posted on Twitter by Victorian Minister for Women, Gabrielle Williams, who called out the study for pushing ‘a not-so-subtle pro-life agenda’.
 
Speaking to newsGP in the aftermath, Professor Mazza, a women’s health expert and advocate, said the headline was a complete misrepresentation of the study.
 
‘[It] seemed to be suggesting that barriers were being put up to curtail access to contraception. Nothing could be further from the truth,’ she said.
 
‘This study, like all the work we are undertaking within the SPHERE Centre of Research Excellence, is focused on improving access to women’s sexual and reproductive health services in primary care and women’s health literacy.’
 
The four-year ALLIANCE Trial will involve pharmacists across 21 participating locations in Victoria, New South Wales and the Northern Territory, who will offer contraceptive counselling to women seeking emergency contraception or those wanting to fill a medical abortion script.
 
If the offer is taken up, the woman will be given information on all contraceptive options, as well as directing them to a service, such as a GP or sexual health service, where they can access it.
 
The pharmacists, who will be trained in evidence-based, patient-centred contraceptive counselling, will offer the service in a private consulting room.
 
‘Women are very anxious about, [and] rightly so, the potential for lack of confidentiality and privacy when having discussions about sexual health and contraception,’ Professor Mazza said.
 
‘They don’t want that to occur in an open space.’
 
Dr Amy Moten, Chair of RACGP Specific Interests Sexual Health, who is in favour of the study, thinks the backlash is representative of concerns within the community that people’s reproductive rights are being eroded.
 
‘Certainly, we’ve seen with some of the state debates around decriminalising abortion, there was a strong push in some quarters to make counselling mandatory for people having a termination, for example, whether that be surgical or medical,’ Dr Moten told newsGP.
 
‘And, of course, many people are making a very well-informed choice and are completely confident in their choice and they feel almost insulted by being told that they need to have counselling before they can proceed.
 
‘So it is important to be clear that the trial’s not about mandating any sort of contraceptive counselling.’
 
Currently in Australia, it is estimated that a third of women will have an unplanned pregnancy in their lifetime, 30% of which end in abortion. Professor Mazza says the data clearly shows more needs to be done to make contraception more accessible.
 
‘You can’t say with those kinds of figures that we’re doing an excellent job in terms of contraception in this country,’ she said.
 
‘The response to that should be that we make every effort to improve women’s knowledge about their contraceptive options and facilitate their access to whatever form of contraception they feel is good for them, that it meets their needs and preferences.’
 
Professor Mazza says for women seeking emergency contraction or medical abortions, preventing an unintended pregnancy requires timely contraception thereafter to avoid another pregnancy.
 
‘So here lies the opportunity for a pharmacist to offer contraceptive counselling,’ she said.

‘We feel that if a pharmacist can approach women and make that offer after the point of sale of those products – so it’s not interfering in any way with the purchase of those products and it’s an optional offer – that some women might want to take it up.’
 
While GPs are experienced in offering contraceptive advice, Professor Mazza says the trial is in no way a dispute about whether that advice is being offered, but rather a question of whether that information is being absorbed.
 
Dr Moten agrees, and says the trial is essentially ‘a complimentary service’.
 
‘I absolutely think all providers of medical termination would be discussing this, but it is an overwhelming consultation and there’s so much information about the termination itself that it’ll be easy for the person not to retain much about the contraception,’ she said.

‘So this will just reinforce, when they do present to fill their script, what their options might be.’
 
To evaluate the trial’s success, contraceptive uptake after each consultation will be measured over a one-year period, and interviews will be conducted with the pharmacists and a subsample of female participants to gain insight into their views on the process. 
 
But Professor Mazza is optimistic, having modelled the study on the successful BRIDGE-IT trial, led by Professor Sharon Cameron in Scotland.
 
‘Women were receptive to receiving counselling from the pharmacist and that trial showed a clinically significant increase in uptake of effective contraception,’ she said. ‘So we’re going to try it in the Australian setting.
 
‘Might be good, might not work; that’s why we do trials, to see if these kinds of interventions work and are worth pursuing.’
 
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contraception counselling emergency contraception medical abortion pharmacy women's health