Poor access to the gold-standard, medically recommended morning-after pill in regional and remote areas is undermining women’s reproductive health, experts say.
The emergency contraception ulipristal acetate is harder to access and more expensive than its less effective alternative, particularly in regional Australia, according to a report published in the international health journal Contraception. Flinders University researchers recently found that almost one-third of pharmacies across the country do not stock the pill, with supply even more limited in rural areas.
Experts express concerns about patients’ ability to make informed healthcare decisions, noting that unintended pregnancies are more common among those living outside metropolitan areas. The internationally recognized first-choice morning-after pill, ulipristal acetate, sold under the brand name EllaOne, is twice as likely as its alternative levonorgestrel to prevent pregnancy when used within 72 hours or up to five days after unprotected intercourse. It is also more suitable for individuals with a higher body mass index (BMI).
Lack of Awareness
Associate Professor Luke Grzeskowiak, the study’s author, highlighted a gap in pharmacists’ understanding of the time frame in which the medication is most effective. “There’s certainly a lack of awareness and understanding of the difference in the effectiveness,” he said. “You can’t be saying that you’re providing evidence-based care if you’re not stocking everything, because you’re not going to be recommending a product you don’t have there to sell.”
Family Planning Australia’s acting medical director, Evonne Ong, emphasized the importance of the extended time frame offered by ulipristal acetate, particularly for individuals who have experienced sexual assault and may need several days to process the incident before seeking medical care. “It’s all about giving people empowerment and choice when they have been put in such a vulnerable position,” she said.
Challenges in Small Towns
Research indicates significant challenges to accessing sexual health care in small towns with limited healthcare options, including distance, cost, and stigma. Ceduna-based pharmacist Louise Lynch noted the embarrassment young women often feel when purchasing the morning-after pill. “There is probably a lot of people that either don’t know about it or are too frightened or think that their window of opportunity is gone,” she said. Lynch usually recommends ulipristal acetate and views it as an opportunity to provide non-judgmental sexual health education.
‘Lucky Dip’ Supply
A survey by the ABC of 10 pharmacies on South Australia’s Eyre Peninsula found that only three stocked ulipristal acetate. Emergency contraception expert Associate Professor Safeera Hussainy stressed the importance of choice and information about medical options for preventing unplanned pregnancy. “If there are barriers to access, such as health professional knowledge, attitudes, lack of stock or availability, then there’s no choice for the consumer,” she said.
Australian legislation allows pharmacists and doctors to conscientiously object to providing emergency contraception and abortion services on moral grounds. However, there is no publicly available register of women’s health-friendly pharmacists, making it essentially a “lucky dip” if a provider refuses to dispense emergency contraception. “There’s actually no way for you to know what a pharmacy stocks or whether or not someone conscientiously objects until you are standing in front of them and have asked them for something that’s obviously super sensitive,” Dr. Grzeskowiak said. “I just can’t see how that’s acceptable.”
