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OTC FOR PLAN B
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by
Sarah Veale
june 19 - 25, 2008 |
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Canadian women will have wider access to emergency contraception thanks to a Health Canada decision to make the drug over–the–counter in many of the nation’s pharmacies.
This new access to the morning–after pill, commercially known as Plan B, means Canada would be the fifth country to give emergency contraception full over–the–counter status, behind Norway, the Netherlands, Sweden, and India. Previously, Plan B was available without a prescription, but women had to consult with a pharmacist before obtaining it.
Over–the–counter status for emergency contraception, which has the ability to thwart pregnancy up to three days after intercourse, eliminates two major barriers. The price point goes down, as those purchasing it will no longer have to pay dispensing fees; and it dispatches with some of the privacy and personal concerns that dogged it behind the counter, such as impromptu surveys about sexual history, or pharmacist refusal based on personal conscience. “This is a good move,” says Anne Rochon Ford, coordinator for Women and Health Protection, an Ontario group that focuses on women’s health issues. “It’s a much less invasive way of dealing with an unplanned pregnancy, or the potential of an unplanned pregnancy.” She adds, “When you have to go through somebody else to get it, it’s a disincentive.”
Plan B is designed to fill the gap where prevention falls through. This can be anything from a skipped birth control pill to a condom breaking, though it’s also important for forced situations, such as rape. Moving Plan B in front of the counter, proponents say, provides an important option for women and prevents unplanned pregnancies. According to Paladin, the manufacturer of Plan B, five per cent of Canadian women turn to it every year.
Emergency contraception hasn’t been welcomed by everyone. Pharmacists grumble their role as counselors could be undermined by over–the–counter status, while pro–life and religious groups claim easy access to the drug will lead to a rise in promiscuity.
Rochon Ford dismisses the idea that women will liberally pop morning–after pills, citing the common side effects (nausea, abdominal pain, headaches, and vomiting) as a practical deterrent. “When we look at the research that’s been done in other countries where it’s available like this, it just doesn’t happen,” she says. “Most people use it in cases of emergency. There is no indication that in any country where it switched from being less accessible to more accessible there was a mass upsurge of people buying it for regular use.”
Emergency contraception consists of a strong concentration of levonorgestrel, a hormone commonly found in birth control pills. Unlike mifepristone — or RU486, which can terminate a pregnancy up to the first nine weeks — Plan B is not considered an abortificiant. Rather, the oversized dose of hormones prevents fertilization or the implantation of an egg in the uterus. Depending on how quickly it is used post–intercourse, it can be effective up to 95 per cent of the time
Though daily–dose birth control pills have been linked to health problems, such as blood clots, in long–term users, pharmacists are not concerned that re–scheduling Plan B will endanger public health. “We feel public protection is guaranteed, and there is nothing to support that there’s anything that could harm the public by moving it [over the counter],” says Sandra Carey, president of the National Association of Pharmacy Regulatory Authorities. “We believe that decision they’ve made has been based on scientific evidence, and we support that.”
Carey stresses pharmacists will still play a role in women’s sexual health. “The public will still have access to that expert advice that you get from a pharmacist. It may be available for self–selection, but they still do have the ability to get the expert consultation from a pharmacist.”
Laura Wershler, executive director of Sexual Health Access Alberta, says the wider access is a good move, especially for the small — but growing — segment of women who are opting out of “the Pill” altogether, either for health reasons or personal choice.
“Emergency contraception becomes an important complement to fertility management for those women,” she says, criticizing the unspoken expectation that pharmacists should guide emergency contraception users towards full–time birth control, such as the Pill. “Women need to be supported, to feel confident to be successful using non–hormonal methods; not told that they need to go back on the pill when they access emergency contraception.”
Though it is ultimately up to the provinces how to handle Plan B, Ontario is expected to follow Health Canada’s decision. Pharmacies will be able to make changes in how Plan B is sold immediately; however it is more likely that, due to packaging concerns, widespread adoption won’t happen until the fall.
“Definitely as the access has increased, more and more women are using it [Plan B] and that’s a good thing,” Wershler says, hailing the change in status. “Women have a fallback position if the condom beaks.” V
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