The Question: In British Columbia, a doctor’s religious beliefs trump a patient’s right to access to emergency contraception. A physician would not provide the drug to me and there was no other doctor at the clinic. My options were to find a 24-hour clinic or go to the pharmacy. I saw a pharmacist and was asked questions that made me feel ashamed. How does it work in other provinces?
The Answer: You have one issue – access to emergency contraception – that occurred with two health-care professionals: the physician and the pharmacist.
Jodi Shapiro, chair of the Society of Obstetricians and Gynaecologists of Canada’s ethics committee, says physicians can refuse to provide it, based on moral or religious objections, but “they are also compelled to refer the client to other locations where the product can be obtained.”
That doctorshould have suggested a sexual health clinic, hospital emergency room, nearby walk-in clinic or pharmacy. If she didn’t, that’s not on.
At the pharmacy, what is recommended is different than what is practised. Though the National Association of Pharmacy Regulatory Authorities ruled that levonorgestrel be available behind the counter in April 2005 [available through a pharmacist]and then over the counter in May 2008 [where you can pick it up like Tylenol] provinces are not bound by that ruling.
Quebec is the only province that requires a prescription, usually through a pharmacist. It is free to all Quebec women 18 or under or those under 25 attending university, so long as they are living with their parents. Since it is a prescription drug, other women in the province may have it covered under private health plans.
In British Columbia, where you tried to obtain the treatment, it was made widely available behind the counter in May 2007 and over the counter in March 2009. Since you indicated that your experience occurred several years ago, the good news is that access has improved and it is unlikely the situation would occur today.
Though technically emergency contraception can be sold on B.C. pharmacy shelves next to condoms and lubricants, it is usually found behind the counter, along with a pharmacist who can provide counselling.
As for the questions asked by the pharmacist, they were part of aresearch project that ended years ago. While researchers tried to make them as embarrassment-free as possible, they felt women needed to be counselled that the drug did not protect them against sexually transmitted diseases, which can lead to infertility if not promptly treated.
The drug costs $26 to $40 in pharmacies. Lower cost options are often available in youth and women’s health clinics plus public health units. In rural areas, it’s often accessible after hours in hospital emergency departments.
“This is an empowerment issue for women,” said Judith Soon, assistant professor at University of British Columbia’s Faculty of Pharmaceutical Sciences, who co-leads the research team investigating access to emergency contraception. “If accidents happen, if they come into a situation where they are at risk of an unintended pregnancy, they have the ability to go and do something about it.”
The Patient Navigator is a column that answers reader questions on how to navigate our health-care system. Send your questions to firstname.lastname@example.org