Standing in a suburban pharmacy, Sophie* didn’t know why she felt ashamed to be filling out a form in order to access a legal, over-the-counter medication.
“Sometimes it’s hard to know if you’re being judged or not when you go and access emergency contraception,” Sophie says.
She has bought emergency contraception four times in the last year, after giving birth to her daughter and not going back on to long-term contraception.
Because of a sense of stigma, Sophie says she went to a different pharmacy on each occasion.
Each time, at both major chains and local pharmacies in Melbourne, she was made to fill in a form to access the medication – despite there being no legal requirement to do so.
The form asks personal and intrusive questions, such as the reason for seeking emergency contraception, if there was pain when urinating, pain during or after sex, unusual vaginal discharge or vaginal bleeding.
Sophie, who works for a leading sexual and reproductive health provider, says she didn’t question being given the form.
“I assumed that there was a legal requirement, but I did feel uncomfortable filling it out, because I’d never have had to do that for any other medication at a pharmacy,” she says.
Health experts and advocates are at a loss to explain why chemists are still using what they say is an outdated and discriminatory document.
The form has never been mandatory for pharmacists, but was introduced when the medication first became available without a prescription in 2004, according to Prof Safeera Hussainy of Monash University’s School of Public Health and Preventive Medicine, who has researched the area for nearly two decades.
It was originally used as a training tool to help pharmacists ask the right questions and familiarise themselves with the medicine, but it has become redundant as familiarity with the “incredibly safe” product increased, Hussainy says.
“Asking women to fill out a form now is not OK, it’s not mandatory, and it’s not a legal requirement,” Hussainy says.
“Pharmacists can have a conversation with someone instead just like they do for other medications, and that conversation needs to be had in an inoffensive, nonintrusive way.”
The pharmacist needs to ask certain questions to meet duty of care requirements, but they cannot require customers to answer those questions on a form, Hussainy says.
But a survey of Australian women accessing emergency contraception, conducted by Hussainy and her colleagues, found many women want the form scrapped, as it was a barrier to them feeling comfortable accessing the medication. The research prompted Hussainy to work with the Pharmaceutical Society of Australia (PSA) to change their guidelines for prescribing the medicine.
The PSA created the form in 2013, and a spokesperson said the “form is not available on PSA resource sites and PSA no longer recommends its use”.
The current guidelines advises that pharmacists “do not use a written checklist or form because the patient … can perceive it as a barrier to care”.
Nevertheless, according to another woman, Elizabeth*, a pharmacy in Perth refused to sell her emergency contraception unless she completed the form, even when she pointed out it was not a requirement.
She says the chemist told her it was required to record the batch number.
In the section for the customer to state the reason for seeking emergency contraception, Elizabeth says one of the options listed was “sexual assault”.
“The very existence of this form is inherently misogynistic, and it’s designed to shame women,” Elizabeth says. “It makes me feel that pharmacists are perverts who want to know about their female customer’s sex lives.”
Refusing to fill it out, she instead obtained the medication from a different pharmacy.
The continuing use of the form comes as Guardian Australia reported health professionals say they are concerned about the barriers and stigma created as publicly funded hospitals use the cover of religion to opt out of providing reproductive care.
Bonney Corbin, the chair of the Australian Women’s Health Alliance, says the different forms issued by various pharmaceutical bodies are “archaic” and a discriminatory hangover from a time when stringent checks were in place around all aspects of sexual and reproductive health, which were criminalised and stigmatised.
“When you have to talk to someone in public about your recent sexual history, it’s incredibly vulnerable space to be in,” Corbin says. “And when we feel questioned about that, and particularly when we have to write it down, it can feel patronising.
“It can be oppressive, it can be potentially traumatising if it’s done in a problematic way.”
Corbin says there is little public awareness around what’s required to get emergency contraception, and most are not in a position to question filling out a form.
“Where you’re at risk of unplanned pregnancy, as a consumer, you’re just going to go with whatever you need to at the time in order to access that medication.”
Larissa Waters, the Greens spokesperson on women who led a Senate inquiry into reproductive health, says the committee heard there were still too many barriers to care.
“That is the message we heard throughout the Senate inquiry – there are currently too many barriers to contraception and reproductive healthcare in Australia,” she says.
“Pharmacists don’t need to be adding to those barriers by imposing requirements that are not supported by national guidelines.”
*Names changed for reasons of anonymity.
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