The morning after she was sexually assaulted in April 2021, Eva* went to a Chemist Warehouse to pick up emergency contraception and antidepressants.
“I was not coping very well at time,” she says.
When she was asked to fill out a form to access the emergency contraception, she decided to be honest and tick “yes” to the question of whether she had been sexually assaulted.
Yet when the pharmacist gave her the medication, she only received the routine advice of how many pills to take.
Eva remembers leaving the pharmacy feeling “really angry and frustrated” and unsure why she was made to answer the confronting question if no further information or support was provided.
In the Australian Pharmaceutical Formulary (handbook) guideline on emergency contraception, pharmacists are advised to “offer support and assistance if there is a valid reason to believe or suspect that the patient has been a victim of sexual assault.
“If appropriate, encourage the patient to consult a sexual assault service, or medical or sexual health practitioner or service,” the guidelines say.
It follows reporting by Guardian Australia that revealed that, when accessing emergency contraception, women are still unnecessarily being made to fill out intrusive forms that ask them about their sexual history, in contravention of best-practice guidelines and potentially causing patient harm.
Eva says the lack of support at the pharmacy, together with a negative experience reporting the assault to police, showed her there are “a lot of pockets within the system that do not support survivors”.
Prof Safeera Hussainy of Monash University’s School of Public Health and Preventive Medicine says experiences like Eva’s highlight why the “tick-the-box approach” of the emergency contraception form is problematic.
“We advise pharmacists to avoid using the form or the checklist and to have that conversation with the person because you can garner the same amount of information from the person – if not more – by having just an empathetic conversation,” Hussainy says.
The form was first introduced to support pharmacists in collecting the necessary information when the medication first became available without a prescription in 2004, but has since become redundant as pharmacists have familiarised themselves with the “incredibly safe” medication, she says.
“This tick-box approach is a very black-and-white approach to healthcare, and whilst you collect the information, what’s more important is what do you do with that information.
“And if information is not acted on and used to inform the subsequent discussions that’s had with the person, then to me it becomes even more redundant,” Hussainy says.
A spokesperson from the Pharmacy Guild of Australia said when prescribing emergency contraception “the best practice is for pharmacists to have a private, supportive and non-judgemental consultation with the patient in a private consultation room”.
The spokesperson said the pharmacist is legally responsible for establishing a therapeutic need and assessing if the medicine is safe and appropriate for the patient. To fulfil those legal and professional obligations, the pharmacist is required to ask the patient some questions, but the Guild does not support the use of a questionnaire, the spokesperson said.
“These questions are not meant to be invasive or make the patient uncomfortable. It is deeply regrettable if that has been the experience of any patient.”
Another patient, Kristy, says she was left “completely humiliated” in the past year when she was asked to fill out the form to access emergency contraception in the public space of a different pharmacy.
“I was asked while filling out the form in the exact words of: ‘Did the condom break, or were you not using a condom at all?’” she tells Guardian Australia.
After Kristy explained that she had not gone back on any long-term contraception since having her daughter, the pharmacist went on to ask her if she was considering another pregnancy.
“I explained that I was actually separated and I was not in a position to have another child.”
Hussainy says there has been extensive training offered to pharmacists since 2004, including face to face and seminars, webinars and professional practice guidelines.
A spokesperson for the Pharmaceutical Society of Australia (PSA) said training to support pharmacists providing emergency contraception is part of their undergraduate degree, and is required to be kept up-to-date through continuing professional development.
“In addition, PSA’s national education conference in 2022 had a session dedicated to the supply of emergency contraception,” the spokesperson said.
Chemist Warehouse was approached for comment.
*Name changed for privacy reasons
• Information and support for anyone affected by rape or sexual abuse issues is available from the following organisations. In Australia, support is available at 1800Respect (1800 737 732). In the UK, Rape Crisis offers support on 0808 500 2222. In the US, Rainn offers support on 800-656-4673. Other international helplines can be found at ibiblio.org/rcip/internl.html
