The morning after pill in Canada

Emergency contraceptive pills. From uncomfortable talks to being turned away, a look at the hoops Canadians jump through to gain access to the morning-after pill.

A broken condom, a missed pill or a diaphragm that just didn’t stay put. When their planned form of birth control fails, Canadian women might rely on Plan B. But, buying this backup plan can have unexpected barriers.

Levonorgestrel emergency contraceptive pills like Plan B (the morning-after pill) can be taken up to 72 hours after unprotected sex or a contraceptive accident. This pill prevents pregnancy by temporarily stopping the release of an egg from the ovary, preventing fertilization and preventing a fertilized egg from attaching to the uterus. While there are no serious risks associated with the pill, purchasing it in Canada isn’t as simple as it could be.

Frédérique Chabot, director of health promotion at Action Canada for Sexual Health and Rights, says the pill is treated differently than other medications and purchasing it includes barriers such as keeping it behind the shelf to provide additional information to patients and requiring counselling sessions before purchase.

“Treating these kinds of medications as if they are exceptional and require an extra step, often without bad intentions, involves some shaming,” says Chabot.

The consultation

Emergency contraceptive pills are an over-the-counter drug in every province except Québec and Saskatchewan, where a consultation is required before purchase. The consultation may include questions about a woman’s period and the sexual encounter that brought her in.

When Emily Heer was visiting Montreal and found herself in need of the pill, her boyfriend walked to a pharmacy down the street. He came back empty handed and told her she would need a consultation with a pharmacist. She was surprised since her boyfriend had purchased it for her before in British Columbia and they had no trouble buying it in Paris.

The pharmacy told Heer the consulta- tion would help the pharmacist decide whether or not she could reasonably have the pill. She was asked her age, what happened during intercourse and when she’d had her last period. “I found it a little invasive, but more than that I knew I needed the pill and I just thought it was unnecessary to ask me those questions,” says Heer.

Heer has worked in a sexual health clinic where women come in and access the pill and are provided with general information about the drug and its side effects but are not asked personal questions. She feels the consultations may deter some young women from purchasing the pill. “During my consul- tation, a 25-year-old man was asking me personal questions about my sex life and my menstrual cycle and a lot of young women would probably not be very comfortable with that.”

“These consultations are steeped in shame revolving around sexuality and fertility and are unnecessary,” Chabot says. “It doesn’t add value in terms of how the medication is properly used. It’s more about the circumstances that lead to using it.”

Chabot had to sit through one of the consultations and says if she needed
it again she wouldn’t feel comfortable going back and telling that pharmacist she needed the pill a second time.

“Maybe people who haven’t experienced it wouldn’t consider the impact it has to have to share intimate details about your sexual and reproductive life with someone you don’t know and don’t have a trusting relationship with and in a context that is shaming to begin with so it’s a very uncomfortable experience.”

Denying the pill

While emergency contraceptive pills like Plan B do not require a prescription, those seeking the pill may not be able to purchase it if the pharmacist decides to deny the sale. During her consultation in Montreal, Heer asked the pharmacist if he would ever deny a woman the pill. The pharmacist told her he would if he felt the woman didn’t need it.

“I didn’t understand why he would deny the pill to anyone when there are no negative health outcomes from taking the pill regardless of whether he thinks it would be effective or not,” she says.

According to the National Association of Pharmacy Regulatory Authorities, pharmacists can choose not to provide a customer with a pill like Plan B. In an emailed response, the association said a pharmacist may choose not to provide a specific medication if they feel the drug presents risk or is inappropriate for the patient.

This was the case for Lauren Vogel, who wrote about being denied the pill in the Canadian Medical Association Journal. Vogel was denied the drug due to a Health Canada regulation that says the pill may be less effective in women weighing more than 165 pounds and not effective in those weighing over 176 pounds.

“I asked the pharmacist about the strength of evidence for the recommendation, or if my body mass index mattered and since she didn’t know, I asked to buy the pill anyway,” Vogel wrote. “She told me to see a doctor and asked to serve the next customer.” She was able to go to another pharma- cy and purchase the pill.

Chabot says denying selling the pill based on the recommendation is dis- criminatory. Despite the recommendation, women who are informed and still wish to take the pill as a precaution have the right to do so. “It’s still a harm reduction method,” she says.

Out of sight

The morning-after pill can be stocked on shelves, but some pharmacies choose to keep it behind the counter. Pharmacies interviewed for this arti- cle said they kept the medication off shelves due to issues with theft or to provide customers with information about the pill before purchase.

An industry insider who asked not to be named says there is no reason to keep the pill behind the shelf. “It should be available for patient access,” he said.

Chabot agrees. She says keeping it behind the counter is a barrier for young people in particular. “They will not access services if they feel their privacy will be breached,” she says.

Element of control

Over a decade has passed since the pill became available to Canadians with- out a prescription. After unprotected sex it’s the one element of control that women have. “I think women should be allowed to take control of their own reproductive health and this is one way that people can do that,” says Heer. “If there’s no reason to tell someone not to take it, then we should just allow wom- en to take it if they feel like they need it.”

The pill comes with a sensitive time frame. While it is effective up to 72 hours after sex, it’s most effective with-in 12 hours. Requiring a prescription or locking it behind the shelf may prevent someone from accessing it within that time. Canada has made strides in making the pill more accessible, but obvious barriers still exist for a scheduled medication that is promoted to be sold on the shelf.

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Author: Payge Woodard is a freelance writer who regularly contributes to OptiMYz Magazine print and digital editions. She is based in New Brunswick, Canada.