Friday, February 22, 2019

Sexual Health or Contraceptive Evangelism?

Sexual Health or Contraceptive Evangelism? by Patrick McCrystal

A pharmacist questions his professions promotion of condoms and the ‘morning-after’ pillbigstock-the-pill-856338
First Published in: Northern Ireland Pharmacy in Focus, January 2007, p25
Reproduced with permission

I recently attended a NICPPET (Northern Ireland Continuing Pharmaceutical Education and Training) pharmacist’s training day on the theme of Women’s Sexual Health and it gave me much food for thought. The presenters were clearly committed, dedicated, sincere and truly believed they were working for the good of their patients. Information delivery was high quality.

Over the course of the day, it became clear that indeed there is a definite role for pharmacy in the arena of sexual health. Whether or not one personally agreed with the lifestyle of patients or clients presenting with a particular sexually transmitted infection (STI), there is a clear role for pharmacy directly addressing and alleviating viral and bacterial infections, sores or other symptoms in a non judgmental way. The idea of a proposed pilot chlamydia testing project for pharmacies to the at-risk section of the population is excellently pro-active and laudable.

However, deeply unsettling questions arose with the profession’s involvement both in the area of condom promotion and regarding emergency hormonal contraception (EHC).
Condom promotion fails in its clinical aims, the moral issues aside. Studies from family planning journals attest to the extensive failure of condoms to lessen abortion. In fact, between 50-70% of women electing for abortion report using some form of contraception at the time of conception. (1,2,3). The so-called ‘safe-sex’ doesn’t actually exist if it means intercourse with condoms. The more subtly termed ‘safer-sex’ is not one iota better to users in practice. Studies report breakage / leakage rates of 8%-42% (4,5,6). Taking even the lowest 8% figure is a 1 in 12 statistical chance of exposure to disease with an infected partner. How many of us would board an airline which had a 1 in 12 chance of crashing en route to our destination. Enough plane flights would effectively ensure our demise. Used long enough and frequently enough, condom use virtually assures STI/HIV transmission. In their stated aim of disease reduction, used frequently, condoms fail, plain and simple. Indeed, we even heard on the sexual health day that, in the experience of one Belfast pharmacy, condoms appear to split much more frequently

than reported by the manufacturers. We also heard of a high EHC uptake among the same user profile as the condoms.
The abysmal failure of condom / contraception promotion to reduce STI’s / unwanted abortion has not only led to an national and global sexual health pandemic, but has contributed enormously to the sheer scale of sexual licentiousness so patently obvious all around us. In response to the statistics of failure rates, incredibly, we hear calls for more contraception. The self-propagating monster feeds on its own failure. Is it right that the profession of pharmacy lends its esteemed standing in the service of authentic healthcare to the purposes of the contraceptive evangelists which advocate a worldview that clinically, scientifically and statistically fails in its stated aims of disease and abortion reduction? Should pharmacy treat its clients for STI’s, then equip hem with condoms, and send them back into the very lifestyle that gave rise to the problem in the first
place? Should pharmacy be going onto university campuses to promote the so-called ‘safer-sex’? Is that true healthcare? Is our noble profession not tacitly affirming the primary problematic behaviour? Do we not tarnish our calling?

Then there is the question of EHC. How is EHC relevant to true authentic sexual health? A pregnant
woman by definition is not diseased, infectious or sick. She is not sexually ‘unhealthy’. She’s expecting a baby.
In this arena, for pharmacy, if a woman is expecting and walks into your pharmacy seeking an abortifacient, does the pharmacist not owe a duty of care to two patients, not one? Is not the supply of an EHC, in effect, a facilitation in the expiration of one of those patients? Had the same woman instead enquired about folic acid tablets  or presented a prescription for methotrexate in psoriasis, would we not act differently in the protection of her ‘baby’?

Some pharmacists do have a genuine ethical problem with the EHC scenario. There are serious questions but no immediately obvious easy answers. Real solutions exist, but they require hard, honest, objective analysis.
There is a coherent basis for pharmacy to cogently and credibly review its involvement in this entire
scenario. Anyone for further discussion?

1) Duncan et al, British Journal of Family Planning, 1990 (15) 112-117
2) New Zealand Medical Journal 25 May 1994
3) Addlestone GR, British Pregnancy Advisory Service News Sept 1985
4) Hatcher et al, Contraceptive technology, 18th ed, New York, Ardent Media, Inc., 2004
5) ALL, Condom and AIDS fact sheet, Stafford, VA, 1994
6) Collart, David, Dr, Condom Failure: A review of the medical literature, 1993