Service standards: chaperones and record keeping.

Journal of Family Planning and Reproductive Health Care 2004: 30(4) Canadian study reviewed the success of a pilot programme for providing EC via a pharmacy without a prescription.4 Almost 7000 prescriptions were obtained and 21% of women stated that if they had not obtained EC in this manner, they would not have obtained it elsewhere. The Canadian health minister recently introduced a bill to remove EC from its current ‘prescriptionrequiring status’ making it available ‘over the counter’, thereby further removing barriers to access by women of all ages. According to the UK guidelines, the cost of licensed EC products available at pharmacies range from £5.50 with a prescription to £24.00 for an over-the-counter (OTC) product. To make matters worse, OTC products are limited to patients over 16 years of age. Imposing these restrictions on EC severely limits access to the products in the population least likely to see a physician and most likely to benefit from their use. The medical eligibility criteria for EC are quite broad. According to the WHO guidelines5,6 there are no absolute contraindications to EC use, which supports the safety of providing EC as an OTC product. If a prescription is required, advanced issue of a prescription for EC does not cause an increase in the use of EC (i.e. patients do not abuse EC as a form of regular contraception). Indeed, they are more likely to use EC when needed and are also more likely to use standard contraception properly.7 Hormonal EC needs to be made accessible to all women, but especially to adolescents. This is most likely to occur in an environment where they can access EC at a convenient time, in a convenient location, at a convenient price (preferably free of charge). Only then might we start to see the financial and social benefits of primary prevention of unwanted pregnancies in this age group.