Provision of progestogen-only pill with emergency contraception in community pharmacy improves ongoing contraception use

Community pharmacy provision of the progestogen-only pill, and the offer of rapid access to a sexual and reproductive health clinic along with emergency contraception, was associated with a 20% increase in use of effective contraception four months later compared with provision of emergency contraception alone, a study in the Lancet has suggested.

The researchers carried out a pragmatic cluster-randomised crossover trial in 29 UK community pharmacies among women receiving levonorgestrel emergency contraception between December 2017 and June 2019. Women aged 16 years and over, who were not already using hormonal contraception and were not on medication that could interfere with the progestogen-only pill, were invited to participate.

In the intervention group, 316 women received a three-month supply of the progestogen-only pill, plus a rapid access card to a participating sexual and reproductive health clinic. In the control group, pharmacists advised 320 women to attend their usual contraceptive provider.

The researchers found that the proportion of women using effective contraception was 20.1% (95% confidence interval [CI] 5.2–35.0) greater in the intervention group than in the control group. The difference remained significant after adjusting for age, current sexual relationship and history of effective contraception use.

Additionally, significantly fewer women in the intervention group used emergency contraception again during the four-month study period.

The researchers said that most women who use emergency contraception remain at risk of unintended pregnancy unless they start an effective method of contraception, and the progestogen-only pill was a safe contraceptive with few contraindications, low cost and high suitability for provision from the community pharmacy.

“Offering a 3-month supply of progestogen-only pill and rapid access to a contraceptive service with emergency contraception might prevent many more unintended pregnancies if this practice became standard practice in UK pharmacies,” they added.

In a report published on 10 September 2020, the All Party Parliamentary Group (APPG) on Sexual and Reproductive Health in the UK recommended that the progestogen-only pill should be reclassified to make it available over the counter without the need for a prescription and improve access for women across England.

The APPG said that there was “a significant opportunity to expand the role of community pharmacists in supplying the POP [progestogen-only pill]”, with independent prescribers and patient group directions already being used in some areas.

“Such initiatives are not only beneficial for women and alternate service providers, but evidence shows that they can encourage the use of contraception and, as a result, may help reduce unintended pregnancies,” it added.