Here's why ACT women should still see a GP before they get the pill

Absolutely, safe and effective contraception is something to which women should have ready access. And according to Simon Blacker, ACT guild president, the Pharmacy Guild wants to make accessing contraceptive scripts more "convenient". He proposes that pharmacists be allowed to continue supply of oral contraceptives, for women who are "stable" on the pill. But is convenient contraception the safest and best choice for women? Or are we missing the wood for the trees and seeking simplistic solutions?

Women do have ready access to the combined contraceptive pill: one visit to a GP and they have a year's worth of prescription. They have a script - provided it's the most appropriate choice for them, at this stage in their life. Provided they're remembering to take it. Provided they haven't started smoking, gained a lot of weight, started suffering from migraines, or are only using it because of coercion from a partner who refuses to use a condom. Provided there's no family history of a clotting disorder. Why is this important? Because women's health isn't just about whether or not they become pregnant. It's also about whether they are being unnecessarily exposed to the risk of physical or mental harm.

What do I talk about when I see a woman about contraception? I ask whether she's having sex, and with whom. If there is consent. Whether she needs STI screening. If she's having trouble remembering to take the pill. Whether there are side-effects. Whether she has genetic or lifestyle predisposition to having a fatal blood clot or a disabling stroke. Whether she has plans to start a family. Whether her cervical screening is up to date. Whether an alternative contraceptive would be safer, cheaper or more effective.

READ MORE:

Are we as women likely to have some tricky conversations with a pharmacist? Even in the privacy of their consulting room, are we likely to disclose the number or gender of our sexual partners? Or will it just be assumed (it is, after all, "convenient" to assume) that women who are "stable" on the pill are monogamous, sexually active cis-hetero women with a consensual male partner? And if we're not all monogamous in our activities, who will arrange the STI screening? Who will perform the overdue cervical screening test? Who will provide the advice on family planning? Is it still convenient to see a pharmacist for the pill if you're referred back to your GP? And who ultimately takes responsibility if things go pear-shaped?

An annual follow-up with a GP isn't necessarily free, but it is good value. A GP is the person who co-ordinates and takes responsibility for longitudinal care in all aspects of reproductive, physical and mental health. That is hard to do well from a distance - how do I ask gently about weight gain, or mood side effects, if all I get is a written summary of an annual pharmacist visit? This sort of care fragmentation is already a regular frustration to hospital patients and GPs - the left hand hasn't been told what the right hand is doing. And the Medicare system recognises this: why else would non-GP specialists require a GP referral, other than to ensure appropriate clinical handover and continuity of care?

Some will call this a turf war between GPs and pharmacists. It's not about that: it's about care versus convenience. True reproductive liberation requires more than a quick-fix script. It means placing value on the health of a whole person. GPs might be busy, but whole-person care is our raison d'être. We're not too busy for that. Pressuring women to see a pharmacist because it's quicker and cheaper sends the patronising and familiar message that we are worth less.

Why do women still need to see a GP to get the pill?

Because our reproductive health is too important to be fragmented in the name of convenience and government cost-cutting.