Poor access to the gold-standard, medically recommended morning-after pill in regional and remote areas is undermining women’s reproductive health, experts say.

The emergency contraception ulipristal acetate is harder to access and more expensive than its less effective alternative, particularly in regional Australia, according to a report published in the international health journal Contraception.

Flinders University researchers recently found that almost one third of pharmacies across the country do not stock the pill and supply is even more limited in country areas.

The study found the median price of levonorgestrel was $13 less than ulipristal acetate.(Reuters: Sarah Silbiger)

Experts say it raises concerns about a patient’s ability to make informed healthcare decisions and that there is evidence that unintended pregnancies are more common among those living outside of metropolitan areas.

The internationally recognised first port of call option for the morning after pill is ulipristal acetate, sold under brand name EllaOne.

Ulipristal acetate is twice as likely as its alternative levonorgestrel to prevent pregnancy when used within 72 hours or within five days of unprotected intercourse. It is also more suitable for people with a higher body mass index (BMI).

Luke Grzeskowiak says everyone should have equal access to ulipristil acetate.(Supplied: Luke Grzeskowiak)

‘Lack of awareness’

Author of the study associate professor Luke Grzeskowiak said there was a gap in pharmacists’ understanding of the time frame in which the medication was most effective.

“There’s certainly a lack of awareness and understanding of the difference in the effectiveness,” he said.

“You can’t be saying that you’re providing evidence-based care if you’re not stocking everything, because you’re not going to be recommending a product you don’t have there to sell.”

Ulipristal acetate is twice as likely as levonorgestrel to prevent pregnancy when used within 72 hours or within five days of unprotected intercourse.(ABC Eyre Peninsula: Amelia Costigan)

The extended time frame enabled by ulipristal acetate can also benefit people who have experienced sexual assault and may need several days to process the incident before seeking medical care, according to Family Planning Australia acting medical director Evonne Ong.

“It’s all about giving people empowerment and choice when they have been put in such a vulnerable position,” she said.

“Often it takes a few days for people to process, and there’s STI testing, whether to do a police report, and then of course, contraception.

“By the time people who have survived sexual assault have thought through all of those things, it may be already a few days in.”

Research has demonstrated that in small towns with limited healthcare options, significant challenges exist to gaining sexual health care, including distance, money and stigma.

Ceduna-based pharmacist Louise Lynch said she was highly conscious of young women feeling embarrassed about purchasing the morning-after pill.

“There is probably a lot of people that either don’t know about it or are too frightened or think that their window of opportunity is gone,” she said.

Ms Lynch said she usually recommended ulipristal acetate and saw it as an opportunity to provide non-judgemental sexual health education.

Safeera Hussainy says women deserve to be able to make an informed choice.  (Supplied: Safeera Hussainy)

‘Lucky dip’ supply

The ABC surveyed 10 pharmacies on South Australia’s Eyre Peninsula and three reported that they stocked ulipristal acetate.

Choice and information about medical options is crucial when making a decision about preventing unplanned pregnancy, according to emergency contraception expert associate professor Safeera Hussainy.

“If there are barriers to access, such as health professional knowledge, attitudes, lack of stock or availability, then there’s no choice for the consumer,” she said.

“If they’re not stocking ulipristal acetate, as this study has demonstrated, then women only really are left with the choice of levonorgestrel.

“Not that it’s a bad choice — it is a very reasonable choice, but it doesn’t provide them with the full range of choices, and certainly a treatment that could be more effective if they’re coming in 24 hours after having unprotected sex.”

Australian legislation allows for pharmacists and doctors to conscientiously object to providing emergency contraception and abortion services on moral grounds.

But there is no publicly available register of women’s health-friendly pharmacists, meaning it is essentially a “lucky dip” situation if a provider refuses to dispense emergency contraception.

“There’s actually no way for you to know what a pharmacy stocks or whether or not someone conscientiously objects until you are standing in front of them and have asked them for something that’s obviously super sensitive,” Dr Grzeskowiak said.

“I just can’t see how that’s acceptable.

“You don’t know until you’re there.”