We called 119 pharmacies: emergency contraception is still difficult to source for women

No pharmacies open on Sunday and public holidays in the coming weeks in Qormi and Santa Venera sell the morning-after pill, a MaltaToday probe shows.

All pharmacies on the Sunday roster from today until 8 December, a public holiday, in Area 3 have told a MaltaToday journalist who posed as a prospective client, they do not sell emergency contraception.

And travelling to the neighbouring localities of Hamrun and Marsa, which comprise Area 2, is unlikely to solve the problem. On five of the six Sundays and public holidays under review, the pharmacies on the roster in Area 2 do not sell the morning-after pill.

In Gozo, on one of the days, none of the only two pharmacies open sell the morning-after pill, which means anybody on the sister island requiring the contraception will have to travel to Malta.

The problems to access the morning-after pill on Sundays and public holidays flagged by this exercise are the same as those identified in a similar review last year.

On Sundays and public holidays, only 20 pharmacies are open around Malta and Gozo on a roster basis. All pharmacies are open until noon, except the airport pharmacy, which remains open until 10pm.

Notably, the airport pharmacy, which is the only pharmacy open every Sunday and public holiday, does not sell the morning-after pill.

The exercise

A MaltaToday journalist called the 119 pharmacies across Malta and Gozo that were listed on the official Sunday and public holiday roster between Sunday 7 November and Wednesday 8 December. The roster is released in advance and is available on the health ministry website.

Posing as a client, the journalist asked whether the pharmacy sold the morning-after pill and other pertinent questions such as whether her partner can buy it on her behalf.

The average of pharmacies on all Sundays that sell the morning-after pill is 61%. However, the rate ranges from 45% on one Sunday in November to 75% on another, making it arduous to source emergency contraception.

Area 7, which covers Sliema, Area 8 (Lija, Attard and Balzan) and Area 10 (Mellieha and St Paul’s Bay), are the most accessible. The exercise showed that on each of the days analysed, all pharmacies in these areas sell the morning-after pill.

A similar exercise in November 2020 found that over the last year, things have remained, for the most part, stagnant, if not marginally worse. Last year the six Sundays surveyed found that 80 pharmacies sold the morning-after pill at 63%.

The morning-after pill (MAP) is a type of emergency birth control that is used to prevent pregnancy for women who have had unprotected sex or whose birth control method failed. It is recommended that the morning-after pill be taken within 72 hours of having intercourse. The earlier it is taken, the more effective it can be in preventing an unwanted pregnancy.

MAP was introduced in Malta in 2016 and can be sold over the counter in pharmacies without a doctor’s prescription as long as the person is over 18.

But MAP is also a contentious subject for pharmacists, who have the right not to dispense the pill on the grounds of conscientious objection.

Some pharmacies have opted not to sell MAP outright, while in others, individual pharmacists can decide not to sell it despite being available.

Observations from case study

The caller experienced a range of reactions from pharmacists, who took the call - from a friendly attitude to hostility. In multiple cases where the pharmacy did not sell the morning-after pill, they willingly recommended other places close by to aid the caller.

In one case, a pharmacist warned that while the pharmacy does, in fact, sell the morning-after pill, and they themselves would sell it, the next person on shift would not.

In another case, the person who answered the phone was hostile to the caller and hung up after replying with a hostile ‘no’ without even letting the caller say ‘thank you.’

Once again, just like last year, there was a wide range of protocols, with some pharmacies requiring ID checks, forms to sign and informing the caller they would have to answer a list of questions while others said nothing was required.

Another pharmacy told the caller that while the morning-after pill was sold over the counter, it was still best to get clearance from a doctor before taking the pill.

Unprecedently, one pharmacy even said that if the caller’s partner came with the ID of the person who was to take the morning-after pill, that was enough. This is not a standard protocol in Malta, however, in countries like the UK, the law allows partners to pick up emergency contraception to save the person from further anxiety.

‘Identification is not necessary’ – Doctors for Choice

Speaking to MaltaToday, Dr Isabel Stabile, a member of Doctors for Choice, said that the NGO feels adamant that identification does not need to be asked for.

Stabile said any questions put to the client by the pharmacist should be strictly medical such as whether the person is on the contraception pill, whether they have any allergies or medical conditions such as liver disease, which could cause an adverse reaction.

Stabile said it was important for people to know what the morning-after pill can and cannot do: “It must be taken within 120 hours (for one particular brand) of unprotected sex, it only protects the person once, after which a condom should be used until the next period occurs. It doesn’t protect against sexually transmitted diseases, and if pain persists, the person should seek medical attention because they could be dealing with an ectopic pregnancy.”

Stabile said the NGO felt strongly that the morning-after pill should be available over the counter to those aged 16 to 18. “The age of consent is 16; at 16, you can vote; why can you not buy the morning-after pill?”

“Working in the field, I know that the most common age of first intercourse is 16 – so it is madness in a country where abortion is banned not to allow 16-18-year-olds to purchase the morning-after pill over the counter,” she said.

‘Many women don’t know how to calculate when ovulation occurs’

During this exercise, the caller came across a pharmacist who told them that if they were far away from ovulation, there was no need for the morning-after pill to be taken.

Stabile said the problem with giving out such advice is that many women in Malta do not know how to calculate when their ovulation occurs.

“Many women in Malta still don’t understand their own bodies. Also, remember a lot of the time, it’s hard to tell exactly when a women’s next period will occur. You can only be sure you will not get pregnant in the first three days of your period. We recommend that to be sure women take the morning-after pill,” Stabile advised.

She also said the morning-after pill at Mater Dei Hospital is not still available at the hospital’s 24-hour pharmacy. “While we have heard that women who are admitted for rape have received the morning-after pill – remember that most women who are raped are not admitted to hospital… This means that the majority of rape victims do not have access to the morning-after pill.”

‘Personal beliefs should not be at the expense of the client’

On conscientious objection, Stabile said she respected people’s right to their own personal beliefs. However, she maintained it should never come at the expense of the client. All pharmacies on Sunday should sell the morning-after pill, she said. “I think in this case the science should be followed – as a professional one should be able to put science ahead of their personal beliefs.”

However, Stabile said a compromise would be for the pharmacy to put up a sign saying they don’t sell the morning-after pill and give information on the nearest facility.

Stabile reiterated that the morning-after pill was not abortive. It is not effective once fertilization has taken place since there is not enough time for it to prevent implantation.

Do you want more information about the morning-after pills? Are you having difficulty buying the morning-after pill in Malta? Reach out to the Family Planning Advisory Service (FPAS) at https://www.fpas.mt/morning-after-pills or 27780037/20341686 for assistance.