Table 3:

Qualitative results: selected quotes

ThemeSelected quotes
Low awareness concerning UPA (knowledge)Patients
My understanding is if you were to have unprotected sex or … reason why you would think that you might get pregnant, the next day you would take the pill. I understand that it hurts your body a little bit. You get quite sick … And, yeah, that nobody really wants to take it because it kind of makes you a little bit sick. (R63, patient)
I think everybody should have sex education and I know not everybody in BC has access to … sexual education … But I think that any time somebody’s talking about contraceptives or sex or sexual health or sexuality to youth in schools, I think there needs to be a conversation that’s age appropriate, when they start talking about contraception to be talking about emergency contraception as well. (R17, patient)
Prescribers and pharmacists
Just the need to know about what’s up to date and particularly like I said, because I don’t recall recently having anybody come in and actually asking me for it. (R40, prescriber)
I mean, a lot of societies are like that … previously we could read the whole guideline and then we were limited to just reading the highlights and then recently we were just not allowed. (R56, prescriber)
Beliefs about or experience of shame and stigma (beliefs about consequences)Patients
Because I really feel that there’s a sense of you only take this if you really screwed up this time. (R30, patient)
I think when it comes to having something that somebody would need an emergency contraceptive for it can be even more shaming. Like why didn’t you use this. Why didn’t you use that. How come you’re not using the pill. How come you’re not using a condom. (R17, patient)
I think it’s a problem people encounter while getting it. So the outcome of having the medication is still the same. But people feel bad about it after because of attitudes that they met from … filling the prescription. (R23, patient)
Prescribers and pharmacists
First of all if you’re sexually active it [EC] shouldn’t be your main source of contraception. But obviously accidents do happen, and when those happen, then that should be an option for you and I will be willing to provide you that care. (R51, pharmacist)
I think that it should be sort of a last-ditch thing … it shouldn’t be used all the time … I mean, normally I’m totally happy to dispense it. I don’t want there to be unwanted pregnancies, unwanted abortions, unwanted children. But I sometimes feel like there should be a little bit more preparation done. (R52, pharmacist)
Health care system barriers (reinforcement)Prescription status as a barrier
If I had 2 options, one was a prescribed pill and one was an over-the-counter pill, I would go for the over-the-counter pill. Because I don’t want to book an appointment with my doctor to go get the prescription, to then go to the pharmacy to pick up the medication. I just want to go directly to the pharmacy and get the pill. (R19, patient)
Counter status
“[We place it] behind the counter, so we want to make sure we don’t miss anything. So even if someone come[s] to the counter request[ing] emergency contraception, the pharmacist will automatically provide counselling to the patient … We dispense medication. And we have to provide counselling of everything that leaves the drugstore. Every kind of medication we provide counselling. And the counselling is done by the pharmacist. (R111, pharmacist)
Tension between pharmacist’s duty to care and patient’s desire for privacy and minimal contact
Someone might be really embarrassed to be in the pharmacy … I know it’s my experience of feeling embarrassed to be inside the pharmacy and want to get out as quickly as possible. Don’t want to look at the pharmacist. You just want to get your pill and leave. (R16, patient)
Medication stock and demand
But for sure if the government allows ulipristal to be also prescribed by pharmacists then I think in general pharmacy is — it’s a business. So they would do whatever that would make them money. So if they think that increasing the awareness of this new birth control pill that’s effective for 5 days after rather than 3 days after, and more girls are aware of it and they kept — more girls are asking for it, then they would see it as a business opportunity. Then that would be what would make them, like, advertise or — to advocate for the change. (R31, pharmacist)
I think cost being the big one. (R17, patient).
  • Note: EC = emergency contraception, UPA = ulipristal acetate.