Victorian senator and former GP Dr Michelle Ananda-Rajah has spoken out against her home state’s controversial stance on contraceptive health.
The Victorian government’s plan for pharmacists to initiate prescriptions for contraceptive pill has been slammed by federal senator for Victoria Dr Michelle Ananda-Rajah, who has argued that the plan is short sighted.
On Wednesday, Dr Ananda-Rajah addressed parliament, warning that the push towards greater pharmacy prescribing in contraceptive care “will skew contraception even further towards the pill rather than long-acting reversible contraceptives”.
This echoed concerns from the RACGP and the AMA, which fear that the initiative will fragment care and disincentivise strong GP-patient relations.
“The main concern I have is that it will … undermine the work that we have done at the Commonwealth level to really promote law and make more affordable long-acting reversible contraceptives,” Dr Ananda-Rajah told The Medical Republic.
“[These include] IUDs as well as implants, which we know 99% or above more effective – essentially set and forget contraception.
“The other thing that I’m concerned about is that without a GP consultation, we’re missing opportunities to talk about other health issues.
“That opportunistic consultation does not happen with the pharmacist, it only happens with a doctor.”
The federal government has not yet directly endorsed a pharmacist-initiated prescribing model for the pill; instead, its involvement has been in announcing a trial which would fund scripts written by pharmacists to the same level as a PBS-subsidised script.
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While this may be seen by some as a tacit endorsement, the Commonwealth’s only action thus far has been to fund a service that states and territories have allowed.
“I am not against a pharmacy driven model, but I think there needs to be some guardrails,” Dr Ananda-Rajah told TMR.
“The first one is that initiation of the pill of contraception, full stop, should be by a doctor, because there are known thrombotic effects.
“We know that … only 10% of [Australian women] are using LARCs, and that’s way below other OECD countries like Sweden, where use of LARCs is in the order of 30%.
“We also know that unintended pregnancy in Australia is very high.
“40% of pregnancies are unintended, and that is a direct consequence of a lot of women historically leaning heavily on the pill, which we know is far less effective.”
This stance on contraceptive prescriptions is supported by TGA advice, with the administrator having previously warned against cutting GP management out of oral contraceptive prescribing.
“I think that this is very gratifying, that we’ve got politicians who are thinking about long term consequences of policy decisions like this,” RACGP Victoria chair Dr Anita Munoz told TMR.
“What we are saying is that women deserve to have very high-quality care that puts their best interests first in terms of safe prescription of medication.
“Jacinta Allan believes that the definition of looking after a woman’s health is getting that person something cheaply and easily, and that is not the definition of good women’s health.
“We know that when a woman is presenting for a discussion about contraception, there is a long list of other things that should be discussed, and that is what the definition of good women’s health is.
“I am dismayed that women’s health is being turned into such a political football like this, and I’m going to continue to speak to the need to put high quality medicine, practice of medicine first in our country.”
