For birth control fixes, chemist is best friend

When it comes to getting birth control products, the youth say the next door pharmacy is everything that health facilities are not.

Pharmacies, the youth say, are fast, private, non-judgmental, and do not engage in unsolicited tests or long-winded counseling.

To them, public health facilities that have qualified staff and whose services are supposed to be free, are old-fashioned, archaic, unwelcoming and slow.

“At the chemist they will understand me better than at the hospital where they will say I do not need to use ‘those things’. Staff at the hospital will even talk to me rudely and harshly,” says a young male client in Kwale.

“The youth are not abstaining hence the high HIV rates, unplanned pregnancies as well as abortions in this group; but we adults would rather bury our heads in the sand,” says Jedida Mawale, a health community worker in Kitui.

Friendly, non-judgmental, confidential She blames her colleagues in the public health sector who have refused to follow official guidelines on the provision of friendly reproductive health services to the youth.

The National Guidelines for Provision of Adolescent and Youth Friendly Services say the 10-19-year-olds should get friendly, non-judgmental and confidential services.

However, the document by the Ministry of Health reveals that only about seven per cent of health facilities are providing youth-friendly services. “The youth should be able to consult within short notice, whether or not they have a formal appointment,” the guidelines direct.

Despite the guidelines, the ministry says its workers remain ambivalent about providing reproductive health services to young people, hence pushing them to retail pharmacies.

“Pharmacies are perceived, by the youth to be to be everything that health facilities are not: fast, private and non-limiting,” says a recent contraceptive survey at the Coast.

Led by Lianne Gonsalves of the World Health Organisation, the research team wanted to know the kind of youth buying contraceptives from pharmacies and why these outlets are appealing.

They engaged 740 men and women aged between 18-24 in Kwale County, according to the report published last month in BMJ Open. Of those who used modern contraceptives, 60 per cent had obtained them from a private retail pharmacy.

“You get to a hospital to find so many people queuing to see a doctor. It is more convenient to go to a chemist rather than a hospital,” said a pharmacy attendant in Kwale.

The young people said they valued pharmacies for their convenience, anonymity, non-judgmental and personable staff, service speed and their predictable and affordable prices.

But it is not just at the Coast or only for the youth that pharmacies have become the main source of family planning (FP) services.

 “They are more accessible, friendly and responsive,” says Wairimu Mucheru, a housewife with three children.

“I do not want more children, but because long term methods do not sit well with me, I am regular at the chemist,” said Mucheru.

“Business is quite brisk during this lock down period, especially in our outlets in residential areas,” says Catherine, a nurse in the public service but who runs a chain of small chemists in Nairobi.

She however observed that the long school break is inviting many underage customers, especially for ‘morning after pills.”  

“We are in business, if we do not sell to them somebody else will,” she explained of the ‘manna’ falling into the cash box.

Short-acting family planning

An earlier survey on the role of pharmacies in the distribution of Family Planning products in Kakamega, Kisumu, Machakos, Mombasa and Nairobi confirmed they have become a major player.

The survey led by Meghan Corroon of the University of North Carolina, USA, had involved 7,085 women and girls aged between 15 and 49 and 223 pharmacies in the five towns.

Retail pharmacies, the survey found, were the most dominant source for short-acting family planning methods including pills, emergency contraception and condoms for the women.

“However, public facilities remained the main source for injectable contraceptives in all the five towns,” wrote Corroon.

The results also showed that younger and unmarried women tend to use short-acting methods.

“Conversely, married women may are more likely to use long-acting methods, which are predominately available in clinics and hospitals,” the report reveals.

The other reason teenagers and unmarried women prefer pharmacies to hospitals for Family Planning, Mawale says, is because society is likely to frown upon pre-marital sex. 

But the rise of the pharmacy as a key source of family planning is not without risks. “Despite pharmacies filling an important gap in family planning, they also present some grave dangers especially due to the proliferation of illegal outlets, substandard products and practices,” warns Gonsalves.

In Kwale, for example, the researchers found unqualified pharmacy personnel administering injectable contraceptives to teenage girls.

While national guidelines allow private pharmacies to stock and sell injectable contraceptives, injections should be administered by a medic in a healthcare facility.

Pharmacies, unlike hospitals, employ less qualified staff, despite claiming to also offer medical consultations, the surveys found.

The Pharmacy and Poisons Board, Mawale, says must not abdicate its responsibility of protecting especially the youth against a profit only driven retail drug sector.