Pharmacists' Attitudes and Practices Toward Contraceptives*

Pharmacists' Attitudes and Practices Toward Contraceptives*

Pharmacists' Attitudes and Practices Toward Contraceptives* By Donald W. Hastings and George E. Provol ntil recently the stated professional stance o...

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Pharmacists' Attitudes and Practices Toward Contraceptives* By Donald W. Hastings and George E. Provol

ntil recently the stated professional stance of pharmacists in the area of family planning was one of "noninvolvement."l The pharmacistpatron relationship was minimally defined with respect to the purchase of contraceptives or the dissemination of information related to birth control. Through the late 1950's professional literature, in large part, disclaimed participation by the pharm~ist in family planning activities. This position was predicated upon ethical and legal injunctions against the sales of contraceptives,2 poisons and abortifacents3 and was further aimed at disassociating the pharmacist from patrons with problems of sexuality-explicitly, ve~ nereal disease4 and, implicitly, unwanted pregnancy.5 Demand for the purchase of prophylactics and contraceptives as well as a recognition of problems concomitant with the increasing population have raised questions as to the relevance of this traditional stance. In the 1960's, professional commitment to family planning was advocated by individual pharmacists as well as the American Pharmaceutical Association. 6 Such a policy change was in response not only to the population explosion,7 but the "pill"-its benefits and hazards-8 and the demand for a modification of the pharmacist's role from technician (or paraprofessional) to that of an "involved" professional.9 This conflict between traditional and contemporary policies suggests that the individual pharmacist may be experiencing ambiguity as to what his role should be in the grey area of marketing contraceptives and advising his patrons.

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Problem

This study explored the attitudes and behavior of pharmacists toward the dissemination of contraceptives and birth control information. An attempt was made to ascertain what factors o Article is based on information collected at the University of Utah in summer of 1969. .

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shaped the pharmacist's attitudes toward family planning, what he perceived his responsibilities to be with regard to the patron and how he dealt with conflicts between personal beliefs and professional obligations. Specific attention was addressed to the following issues-What was the extent of the pharmacist's knowledge of the law regarding the sale of contraceptive devices? What were the pharmacist's attitudes concerning the sale of various types of contraceptives to (a) married persons, (b) unmarried adults and (c) unmarried minors? Was the pharmacist ever consulted for advice with rega:rd to contraceptive usage, and if so, what was his response? Finally, what social factors were associated with the pharmacist's attitudes and practices in each of these areas? Findings

All commercial outlets (excluding hospital and industrial outlets) within Salt Lake City, Utah, were contacted in order to arrange an interview with one registered pharmacist representing each firm. Each interview lasted approximately 20 minutes and was conducted at the pharmacy during a "slack period" or at a location designated by the respondent. In cases where interviews could not be arranged, pharmacists were requested to fill out the questionnaire and return it by mail. Pharmacists interviewed were more predominantly male, in their late thirties or early forties and had earned their BS in applied pharmaceutical science degrees from universities in the inter-mountain area. The majority of the interviewees were in owner and manager-owner positions with the remainder employed as staff pharmacists. Respondents were long~term residents of the state with· all but four living in-slate ten years or:/ more. Finally, the majority of pharmacists interviewed were members of the Church of Jesus Christ of Latter-Day Saints. Due to the purposive nature of this sample and its unique character of residential stabilitylO and homogeneous

Journal of the AMERICAN PHARMACEUTICAL ASSOCIATION

religious composition, any findings based on this sample demand replication in a different geographical region consisting of a more heterogenous sample. We suspect, however, that the results obtained would likely be valid for other communities with a stable popUlation of pharmacists and a strong moral climate against extramarital sexual intercourse. Our findings indicate that, in general, pharmacists assume sexuality to be a fundamental human need and contraceptives should be made available for the mature patron. Most agreed that FDA-approved prescription and non-prescription items should be made available to married and unmarried adults. They contended the patron should be allowed to exercise the option of use or nonuse for prevention of unwanted pregnancy or disease. In short, the adult patron, married or unmarried, was· perceived by the pharmacist to be legally and socially responsible in recognizing the physical, social and moral consequences of sexual intercourse. When asked whether or not pharmacists in practice made contraceptives available to adults, all responded they did. For adults, the majority made no distinction as to marital status. As one pharmacist stated, "I don't ask if individuals are married. If I can see that they are adults I sell to them." Thus the fact that pharmacists often were not aware of an individual's marital status is not surpnsmg. Visibility of a patron's age and maturity and not specifically his marital status was the chief influence on the pharmacists' decision to sell contraceptives to adults. Despite the presence of contrary personal beliefs pertaining to the moral and social issues involved in sexual intercourse, adult Jequests for purchase usually were honored. Interestingly, the law requires no such recognition of "adulthood" in the purchase of nonprescription contraceptives excepting prophylactics,n Respondents were ambivalent

whether or not to make contraceptives available to unmarried minors. One half of the pharmacists interviewed felt that easy access to contraceptives generates increased rates of promis(Recuity and venereal disease. spondents who argued that venereal disease was a consequence of accessibility to contraceptives were implicitly assuming use of some device other than prophylactics.) Further, these same respondents felt that traditional church teachings on chastity prior to marriage were severely tested. The remaining half of the sample con tended that "sexual intercourse is going on anyway," so the pharmacist should "make available some form of protection and thereby prevent an individual from suffering an illegitimate birth or becoming a social debit on the welfare rolls." The age of the pharmacist was found to be related to the position taken on this issue. Those who consented or replied that the needs of the minors should be evaluated, tended to be younger or more recent graduates than pharmacists who were dogmatically opposed to selling devices. When asked if in practice they made contraceptives available to unmarried minors, the majority of pharmacists appeared to conform to the "spirit of the law" as specified in the Utah Code of 1937 11 which only regulates the selling of prophylactics. Reasons offered for refusing to sell prophylactics to the patron who was clearly under age (i.e., younger than 18 years old or unmarried) included such statements as reiterating the provisions of the statute, telling the minor that stock was exhausted, requesting to see proof of marriage or asking the patron "to come back when you are a man." A few pharmacists interpreted the law more stringently than in fact it was written and refused prophylactic sale to unmarried persons under 21 years of age. Pharmacists who took this position often justified it by referring to their own religious background. The decision to sell contraceptive devices ( other than prophylactics) to minors more often than not was based on the patron's perceived age or maturity. In those instances where the patron was perceived as too young or immature, the sale of all contraceptive devices including o-t-c items was refused. Minors judged by the pharmacist to be mature were sold contraceptives more often than not. Most of the pharmacists felt that the present law (or lack of it) was sufficient for defining the responsibilities of the pharmacist in this area. They voiced the sentiment that knowing the mores of the community they could better regulate the flow of contraceptives to youth. Clearly the attitudes of pharmacists with regard to dispensing birth

Donald W. Hastings is an assistant professor at University of Tennessee in the department of sociology. Prior to moving to Tennessee, Hastings was an assistant professor at the University of Utah department of sociology. He completed his requirements for a PhD in 1971 at the department of sociology and anthropology, University of Massachusetts. Hastings' present research focuses on social background factors which influence acceptance of family planning by couples in their fertility decisions, specifically childbearing and decisions about voluntary sterilization. He has completed a study of pharmacists' attitudes and practices surrounding VD prevention and contraceptive sales. His memberships include the American Sociology Association and the Population Association of America. George E. Provo} is currently a counselor with the Salt Lake County Juvenile Detention Center. He recently has finished his studies for an MS from the University of Utah where he was a teaching assistant in the department of sociology and where he earned his BS in sociology as well. Provol was the recipient of a National Science Foundation Traineeship, 1969-1970. His main research interests are centered in demography, particularly as related to current ecological concerns. He also has aided in the re.search for a book, The Sociology of Death, by Glen M. Vernon, sociology department chairman, University of Utah.

control devices to minors were inconsistent. This inconsistency is a product of the religious beliefs which proscribe premarital sexual intercourse and stress chastity, and the lack of legislative guidelines which makes every pharmacist guardian of the community's morals. Pharmacists were asked if they had ever been approached for information or advice with regard to contraceptive devices. Virtually all respondents indicated they had. Those interviewed were particularly sensitive to the meaning attached to the terms "information" and "advice." "Advice" was connoted to be counseling the patron in selecting a technique which was most suitable to his physiological and psychological needs. For the most part respondents tended to relegate this responsibility to the physician. "Information" was interpreted by the respondent to mean a listing of available items with a specification of cost and description of how the item was used. Occasionally the pharmacist let his own preferences enter into the discussion such that he would recommend to the patron a particular device. Such a recommendation, however, was made only when the patron explicitly appealed for this type of counsel. In itemizing available devices a number of factors entered into the discussion with the patron. For the male patron the merits of various types of prophylactics were noted, i.e., cost and lubricated versus nonlubricated condoms. Many pharmacists recommended condoms for short-term protection. For the female patron the pharmacist weighed such factors asthe esthetic appeal of each device (i.e., whether it could be taken orally or had to be inserted only once or before each coitus); the relative cost of the items;

the effectiveness of the item as compared to the potential physiological side effects and feasibility of the item's use given the age of the patron. One fact emerged with clarity. Pharmacists felt that despite the convenience of the "pill," greater care, if not more stringent controls, should be exercised in its prescription, dispensing and use. In sum these results clearly indicate that the pharmacist casts himself in the role of technician. He was hesitant to give advice and preferred to offer only information, in effect removing himself from active involvement with the client. He perceives himself as capable of making minimal kinds of decisions selecting generic over brand name or vice versa for prescription contraceptive devices, and providing information on cost and effectiveness. The pharmacist's decision to sell or offer advice to a patron was based primarily upon the factors of sex and maturity and secondarily upon marital status. Reactions to these visible clues were shaped by personal beliefs regarding religion and management practices. In the latter case the standard of ethics governing practice was more often learned on the job as an intern than in the classroom. Rarely was the subject of contraceptive sales and dissemination of birth control information or advice treated with sufficient depth to provide the pharmacist with a working set of guidelines. The pharmacist's legal knowledge often was imprecise. Personal guidelines, however, had been established by most pharmacists as interns. Types of contraceptive devices recommended as acceptable for the adult patron were based on considered physical and psychological side effects. The tendency to limit contraceptive sales to minors (continued on page 81) Vol. NS12, No.2, February 1972

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