Think:Health cultivates and articulates the best in health research and news.
The following program, which aired on Sunday 18th October 2015, features:
- the effect being a full time carer has on your relationship (01:21); and
- accessing emergency contraceptive pills (ECP) in low and middle income areas (11:32);
Guests:
- Dr Caleb Ferguson - Director of Postgraduate Nursing Studies at the UTS Faculty of Health.
- Dr Anglea Dawson - Senior Lecturer at the UTS Faculty of Health.
- Dr Deborah Bateson - Medical Director of Family Planning NSW
Presenter:
- Ellen Leabeater, 2ser
Transcript:
[Opening theme]
Facilitator: Hello and welcome to Think Health, where we cultivate and articulate the best in new health research. I'm Ellen Leabeater and you are tuned in to 2SER 107.3. Today on the program we find out what it's like to be a fulltime carer and do emergency contraceptive pills cause abortion? We bust some myths about the pills in Australia and take a look at how they are being used in lower middle income countries.
Female 1: I commonly hear that women think that first of all it's well, what I call an abortifacient. It causes abortion, which it doesn't. It delays or prevents ovulation. They feel that it's going to affect their future fertility and we know that it has no effect on future fertility.
Facilitator: But first on the program. Imagine waking up in the morning. You're not able to get yourself out of bed. Someone has to make breakfast for you and someone has to be on call for you at all hours of the day. That's the reality for many survivors of stroke, who have become incapacitated to the point of relying solely on the help of others. The role of carer can place a huge strain on the relationship and wellbeing of both the carer and stroke survivor.
Facilitator: This week is National Carers Week, a week that recognises the dedicated hard work of caregivers all around the country. Many carers work for free and as carer, [Sherry Mead] told [Jake Morecombe], knowing when to ask for help looks after the both of you.
Female 2: The stroke had a huge impact on him, also following on from that, affected by role as his wife, because I then became his full time carer.
Male 1: Sherry's husband Jim had a stroke five and a half years ago. As a result, he lost the ability to move more than 30 per cent of his body.
Female 2: So his left side has been affected totally and he can't use his left arm. He needs assistance with a support on his left leg, so he can walk and he also uses a cane to be able to walk.
Male 1: After the stroke Jim was no longer able to work. Sherry operated her own business. But since becoming a fulltime carer, this had to change.
Female 2: Basically that was fine. I just found that once Jim had his stroke, I had to cut back my hours. Then it got to the point where I couldn't manage taking care of him as well as running a business. So I made the decision to close my business, so I could spend more time looking after my husband.
Male 1: Sherry has also had to change other parts of her day to day life, to meet her fulltime caring duties.
Female 2: It just means that a lot of the - what I need to, separate from caring for my husband. If I need to go out shopping or go to a doctor's appointment, I work that around what needs to be done for my husband. There are blocks of time during the day that I know okay, so I need to go out. He'll be alright for that short time I'm away. But I can't just at the drop of a hat, just go off somewhere to do something. So everything has to be pre-planned.
Male 1: For Sherry, there is a lot of pressure on her. Making sure Jim has what he needs. Making sure the house is still running in order. There is not much time for her to sit back and think of her own needs. This is an issue faced by a huge number of caregivers. Many don't recognise the huge impact that a stroke experienced by one of their family members has on their own mental and physical health.
Male 2: A lot of people think of caregivers primarily older and I think that's quite a myth and a stereotype. The average caregiver in Australia is around about their mid-forties, is more commonly female and will usually have some responsibilities themselves in terms of some children to upbringing as well.
Male 1: That's [Caleb Ferguson]. He's a stroke safe ambassador for the National Stroke Foundation. He says that stroke can affect anyone and it's not something you can prepare for.
Male 2: Going from being fit and healthy one and to having this devastating sudden onset event, can be quite devastating for a lot of individuals and their family members to cope with. It's quite a stressful time for individuals in that first period of stroke. But then I guess that coping and adjusting with your lifestyle, not being able to conduct some of your normal activities of daily living, can be a highly stressful experience for a lot of individuals and that have a stroke and their caregivers.
Male 2: I guess if your wife is the one that does the driving or usually takes care of the finances at home. If suddenly one day she isn't able to drive to the local supermarket or take care of the banking, there tends to be that shift in the dynamics of that relationship. It can be very stressful for the family unit. It's really important that the support networks that that family has really comes together to support that individual post stroke.
Male 1: After the initial hospitalisation of stroke, there are a few places where patients can go. Stroke survivors might have to undergo continuing rehabilitation which might include going back and forth between the hospital, between doctors or visiting other medical professionals. For the caregiver, Caleb says this can be very emotionally stressful.
Male 2: So I guess it really depends upon the severity of the stroke and how that individual is impacted. A stroke can impact people in a lot of different ways and could be the individuals left with impairments that affect potentially their mobility and their cognition and eating and drinking, swallowing. So I guess how they then are supported by the caregiver to live with these impairments and to achieve their optimal rehabilitation and live as best as they can with those impairments and achieve optimal life for them.
Male 1: The National Stroke Foundation have introduced a new package called My Stroke Journey which answers some of the questions both stroke survivors and caregivers might have about getting things back on track.
Male 2: Which is a fantastic resource, where it helps in that transition and care planning phases from the hospital to home. They have a new platform which is super exciting. It's amazing. A piece of online platform and that they've developed and it just launched earlier this year. That's a platform you can just Google. enableme it's called. It's almost like a Facebook for stroke survivors and their caregivers and the health professionals as well.
Male 2: It's a social platform that allows patients, caregivers and health professionals to get together online and chat about all things stroke. Because if you think about when you are in hospital you might have some questions that are unanswered. You might think about when can I return to driving or when can I return to having sex, which are things that might not be at the front of everyone's mind, when they are in an acute care setting. They might have not had the chance to discuss that with a health professional in the hospital.
Male 2: That platform really allows patients at a later stage to maybe hop on and share their experience of living with stroke, across the spectrum of stroke care, from that really hyper acute stage to living with stroke 10 years later and for people to share their experiences.
Male 1: What kind of other support services or support platforms are out there for the caregivers?
Male 2: There are a broad range of supports available. I think it's about helping caregivers and stroke survivors to recognise for what they are and how useful they are and where to find and access those resources. Often and from previous research, has shown that a lot of caregivers and stroke survivors might not think that those resources are too appropriate for them. Or they're not great quality for them as well.
Male 2: Some of them are underutilised and untapped. It's really important that we highlight in the acute stages as well around about the supports that are available when stroke survivors and caregivers are transitioning from hospital to home. There also is a lot of work to bring in new interventions that help the caregivers and stroke survivors after stroke and that we develop and test these interventions and really embed them in general practice as well.
Male 2: Throughout primary care, because we know that a lot of people now survive stroke. In fact 67 per cent of people that will survive stroke will have some type of either cognitive or functional impairment after stroke. So it's really important that we have interventions that are - the spectrum of care, not just an acute care sector. To support the caregivers in the long term as well.
Male 1: Caleb Ferguson/safe ambassador for the National Stroke Foundation. How stroke can change your life. Fulltime carer Sherry says takes getting used to. I asked her if she had any advice for a new carer of a stroke survivor. She said.
Female 2: To not be afraid to take those breaks. It is recommended that carers have regular respite breaks. That might mean taking one or two hours in the week to go off and meet friends for coffee. Or it may mean taking a longer break, going away for a weekend. Or going away for one or two weeks and being able to arrange for other people to come in, take care of the person you are looking after.
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Facilitator: You're listening to Think Health on 2SER. Up next, how accessible is emergency contraception in low income countries? We talk to [Dr Angela Dawson] from the University of Technology Sydney to find out more.
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Facilitator: Now, if you're a female, you probably take it for granted that you can walk into a pharmacy and purchase emergency contraception if something goes wrong. But for many women in lower middle income countries, this isn't an option. This is despite the fact that emergency contraception, specifically emergency contraceptive pills, are recommended to be on the Essential Medicines List by the World Health Organisation.
The availability of emergency contraceptive pills or ECPs vary from country to country. Some countries have no access at all, while others have access, but at a cost. Dr Angela Dawson is a senior lecturer on the Faculty of Health at the University of Technology Sydney. She has studied the access to ECPs across the world and spoke to me to give us an overview of the challenges and benefits of ECPs.
Female 3: Emergency contraction covers two areas. One is emergency contraceptive pills, which we call ECPs and the other covers a form of contraception known as the IUD or the intrauterine device. So my work is mostly concerned with emergency contractive pills, ECPs.
Facilitator: So why are emergency - why is access to emergency contraceptive pills so important for women in lower middle income countries?
Female 3: Well, it's really important because it's a very effective means of having a second chance to prevent a pregnancy. This is particularly important in cases where sex has been forced or where contraception has failed, such as a burst condom or when women have not been, for whatever reason, able to procure contraception. So it's really important because it provides that window of opportunity to prevent that pregnancy up to five days.
Female 3: They are various products available that can do this. The UN's focus has been one particular product, Levonorgestrel. But this product is a product that WHO has advocated for countries to put on their Essential Medicines List. Some countries don't have this product on their Essential Medicines List. One of those is Guatemala, for example. The Philippines doesn't. These are countries where abortion also is heavily restricted or illegal.
Female 3: But in many other low middle income countries, great effort has been made towards, including these on the Essential Medicines List.
Facilitator: So exactly, how many women in these countries are able to access this pill?
Female 3: Oh that's a really good question. We've got various data from various countries. But to give you one example, some work that we are doing in Cambodia at the moment, which was a survey just in Phnom Penh. You would imagine that being probably an area where women would get better access and have better knowledge. So, despite Levonorgestrel ECP being on the Essential Medicines List since 2007, only 60 per cent of our sample of women had knowledge that this was available.
Female 3: Our survey of providers, so facilities private and public facilities, showed a dearth of availability, was only really available in pharmacies, private pharmacies that is.
Facilitator: So this 60 per cent of women, how did they know that this pill was available?
Female 3: Through the media they say and through the work of NGOs, such as Population Services International. That have a very good social marketing program. But that's focussed on marketing their own product brand of emergency contraceptive, not the ones that the Government procures and distributes. So we've got availability and access issues in the public and in the private sector and in the NGO sector in fact, through PSI.
Female 3: But we've got a situation where in Cambodia the private access exceeds that in the public and in a very poor country where you have to pay for things, which tend to be more expensive in the private sector than in the public. Affordability is a big issue.
Facilitator: So what needs to be done to boost the levels of access to emergency contraception in low middle income countries?
Female 3: We've got some really exciting examples from work that's been undertaken. One of the things that I really love is the work that's being done to - in the area of sexual assault. There has been work, particularly in Zambia and the Copperbelt, where police have been trained to not only counsel rape survivors when they attend the police station, but also to dispense ECP and care for a woman and then take her immediately to the health centre.
Female 3: In fact, that's been so successful - and one of the outcomes is not so great, but does show that the health sector didn't do so well in this picture. That they were coming back to the police stations to ask for more supplies of ECP because they had run out themselves. So it’s a procurement in supply. The police stations were very good and the police were referring on, even better than the health sector. But some of the problems were actually transporting women to the health centre and all the paperwork involved.
Female 3: Other approaches to improving access have been to - in the area of demand generation. So using mobile phones in Tanzania to advertise ECP and seek to answer women's questions or queries about the commodity itself. But work needs to be done in that area. But that's quite an exciting project. But there is little work really in the private sector.
Female 3: We don't really know what's going on in the private sector. We don't know about the training of staff, because often it's retail staff who are giving out this product.
Facilitator: Dr Angela Dawson, senior lecturer in the Faculty of Health at UTS. Coming up next, do you have to use ECPs the day after you've had sex? We bust some emergency contraceptive pill myths.
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Facilitator: Welcome back to Think Health on 2SER. I'm Ellen Leabeater. Now, we just heard from Dr Angela Dawson about the availability of emergency contraceptive pills in lower middle income countries. But how does Australia compare? You might be surprised to hear that many women in rural and remote parts of the country don't have the best access to ECPs and a lot of women still have misconceptions about how the pills work.
Female 4: You may have noticed that we're not calling ECPs by their more well-known name, that is the Morning After Pill. Well, that's because ECPS can be used up to three days after unprotected sex, which is soon going to be five days. We spoke to [Dr Deborah Bateson], Medical Director at Family Planning New South Wales, to find out more about the state of play in Australia.
Female 4: Since 2004 it has been available. I'm talking about the single dose Levonorgestrel pill. It's a single tablet and it has been available over the counter from pharmacies since about 2004. But that said, we still do know that it can - access can be a little bit challenging, possibly - particularly probably in some rural areas maybe or remote areas. So we know from some interesting research, sort of shopper type research, that access can still be a bit of a challenge.
Facilitator: So in those rural and remote areas, is that just a case of actually physically getting the product to those areas or is it more of the people who are giving out the products?
Female 4: Yeah. So, it can - some of the challenges can lie in the fact that if you do have a pharmacist who perhaps is a conscientious objector and doesn't stock it, then that can be very difficult. The Pharmaceutical Society of Australia has actually put out extremely useful guidelines. That includes if someone is a conscientious objector, they do need to be able to refer that woman to the nearest other supplier.
Female 4: But given distances, that can be challenging in that rural environment. We know that the experience that women, some women have, when they are accessing emergency contraception, that can also be a bit challenging as well and differ from place to place. The key thing is that we want to make access to this very safe medication as easy as possible.
Facilitator: So, in Australia we do have quite good access to more sustainable forms of contraception like the Pill and condoms, for example.
Female 4: Yeah.
Facilitator: How many women actually use emergency contraceptives in Australia?
Female 4: I haven't got that data on the top of my head, I have to say. But we do know that - sometimes it's surprisingly a little bit lower than you would think. So we do want to remind people and encourage people to know about this very effective - well, we used to call it the Morning After Pill. But we actually call it emergency contraception now, because we know it's got a longer duration of action than just the morning after.
Female 4: In fact, it can be used - it's licensed for up to 72 hours. But we would advise it can be used up to 120 hours after unprotected sex. But you're absolutely right. It's very important that women obviously know about those more effective methods of contraception that they are going to use in the long term. But it's certainly - it's a very useful thing for women to know about and be able to easily get, if they have had unprotected sex.
Facilitator: That's actually something that I was thinking about before this interview, is that to me, this has always been known as the Morning After Pill. But that gets people in the mindset that they need to use it straight after they have had sex, as soon as they've had unprotected sex.
Female 4: Yes.
Facilitator: But that's not the case.
Female 4: No it's not the case. But I will say the earlier the better. We do want women to access it as early as possible. So it is earlier the better. But we do know that it can be effective. It does lose effectiveness really around about 96 hours. But it can be effective and we've certainly got a very low threshold for recommending it. We'd recommend it up to five days from unprotected sex.
Female 4: But it's an interesting point actually, because there is also the possibility of having an advance supply as well. For women in - that's certainly something that can be thought about as well. I think it's we're moving those barriers to use of this medication.
Facilitator: There is actually some very exciting news in the world of emergency contraception, I believe.
Female 4: Oh look - well, there is actually. The whole world is actually thinking about emergency contraception. I've just been at a very big international conference. Emergency contraception features very highly. There is a - well, it will be new for Australia, but it's a newer emergency contraceptive medication that's called Ulipristal acetate. It's a progesterone receptor modulator. It's been approved in Australia.
Female 4: It's not available yet, but hopefully sometime early next year it will be available, to give more option for women. It has got a longer window of effectiveness. It has got that proven effectiveness out to five days after unprotected sex. Again, it's just - it's an alternative.
Facilitator: You mentioned that new emergency contraception - sorry, emergency contraceptive pill becoming available in Australia hopefully next year.
Female 4: Yeah.
Facilitator: While other countries have had it before.
Female 4: Yes.
Facilitator: Is it just a case of the TGA not being 100 per cent sure about it? Or is it a bit more political than that?
Female 4: No. Look, I think in this case actually, it was a matter of a sponsor actually putting it up before the TGA. I don't think - although some drugs in this area have been certainly quite challenging, if we think about Mifepristone. We've had quite a chequered history. That's used now for medical abortion and luckily now that is available in Australia as a prescribed drug, of course.
Female 4: But no look, I can't - I don't think that in this situation it is political. But that's not to say that it will all be smooth sailing. I have been reading some recent reports from the UK around this new emergency - well, newer - emergency contraceptive drug, Ulipristal acetate, where there have been a lot of debate and media concern. Whereas in fact, again, it's a very safe drug and it's certainly very, very useful to prevent unintended pregnancy.
Facilitator: If you would like to find out more about that story or listen to any of our past programs, head to our website at 2ser.com/thinkhealth. This show is produced with the support of the University of Technology Sydney, Faculty of Health. Please remember that you should not consider the contents of this who medical advice and you should consult your physician if you have any concerns. I'm Ellen Leabeater. This has been think health. See you next week for more in health research and news.
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