OPEN LETTER: Victorian women deserve contraceptive choices and safe, high-quality healthcare

The Royal Australian College of GPs (RACGP), Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG), and the Rural Doctors Association of Victoria are writing to express our shared concern regarding the expansion of new retail pharmacy prescribing models for contraception in Victoria.  

While improving access to contraception is an important objective, it must not come at the expense of patient safety, quality of care, or informed choice. 

Contraceptive care extends beyond the supply of a medicine. It requires clinical assessment, discussion of available options, consideration of individual risk factors and ongoing review.  

These consultations also provide a valuable opportunity to identify and manage broader sexual and reproductive health concerns, including the need for sexually transmitted infection screening and cervical screening, as well as the assessment and management of abnormal menstrual symptoms, endometriosis, polyendocrine metabolic ovarian syndrome, pregnancy planning, menopause-related concerns, family violence, and reproductive coercion. 

New models of care should be robustly trialled before they are rolled out to the public. Independent analyses by the Sax Institute and Grattan Institute have highlighted the limited evidence supporting emerging retail pharmacy prescribing models and the need for rigorous evaluation of patient outcomes. We are concerned that these models are being expanded without robust evidence, transparent monitoring, or comprehensive assessment of their long-term impacts. 

The key question is not whether contraception can be prescribed safely in individual encounters, but whether the broader regulatory framework adequately manages clinical risk and protects patient safety over time. 

Women require personalised, ongoing contraceptive care, including management of potential complications that may arise, as well as access to the full range of contraceptive options and choice. 

A wide range of contraceptive options are available today, varying in effectiveness, convenience, suitability and the individual response to side effects. Long-acting reversible contraceptives (LARCS) are among the most effective forms of contraception, so much so that they are recommended for first-line use in health guidelines.  

Models of care focused only on access to the contraceptive pill risk narrowing women’s choices and do not provide the breadth of care required to support informed decision-making.  

We are also concerned that the unintended consequences of retail pharmacy prescribing models for contraception will be delayed access to care for many women because patients with any level of complexity will be ineligible. This could cost time and money for those who discover they are ineligible and need to go to another health service to get the care they need, particularly those in rural and remote communities who need to travel long distances. 

Further, the model may create a perceived conflict of interest, whereby pharmacists derive revenue from prescribing and supplying the contraceptive pill, rather than referring patients to a clinician for consideration of alternative options such as LARCs. 

We are concerned that Victorian women are being asked to rely on models of care that have been implemented ahead of a robust evidence base, without adequate safeguards, transparent monitoring or a rigorous evaluation of health outcomes. Questions also remain regarding the governance arrangements underpinning expanded pharmacy prescribing models. There is a recognised need for significant clinical governance uplift. 

Accordingly, we call on the next Victorian government to commit to an independent review of patient outcomes and adverse events, and broader system impacts associated with these new models of care, including Chemist Care Now.  

Victorian women deserve confidence that the care they receive is safe, evidence-based, clinically appropriate, and supported by robust safeguards.  

Expanding access to contraception and sexual and reproductive healthcare should instead be underpinned by sustained investment in the women's health workforce, ensuring access to timely, comprehensive, and personalised care that meets women's individual health needs.