Are pharmacists prepared to be sexual/reproductive health educators?
To the Editor. Recognition of people's sexual and reproductive health needs has gradually increased. Accepting the notion that sexual health is part of an individual's reproductive health that includes healthy sexual development, free from illness, disease, disability, and violence, are crucial. With the world population expected to reach 8.9 billion in the year 2050,1 sexual and reproductive ill-health continue to affect women and adolescents, especially in developing countries.2 Every year, more than 120 million couples have an unmet need for contraception, 80 million women have unintended pregnancies (45 million of which end in abortion), more than half a million women die from complications associated with pregnancy, childbirth, and the postpartum period, and 340 million people acquire new gonorrhea, syphilis, chlamydia, or trichomonas infections.2 Other pressing issues such as incest, HIV/AIDS, sexual coercion, sexual abuse, and gender-based violence certainly need greater attention from medical professionals, including pharmacists. 
 
Notably, pharmacists have the advantage over other health care professionals in that they have easier access to the public. In the provision of pharmaceutical care, sexual and reproductive health care undeniably constitutes a huge portion of a pharmacists’ daily practice, especially in the primary care setting such as a community pharmacy outlet or government-owned health care clinics. Pharmacists have the professional and social responsibility to educate the public on sexual/reproductive health matters, as well as contributing to treatment and prevention of sexually transmitted infections (STI) and HIV/AIDS, unplanned pregnancies (especially among the young), menopausal women, abortion, and sexual violence. 
 
There is growing evidence that pharmacists are capable of providing sexual and reproductive health care. Pharmacists have been included in various sexual health care programs that include empowering pharmacists to provide progesterone depot injection (Washington State project). Administration of subcutaneous depot medroxyprogesterone acetate (DMPA-SC) by pharmacists in a pharmacy setting was found to be feasible.3,4 Continuation rates and patient satisfaction with DMPA-SC and the pharmacy setting were comparable to those who received DMPA-SC in a family planning clinic. Meanwhile, women who went to a pharmacy had more rapid access to emergency hormonal contraception compared to those who chose to attend a clinical service.5 Also, Chlamydia screening for patients seeking emergency hormonal contraception at pharmacies is warranted.6 
 
Despite these concerted efforts by our colleagues to make our presence felt in sexual and reproductive health care, are pharmacists truly ready to be sexual/reproductive health educators? Are we trained adequately? What are the attitudes and competency levels of pharmacists worldwide to provide pharmaceutical care in this delicate and personal area of care? How well do our young pharmacists cope when they attend to patients who complain about their sexual dysfunction problems, especially in developing countries where sex remains taboo? Are we prepared to practice evidence-based medicine in this sensitive area, knowing that the market is flooded with various herbal and supplement products enticing the public, claiming to be able to boost sexual drive or performance? 
 
In my opinion, sexual and reproductive health topics are neglected in many pharmacy degree programs. I do think we need to reexamine the curriculum to determine whether it has addressed these issues sufficiently. Our graduates must be trained properly and possess the skills to care for the unmet needs of the public in this sensitive area. Establishment of sexual/reproductive education programs and sexual health clinics that incorporate pharmacists as educators should be considered. This is especially true in developing countries where pressing issues such as unplanned pregnancies and HIV transmissions among adolescents are increasing at an alarming rate. 
 
 
Chin Ken Lee, MPharm 
 
Faculty of Pharmacy Universiti of Teknologi MARA Selangor, Malaysia