Introduction and methods
In late 1999 and early 2000, community pharmacists in Manchester, Salford and Trafford (MST) and Lambeth Southwark and Lewisham (LSL) Health Action Zones began supplying emergency hormonal contraception (EHC) under patient group directions (PGD). On completion of a training programme, pharmacists could supply EHC to women (initially Schering PC4, now Schering Levonelle) at no cost, following a confidential consultation. Pharmacists are paid a fee per consultation. Evaluations of both projects began in late 2000 by researchers from the University of Nottingham and Kings College, University of London.

Depth interviews were carried out with twenty pharmacists in LSL and with twenty-four pharmacists in MST. In LSL, the age of respondents ranged form late 50s to mid 20's; 17 were male and 3 female; eighteen were south Asian, 1 Chinese, 1 white British. In MST, respondents were of a similar age range; 14 pharmacists were male, 6 were of south Asian origin, two were Chinese and the remainder, White British.

Results and discussions
Pharmacists were extremely positive about supplying EHC under PGD. The perceived benefits to users included greatly improved access to EHC, at no financial cost to the user, via a confidential and thorough consultation with a specially trained pharmacist. This ensured appropriate supply of EHC and a potential reduction in unplanned pregnancies.

However, some were concerned that the supply of EHC through pharmacies might encourage 'abuse' or repeated use, although there was little evidence of this. Anxieties were often couched in terms of perceived clinical contraindications or the safety of EHC, although many admitted it was a 'safe' product to use. Pharmacists sometimes referred to the 'potency' of EHC, although it was unclear whether they were referring to its social or clinical dimensions. When probed, anxieties appeared to revolve around the promotion of 'casual' sex in the absence of 'proper' methods of traditional contraception.

Pharmacists were against deregulating EHC on the grounds that it might promote abuse of a potentially 'potent' product. The cost of EHC was thought likely to be a disincentive to use amongst poor women. There were also concerns about the ability of their 'untrained' colleagues to supply the product appropriately. Indeed, professional issues loomed large: many felt that supplying EHC under PGD set them apart from others: training, conducting a consultation and maintaining records were activities which not only ensured a safe sale, they also imparted enhanced professional status. Providing EHC under PGD was the 'way forward' for pharmacy in terms of being essential for their professional image.

Discussion
Accounts about safety and appropriate use of EHC were seemingly intertwined with social attitudes and values. In addition, pharmacists support for the PGD supply route appeared to stem from the desire for enhanced professional status as much as providing an important service. We suggest that the supply of EHC through community pharmacies appears to be a novel and beneficial way to extend the availability of EHC. However, as regulators of sexual behaviour, the supply of EHC raises some thorny issues for pharmacists. Because it is used after sex, EHC may constitute an awkward bedfellow in the pantheon of contraceptive methods in the sense that it does not fit with the ordered, regulated ethos of family planning.