Sunday, June 8, 2008

From The Sunday Business Post: The Morning-After Pill

08 June 2008
By Jennifer O'Connell

It's time Ireland accepted that its young women are not fools and made the morning-after pill available over the counter in pharmacies

I'm not pregnant. That's not a claim I've been able to make too often over the past two and a bit years.

And as long as I'm still buying nappies in two different sizes, the prospect is enough to induce in me the kind of trepidation normally only seen in the waiting room of the Well Woman Clinic the day after the Leaving Cert results come out.

Which is perhaps why I found myself feeling a stab of indignation at the realisation that the waiting room of the Well Woman Clinic remains the refuge of choice for those who find themselves in need of somememergency contraception with their croissant on a Sunday morning.

The Department of Health and the Health Service Executive are considering the question of whether it's time we caught up with muchof the rest of the world and made the morning-after pill available over the counter in pharmacies.

The department seems to have been considering this measure on and off since Sex was the name of a book by that upstart Madonna.

The latest recommendation is one of several contained in a report by the Pharmaceutical Society of Ireland. It's under review by Mary Harney's department, but there are, she says, ''major issues'' that will have to be considered first. And I think we all know what that

The second-to-last time this proposal was raised - in 2006 - it was promptly shot down by the Irish Medical Organisation (IMO). The chairman of its GP committee said his members needed to be available to lecture women in need of emergency contraception on ''the
implications of being sexually active and how to protect against sexually transmitted diseases''. Oh, and to take their €50 consultation fee for the pleasure.

In 2008, it seems nonsensical that we still insist on making young women (and according to the IMO, the vast majority are in their teens or early 20s), anxious to take responsible action to prevent an unplanned pregnancy, wait until their GP can squeeze them in on Tuesday at 11. That's if they're brave enough to see their family GP, and can afford the consultation fee.

And that's presuming they have a GP in the first place - what student living away from home does?

There is, of course, a need to ensure that anyone getting emergency contraception understands it is just that. But surely you don't need a medical degree in order to impart to teenagers the real risks of having sex without protection? I'd have thought a pharmacist was every bit as qualified to do this.

Just think about the mixed messages we are giving here to our teenagers and twentysomethings. We feed them an endless diet of sexually provocative imagery on TV and in magazines. We buy them clothes emblazoned with the Playboy logo. We manufacture alcoholic
drinks in friendly little fruit flavours.

We force them through one of the most high-pressure education systems in Europe and, when they finally come out the other end, we drop them off at discos to celebrate, wearing low-cut tops and with something akin to Paris Hilton's hairband around their waists.

Then, in case all this hothousing and pressure and alcohol conspire to have the expected effect, we make it extremely difficult for them to get the morning-after pill, because we really don't want them waiting until they've finished their education and made a decent start in life before getting on with making babies.

At least, I think that's the idea. There are two things that matter about emergency contraception. The first is that it is available in emergencies, when other methods have failed, or haven't been given the chance to work.

Such emergencies, I would venture, usually don't arise on a weekday between the hours of 9am and 5pm. The second thing is that it works for up to 72 hours after intercourse, but it is more effective the earlier it is taken. A 1998 WHO study found that it worked best in the first 12 hours after sex. After that, its effectiveness declines by the hour.

It seems like a particularly Irish solution to license the morning-after pill, but only to make it available through GPs' surgeries, and by extension to diminish its ability to prevent pregnancy.

Let's not get into Irish solutions to family planning problems: the emergency contraceptive pill does not need to get mixed up with the abortion debate. But, since we're on the subject, let me just set the record straight.

The morning-after pill works in three different ways, depending on the time of the cycle and when it is taken: it delays ovulation, alters the transport of sperm along the womb and, in case all else fails, alters the lining of the womb so as to prevent implantation of a fertilised egg – a bit like a combination of the normal pill and the IUD.

Medically and legally, it is not an abortifacient because it acts before implantation. In fact, several studies have shown that the morning-after pill works to reduce abortion rates - including one that attributed half the 11 per cent decline in the abortion rate in the US to the availability of the morning-after pill.

Aside from the ethical issues it has become tangled up with, those opposed to making it available over the counter (coincidentally, in a recent survey, they were the demographic least likely to ever find themselves frantically searching for it: namely the over-50s) appear to feel that if they made it too easy, we silly girls would just keep popping morning-after pills instead of abstaining or organising proper contraception.

Because, of course, who'd want to go to all that trouble when they have available to them a more expensive, less reliable hormone solution that offers the giddying prospect of making them vomit their guts up instead?

The morning-after pill is now available over the counter in 44 countries, including the US, where individual pharmacists have an ethical opt-out.

A recommendation from the Council of Europe that all member states make it available in this way has been adopted in France, Belgium, Denmark, Finland, Norway, Portugal, Sweden, Switzerland and Britain.

In most of these countries, it is classed as a 'non-prescription' drug, which means it is still subject to significant restrictions and usually only available following a consultation with the pharmacist.

According to the British Medical Journal, there has been no increase in its use, and no decline in the use of other forms of contraception since it went on sale without prescription. This suggests that women are continuing to use it as they always have: sensibly and
judiciously. Because to use it otherwise, surely, is not to use it at all.

As long as there are men and women, as long as there are hormones and alcohol, there will be moments of unplanned and unwise passion.

There may even be quite a few of them later this month, when 50,000 students emerge from the fog of the Leaving Cert bristling with pent-up energy and in urgent need of ways to release it.

Of course, we would prefer them not to, and if they really must, we would prefer that they used safer barrier methods of contraception that also offer protection against STDs. But this is the real world, and in the real world, who benefits from us making it more difficult for them to avoid an unplanned pregnancy?