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Contraception
   
  France: Government to introduce Emergency Contraception in Schools
By Jean-Francois Andre

Last November, Segolene Royal, French Minister of State for schools, announced that Norlevo, a kind of morning-after pill, would be available from school nurses. This is part of the new unified health care procedure for schools that is being devised.

The French government is increasingly concerned with some trends in teenage sexuality. Each year, there are 10,000 teenage pregnancies, 6,700 of which will end up in an abortion. The Minister is also worried about the higher level of sexual violence among young people.

THE TREATMENT IN QUESTION

The scientific name of Norlevo is levonorgestrel. It is made up exclusively with progesterone, without oestrogen, which minimises side effects. It consists in two pills, one of which should be taken a.s.a.p. after the intercourse, and the other between 12 and 24 hours after. If it is taken during the first 24 hours, this contraception is 99% efficient; it remains 85% efficient if it is taken during the first 72 hours.

Norlevo has been available in French pharmacies since last June. It can be obtained without medical prescription, but is not refunded by the Social Security. One treatment costs between 5.5 and 6.5.

THE WAY IT WILL BE PROVIDED TO HIGH SCHOOL TEENAGERS

A note has been issued to nurses as to emergency contraception. It provides that, first, the nurse shall ask the teenager how she has become pregnant (e.g.: has she forgotten to take her pill? Was the intercourse non-consensual?), and about her family antecedents.

Then, if the teenager is a minor, the nurse should try to contact her parents, unless the patient absolutely objects to it, in which case she should be referred to a family planning centre. If this is not practicable in good time, and if the teenager is in great distress, the nurse will be able to provide her with Norlevo.

If the teenager is over 18, she should be referred to a family planning centre or to a hospital, or, if impracticable, she should be told of the possibility to obtain Norlevo from a pharmacy. If no pharmacy is reasonably available, the nurse can provide the teenager with Norlevo.

In any case, the teenager must be told that Norlevo must not be used beyond 72 hours after the intercourse, and that it must not be used repeatedly.

REACTIONS TO THE DECISION

The issues are moral, but also practical (e.g., are there enough nurses to implement the measure? Shouldn't it be the role of doctors rather than nurses to advise on medication?)

The Minister said that this was a purely medical matter, and that she needed to consult only doctors and nurses.

According to the Association of Rural Families, this decision "is full of hidden risks: once again, the role of parents in education is forgotten; the mediating role of health professionals, including the family GP, is overlooked, only to impose a supplementary burden on nurses". Moreover, "this decision cannot be implemented in rural communities, where many high schools simply don't have a nurse".

The Association of Catholic Families is "worried" by the measure. It says "yes to a policy to reduce the number of abortions", but "no to the means used". "Shouldn't we rather try and prepare young people to live a true sexuality, respectful of persons and experienced within the fidelity to conjugal promises?" The Vatican condemned the measure as a "cruel hypocrisy", while the Spokesman of the Conference of French Bishops said: "If we delude ourselves by thinking that the consequences of irresponsible behaviours can be made good with easy medical responses, we deceive the youths, and we go against any true idea of education".

The measure has also been criticised by the most conservative of the two associations of high school students' parents.

Most school nurses' unions support the measure, though some of them are concerned that there are not enough nurses for this task, since there are about 5,000 school nurses in France, for about 7,000 high schools. One of the unions fears that it will poison the relations between doctors and nurses.

The two main high school students' unions approve of the measure, and so does the main union of the National Education Services. The main union of high school headteachers has said, in support of the decision: "the executive staffs cannot condone reactions that deny the true character of the dramatic situations experienced by teenage girls, and are trying to persuade us that waiting is the appropriate response to emergencies."

According to an opinion poll, 66% of the population support the decision, including 83% of those aged between 15 and 24.

LEGAL PROBLEMS

The Contraception Act 1967 provides that hormonal and intra-utero contraception shall only be available on a doctor's prescription. However, the Government is of opinion that no reform of the law is needed. First, it said that Norlevo was not a contraceptive drug, since it did not prevent conception itself, but merely the installation of the egg in the womb. Secondly, a European directive requires levonorgestrel to be available without a doctor's prescription, and it takes precedence over French law.

THE NEXT STEP

Segolene Royal has said that "teenage sexuality should not be viewed as a victory for women: a sexual relationship should be based on an emotional one, on self-respect and on respect for one's partner".

The Government has re-emphasised the need for more sexual education. It will focus on the emotional dimension, together with the respect for freedom and the right to say "no". The youths shall also be given an opportunity to reflect on what parenthood means.

In addition, an information campaign on contraception is going to be launched, with five million copies of a Pocket Guide to Contraception being distributed to high school students. This is the first campaign of this kind since 1992. There had been Aids prevention campaigns, but the Government is concerned that have deflected the attention of teenagers from the pill, since they only talk of condoms. Moreover, according to Segolene Royal, "the youths had stopped listening, as they were presented with a sad and negative image of sexuality".
 
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