over the counter
By Ann Furedi
The Medicine's Control Agency's plans for public consultation
on whether emergency, after-sex contraceptive pills should
be available without a prescription from pharmacists, suggests
that some policy makers are coming to their senses. The argument
for taking the new progestogen-only, emergency contraceptive
pills Levonelle 2 off prescription is almost impossible to
oppose. In the US they would call it a "no-brainer".
is safer than aspirin or paracetamol. The Committee on Safety
of Medicines (CSM) has already considered the proposal and
advised that the pills are "unlikely to present a direct
or indirect danger to the health of women aged 16 and over
when used without the supervision of a doctor".' Levonelle
2 matches none of the criteria that usually restricts a
medicine to prescription use; it is unclear why the manufacturers
applied for prescription-only status in the first place.
Predictably, this will trigger
protests from the shrill minority that believes that emergency
contraception is "a bad thing". There is an irritating
presumption that only wild, impulsive, immature young things
need emergency contraception. In truth, mature, married
women need it too. We, too, sometimes "fail" to
use contraception. We too sometimes "fail" to
plan for sex. We too sometimes want sex for fun. Emergency
contraception could, potentially, prevent significant numbers
of unwanted pregnancies. Used within 72 hours, it prevents
three-quarters of pregnancies that would otherwise have
On prescription, the pills
are difficult to get. A woman must be super-assertive to
insist on a doctor's appointment, super-organised to get
there and super-cool (or super-brash) to face the prospect
of a grilling on the circumstances that led to sex. Most
of us are not super-woman - and the temptation to take a
chance and hope for the best is strong.
Repeated public health campaigns
have increased awareness of emergency contraception, but
uptake has remained low. Pharmacy provision could change
that, as long as pharmacists and other health professionals
resist the temptation to introduce additional guidelines
to limit its use. Already there have been worrying murmurs
about the need for women to be "counselled", concerns
about "abuse" and whether women will be able to
use the method correctly.
These concerns are bizarre.
If Levonelle 2 is safe to be provided for pharmacy sale,
it should be treated as any other pharmacy product. Women
drive cars, raise families, programme videos and follow
recipes by the Naked Chef - why assume they are incapable
of following the instructions contained on a pack of pills?
For some pharmacists, the
purchase of emergency contraception may seem like the right
time to provide on opportunistic consultation on broader
sexual matters such as the relative efficacy of different
contraceptive methods, the risks of sexually transmitted
infections and so on. Some of the women who come to the
British Pregnancy Advisory Service (BPAS) for abortions
tell us that they didn't use emergency contraception because
they were ashamed to admit to their doctor that they had
had unprotected sex. A pharmacist is unlikely to be more
status could do more than make emergency contraception easier
to obtain. It would send out a clear message: it is safe,
it is legitimate, and it is for women "like you".
Much of the potential of pharmacy-provided emergency contraception
rests on the fact that women will be able to buy it conveniently
and without embarrassment. Any hint of the need for "special
counselling" reintroduces an unnecessary stigma.
When ministers review the
results of the consultation later this year, they will consider
the safety and desirability of providing emergency contraception
without a prescription. The CSM's recommendations have put
the safety issue to bed. In these days of respect for evidence-based
medicine, it must be unthinkable that government would seek
to maintain restrictions for social or moral reasons.
Ultimately the decision
about the status of Levonelle 2 will be a litmus test of
how government regards women and how it regards sex. Do
they trust women to use pharmacy medicines appropriately?
Do they value women's participation in society enough to
allow the necessary means to control our fertility? Do they
accept that sex can be for fun?
The author is communications
director, BPAS. The consultation document can be obtained
from Martin Bagwell, MCA, 1413 Market Towers, Nine Elms
Lane, London SW8 5NQ. Deadline for responses is June 29