The `morning-after' pill will become available over-the-counter in the North early next year. But in the Republic it is not available even on prescription
When the `morning-after' pill is available over-the-counter in the North next January, will it be another British solution for women in the Republic facing the risk of an unwanted pregnancy?
Sex is a human impulse, and chances are that despite all the warnings, there will be plenty of men and women who will risk unprotected sex over the Christmas holiday. If you take the risk of having unprotected sex on the Saturday before Christmas, it will probably be the following Wednesday before you find a family planning clinic or GP available to prescribe you emergency post-coital contraception, and a chemist open who is willing to dispense it. By then it will be too late, which means that for Christmas 2000, the chances of unwanted pregnancy will be particularly high, warns Dr Sheila Jones, medical director of the Irish Family Planning Association.
In the UK (including Northern Ireland), the "morning-after pill" is to be available over-the-counter from mid-January. In the Republic, the morning-after pill isn't licensed for sale even on prescription.
The morning-after pill is most effective taken 12 hours after sexual intercourse, then again 12 hours later. But doctors may not be accessible in the 12 hours after intercourse, especially at weekends and over the Christmas period. The pill can be taken within 72 hours, but the longer you wait, the less effective it is. For this reason, the Lothian Health Board in Britain and the British Pregnancy Advisory service have started offering women advance supplies of the morning-after pill on the NHS, in order to reduce the abortion rate and the number of unwanted pregnancies.
While one in 10 pregnant Irish women is travelling to Britain for an abortion, it's likely that thousands more Irish women will be travelling from the Republic to Northern Ireland early next year to get the morning-after pill instead. When Levonelle - a new generation morning-after pill - becomes available over-the-counter in the UK, yet another British safety valve will be in place to rescue the Republic's women from unwanted pregnancy.
The scenario could be reminiscent of the contraceptive trains of the 1970s, as women travel to Newry for this emergency contraception.
The lack of a licensed morning-after pill in the Republic puts Irish women at a disadvantage shared by few others in Europe. Here, women seeking emergency post-coital contraception are prescribed Ovram, an old-fashioned, strong oestrogen and progesterone-based contraceptive intended as daily contraception for women who, for medical reasons, cannot take the commonly used, progesterone-only, daily contraceptive pill.
While Ovram is not licensed as a morning-after pill, Irish GPs commonly prescribe Ovram for women who have had sexual intercourse without contraception, making Ovram yet another Irish solution to an Irish problem.
Until recently, the most commonly used form of post-coital contraception in the UK was PC-4, a pill containing oestrogen and progesterone, available only on prescription. Virtually identical to Ovram, PC-4 has never been available in the Republic.
Levonelle has a higher success rate and fewer side effects than PC-4 or Ovram, and so is helping to revolutionise the post-coital contraceptive scene not just in the UK, but all over Europe. This pill - which contains a progestrogen called levonorgestrel - has been scientifically proven by the World Health Organisation to be more effective, safer and causing fewer side effects than PC-4 or Ovram. Ovram and PC-4 make women nauseous and physically sick, while Levonelle doesn't. Ovram and PC-4 are 75 per cent effective, while Levonelle is 99 per cent effective.
The decision by the British government to make Levonelle available over-the-counter in mid-January has been driven by its policy of reducing its soaring teenage pregnancy rate. In France, where the teen pregnancy rate is well below that of the UK and the Republic, the morning-after pill is even available to young women in secondary schools without their parents ever having to know.
Making Levonelle available over-the-counter in the Republic would be a bit like running before you can walk, since we haven't even got it on prescription yet. Family planning doctors would simply like Levonelle to be available on prescription for Irish women - yet the Republic and Greece are the only two countries in Europe to fail to authorise the drug.
When the Irish Family Planning Association asked the Irish Medicines Board why Levonelle was not licensed for availability on prescription in here, the IMB replied that it believed Levonelle to be a "licensed abortifacient and therefore unconstitutional at present".
"You don't have to be a rocket scientist to see that Levonelle is not an abortifacient. All you need is logic," says Dr Mary Short, a GP in Blackrock, Co Dublin and secretary general of the European Society of Contraception.
If pregnancy - which requires the fertilisation and implantation of an egg - has already occurred, then Levonelle is useless. While the WHO reported in the Lancet that the exact mechanism by which Levonelle works is unclear, it is thought that it works either by stopping an egg from being released from the ovaries, or by slowing the egg down, or by preventing sperm from fertilising the egg. It may also stop a fertilised egg from attaching itself to the lining of the womb, although in most cases fertilisation probably doesn't occur.
For the greatest chance of success, Levonelle is best taken 12 hours following unprotected sexual intercourse, although it may still be effective if taken within 72 hours. Dr Short says anyone who has studied biology knows that it takes days for sperm to fertilise an egg, so that if Levonelle is taken promptly, no fertilisation would have taken place, therefore it could not be an abortifacient. And she asks the pertinent question: "One in 10 Irish women is going to Britian for terminations. Isn't it better to take something before you have even ovulated, never mind conceived?"
Adding her voice to the argument in favour of making Levonelle available in the Republic, Dr Sheila Jones says: "Levonelle is not an abortifacient. The morning-after pill has been around since the 1970s. It's totally safe. The fact that Irish women cannot avail of it is ridiculous."
There is also a health risk for some Irish women as a result of Levonelle's unavailability, since Ovram should not be used by women at risk of blood clotting or who are experiencing migraine headaches. These women must choose between the risk of pregnancy and the risk of - for example - a brain haemorrhage.
While in the Republic we are still exploring whether Levonelle should be available on prescription, in the UK women will be able to walk in to specially trained staff in chemists' shops and receive counselling and the morning-after pill for £20. This is an entirely different issue and one which we are nowhere near dealing with in the Republic.
Schering Health Care, which markets Levonelle on behalf of the manufacturer, Gideon Richter, was surprised by the British government's decision to make Levonelle available over-the-counter.
"Schering had been in talks with the British Department of Health for some time and were concerned. As in, what were the government going to do? Sell it in vending machines?" says Eugene O'Connor, manager (female health) with Schering in the Republic.
If women are encouraged to use the morning-after pill as their only means of contraception, they may be missing out on important advice concerning long-term, reliable contraceptive use, sexually transmitted diseases and so on. This is why the British government will only allow specifically trained chemists to sell the drug, but this has not satisfied a conservative lobby within the UK.
Family and Youth Concern in the UK has condemned emergency contraceptives as "promoting promiscuity and encouraging a lack of meaningful relationships". It argues: "the only way to stop unwanted pregnancies is to teach younger people the need to have timely and protected sexual intercourse in loving relationships".
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