No fudge is allowed on next-day pill

This is still, at times, a weird country, full of strange ambivalences and outlandish contradictions. When a sign of maturity appears, it is at once obscured by old obfuscations. Just when you think our public institutions are about to catch up with the complex realities of Irish lives, you are pushed back into a morass of crude simplicities.

Last Wednesday, for example, the All-Party Oireachtas Committee on the Constitution published its report on abortion. Everyone who commented on it agreed that it was an impressive document: serious-minded evidence of the ability of our much-derided politicians to make themselves relevant to Irish society.

Whether or not you agreed with its conclusions, the committee had really tried to change the tone of an often hysterical debate about sex, morality, gender and power. Here was a democracy engaged in an adult conversation. Yet next day another arm of the State signalled the continuing power of obscurantism.

One issue to which the report brings a new sense of honesty is the morning-after pill. It quotes evidence from Dr Harith Lamki, a consultant obstetrician and gynaecologist, about the Belfast Royal Maternity Hospital's "very big morning-after pill clinic, which means we have a big reduction in the number of unwanted pregnancies at present". It also quotes the president of the Medical Council in the Republic, Prof

Gerard Bury, as saying that providing the morning-after pill is now "part of normal practice that hasn't been challenged or in fact even addressed within the ethical guidelines".

The committee "attaches importance to the general availability of the morning-after pill". While the Family Planning Act prohibits the distribution of abortifacients, which some people believe the morning-after pill to be, the report suggests this is not a problem in practice. "In as much as the morning-after pill is available and prescribed, the legal presumption must be that it is not regarded as an abortifacient."

NO sooner were these words out than up pops the Irish Medicines Board to say it has advised the makers of a morning-after pill, Levonelle-2, that its drug is an abortifacient. The manufacturers then had no choice but to withdraw their application for a licence to market it here.

Levonelle-2, which is more suitable for many women because of its milder side-effects, will not be available here. What the president of the Medical Council believes to be "normal practice" may indeed be so in the other EU countries where the drug has been licensed. But in Ireland, normality is still a difficult concept.

What's going here is that the official State regulatory agency is effectively siding with conservative pressure groups against mainstream medical opinion. Last year, for example, the Irish College of General Practitioners released an information leaflet on "emergency contraception" for distribution to patients by their family doctors.

It states quite simply that morning-after pills "prevent pregnancy and do not cause abortion". It prevents the implantation of the fertilised egg in the womb and, the leaflet said, "abortion can only take place after a fertilised egg has implanted in the womb".

One of the leading anti-abortion groups, Human Life International, strongly objected to this leaflet. In a letter to The Irish Times, its executive director, Patrick McCrystal, described these statements from the ICGP as "patently misleading".

The leaflet's author "has mischievously indulged in the subtle muddling of definition of the terms `pregnancy' and `abortion' to deceive readers about when life begins. The true abortifacient nature of the drug is denied. This leaflet and the wording it employs is a scandalous distortion in a matter of the most profound sensitivity any woman has to face - the snuffing out of the life of a child in her womb."

Given that Human Life International's conference last year was also told by its guiding light, Father Paul Marx, "the [contraceptive] pill is an abortifacient", its views might reasonably be regarded as extreme. Yet in effectively banning Levonelle-2 the Irish Medicines Board has found that Irish law reflects those views.

Whatever the medical profession, its council or the all-party committee might think, the assumption that the morning-after pill is legal does not apply in the parallel universe of theologically-inspired definitions that our legal system has been saddled with by anti-abortionists.

Fianna Fail's preferred option - "Legislate to protect best medical practice while providing for a prohibition on abortion" - is vastly more complicated than it sounds. "Best medical practice" as understood by doctors is that the morning-after pill is perfectly acceptable in Ireland. Yet the "prohibition on abortion" as understood by the Irish Medicines Board requires the effective banning of a morning-after pill.

AND this isn't just a small technical matter. It arises from a fundamental disagreement about the most basic question: when does life begin? The ICGP believes it begins when the egg is implanted in the womb. But the Pro-Life Campaign and its allies insist it begins at fertilisation. If they are right, then a great deal of "best medical practice" - the morning-after pill, the IUD and some practices necessarily involved in in vitro fertilisation - amount to abortion and must be banned. The Irish Medicines Board's definition of a morning-after pill as an abortifacient shows this is far more than a theoretical possibility.

Even Fianna Fail is going to have to make real choices. It cannot support the Oireachtas committee's recommendations to make the morning-after pill more widely available so as to reduce the number of crisis pregnancies without confronting anti-abortion pressure groups that insist life begins at conception. Whatever about a woman's right to choose, the Government's obligation to choose is not going to go away.

fotoole@irish-times.ie