Comment & Reviews
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
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.
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
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
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".