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Opinion, Comment & Reviews
  Sex 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".

Emergency contraception 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 occurred.

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 approachable.

Removing prescription-only 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

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