The Emergency Contraceptive Newsletter
By Ellie Lee
11/12/00

From the New Year, emergency contraceptive pills will be available over-the counter in chemists, it was reported today. From January, those pharmacies with sufficient stocks of emergency contraception will be able to dispense pills to women. The measure, to be formally ordered by the Health Secretary Alan Milburn in Parliament today, has been welcomed by family planning and abortion provision organisations.

Anne Furedi, director of communications for BPAS, Britain's largest abortion provider, said: 'Difficulty in obtaining emergency contraception up to now has been a big disincentive for women to obtain and use it in time to prevent an unwanted pregnancy. Pharmacy provision will make it easier for women to take action to prevent conception when they have had unprotected sex.'
'The Committee on Safety of Medicines is satisfied that emergency contraception is safe and we are delighted to read reports that Government is readying itself to take this step.'

Dr Jenny Tong, Liberal Democrat MP for London's Richmond Park, and former family planning doctor said: 'This is excellent news and long overdue'. 'As a family planning doctor for over 20 years before I came in to Parliament I have campaigned long and hard for women to be able to control their fertility in this safe and effective way'. 'It is not an abortion. It is very safe, and I hope it will prevent many unplanned pregnancies in the future.'

The system of provision will however, be far from the: 'Morning After Pill For Sale on Demand', suggested in the banner headline of today's Daily Mail. As Sarah Boseley, writing in the Guardian, pointed out, The Department of Health and the Royal Pharmaceutical Society, who have drawn up the new guidelines, have done so in such a way as to make what can be considered a simple medical decision 'acceptable to Middle England'. As a result, women will have to have a discussion, akin to a medical consultation, with the pharmacist. The Royal Pharmaceutical Society has agreed that its members will ask women who seek ECP questions about, among things, whether they had unprotected sex. Pharmacists will not be able to supply ECPs to under 16s, and the pills will cost £20, an inflated price which can be interpreted as an attempt to prevent women using ECP as 'regular contraception'.

Opposition from anti-abortion groups has been widely reported. Predictable objections have been raised: Nuala Scarisbrick from Life contended:' This is a disgraceful decision. It is not a contraceptive pill - it works only by destroying human life'. Anne Widdecombe, shadow Home Secretary condemned the decision as morally and medically flawed, arguing that 'it must always be in a woman's best interests to consult her doctor'. Allegations about the negative health effects of ECPs have also been raised by the group Parents Against Oral Contraception. Indeed, so far, the extent to which over-the-counter provision will help or harm teenagers has been central to the debate.

As over-the-counter provision becomes a reality in 2001, hopefully the importance for adult women of being able to access this safe contraceptive more easily will be highlighted (after all, it will only be available to the over 16s). Despite the high profile given to the problem of teenage pregnancy by all sides in the debate, most of those who end up faced with unwanted pregnancy, and seek abortion, are women in their 20s and 30s. For these women, who without doubt are capable of reading pill packet instructions, and regularly buy and use drugs from chemists, easy access to ECPs is a vital step in facilitating greater control over their fertility. They are competent adults, should be treated as such, and should not have to discuss their sexual practices with anyone, including pharmacists, unless they want to. While under the new guidelines, ECP use has not been normalised, let's hope it will be, and that in the future, it becomes as accepted a part of the family medical cabinet as aspirins. Women should be able to buy these pills, no questions asked.

BBC News on-line, Morning-after pill to go on sale, 10/12/00
Sarah Boseley, 'Morning after pill to go on sale', The Guardian, 11/12/00
James Chapman, 'Morning after pill for sale on demand', The Mail,11/12/00.

American Medical Association urges FDA to allow over-the-counter sale of emergency contraception

It was reported last week, that in the US too, pressure is building for ECPs to be sold over-the-counter in pharmacies. According to Kaiser Daily Reproductive Health Report, the American Medical Association's House of Delegates approved a resolution 'without discussion' urging the FDA to allow the sale of the 'morning-after pill' over the counter. The AP/Los Angeles Times reported that the vote came during the organisation's four-day convention in Orlando, Fla.

Lobby groups responded by issuing statements, for and against the AMA position:

In favour:

• Gloria Feldt, president of the Planned Parenthood Federation of America, said, 'We applaud the decision today by the [AMA] to support making emergency contraception available without a prescription. ... But it can't be used if a woman can't get it when and where she needs it. ...This kind of support from an organization with the influence and respect of the AMA will go a long way toward convincing the FDA, and the public, that making emergency contraception available over the counter is the right thing to do'.
  (Planned Parenthood release, 12/5). PPFA Senior Vice President Joan Coombs said, 'This is a wonderful decision by the AMA. This is a terrific resolution. ... [I]t will make [emergency contraception] more acceptable and consumers will demand it.' She also said that widespread use of the drug could prevent 1.7 million unplanned pregnancies and 800,000 abortions per year (AP/Los Angeles Times, 12/6).
• Judy Karandjeff of Planned Parenthood Affiliates of Michigan said, 'Having [emergency contraception] available over the counter would have an impact on thousands of women in Michigan,' noting that Planned Parenthood clinics in Michigan distributed 4,000 emergency contraception kits last year (Trowbridge, Detroit News, 12/6).
• Voters For Choice joined attorneys at the Center for Reproductive Law and Policy to sign the 'Citizen's Petition,' a request that the FDA permit sales of Preven and Plan B over the counter. VFC's founder and Board President Gloria Steinem said, 'Even those who are antichoice should support the availability of contraception. Providing this method over the counter in a normal and natural way is long overdue.' Executive Director Maureen Britell added, 'We believe that the switch of emergency contraceptives to over-the counter status is not only appropriate, but essential to the promotion of public health' (Voters for Choice release, 12/6).

Opposed:

• According to the Washington Times, Secretariat for Pro-Life Activities Spokesperson Cathy Cleaver states that 'proponents of the morning-after pill are misleading the public with claims that it prevents pregnancies rather than causing abortions' (Washington Times, 12/6).
• Renaming the AMA the 'American Medical Aberration,' American Life League President Judie Brown said the 'morning-after' pill is 'more accurately described as morning-after abortion.' She added, 'All deceptive rhetoric aside, the AMA can no longer tout itself as representing sound medical ethics. Abortion is not ethical. It is immoral. It is an abomination. The personhood of the preborn, from the moment of conception, is clearly established by empirical scientific information' (American Life League release,12/6).
• Diane Trombley of Right to Life-Lifespan of Metro Detroit called the AMA recommendation 'dangerous,' asking, 'At what ages will people be buying this? Will parents know about it? Will teens be wise enough to follow instructions?' (Trowbridge, Detroit News, 12/6).
• The Family Research Council said the AMA recommendation 'pushed the [Hippocratic Oath] under the table' when making its decision. FRC Advisory Board Member John Diggs said the AMA 'ignored' issues like the drug's efficacy rate, as it is 'described as 75% effective.' He added, 'The AMA speaks with a forked tongue by even describing this cocktail as 'emergency contraception.' Ambulances do not transport people with lights flashing and sirens blaring simply because they may be four days pregnant.' Diggs added, 'The AMA document freely admits that a major mechanism of the pill is to keep a fertilized egg from implanting. That means conception has already occurred. Doctors, that is an abortion, not a contraceptive' (Family Research Council release, 12/7).

Kaiser Daily Reproductive Health Report, 8/12/00