Emergency contraception
Expanding availability

Dr Jenny Tonge MP asked the Secretary of State for Health what plans he has to make emergency contraception available from (a) community pharmacists and (b) school nurses.

Yvette Cooper MP (Minister for Public health) replied that an application has been received to reclassify levonorgestrel 0.75mg (marketed as Levonelle-2) for emergency contraception from prescription only to pharmacy availability for women aged 16 and over. Public consultation was completed on 30 June. The application has now been considered by the Medicines Commission. If we decide to proceed, an Order will be laid shortly. In addition there are pilot schemes running whereby emergency contraception is issued by pharmacists under National Health Service arrangement using patient group direction. Sex and Relationship Education Guidance issued by the Department for Education and Employment in July this year states that health professionals can provide pupils with specific and up-to-date information about sexual health and contraception. Health professionals can also play an important part in ensuring young people know about their local advice services. The specific role of school nurses in providing services to young people is at the discretion of school governing bodies, in consultation with parents and the school community.
Written answer 20 November 2000

When pregnancy begins

John Gummer MP asked the Secretary of State for Health what recent advice he has taken and from whom on the point at which pregnancy can be said to begin.

Yvette Cooper MP replied that the accepted legal and medical view is that a pregnancy begins at implantation. This has been the policy of successive Governments and is based on advice given to the Department by the Attorney-General in 1983, about the legal position under the Abortion Act
1967.
Written answer 23 October 2000

The impact of emergency contraception

John Gummer MP asked the Secretary of State for Health what evidence his Department has collated on the impact of the morning after pill on the abortion rate; and if he will make a statement.

Yvette Cooper MP replied that a study of self-administration of emergency contraception following advance prescribing has been performed by Glasier et al in Edinburgh. This concluded: 'making emergency contraception more easily available . . . may reduce the rate of unwanted pregnancies.' However, the number of women studied was small and at the present time there are insufficient data to know how availability of emergency contraception might affect outcome measures such as therapeutic abortion rates. It should be noted that fluctuations in the abortion rate may be subject to a number of different factors and it is therefore difficult to attribute any
changes to one intervention or event.
Glasier A, Baird D. The Effects of Self-Administering Emergency Contraception. New England Journal of Medicine 1998; 339: No 1 1-4.
Written answer 23 October 2000

Levonorgestrel

John Gummer MP asked the Secretary of State for Health what plans he has to frame the proposed re-classification of levonorgestrel 0.7 mg as an over the counter product so that it does not contravene Section 58a of the Medicines Act 1968 in relation to its side-effects; and if he will make a statement. Gisela Stuart MP (Minister for Public Health) replied that proposals to widen availability of emergency contraception follow an application to reclassify levonorgestrel 0.75 mg for emergency contraception from prescription only to pharmacy availability for women aged 16 years and over. The application was referred for independent expert advice to the Committee on Safety of Medicines (CSM). In formulating their advice, the CSM carefully considered each of the relevant criteria for prescription control laid down in Section 58A of the Medicines Act 1968. The Committee concluded that all the steps required to safely supply emergency contraception could be successfully completed in a pharmacy and advised that levonorgestrel 0.75 mg for emergency contraception may safely be supplied as a pharmacy medicine for women aged 16 and above. The Committee noted that information on correct use would be provided with the product including any possible side effects and advice on what action to take. The results of a public consultation on the proposal, and the advice of the Medicines Commission, were presented to Ministers for a decision.
Written answer 7 November 2000

Emergency contraception as prescription only medicine

On 12 December 2000, the Government laid an Order before the House, that the Medicines - Prescription Only Medicine (Human Use) Act be amended to allow the sale of emergency contraception in pharmacies, without prescription. After 40 days this will become law, unless challenged. On 18 December 2000, the Leader of the Opposition, William Hague, challenged the Order (known as praying against) using an Early Day Motion (No 120). The Motion, which calls for the annulment of the Order, may be debated in January. If a majority of MPs vote in favour of annulment, the Order will be rescinded. The Early Day Motion has the support of 13 Conservative members.
Statutory Instruments 20 December 2000. EDM 120 18 December 2000

Early Day Motions on emergency contraception

On 12 December, Alice Mahon MP put down an Early Day Motion entitled Morning After Pill. It was supported by 31 Members and reads: 'That this House congratulates the Government on making the morning-after pill available for sale without prescription in chemists to all women over the age of 16 years; and recognises that this will prevent many abortions and unplanned teenage pregnancies.'
EDM 87 12 December 2000

On 13 December, Harry Cohen MP, supported by six MPs put down an Early Day Motion about the cost of emergency contraception: 'That this House believes that the cost of the emergency oral contraceptive known as the morning after pill is too high at the likely price of £20 and that this may deter those who would most benefit from it.'
EDM 113 13 December 2000

Sexual health

Cost to the NHS of sexually transmitted infections

Gerald Howarth MP asked the Secretary of State for Health (1) what the total cost to the NHS was of treating sexually transmitted diseases including in-patient and outpatient treatment and prevention in (a) 1970, (b) 1980, (c) 1990 and (d) 1999; (2) what the total cost was of providing abortions on the NHS in (a) 1970, (b) 1980, (c) 1990 and (d) 1999; (3) what the cost was to the NHS of treating cancer of the cervix and other cervical abnormalities in (a) 1970, (b) 1980, (c) 1990 and (d) 1999; (4) what the cost to the NHS was of infertility treatment in (a) 1970, (b) 1980, (c) 1990 and (d) 1999; and of this, how much was as a consequence of previous sexually-transmitted disease, with particular reference to chlamydia.

Yvette Cooper MP replied that the information requested is not available centrally.
Written answer 23 October 2000

Sexual health and HIV strategy

Sandra Gidley MP asked the Secretary of State for Health if he will make a statement on progress on his sexual health and HIV strategy.
Yvette Cooper MP replied that following the merger of the Sexual Health and HIV Strategies earlier this year, considerable progress has been made with producing an integrated strategy. The strategy will set a programme of action on sexual health and HIV for England.
Written answer 21 Nov 2000

Human papilloma virus

Dafydd Wigley MP asked the Secretary of State for Health (1) what plans he has to introduce human papilloma virus testing as part of the National Cervical Screening Programme; (2) for what reason the plan to pilot human papilloma virus testing for women has been delayed until March 2001; (3) what representations he has received concerning the need for human papilloma virus testing as part of improvements to the National Cervical Screening Programme.

Yvette Cooper MP replied that the National Health Service cancer plan sets out our commitment to introducing new developments to the cervical screening programme. Plans to pilot the new techniques in liquid based cytology (LBC) and human papilloma virus (HPV) testing are highlighted in the plan as the means for informing service improvement. After receiving advice from the National Institute for Clinical Excellence in June 2000, we decided to pilot LBC and HPV jointly. A joint protocol was developed which will provide more useful information and be more convenient for women as a number of tests can be carried out from the same sample. Sites in England have now been chosen and the joint pilot will start in March 2001.
Written answer 21 December 2000

Teenage pregnancy
Teenage pregnancies

Jim Cunningham MP asked the Secretary of State for Health what steps he is taking to reduce the number of unplanned teenage pregnancies (a) nationally and (b) in the West Midlands.

Yvette Cooper MP replied that the Social Exclusion Unit's report on teenage pregnancy, published on 14 June 1999, sets out a 30-point action plan working across Government. It sets out a £60 million package to tackle the issue, and highlights two main goals: reducing the number of teenage conceptions, with the specific aim of halving the rate of conceptions among under 18s by 2010; and getting more teenage parents into education, training or employment to reduce their risk of long term social exclusion. Following the launch of the report, every area in England now has a local teenage pregnancy co-ordinator in place, making a total of 141. Their role is to develop strategies to tackle teenage pregnancy in their area, in consultation with local communities. They will report annually on progress to the Department of Health. £7.5 million has been made available for innovative local projects in the current financial year. The NHS Plan has set an interim target of achieving a 15 per cent reduction in under-18 conception rates by 2004.
New guidance on sex and relationship education was issued to schools in July. A national media campaign began at the end of October, when the first adverts appeared in teenage magazines. The campaign was developed drawing on comprehensive research on what works best with young people. It is aimed as much at boys as at girls. During 2000-01, Government provided funding of over £1 million to the West Midlands to develop local services to prevent teenage pregnancy and support teenage parents. Specific initiatives include a Sexual Health and Drugs Outreach Work (SHADOW) project in Coventry that addresses sexual health, pregnancy and healthy lifestyles for young people. This will link to a one-stop shop, due to open shortly in Coventry city centre, to deliver a number of services such as Connexions, youth information and a general advice and counselling service for young people. A mobile sexual health and advice clinic has been set up in North Staffordshire, enabling young people to access services in youth and leisure facilities.
Written answer 6 November 2000

Sexual relationships

John Bercow MP asked the Secretary of State for Education and Employment what guidance is issued to schools about the approach towards sexual relationships between pupils aged (a) under 16 years and (b) 16 years or above.

Jacqui Smith MP (Parliamentary Under Secretary of State, Education and Employment) replied that sexual relationships involving children under 16 are a criminal offence. Recently published Sex and Relationship Education guidance sets out the procedure teachers should follow if they become aware that a child under the age of 16 is having, or contemplating having, sex. The guidance also explains the benefits of and the reasons for young people delaying sexual activity, and this is backed up by the campaign to reduce teenage pregnancies.
Written answer1 November 2000

School exclusions

Chris Ruane MP asked the Secretary of State for Education and Employment (1) how many female pupils were excluded from school because of pregnancy in England between 1980 to 2000; and if he will make a statement; and (2) if he will list the 10 education authorities with (a) the highest and (b) the lowest percentage rates of school exclusions because of pregnancy;
and if he will make a statement.

Jacqui Smith MP replied that the detailed information requested is not held centrally by the Department. The latest information on permanent exclusions will be published in a Statistical Bulletin, a copy of which will be placed in the Library. The DfEE issued guidance in 1999 to all local education authorities and schools, which made it clear that pregnancy on its own was
not a reason for exclusion from school. In addition to the Government drive to cut truancy and school exclusions, it is also working to cut teenage pregnancy rates and to reduce the social exclusion often experienced by teenage parents and their children. Government is issuing some guidance to help schools to support teenage parents in school and also funding reintegration work in selected LEAs to help girls back in to education after they have had their baby.
Written answer 28 November 2000

International development
Contraception Advice

Laurence Robertson MP asked the Secretary of State for International Development what advice she gives to people in the third world about contraception; and if she will make a statement. Clare Short MP (Secretary of State for International Development) replied that the Government is committed to the principles of freedom and choice in reproductive health services as agreed at the 1994 International Conference on Population and Development, and to the International Development to attain universal access to reproductive health services before 2015.
Written answer 8 November 2000

Contraception

Chris McCafferty MP asked the Secretary of State for International Development if she will make a statement on her Department's contributions to the provision of contraceptives in the developing world. George Foulkes MP (Parliamentary Under Secretary of State for International
Development) replied that Government is committed to the International Development target to attain universal access to reproductive health services before 2015 and has substantial involvement in efforts to ensure women and men in developing countries can access contraceptives and other reproductive health commodities. The recent pledge to contribute an additional £25 million to the United Nations Population Fund, on top of the annual core contribution of £15 million, will help meet immediate and short-term needs, and assure continued access to essential reproductive health commodities, including condoms for family planning and HIV/AIDS prevention, in a number of countries which are facing shortages. Chris McCafferty MP asked the Secretary of State for International Development what representations she has made to other donor Governments about the supply of contraceptives in the developing world. George Foulkes MP replied that the recent pledges by this Department and the Government of the Netherlands, to contribute an additional £51 million to the United Nations Population Fund to help fund immediate and short-term needs in developing countries for reproductive health commodities, is a further demonstration of the commitment of both Governments to the health of poor people. Government will continue to encourage other donors and developing countries to make every effort to meet the rising demand for contraception in the developing world.
Written answer 20 November 2000

Sterilisation

Gerald Howarth MP asked the Secretary of State for Health, how many (a) sterilisations and (b) reversals of sterilisation were carried out by the NHS in (i) 1970, (ii) 1980, (iii) 1990 and (iv) 1999. How many were requested as a result of people getting married or acquiring new partners; and what the total cost to the NHS was in each of those years.

Yvette Cooper MP gave the following information

Data were collected via the Hospital In-Patient Inquiry, which was based on a 1 in 10 sample of discharges and deaths from non-Psychiatric and non-Maternity NHS Hospitals in England.
Written answer 20 November 2000

Northern Ireland assembly

Health and Personal Social Services Bill: Second Stage Jim Shannon MLA spoke on the Bill as follows:
I would also like to address Part IV of the Bill, which has direct implications for the pharmaceutical chemist. I have made it my business to speak to some chemists, and they expressed specific concern that they could be forced to sell, on prescription, the "morning after pill", the PC4. Under this legislation, will chemists be forced to make a moral decision? Some will neither stock, prescribe nor sell this pill. Will the Minister confirm that, under the legislation, pharmaceutical chemists will not be constrained to prescribe? Not enough research has been done on this, and chemists have a real concern that the pill will be taken off prescription and they will be asked to sell it over the counter. Not enough research has been done to determine if the effects of the pill could be detrimental. Following hard on the abortion debate and the overwhelming vote against it, I urge the Department of Health to be cautious towards pharmaceutical chemists who will, generally, refuse to accept any directive or ruling from the Health Department. Will the Minister confirm her position on the PC4 pill?
Bairbre de Brun MLA (Minister for Public Health, Social Services and Public Safety) declined to respond.
23 October 2000

Members in this issue

John Bercow MP. Con, Buckingham
Harry Cohen MP. Lab, Leyton and Wanstead
Yvette Cooper MP. Lab, Pontefract and Castleford
Jim Cunningham MP. Lab, Coventry South
George Foulkes MP. Lab, Carrick, Cummnock and Doon Valley
Sandra Gidley MP. LibDem, Romsey
John Gummer MP. Con, Suffolk Coastal
William Hague MP. Con, Richmond (Yorks)
Gerald Howarth MP. Lab, Knowlsey North and Sefton East
Alice Mahon MP. Lab, Halifax
Chris McCafferty MP. Lab, Calder Valley
Estelle Morris MP. Lab, Birmingham Yardley
Laurence Robertson MP. Con, Tewkesbury
Chris Ruane MP. Lab, Vale of Clwyd
Clare Short MP. Lab, Birmingham Ladywood
Jacqui Smith MP. Lab, Redditch
Gisela Stuart MP. Lab, Birmingham Edgbaston
Dr Jenny Tonge MP. LibDem, Richmond
Dafydd Wigley MP. PC, Caernarfon
Jim Shannon MLA. DUP, Strangford
Bairbre de Bruin MLA. SF, Belfast West