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Parliamentary Debate on Emergency Contraception (Cont.)

Prescription Only Medicines (Human Use) Amendment (No. 3) Order 2000

House of Lords

Baroness Young
rose to move, That an humble Address be presented to Her Majesty praying that the order, laid before the House on 12th December, be annulled.

The noble Baroness said: My Lords, I think that there has been some misunderstanding about the order and my purpose in tabling a Prayer against it. Therefore, let me start by saying what I am not against.

The Prayer is not against the principle of prescribing the morning-after pill. The pill has been in existence since 1985, although in its present strength for only a short time. It is currently available on prescription from GPs, 1,300 family planning clinics and a great many hospitals. Indeed, last year some 800,000 morning-after pills were supplied.

If my Prayer is carried this evening, the law will remain as it was before 1st January this year. My concern in tabling the Prayer is that pharmaceutical chemists will be able to sell the morning-after pill over the counter to women aged 16 and over, and that it will inevitably be bought by girls under the age of 16.

I am not in any way against the principle that pharmaceutical chemists ought to be able to prescribe a wider range of medicines and so help the community at large and take some weight off GPs and the NHS. As proof of this, perhaps I might add a personal note and say that my father-in-law was a pharmaceutical chemist, as were his two brothers. They must have been good at this work as, between them, they won two gold medals and one silver medal from the Royal Pharmaceutical Society. I therefore see pharmaceutical chemists as a very important part of the health provision of our country, and I have on more than one occasion been very grateful for the help given to me by the local chemist.

My concern about the order is twofold; the first constitutional, and the second in principle.

The order is introduced under the negative resolution procedure, the weakest of all parliamentary procedures. The order was laid before Parliament on 12th December 2000. It must lie on the Table for 40 days after publication, before it becomes law, in order to give an opportunity for debate. In this case, the Government brought the order into force on 1st January, although the 40 days do not expire until 4th February. This order has been brought in, therefore, without any proper parliamentary scrutiny or debate. The debate in the committee in another place was on 24th January and it is in your Lordships' House today.

There was a time when the Government talked about the importance of openness and transparency, but this, if I may say so, is an example of trying to bypass Parliament on an issue of great importance to a great many people, without discussion.

On a separate but related issue, an important order was laid on 17th July last year. I refer to the Prescriptions Only Medicines (Human Use) Amendment Order 2000. Under that order, the Government made it possible for the morning-after pill to be distributed free by school nurses and some other health professionals. Under this order it is also possible for chemists to dispense the pill free to girls under the age of 16 where the local health authority has made an appropriate patient group directive.

I suspect that few have heard of this order, or whether or not a patient group directive applies in the area where they live.

Clearly, this is an issue of great concern to parents. This order, however, was not debated in Parliament because it was a general enabling power for health authorities. However, it had wide implications: it makes the pill available to girls aged 16 and under. My point in raising the issue is that it makes much more important the debate on the order before noble Lords this evening.

The second constitutional point is that the order applies throughout the United Kingdom. In Northern Ireland, the age of consent is 17, and the order would appear to conflict in law with that part of the United Kingdom by stating that it will be available to girls at the age of 16. I appreciate that the order was signed by the Northern Ireland Minister, Bairbre De Brun. It would, however, be helpful to know whether the order has the full support of the Northern Ireland Assembly and what the position is in that part of the United Kingdom.

I turn now to the principle. I have often been accused in the past of being concerned only about boys. That has never been true, but today I am concerned about girls. My concern, as always, is the protection of young people, and 16 year-olds are children in law. I have also said on more than one occasion that all law sends a signal. So what signal does this order send? First, it says that unprotected sex is all right. This is exactly the opposite of what the whole sex education industry has been saying for at least 20 years. It is of course a very dangerous signal because it will increase the incidence of sexually transmitted diseases.

The Department of Health's document, National Sexual Health and HIV Strategy, states:

‘Virtually all the sexually transmitted infections (STIs) are increasing. The number of attendances at departments of genito urinary medicine/sexually transmitted diseases now totals 1 million per year, a doubling over the last decade ... Chlamydial infection seen in clinics has risen by 21 per cent between 1996 and 1997, and a further 13 per cent from 1997 to 1998 (latest figures). Population surveys have reported rates of chlamydia as high as 20 per cent, particularly in young women. There has been no reduction in the annual number of new diagnoses of HIV made, and the latest annual figures (1999) saw the highest number of new HIV diagnoses ever recorded’.

I, for one, think that we should take those figures very seriously.

The Government's Teenage Pregnancy White Paper quotes a boy as saying:

 ‘I have used a condom, but I don't like it. It puts you off. What's the use of having sex if you don't enjoy it?’

The pressure will be on for the morning-after pill. In other words, it will be an encouragement to unprotected sex.

Secondly, promiscuity will be encouraged. Everyone, including GPs, health authorities and now chemists, and, as I have already mentioned, nurses and youth workers, will be making the morning-after pill available to young girls. One can picture the scene. The boy will say to the girl, ‘why not; you can take the morning-after pill?’ The girl will think: ‘Why not? I could take the morning-after pill and be all right.’ The consequences of sleeping around will be thought to be dealt with by the pill. I am sure that this is not what the Government will say because this is not intended.

As I have discovered, there is no difficulty in getting an ID card. Teenage magazines are full of advertisements showing how to obtain one. Not only will the chemist not know the true age of the girl, but he or she cannot consult the girl's GP and find out anything about her medical history. I heard only this morning of the case of a 14 year-old girl getting the pill from a chemist in Newcastle. I think that we should take this situation very seriously. We are saying that young, under-age girls, can buy for £20 a very strong pill, and the chemist can supply it without knowing anything at all about her medical history.

It is, I believe, disingenuous to say the least, as Yvette Cooper did in another place on 24th January at col. 6 of the committee's proceedings:

 ‘It is an offence under the Medicines Act 1968 for pharmacists knowingly to supply the product to women under 16. The chance of the measure having the effect of increasing the amount that young women use emergency contraception is highly unlikely’.

On what evidence did she base that statement? It certainly flies in the face of all experience. I hope that the Minister will tell us more.

That further development means that girls can obtain the morning-after pill without the knowledge of their parents. That undermines family life. How many of us would like such medicines to be given to members of our family without our knowledge? In many cases, the current approach ignores the wishes of parents and of many religious people, especially Muslims, who have made very strong representations to me on this matter. They are greatly concerned about the effect of such provisions on their family lives and on their girls.

I was interested to hear that Superdrug was selling the morning-after pill on the Internet as recently as last Friday. I also heard that the Department of Health had asked Superdrug to withdraw it. I understand that the company will resume the scheme after a clarification of the guidelines by the Royal Pharmaceutical Society. However, what Superdrug was doing is perfectly legal under the order. If it is agreed to, the home delivery service of the morning-after pill will start again, and the drug will be even more readily available to young girls.

The Government want to halve the number of teenage pregnancies by 2010. Currently, 90,000 teenage girls become pregnant each year, of whom 8,500 are under 16. That is a tragedy for the girls and the babies. The figure has remained at the same level for the past 10 years, despite the fact that millions of pounds have been spent on sex education and on the provision of advice from clinics and doctors. The same is true of the overall abortion rate, which is higher now than it was in 1990. Those developments occurred despite an increase that is almost in four figures in the use of the morning-after pill. If the order's purpose is to bring down the number of teenage pregnancies, the figures do not suggest that it is likely to be successful.

I want to make a final point. Many people, in your Lordships' House and outside it, have put to me the argument that it would be better for a girl to have the morning-after pill than an abortion. As I have already said, the evidence shows that the more morning-after pills there are, the higher the number of abortions.

What, someone might ask, if a girl has had unprotected sex and is at risk? What would your Lordships do? Give her the morning-after pill, or what? Under those circumstances, I would say that she should go, preferably with her parents--or one of them--to her doctor or a clinic or hospital, because that is a far better and safer route. If she went to her GP, she would go to someone who knew her medical records and her family and who could give good advice. That is far better than going to an anonymous chemist, who would know nothing at all about her. If I were in that position and one of my daughters was concerned, that is what I would choose.

Is the morning-after pill safe? Each treatment, I understand, is 50 times more powerful than the previous contraceptive pill. What adults choose to do is a matter for them but, as I have said before, we have a responsibility to the young. The order is one more example in a series of provisions that give unsound and wrong advice. There are very few parliamentary opportunities to take a stand as a matter of principle and to help the young. This is one, and I believe that we should take it.

Moved, That an humble Address be presented to Her Majesty praying that the order, laid before the House on 12th December, be annulled (S.I. 2000/3231).--(Baroness Young.)

The Earl of Longford: My Lords, we are undoubtedly faced with a difficult decision. Good men and women can be found on both sides of the argument.

Like others, I have received many unsolicited briefings from people on both sides of the argument. Those who support the Government's policy strongly suggest that the number of teenagers with unwanted pregnancies will diminish. On the other hand, it is argued with equal strength that adultery and fornication will increase. No one can predict exactly what will happen or how far the evils in question will be apparent. If we had to choose between reducing the number of teenage pregnancies and reducing the occurrences of fornication and adultery, I know which I should choose. I know that some Christians will disagree with me, but I cannot imagine how a Christian could think that adultery and fornication were the lesser evil. However, that is a matter of opinion--this is a free country and we sit in a free House.

We have a Government who contain five Christian socialists. To that extent, they are, potentially, the most Christian government in my time. I should add, although the Government may not welcome such comments from me, that this is the best government we

have had in my time, except for the government over whom Lord Attlee presided between 1945 and 1950, who were equally good. The present Government are very successful and get things right 90 per cent of the time. Just occasionally, they get things wrong, and it is the duty of candid friends to say so. I could not possibly vote for a policy that would make fornication and adultery more likely--there is quite enough of it already.

Baroness Gould of Potternewton: My Lords, I rise to oppose the Prayer and to support the order which will allow emergency contraception to be sold over the counter to women who are over 16. I must, however, declare an interest as the president of the Family Planning Association.

The noble Baroness, Lady Young, concentrated some of her remarks on the need to protect young girls and to reduce the number of teenage pregnancies, which of course are important. I fully support the need to protect young girls and to reduce the number of teenage pregnancies. I shall return to that later.

The order was introduced to reduce the number of teenage pregnancies, but it is more about providing access to emergency contraception for mature and older women, and I shall concentrate my remarks on that.

There is a presumption that it is wild, immature young women who will need emergency contraception. In truth, it is mature women in stable relationships--women in their mid or late 20s--who are most likely to wish to prevent an unplanned pregnancy and who need access to the morning-after pill. All the professional bodies support the order as part of a national strategy to reduce the number of unwanted pregnancies and abortions. That view is supported by organisations that are involved with public health and family planning, by community and hospital pharmacists and by the majority of the adult public.

One might argue, as the noble Baroness did, that the fact that we can obtain emergency contraception from GPs, family planning clinics, NHS walk-in centres and some hospital and A&E departments makes its sale in chemist shops unnecessary. However, easy access is absolutely essential.

For emergency hormonal contraception to be effective, it is essential for it to be taken with some speed. It is 95 per cent effective if taken within 24 hours, 85 per cent effective if taken within 25 to 48 hours and only 58 per cent effective if taking the drug is delayed to between 49 and 72 hours.

Time and again, women call the Family Planning Association helpline saying that they have rung their doctor but cannot get an appointment within the 72-hour period, that they have not been able to get time off work to see their doctor or that they were embarrassed to discuss the reason that they needed an urgent appointment with the doctor's receptionist. Women often ring the helpline in tears of frustration and despair. A woman who has had unprotected sex, or whose regular contraception has failed, knows that speedy access to emergency contraception is key to preventing an unplanned and unwanted pregnancy. Those calls for help account for about one-fifth of the calls to the helpline. That is particularly true on a Monday or after a bank holiday. But these women or men--men also ring for advice--are not irresponsible, reckless or promiscuous. They are acting responsibly in trying to prevent an unwanted pregnancy in a world where there is no 100 per cent safe method of contraception and where human beings are fallible.

Allowing EHC to become available directly from Britain's 12,000 pharmacies has many advantages which should not be lost. Women will be able to buy it conveniently, at weekends and when GPs' surgeries are closed, and without embarrassment in an area out of earshot of other customers. Most importantly, it will increase the chance of access to advice from professional pharmacists and will limit the number of unwanted pregnancies and abortions.

I want to comment briefly on the point raised by the noble Baroness, Lady Young, in relation to teenagers. No one would deny that it would be preferable for teenagers to delay having sex. But surely it is also preferable to prevent pregnancy rather than to refuse help. We must accept the reality that one-quarter of teenagers will be sexually active before their 16th birthday. A recent survey in Scotland showed that that is true for 35 per cent of girls and 30 per cent of boys.

My view is that the social and psychological impact of an unwanted pregnancy far outweighs concerns about the morality of prescribing emergency contraception. The noble Baroness, Lady Young, also raised that point and related it to the question of abortion. I want to refer to the remarks of Dr Trevor Stammers, spokesperson for Family and Youth Concern. He made it clear that, although a school's sex education policy should have as its basis providing assistance to young people to resist the pressure to have sex, the morning-after pill is the lesser of two evils--rather the pill than the trauma of a possible abortion.

The noble Baroness, Lady Young, is wrong to believe that providing emergency contraception will tempt young people to try sex for the first time. By the time it is prescribed, sex has already taken place. Voting against the Prayer will in no way prevent teenage pregnancy; a vote in favour will.

After going through all the proper procedures, the Committee on Safety of Medicines and the Medicines Commission have advised that taking the morning-after pill is safe and effective and does not constitute an abortion. Medical care is about providing the right support and the right medication at the right time. That is exactly what emergency contraception provides. It provides a useful avenue of accessibility for women and teenagers, and its use is highly responsible in the face of a potential, unwanted pregnancy. Voting for this Prayer tonight will deny many women the right to take that responsible action. I urge noble Lords to vote against it.

Lord Moran: My Lords, I listened very carefully to the eloquent case made against the prayer by the noble

Baroness who has just spoken. However, I am afraid that I am not convinced. The government official in Nigeria--the father of Damilola Taylor, the boy who was murdered not long ago in Peckham--spoke three days ago of a breakdown in moral values in Britain. I am afraid that he may be right.

Week after week, we in this House are faced with government proposals for sexual licence: Section 28, the reduction in the age of consent, and now this. Clearly, the Government are helping to create the climate of permissiveness which is bringing about the breakdown of which Mr Taylor spoke.

The selling of the morning-after pill over the counter by chemists seems to me to be a mistake. Although it may, if used soon enough, protect against pregnancy, it does not protect against sexually-transmitted diseases‑genital warts, chlamydia and gonorrhoea, among others‑which may lead to HIV or cervical cancer. Inevitably, it will lead to an increase in unsafe sex and will give the green light to ‘sleeping around’, resulting in a substantial increase in the already very high level of promiscuity.

The drive to provide explicit sex education at ever-decreasing ages and the availability of the morning-after pill on prescription for the past 10 years have not succeeded in improving matters. Abortion rates have not been reduced, and teenage pregnancy rates in this country--already the highest in western Europe--continue to rise.

It is surely very unwise to allow pharmacists to sell this pill to women. They are not allowed to consult the doctor concerned; they have no access to medical records; nor can they check the age of girls who seek to buy the pill. I gather that the pill should not be taken by women who are or may be pregnant, have high blood pressure or heart disease, or have had a stroke or breast cancer. Pharmacists often cannot know whether those who come to them fall into any of those categories. Therefore, risks to health will multiply. Meanwhile, doctors cannot know how often their women patients have used the pill. That can seriously affect decisions about medical treatment and be dangerous to the women concerned.

The selling of the morning-after pill over the counter gives the green light to ‘sleeping around’ and will result in a substantial increase in the current level of promiscuity. For those reasons, I support the prayer introduced by the noble Baroness, Lady Young. I am sure that she is right.

Baroness Walmsley: My Lords, I must confess that the speech of the noble Baroness, Lady Young, leaves me somewhat puzzled. I believe that I live in the real world. In the world where I live, people of all ages have sexual relationships. In the world where I live, these days most couples take responsibility for their own fertility. They take advantage of the fabulous advances which have occurred in medical science over the past 50 years and use the hormonal and barrier products which ensure that, when they have a child, it is a wanted child. Surely that is what we all want: that every child is a wanted child, born into a home where it will be loved and looked after properly.

However, in the real world where I live, things sometimes go wrong with the normal methods of contraception used by responsible people. Condoms split or come off; women forget to take their pills; or they may be sick and lose the pill. Human being are not perfect. In those situations, surely a responsible, mature woman must not be condemned to bear a child which she does not want simply because she cannot obtain the help that she wants easily and readily. Of course not.

In the real world where I live, young people are very street-wise. Although there are shortcomings in our provision of sex education, most young people know that if they have unprotected sex they are in danger of pregnancy and infection--dangerous infections which can kill. Fortunately, every woman who is in a sexual relationship today can readily obtain contraceptive advice and treatment without undue cost.

But--and this is a big ‘but’--people sometimes behave under the influence of powerful chemicals which can interfere with their normal good judgment. No, I do not mean alcohol, Ecstasy or any similar drug; I refer to testosterone and oestrogen. Those chemicals are incredibly powerful and are particularly plentiful when young people may not yet be used to their effect. Therefore, should we be trying to punish women of all ages who suspend their normal good judgment or have an accident by forcing them to bear children they do not want by taking away the help that they need? That would be the effect of the proposal of the noble Baroness, Lady Young, if it were carried today.

We have heard that we in this country have the highest rate of teenage pregnancy in Europe. How can that be when we have sex education and free family planning facilities? We seem to have done everything to inform, advise and supply treatment, yet still these tragedies happen. Well, we have not done quite everything. One thing we have not done is to make provision for the accidents, the unplanned errors of judgment and the coercion and abuse situation--until now. Now we have a weapon which should help so long as it is made easily available at no undue cost.

In doing so, we may also be able to reduce the number of abortions. Recently, evidence has been published showing that 90 per cent of pregnancies that were terminated could have been prevented by emergency contraception, and 70 per cent of women seeking abortion would have used emergency contraception if they had known about it and known where to obtain it quickly.

Some people who oppose the availability of this medicine over the counter believe that it may lead to irresponsible attitudes to sex. This is nonsense. Those who say so have not done their homework. Recent studies have shown that only four per cent of users wanted the product more than twice a year.

It is obvious to any woman why that is. Frequent use will disrupt the normal pattern of periods and there is nothing women hate more than periods that have gone haywire. It drives them mad; it cramps their style. If we do not know that, the advertisers of sanitary protection certainly do because they base their advertisements on the fact. Women who acknowledge they are at risk of an unwanted pregnancy and take action are to be commended, not stigmatised. They deserve the safeguards which have been put in place by the Government.

There is one more thing we could do, and I wish we would. We could stop talking about sex as if it were some terrible immoral activity that causes untold harm to society and start accepting it as normal human behaviour, we should learn to discuss it with our children openly, frankly and without embarrassment. As long as it is something hidden and ‘naughty’, children will want to do it. And they may want to do it before they are ready for it, understand it or are prepared to deal with its consequences. What we should be doing today is saying to the Government, ‘Well done, keep going, extend the arrangements that make the product free to those for whom cost might be a barrier to getting help.’

I welcome the checks on pharmacies carried out recently by some members of the press to ensure that pharmacists are following the guidelines. But I have to say that it is much more of a tragedy for a 15 year-old girl to have a baby than to have a pill that she should not have had. These tests, one hopes, will put pharmacists on their mettle and ensure that they follow the guidelines conscientiously. None of them wants to be exposed by the Daily Mail. I also welcome the fact that Superdrug has shelved the idea of selling the product over the Internet. The safeguards and advice available through this method are just not good enough.

One of the most important aspects of advice given by pharmacists and nurses is that unprotected sex can lead to dangerous infections as well as pregnancy. Most young people know this very well and take appropriate precautions. However, there is no evidence that the availability of this product will make women so careless of their own health that they will take dangerous risks.

What is important now is that the properties and availability of this product are made part of an integrated sex education programme for both adults and schoolchildren which informs but does not judge, which protects but does not control, which understands but does not patronise.

The Lord Bishop of Southwark: My Lords, I can well understand the desire of the noble Baroness to prevent pharmacists selling the morning after pill over the counter. She has marshalled powerful arguments for her viewpoint. These stem from her deep humanitarian and religious sense of values and her concern for the welfare of young people.

The Church shares these values. There is no doubt that the gift of sex is a precious gift of God, to be used within a loving marriage relationship. That is what we teach, have always taught and will continue to teach. However, that teaching is not always heard and, if heard, is not always accepted. Sexual intercourse is not confined to the marriage partnership and while, in these enlightened times, many might say that what adults do in their private lives is a matter for themselves alone, some of the figures concerning teenage sex must surely concern us all. Your Lordships are well aware of them, and they have been rehearsed this evening: the worst teenage pregnancy figures in Europe, appalling rates of teenage abortions and young teenage mothers, no older than children themselves sometimes, struggling to bring up a baby while losing education and training opportunities, being trapped into a spiral of poverty which gives the worst possible start in life for the new infant.

How are we to respond? With this debate in mind, I consulted one or two teachers of teenage children in our inner city secondary schools. In their view, some teenagers will engage in sex and some will not. Those who will not have taken that decision because they respect what they have been taught by home, church or school. Or they will not because they believe that in the future they will have a happier and more loving relationship because sex is special and it will have a special place in their lives.

In my view, these young people are right. I wish that all teenagers believed and acted like them. Of course we should all do what we can through our teaching, our preaching and our parenting to strengthen their resolve and spread it to others. However, popular culture is against us. Judging by much of the media, sex is compulsory for all, at any age. So it is not surprising that another group of teenagers do indulge in sex from time to time. We may preach against it, and we do; we may teach against it, and we do; but it goes on happening.

The question then is: do we make the best the enemy of the good? The best is sex within marriage. The good is surely to enable all teenagers, even foolish weak-willed teenagers, to survive their teenage years without the burden of an unwanted baby, pregnancy or abortion. The availability of contraception has surely saved many teenage girls from this fate. I know there are those who believe that the availability of contraceptives has encouraged teenage sex, but that is not a universal view. The teachers I talked to believe that without contraceptives we would see an increase in unprotected teenage sex, with a consequential increase in pregnancy.

Many people view the morning-after pill as an emergency form of contraception--emergency because regular use might well bring health problems; emergency because the pill is expensive, certainly to the teenage pocket. But the one-off use of the pill might save a one-off abortion or a one-off birth of an unwanted child. Thirty-three community pharmacists in the health action zone where I live in south London have been involved in a pilot project testing out the procedures in the new order. The project has been part of a strategy for reducing unintended young pregnancies and it is reported that the response has been almost universally positive. It has proved to be the case that the pharmacist's is a less threatening place for some vulnerable young women to approach than the doctor's surgery or clinic.

There is no question that we must strengthen long-term methods of teaching morality, developing good sex education for boys and girls, and increasing hope and choices for girls in areas of deprivation. All these things we must continue to do, but in the meantime the morning-after pill provides an emergency last resort for those who have fallen through the sexual net. I believe it is right for us to be very uneasy about the right way forward in this debate. I, for one, am uneasy for I certainly do not believe that all the moral arguments are on one side. But speaking for myself, I believe that unwanted teenage pregnancies are such a great evil which blights lives that we must not let the best be the enemy of the good. So, with regret, I shall not be following the noble Baroness into the Lobby tonight.

Lord Davies of Coity: My Lords, it is well known in the House that I supported the noble Baroness, Lady Young, when she opposed the promotion of homosexuality in schools and we had a debate on Section 28. I spoke and voted in this House not to allow a reduction in the age of consent of homosexuality. But in all honesty I cannot support the proposition that has been put forward this evening. Of course I will support measures that I believe will reduce promiscuity. I will certainly support, as indeed we all will, any measure that reduces the transmission of sexual diseases. But I cannot accept the proposition that the taking away of a measure after the event somehow controls what happens when the event takes place.

The measure proposed by the Government is twofold: to prevent unwanted pregnancies and to prevent more abortions taking place; that is, to prevent the kind of things none of us wants to happen. We want to see family relationships established and built considerably. However, I cannot see how such relationships, those between teenagers and those between parents and teenagers, can in any way be conditioned by not having the measure of the morning-after pill. The reasons for the measure are sound and good. I believe that the House should vote against the proposition of the noble Baroness.

Lord Patel: My Lords, I speak in support of deregulation of progesterone-only Levonorgestrel emergency hormonal contraception. I speak on the efficacy of this pill as an effective contraceptive and not on any procedural or constitutional issue. I had rather a long speech. However, it was considerably shortened after I listened to the notable speech given by the noble Baroness, Lady Walmsley. I cannot but agree with just about everything she had to say. She spoke as a teacher. I speak as a gynaecologist who has seen many unwanted pregnancies.

There are many reasons why this deregulation measure is necessary, not the least of which is as one of the many measures needed to reduce the rate of teenage pregnancies in this country. We heard about the high rate of unwanted pregnancies which end in termination in the United Kingdom compared to the rest of the western world, except the United States. There were 173,000 in England and Wales alone in 1999.

Evidence from smaller studies carried out in Scotland suggests that in women between the ages of 16 and 29 who take emergency contraception, the rate of unwanted pregnancy has been reduced. Larger studies are currently being conducted. The progesterone-only pill, Levonorgestrel, works by delaying ovulation and preventing fertilisation. It is not an abortifacient. The pill is safe and effective. I do not know what the noble Baroness, Lady Young, meant when she said that the pill is 50 per cent more powerful. It is certainly 50 per cent more effective.

In trials which have been reported, including those by the WHO, few complications have been reported, nausea and vomiting being the main ones. That, too, has been in far fewer women compared to those using the combined emergency contraceptive pill. No serious complications have been reported. There are practically no contraindications. In trials reported by the WHO, the rate of pregnancy was 1.1 per cent among the progesterone-only pill group. The effectiveness of the pill relates to the time of taking it following unprotected intercourse. The noble Baroness, Lady Gould, stated the correct figures, as reported by WHO. There has been a 95 per cent success rate in terms of avoiding unwanted pregnancy if the pill is taken within 24 hours of unprotected intercourse. That is the crux. The sooner the pill is taken after intercourse, the more effective it is. If taken inappropriately, or if pregnancy occurs, the trials reported no adverse foetal outcomes.

Therefore, the pill has to be easily available. Making it available only through general practitioners, family planning clinics, A&E departments of hospitals or even patient group directives--not all of which are funded for this--will delay women receiving the pill. Despite the low levels of complications reported, the Royal Pharmaceutical Society has issued guidance to pharmacists.

Concern has been expressed that women will use the emergency contraceptive pill as regular contraception or that there will be an increase in sexual activity in young people. As we have heard, and I concur, neither of those concerns is borne out by the evidence. The age group with the highest incidence of the use of emergency contraceptive pills is that between 20 and 29. The lowest incidence is in the group aged 16 to 19 and below 16. Evidence from trials in other countries and in the Lothian area of Scotland does not suggest repeated use of the pill. A small number of women used emergency contraception on more than two occasions in a year. Couples who normally rely on other forms of contraception, such as the pill, the inter-uterine contraceptive device or condoms, may, for a variety of reasons, need to use the emergency contraceptive pill where there is a risk of failure of the usual form of contraception.

In such situations, emergency contraception offers women peace of mind from unwanted pregnancy. Levonorgestrel is the safe choice. However, I agree that the cost of obtaining the pill from pharmacists, nearly £20, half of which I understand is the cost of the pill and half the dispensing cost, may reduce its use. It is interesting to note that the cost of a similar product in France is equivalent to £5. But that is no reason for us to stop Levonorgestrel being available through pharmacists. The progesterone-only emergency contraception pill, taken in 0.75mg tablets, 12 hours apart within 72 hours of unprotected intercourse, is safe, effective and free from complications. I hope that it will help to reduce the incidence of unwanted pregnancies. Anything that we can do to make it more easily available has to be good.

It is interesting to read the editorial comment in the New England Journal of Medicine, a prestigious medical journal. The conclusion states:

 ‘Making emergency contraception more easily obtainable does no harm and may reduce the rate of unwanted pregnancies’.

Lord Elton: My Lords, I rise first to assure the noble Baroness, Lady Walmsley, that my noble friend Lady Young lives in the real world. I have often met her there and she speaks from it, from a wealth of experience gathered in many ways, particularly as a parent and grandparent.

I find this a difficult and sad debate. There are genuinely important considerations in both directions. One cannot simply rely on habit or friendship when making up one's mind. However, considering the context in which we hold it, I am saddened by the change in the attitude to love which has taken place in the past half-century and the relationship between sex and love. That relationship is central to a healthy society. If we divorce the two, we revert to the animal. If we ally the two, we move towards the human and the spiritual. I am sorry if that leaves some of your Lordships completely baffled. To me, it is real and important.

I am troubled by the fact that the Government have shown so little willingness to offer what I would regard as common-sense moral advice. They are happy to tell people that it is wrong to smoke, and the consequences of so doing. They are happy to tell people that it is wrong to drive and drink, and the consequences of so doing. But nobody has said that it is wrong to take the risk of siring or begetting illegitimate children. The purpose of the sexual mechanism in the human race is to produce children. That is completely forgotten in most of our contemporary literature and contemporary films. It is seen as an end in itself. My noble friend referred to a child who asked, ‘What's the point of having sex if it isn't fun?’ The answer is that it is tremendous fun but that is not the end purpose. The end purpose of it is to have children within marriage; and if we stop doing that, we stop having a viable society. Therefore, there is a political as well as a spiritual priority and I deeply regret the Government's reluctance to see that, to take it on board and to give moral as well as medical advice.

I hope that the noble Lord will not disappoint me by failing to offer such advice in the context of his reply. If the issue is treated purely as mechanical and medical, I shall find myself unable to go other than with my noble friend into the Lobby. If he can tell us that it is about something else, I shall find it much more difficult to accompany her.

Lord Carlile of Berriew: My Lords, I wish that like some noble Lords who have spoken in favour of the Prayer I was confident in the belief that I had a special insight into the conscience of the nation. I do not claim that credential for speaking in this debate. However, I claim two other credentials. The first is the special misfortune during the past 30 years of having appeared all too frequently in cases involving the deaths of babies who were virtually condemned to death when they were conceived in haste. The second is the much happier credential of being the parent of three adult women.

Some parents, unlike me and many of my friends, may have been extremely lucky. Their daughters may have passed seamlessly from the age of reason to the age of responsibility. But I do not believe that that is the general experience of many of us. We must protect our daughters and the girls of this country by the best means available, combining good moral sense and good medical science.

There is a moral issue which concerns me greatly. I start from the viewpoint that in this country there are far too many abortions of viable foetuses well embarked upon gestation. My observation and understanding is that abortion is physically and emotionally a potentially disturbing experience for almost all who undergo the process and that for many it is a completely ruinous experience which affects and damages for them for the rest of their lives.

Wherever it is realistically appropriate to avoid abortion, abortion should be avoided. I do not accept for one moment the proposition put by the noble Baroness, Lady Young, that the use of the morning-after pill prescribed by pharmacists will increase the number of abortions. That seems a completely perverse misuse of logic.

Another moral issue seems to me to be held in the answer to the following question--

Baroness Young: My Lords, I am sorry to interrupt the noble Lord and thank him for giving way. The point I made was that although more than 800,000 morning-after pills were supplied last year, the number of abortions has risen.

Lord Carlile of Berriew: My Lords, the noble Baroness will know that the sexual habits of young people are complex issues. I know of no research material which suggests that the availability of such a pill over the counter from a properly regulated pharmacist will do anything other than reduce the number of abortions.

However, another important moral issue seems to me to be held in the answer to the following question. Are we prepared to respect women of 16 and upwards as the custodians of their own bodies, in the absence of a paramount public interest to the country? After all, girls of 16 may lawfully have sexual intercourse, so why should they not control the consequences of that sexual intercourse? They can purchase contraceptive devices before they have intercourse, so why should they not purchase a contraceptive device, as the noble Lord, Lord Patel, described it, after they have had intercourse--because that is the scientific way in which it works? They may even marry lawfully at the age of 16.

It seems to me that to allow young women the option offered by the order is both consistent and logical in giving women greater custodianship of their own bodies. That is particularly so, as the scientific advice is clear, because the new morning-after pill is far safer than its oestrogen-strong predecessor. Furthermore, let us not forget that the Royal Pharmaceutical Society, which is an extremely responsible professional body and regulator of its profession, has introduced and will enforce stringent professional standards concerning the supply of these pills.

It has also been suggested by some noble Lords that this order--this change in the law--will lead to more casual sex by the over-16s. I am afraid that that view beggars reality. That particular horse bolted years ago! Appalled as I am--and I genuinely am--by the sexual content of many teenage magazines aimed at girls--I recall an occasion when my wife went around the house throwing out every one she could find because of its content--I believe that one must recognise the truth of their content. They are no more than a reflection of their readership's life and times. However uncomfortable are the facts of life for older teenagers, the life of facts is that most teenage girls are sexually active before they reach the age of legal consent.

The noble Baroness, Lady Young, spoke of the desirability of dealing with these issues by girls going with their mums, or possibly their dads, to see their nice GPs who knows the family history. I have to ask the noble Baroness whether she has looked at the demography of this country and at the lack of interest of some parents in what happens to their children. I ask with great respect to the doctors in the House whether the noble Baroness really believes that one can rely on the wisdom of every general practitioner in this country to aid that process. The truth of the matter is that, as regards young women over the age of 16, now that the science is safe these matters are surely best left in their hands.

The order recognises changes in science and in society. I hope that this House will not thwart that recognition.

Baroness Massey of Darwen: My Lords, I shall speak but briefly today. However, I am extremely concerned about the issue. I believe that anyone who is concerned about abortion rates and about unintended pregnancies producing unwanted children, cannot support the noble Baroness, Lady Young, tonight. I shall not concentrate particularly on young women but on women in general, for it affects them. ‘Emergency contraception’, to give it its correct title, is not an encouragement to promiscuity; it extends a woman's choice of whether or not to risk pregnancy in emergency. I emphasise the word ‘emergency’. Emergencies happen; condoms split and people have unprotected sex whether or not that is wise or responsible. Pharmacies are convenient and accessible, as was stated by my noble friend Lady Gould. People go to their pharmacy for advice and service for many items. It is not always easy to get to a doctor or a clinic. Your Lordships have heard the medical evidence described so clearly by the noble Lord, Lord Patel.

There is no evidence that women are using emergency contraception repeatedly, either in the UK or in France where it has been available since 1999. I stress what other noble Lords have said; that one survey showed that only 4 per cent of women used emergency contraception more than twice a year. That is a small number.

This pill is not an abortion pill, as is sometimes stated. It cannot terminate a pregnancy which has begun. I am not pro-abortion as such. I am pro women having choices about whether or not to have children. Women who make that choice are behaving responsibly, not irresponsibly--and it is mainly women who make the choice. Methods of male contraception are limited; certainly, there are no emergency contraceptives for men.

Who is most likely to use this pill? Not teenagers. The notion that under-16s will line up to pay £20 for this contraceptive in a pharmacy, or that it will be doled out in schools, is ludicrous and untrue. In a pilot scheme in Manchester the average age of women who used emergency contraception was 24, not the under-16s. That is not surprising, given that most unintended pregnancies occur in women aged between 20 and 25, not the under-16s. The average age of first sex in England is 17. Of course some have sex earlier and, unfortunately, become pregnant. Those who avoid having an unwanted child are behaving responsibly, not irresponsibly. Unwanted pregnancy can still result in young women in particular attempting to use dangerous methods to self-abort. None of us wishes to return to that, certainly not parents. Emergency contraception is legally available to the over-16s. Some girls under 16 will obtain it--even when not sent in by newspapers. I doubt that there will be many genuine cases.

I respect principles, idealism and certainly love. There is a good deal of moral advice in the new personal and social health education guidelines for schools. People should behave responsibly. I do not advocate that anything goes as long as pregnancy does not occur. However, to be charitable, I believe that idealism must be tempered with pragmatism and reality. People will continue to have sex and some will take risks or make mistakes. We should do all that we can to ensure that those risks and mistakes do not result in unwanted children. Emergency contraception is safe and extends a woman's choice over her fertility.

A women is unlikely to make much use of this method of contraception, and in the vast majority of cases it will be used by women over 16.

The noble Baroness, Lady Young, has spoken in this House about fighting to the death for principles. I and others will fight to the death to preserve and extend a woman's right to control her fertility. If we remove one possible method--the ability to purchase emergency contraception from pharmacies--we shall not be thanked.

The Earl of Listowel: My Lords, the subject of the Motion last Wednesday was boys growing up without the care of a father. My noble friend Lord Northbourne then stated that,

‘in the age of effective contraception, to conceive an unwanted child is a form of child abuse on the part of both parties’.--[Official Report, 24/1/01; col. 305.]

My noble friend Lord Laming, with all his experience of social services and the care system as a former director of the Social Service Inspectorate, said at col. 313 that,

 ‘every child should be a wanted child ... Adults are free to choose their lifestyles but we must emphasise that this should not be at the expense of defenceless children’.

I respect the concerns of the noble Baroness, Lady Young. I also read with interest the briefing of the Christian Institute. However, their concerns are outweighed by the often appalling consequences of unwanted pregnancies. Children have a strong interest in not being born by default but, so far as possible, only after a deliberate choice. I urge your Lordships to reject the Prayer.

Lord Rea: My Lords, with respect I suggest that the noble Baroness, Lady Young, has fallen into one of the most elementary statistical mistakes. She has related two variables moving in the same direction as if one is the cause of the other. Both can be due to a common cause or each due to a cause that is unrelated to the other. I believe that the noble Lord, Lord Carlile, has made it clear that it is very unlikely that the use of emergency contraception has resulted in an increase in the number of abortions.

Although emergency contraception has been available free on prescription on the National Health Service for 17 years, as my noble friend Lady Massey points out it is not used so much by teenagers as by older women. One reason for it is that teenagers do not want the embarrassment of revealing to a doctor who may well have known them from birth that they are now sexually active. As a general practitioner, I know that that is so in a number of cases. The order will allow a teenager to go to a pharmacist perhaps slightly out of her locality who does not know her. Based on the protocols which have been given to pharmacists, they will be able to provide good advice to teenagers. The evidence is that the fright caused by having to use emergency contraception will result in the subsequent regular use of adequate contraception by those who continue to be sexually active.

Lord Monson: My Lords, I apologise for interrupting the noble Lord, but he said that the order would allow teenagers to go to pharmacies. It will not. The order allows only teenagers aged 16 and over to go to pharmacies. At least four noble Lords who have spoken against the noble Baroness, Lady Young, have deplored teenage pregnancies, so the logic of it is that one must make the pill available to 12, 13, 14 and 15 year-olds as well as 16 year-olds.

Lord Rea: My Lords, one cannot let that point go unanswered. There is a case for allowing pharmacists to make their own judgment in this matter, but they are expected to discover the age of their clients and not provide the drug to girls under 16.

At the moment, 74 per cent of emergency contraception is used by women aged 20 or over, but even there is the deterrent effect the embarrassment of admitting a contraceptive slip-up to their GPs.

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