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
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'
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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.