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  Parliamentary Debate on Emergency Contraception (Cont.)

Sadly, the high cost of the currently available over-the-counter emergency contraceptive Levonelle-2 (which is a well known synthetic progestogen that has been available for a long time and is well out of patent) will deter its use. My local pharmacist tells me that, of the £19.99 that the drug costs the patient, £11.06 goes to the manufacturer Schering, £5.95 to the pharmacist and £2.98 in VAT to the Government. The same product is available on prescription on the NHS but in that case only £5 goes to the manufacturer. The cost to the manufacturer of producing the material is less than £1. My pharmacist suggests, and I agree, that the same sum--£5--should go to the manufacturer whether the product is supplied on prescription or over the counter. The price to the patient will then be reduced to £11.99, which is a more acceptable figure.

The BMA suggests that this contraception should be free in order completely to remove the price deterrent. I doubt that my noble friend will agree to that. However, at least the product is so non-toxic that there is no danger from an overdose, however much people buy it, other than causing irregular periods.

I very much hope that your Lordships will pass this order and oppose the noble Baroness's Prayer. If we are successful in passing the order unamended, I hope that my noble friend will agree to look closely at the question of how the price of the product may be reduced.

The Lord Bishop of St Albans: My Lords, this debate is ostensibly about making available to women a contraceptive in a new way, but I believe that behind it lies not one but a series of moral issues that I should like to try to highlight. If the figures for 1998 provided by the Department of Health can be extrapolated to 2001, by the end of today in this country just under 500 children will be aborted. The weekly figure is 3,290. Every week the equivalent of a large village or small market town filled with children is wiped out.

I find those figures chilling; but I need to add, lest I be misunderstood, that in relation to abortion I am not an absolutist. I can, and do, acknowledge that there are, and will be, situations where abortion may be justified. I certainly would not wish to return to the situation surrounding abortion which obtained before the 1967 Act. Furthermore, I cannot believe that the rate of abortion in this country is in any way morally acceptable. We are rightly appalled by the abuse we see of individual children, but nationally we remain largely silent about the wiping out of villages filled with children week in and week out.

Secondly, I found the debate last week on human embryology fascinating. While the position I took on the subject was rejected by the majority, it was, nevertheless, a huge privilege, and one I shall never forget, to be in this Chamber to listen to and take part in that debate. I want to add some figures from that debate to this one. Between 1991 and 1998 almost one quarter of a million embryos up to the age of 14 days were disposed of as a result of decisions taken in IVF treatment. In that debate I argued that there was a step change going on in the way we human beings now perceive ourselves. I argued, and would continue to argue, that for the moment the utilitarian philosophy in our nation that perceives human life as either a useful or useless commodity has won the day. I shall return to that matter in a moment.

Thirdly, a fortnight ago in this Chamber we had a ministerial Statement about the treatment of corpses in a mortuary chapel in a hospital in Bedford. We were told that an inquiry would be held and that the incident was shocking. I welcome the inquiry; I agree it was shocking.

In this Prayer I have linked three apparently unrelated topics. I have done so deliberately because in each of them it seems to me that we see evidence of a downgrading of the concept that life has sanctity. The powerful Judaeo-Christian concept that we are made in the image of God, which has shaped our society for thousands of years, has now been pushed to the very margins of our consciousness. The sanctity of human life, a concept which philosophically links us as humans to some eternal absolutes, is under such serious pressure that, as a concept, it is being placed in a museum cupboard for inspection in a curiously detached way--forgive the phrase--by generations yet to come. I believe that loss has consequences which we are so far unwilling to face, but which are frightening.

I now confess that I face a dilemma. I have a serious ethical problem with tonight's debate. I am genuinely alarmed by the shifts going on in our society which will lead us to a future where life of any age is seen as mechanistic and where the worth of human life is judged in utilitarian ways. I raise the question: is not involuntary euthanasia found along that very same spectrum? However, in this debate, I am prepared to acknowledge that the morning-after pill may be the lesser of two evils. Better this form of contraception than a steady rise in abortion.

Yet it would be disingenuous in the extreme to suggest that the morning-after pill will have only positive benefits. I suspect that the rise in sexually transmitted diseases will be considerable. I should not like to be the CEO of a pharmaceutical company or a chemist chain when the first litigation arises over what a pharmacist may or may not have said to a young woman who may or may not have been 16 years of age.

Therefore, I find myself absolutely caught. I want to convey very serious concern that the result of well-intentioned legislation is that the sanctity of life is being eroded at a dangerous pace and with potentially dangerous consequences. At the same time, I cannot but agree that the morning-after pill is the lesser of two evils.

In those circumstances the clear message is that far more effective sexual education is needed. I have been a teacher and heard that cry for the past 30 or 40 years. But we must not be naive either. Many of the young people I once taught who became pregnant were desperate to have a baby. They wanted something to love and someone who would love them unconditionally because their own lives were so full of despair, self-neglect and they lacked self-worth. Here is the difficulty. In order to help those young people we will offer a pharmaceutical solution which will play a part in creating conditions in which the sacredness, nobility and purpose of human life is inevitably downgraded.

I am looking for a concerted national campaign to increase the sense of the sacredness of human life; which will increase the sense of self-worth among many young men and women; which will support and encourage all those young people who genuinely do not want to give in to peer or media pressure and who find adults copping-out of their moral responsibility to guide them; and I want something which will recognise that our moral sensibilities about human life are being trampled over with extraordinary lack of concern for the potential consequences for individuals and our nation.

Lord Clement-Jones: My Lords, we have had an excellent debate tonight. I intend to be extremely brief in replying from these Benches. My colleagues on these Benches will be deciding, as individuals, whether to support the noble Baroness in her Prayer against these regulations. I suspect, however, that few of them will be convinced by the arguments of the noble Baroness, sincerely though her arguments were made.

I want to emphasise that, whatever the temptations, tonight's debate is not about the availability of emergency contraception to young girls without their parents' consent or about the limited number of pilot schemes in certain health action zones under what is known as a patient group direction from local GPs. It is not about the quality or quantity of sex education. Indeed, it is not even about the Government's strategy for teenage pregnancy, important though all these issues are. It is simply about the availability in pharmacies of Levonelle-2, the emergency contraception product.

First, what is the product? The noble Lord, Lord Patel, made the action of the product very clear, together with the fact that it does not induce abortion. That is not the action of the product. Levonelle-2, however, is clearly more effective and has fewer side effects than the previous emergency contraception products, in particular PC4. Research sponsored by the World Health Organisation has clearly shown that. Clinical trials show that the earlier it is used, the more effective it is. As the noble Baroness, Lady Gould, so cogently pointed out, that emphasises how important early access to it is. As the noble Baroness, Lady Massey, pointed out, it is not always easy to have that early access. The retail price of the product will be £19.99. It will hardly be an impulse buy. In my terms, it is rather expensive.

I refer now to the process for the approval of Levonelle-2. The Committee on Safety of Medicines and the Medicines Commission have advised that the medicine is safe for pharmacy sale. This advice and the results of a public consultation were put to the Department of Health which approved the change.

What is the role of the pharmacist? Pharmacy status for emergency contraception means that any pharmacist who wishes to do so can supply according to the relevant guidelines after having obtained appropriate information from customers. Comprehensive guidance on best practice for the supply of emergency contraception has been sent to all pharmacists by the Royal Pharmaceutical Society and the Pharmaceutical Society of Northern Ireland. That guidance includes the question of supply to under-16s. This guidance is supported by training provided by the Centre for Postgraduate Pharmacy Education. Those are all responsible steps to have put in place. I am sure that the Royal Pharmaceutical Society will make sure that the supply is carried out in the appropriate fashion.

I welcome the decision by Superdrug to discontinue sales over the Internet since I do not believe that is the way in which this product should be sold. I believe that it should be sold through pharmacies.

I refer next to some of the questions raised in the debate. It has been said that the wider availability of emergency contraception will encourage promiscuity. I have not heard any evidence tonight to suggest that wider availability of Levonelle-2 will encourage promiscuity. What evidence is there that this will adversely affect the level of sexually transmitted diseases, a major problem? We have seen from recent figures, whether for chlamydia or AIDS/HIV, that these diseases, should be taken extremely seriously. The answer lies in better sex education, not in banning emergency contraception.

What evidence do we have that pressure will be put on young girls to have unprotected sex? That is purely anecdotal, drawn from individual experience. I know of no paper which has demonstrated that to be the case. The information from pilot schemes where emergency contraception is available from pharmacies under patient group directions indicates that this emergency contraception is being sought mainly after failure of contraception. The data show that women aged 20 to 29 years are by far the greatest users. As the noble Lord, Lord Patel, said, they account for 53 per cent of users. Women aged 16 to 19 years old comprise 22 per cent, and women aged 30 to 40 years old comprise 17 per cent of users. Very few under-16 year-olds asked for emergency contraception via this route.

The right reverend Prelate the Bishop of Southwark had it absolutely right, in my view, in his analysis of the benefits of the current pilot scheme in Lambeth, Southwark and Lewisham. I live in the same health authority as the right reverend Prelate. Certainly, the benefits vastly outweigh the disadvantages or the reservations.

The remainder of requests are made by women over 40 years of age. This profile is confirmed by the Department of Health's statistics that show that most abortions are performed on women in their 20s rather than on teenagers. This suggests that the take-up of the pharmacy product will be among the more mature age group. Effectively, we are giving older women the freedom to control their own lives so that they are able to avoid abortion. My noble friend Lord Carlile of Berriew made this point: it is a matter of choice for women.

What evidence is there that emergency contraception leads to multiple use? All those concerned in the development and marketing of Levonelle emphasise that it should not be seen to be an alternative to long-term reliable forms of contraception. Moreover, a recent British Journal of Family Planning paper which studied over 15,000 women taking emergency contraception showed no significant trend to multiple use. My noble friend Lady Walmsley made it quite clear why, physically, that is so.

In conclusion, there are legitimate concerns about unlawful supply to under-age girls. I hope that the Minister can give assurances about the strength of the guidance to pharmacists and how this will be enforced. The product is a safe and effective method of preventing pregnancy where a woman has had unprotected sex or something has gone wrong with her usual method. The benefits for the older age group vastly outweigh the problems of access by the under-16s. This is not a measure principally directed at teenage pregnancy rates. Pharmacy supply will be a very welcome additional route for women to access emergency contraception with minimum disruption to their work or family lives.

I do not believe that by simply being available at pharmacies it will encourage a casual attitude to sex. There is absolutely no evidence of this. On the contrary, it is another step to ensuring that only children who are wanted are born in this country. The noble Lord, Lord Davies of Coity, added, absolutely rightly in this respect, that if passed this Prayer would not help older women or the young, as the noble Baroness claims; it would penalise them. As my noble Lady Walmsley said, it is vital that women should have access to this emergency contraception. Certainly I shall not be supporting the noble Baroness, Lady Young, in her Prayer. I prefer to support the views of the Family Planning Association, the Royal College of General Practitioners, the Royal College of Nursing, the Royal Pharmaceutical Society and the Community Practitioners and Health Visitors Association, let alone those of the vast majority of adults in this country. I hope that my colleagues will join me in voting against the Motion.

Earl Howe: My Lords, it is a pleasure and at the same time a difficult job to follow my noble friend Lady Young in speaking to the Motion. I find myself, as ever, deeply impressed by what she said. We should not doubt for an instant that she speaks for very many ordinary, moderate people who are deeply worried by the order before us and its implications. I cannot hope to better her in arguing the case she has put.

I shall concentrate on a few particular aspects of this issue which cause me profound disquiet. They are aspects that relate to patient care. To many it might seem odd that a measure of this sort which has met with the approval of the Royal Pharmaceutical Society, the BMA and the Royal College of Nursing could possibly be considered detrimental to patient care. Clearly, to take issue with such reputable bodies is not something to be undertaken lightly or wantonly.

We all agree that pharmacists represent an under-utilised resource in primary care. Pharmacists are highly skilled, professional people. It is absolutely right that we should look for ways of broadening and developing the service they provide for patients. However, this does have to be done in a manner that is safe. The point at issue here is whether the direct supply of the morning-after pill by pharmacists is something that can be done both safely and ethically in all cases.

Reading the pharmaceutical press, as I do each week, it is apparent that pharmacists are alarmed at what is being asked of them and so are some members of the medical profession. Part of their concern can be summed up as follows. The more that young women at risk of an unwanted pregnancy are enabled to bypass their doctor or avoid even a cursory clinical examination, whether by a doctor or a nurse, the more risk they run of damage to their health. My noble friend Lady Young mentioned sexually transmitted diseases. The statistics published last week saw large increases in gonorrhoea and chlamydia during the year 2000 as well as the highest ever number of new cases of HIV. The highest rates of chlamydia are in 16 to 19 year old females and 20 to 24 year old males. The diagnostic rates for gonorrhoea were also the highest in those age groups.

The rise in diagnoses in young females suggests that there has been a significant increase in heterosexually transmitted gonorrhoea. If one goes into a chemist shop to buy emergency contraception after having unprotected sex there is no one to pick up the warning signs of sexually transmitted disease. If chlamydia is allowed to develop--and it does so insidiously--it can render a woman sterile. It is important for the country as a whole, and vital for patients, that there should be effective monitoring and reporting of all sexually transmitted disease. There is not a shadow of doubt in my mind that this order will hinder that process.

Pharmacists cannot hand out the pill without questions being asked. There is an extensive list of questions that the Royal Pharmaceutical Society has devised which chemists are recommended to follow. But the sheer length of the list is enough to make one question the wisdom of what is supposed to happen. The pharmacist must first ascertain from the woman what circumstances have led her to believe that she needs the pill. He must then try to determine whether or not she is already pregnant. From the answers he gets he must be able to distinguish chlamydial infections, which can cause bleeding between periods, from pregnancy or miscarriage. He must find out whether the woman has used the morning-after pill since her last period. He must find out whether she is taking any of 11 drugs which react adversely with the pill. He must ascertain whether the woman has a severe liver dysfunction or whether she has any condition associated with the malabsorption of drugs such as Crohn's disease. He must ask if she has previously experienced any allergic reaction to oral contraceptives. Crucially, he must be satisfied that the patient in front of him is over the age of 16.

Now, chemists have been told that in cases of doubt on any of these questions, they should refer the patient urgently to a GP or family planning service and not dispense the morning-after pill. I do not see, and nor do many responsible pharmacists, how it is possible for a pharmacist, during a brief interview, to be satisfied that by dispensing the pill to a particular woman he would not be running a risk with that patient's health. Pharmacists, however conscientious, are not permitted to perform a physical examination of the patient. They cannot contact the patient's GP. They must rely on the accuracy of the answers they get to a checklist of questions. It is quite interesting that one of the main risks of taking the morning-after pill--which is the risk of having an ectopic pregnancy--is not even mentioned in the guidance prepared by the Royal Pharmaceutical Society. Nor does it mention some of the other warnings contained in the patient information leaflet from the manufacturers; for example, that the pill should not be taken in cases of high blood pressure or diabetes or where there is a history of breast cancer.

Responsible pharmacists will find all this out. But this is the point. Patients are entirely dependent on the ethical and professional standards of individual pharmacists. There is no requirement for a pharmacist to undergo training in order to be able to supply and dispense this medication. Specific training in entirely voluntary. Even those pharmacists who wish to receive training have in many cases not yet received it. Perhaps that should not surprise us. Pharmacists were not consulted on whether the morning-after pill should be available nation-wide over the counter. The first they heard of it was when the Government announced it to the press. It does not take a genius to work out that, with pharmacists demonstrating different degrees of assiduousness and different degrees of training in regard to the protocols to which they are meant to adhere, patients will simply gravitate to the chemist's shop where they know there will be the least hassle.

And that is where the trouble is likely to begin. I had a brief conversation with the noble Lord, Lord Clement-Jones, last week in which he indicated that I would be unlikely to persuade him that opposing the order made any sense at all. Well, I invite him to consider the point that I am now making. It is not what happens when everything goes right with an over-the-counter supply that I am worried about. It is the unintended consequences when things do not go as they should.

Many noble Lords will have seen the article in the Daily Mail a few days ago, which described how a girl of 15 was able to obtain the morning-after pill from two chemists in London with the minimum of questioning. She was not asked her age. One of the chemists took only two minutes to hand over the pill to the girl. On the other hand, another chemist did ask her age and took considerable trouble over the interview before referring the girl both to her GP and to her parents. The point here is that while the Royal Pharmaceutical Society without doubt approached this whole issue in a completely responsible and professional way the same cannot necessarily be said of all its members.

Lord Peston: My Lords, I am sorry to interrupt the noble Earl and I do so reluctantly. I must declare an interest as an honorary member of the Royal Pharmaceutical Society. My listening to the noble Earl suggests that his view is that the Royal Pharmaceutical Society is, first, irresponsible in strongly advocating this intervention and, secondly, does not speak for the overwhelming majority of its members. Does he accept that the Royal Pharmaceutical Society is completely responsible in what it says and does speak for the overwhelming majority of its members? Will he say that in terms, speaking from the Opposition Front Bench?

Earl Howe: My Lords, I believe that the Royal Pharmaceutical Society has adopted an entirely responsible approach. I could pick holes in the detail of the guidance it has given. I certainly accept that it is acting with the approval of the majority of its members but I am also saying that a significant majority of its members--the noble Lord will know this from reading the pharmaceutical press--are worried and concerned for the reasons that I am now giving.

It was not altogether surprising that the chairman of the BMA prescribing committee, Dr George Rae, said in response to the Daily Mail story:

‘The whole thing is turning into a bit of a hotchpotch and it needs looking at again. I do not think it is properly thought through. We must avoid the fragmentation of health care which could be dangerous’.

The dangers arise from any failure to ascertain vital information from the patient and from the absence of the kind of care which, with the greatest respect to the pharmaceutical profession, only a doctor or a nurse can provide.

I have already run through the list of medical contra-indications, any one of which renders the supply of the pill unsafe. I have not read out the long list of other items that a chemist is supposed to cover with each patient--warnings about side effects, about the need to repeat the dose if you vomit within three hours of the first one, about what to do if you are taking an ordinary oral contraceptive as well, or if you are breast-feeding. The list goes on. Responsible chemists will follow it, and it is to be hoped that patients will understand it all. But it is no substitute for seeing a doctor or a nurse. There are just too many pitfalls.

Before I finish, let me make one thing clear. The issue of unwanted pregnancy and of abortion are ones I understand completely. I understand about busy doctors' surgeries and the embarrassment that girls feel in going to their doctor. But in the light of the risks I have identified, we believe that a better alternative to making the morning-after pill available over the counter would be to allow practice nurses to prescribe it. That measure of deregulation would allow greater flexibility for patients yet keep emergency hormonal contraception within the context of a general practice setting.

In our judgment, the order compromises patient care. I urge all noble Lords to reject it and in so doing allow the Government to think again.

Lord Hunt of Kings Heath: My Lords, I am very glad to have the opportunity of responding to the debate on the order. We have certainly had a wide-ranging debate. I listened with great interest to the right reverend Prelate the Bishop of St Albans as he touched on a number of moral, religious and ethical questions. But I want to start with some fairly straightforward points about the background to the order.

I believe that women and their partners have the right to make responsible choices about the size of family they have. As noble Lords have pointed out, the effectiveness of hormonal emergency contraception is greatest the sooner it is taken after unprotected intercourse. The option of rapid availability from a pharmacist without the need for attendance at clinic or GP surgery is therefore to be seen as a welcome addition to responsible family planning measures.

There has been positive support for pharmacy availability from a wide range of professional bodies. I say to the noble Earl, Lord Howe, that pharmacists are professional and responsible and will receive full guidance in the safe supply of this medicine from the Royal Pharmaceutical Society of Great Britain. Pharmacy supply will improve and build on existing links between pharmacists and family planning services. This network will help to ensure that the under-16s and other women who need to see a doctor for contraceptive advice can be referred on quickly.

The background to the order is an application by Medimpex UK to change the legal classification of Levonorgestrel. The application was to change its legal classification from that of a prescription-only status to that of a pharmacy status, which means that it can be sold over the counter by a pharmacist. Under UK law, a medicine is legally classified as ‘prescription only’ if it needs to be supplied under the supervision of a doctor to ensure that it is used safely. It can be sold in pharmacies only if the legal criteria for listing medicines as prescription only no longer apply.

The Government are committed to making medicines more widely available where it is safe to do so. The most effective way of doing that is through the reclassification procedure for licensed medicines as I have described. The UK has considerable experience in this regular and routine procedure. I pay tribute to the last government, who, in 1992, established the well-ordered procedures to enable this to happen. As a result of that action, more medicines have gone down this route and the public have benefited enormously.

It is down this route that Medimpex UK has gone. When the company applied to the Medicines Control Agency, a standard procedure was followed. First, the Medicines Control Agency assessed the safety of the medicine in use in the light of the legal criteria for prescription only status. Then the application was referred to the advice of the Committee on the Safety of Medicines. That committee recommended that the order should be amended to allow the non-prescription supply of this medical product. The matter was then put out to public and professional consultation. Virtually all the main medical and pharmaceutical bodies which responded were in favour of a move to pharmacy supply. Furthermore, they did not raise any concerns about the safety of supply in a pharmacy setting. Both the Committee on the Safety of Medicines and the Medicines Commission carefully considered all the available evidence. They advised that Levonelle can be supplied safely under the supervision of a pharmacist for emergency contraception.

Perhaps I may turn to the safety issues. Considerable experience of worldwide use has been gained. In the UK the active ingredient has been available in other contraceptives and HRT products for 30 years, although only more recently as an emergency contraceptive. It has been used for emergency contraception in other parts of the world since the 1980s. In France it has been available from pharmacists since 1999. I understand that Norway and Portugal have since agreed to do the same.

I am advised that the side-effects of this medicine are usually mild and short-lived. The most common side-effects reported from clinical trials are vomiting and nausea. The committees therefore considered that the medicine had an acceptable safety profile to supply under the professional supervision of a qualified pharmacist and that women would be able to use the product correctly.

Perhaps I may now turn to the safety issue in relation to women aged under 16. I have been asked for reassurance on this point and I am happy to give it. The most important point to make here is that, while under this order the product can be bought from a pharmacist only if the person is aged 16 years or older, the same product can be prescribed by a doctor with no age limits. There is no biological significance to the age limit of 16 years and over. Indeed, the original licensing of the prescription product used evidence from a large, randomised control study that included women under 16 in the trial.

Having considered the safety issues and on the basis of the advice received from the Committee on the Safety of Medicines and the Medicines Control Agency, we have laid the order before the House tonight. In support of this change, the Royal Pharmaceutical Society has set professional standards and developed comprehensive guidance for pharmacists on the retail supply of emergency contraception. I should say to the House that it is primarily the responsibility of the Royal Pharmaceutical Society to enforce the Medicines Act in this area. It is the regulatory body.

While pharmacists are already familiar with the product through prescription supply, additional training is being provided, a distance learning programme is being sent to all pharmacists ahead of the product launch and workshops are also available. The noble Earl, Lord Howe, referred to the minimum standards set by the Royal Pharmaceutical Society. Those are in place to ensure that pharmacists have sufficient knowledge of emergency hormonal contraceptives to deal with requests personally and to decide whether to supply the product or to refer; to ensure that they provide all the necessary advice and information about the medicine to the patient; to handle requests sensitively, respecting a woman's right to privacy; only in exceptional circumstances to supply the product to a person other than the patient; and wherever possible to take reasonable measures to inform the patient about regular methods of contraception, disease prevention and sources of help.

I do not share the concerns expressed by the noble Earl, Lord Howe. The pharmacy profession has had considerable experience in the move of medicines from prescription only to pharmacy. I believe that pharmacists are ideally placed to provide advice on regular methods of contraception and local family planning services to help women avoid the use of emergency contraception in the future. Furthermore, I am satisfied that the overall rigorous approach to regulation within the pharmacy profession will ensure that sufficient safeguards are put in place.

Lord Mackay of Clashfern: My Lords, I wonder if the noble Lord could develop that point? Can he tell the House whether the supply over the Internet of this drug by Superdrug was lawful in terms of the standing regulations?

Lord Hunt of Kings Heath: My Lords, I understand that it is lawful to supply over the Internet, but the issue is whether in so doing, the company would follow the minimum standards laid down by the Royal Pharmaceutical Society. If it did not follow those minimum standards, a pharmacist involved in Internet supply would fall foul of the regulatory provisions set by the Royal Pharmaceutical Society. On that basis, the intention to supply over the Internet has been withdrawn until discussions can take place between Superdrug and the society.

This order will be welcomed by many women. A number of noble Lords referred to the 800,000 women who were prescribed emergency contraception in 1999. The medicine is far more effective the earlier it is taken. Waiting to see a doctor may cause delay and therefore reduce the chance of it working. Providing for direct sale through pharmacies will be an important additional route, in particular at times when traditional services may not be available. That is a very pertinent point. Huge numbers of women in this country will know the frustration of trying to track down emergency contraception over the weekend after contraception has let them down.

Much of the debate has focused on under 16 year-olds and the feeling that this will encourage teenage promiscuity. I should like to place on the record the fact that the company which holds the licence for the product applied for the age limit of 16 years for pharmacy availability and that the expert advisory committees accepted that that was reasonable. This is not the only pharmacy-supply medicine that has an age restriction and I am confident that pharmacists have the experience and judgment to determine which clients should be referred to a doctor. The guidance from the Royal Pharmaceutical Society reflects that position. It states that,

‘Pharmacists should make every reasonable effort to satisfy themselves that clients are aged 16 or over. Pharmacists should ensure that where they believe a client to be under 16, the request is dealt with sympathetically and the client is offered appropriate help and support to enable her to obtain emergency hormonal contraceptives by another route’.

The point I should like to make is that every day, pharmacists have to make judgments in their pharmaceutical outlets. The members of that profession are extremely well trained and I believe that they can be expected to operate the law effectively.

I do not believe the suggestion that this will all encourage promiscuity, for the following reasons. First, there is evidence from a study in Scotland, where women were given advance prescriptions for emergency contraception to be kept at home. It found that women did not change their sexual behaviour or their use of regular contraception. A further four-year study of 95,000 women aged 14 to 29 found that repeated use of emergency contraception was rare, and that many women used regular contraception for the first time after the use of emergency contraception. Indeed, as the noble Baroness, Lady Walmsley, suggested, we know that the regular use of emergency contraception disrupts a woman's menstrual cycle, which means that she will have irregular periods and breakthrough bleeding. This will be unacceptable to most women, and they will quickly seek medical advice.

On top of that, there is the matter of cost. I tell my noble friend Lord Rea that the cost of the product, at £19.99, is a matter for the company concerned, but, whatever one's view on the price, I think we can all agree that it will be a deterrent to regular use.

I share the view of my noble friend Lady Gould of Potternewton on the balance to be arrived at between access to emergency contraception and a potential abortion; as the right reverend Prelate the Bishop of Southwark suggested, one-off use of emergency contraception may prevent an abortion. Noble Lords have tonight referred to the very high figures of abortions being performed in this country. They are very high, and this Government remain concerned about that. If emergency contraception can help to reduce the level of abortions, surely it is to be welcomed.

The noble Baroness, Lady Young, talked about parents. Recent research among parents, commissioned by my department, found that over 80 per cent supported the provision of confidential contraceptive advice for the under-16s. Of course, I fully recognise the role that parents play in supporting their children in sex and relationship education. Indeed, it is pretty clear that the more open parents are about sexual issues with their children, the later those children become sexually active and the more likely they are to use contraception if they do become sexually active.

But we have to face the fact that not all parents manage to talk to their children. Indeed, one study showed that one third of girls had not been told about periods before they started. So there is much that we have to do in relation to health education generally. Good comprehensive sex and relationship education can help young people delay first sex and make them more likely to use contraception when they do become sexually active. Countries that report low or falling rates of teenage parenthood all include sex education as part of their overall programme. That is why the Government have issued new guidance to schools to improve the quality of sex and relationship education, to give young people the information and skills they need to resist peer pressure to have early sex and to negotiate safe and responsible relationships. As my noble friend Lady Massey of Darwen said, there is plenty of moral value to the guidance, including that pupils should be taught about the nature and importance of marriage for family life and bringing up children.

With regard to the issue of sexually transmitted infections, there is of course concern about their level in this country, and the Government are committed to doing all they can to reverse that trend. But, as the noble Baroness, Lady Walmsley, suggested, no method of contraception is 100 per cent effective, and if an accident happens emergency contraception is an effective method of preventing pregnancy. I have seen no evidence to suggest that the availability of emergency contraception would lead to a rise in sexual disease.

This has been an extremely interesting and wide-ranging debate. I share with the right reverend Prelate, the Bishop of St. Albans, a sense of the sacredness of human life and the need for us to encourage self-regard in young people. But I believe that what we are talking about tonight is a sensible and entirely justified course of action, reached after very careful consideration and after the proper processes have been gone through, the processes laid down by the party opposite in 1992. It is action endorsed by the Medicines Control Agency and the Committee on the Safety of Medicines, which advised that this product can be safely supplied under the supervision of a pharmacist for emergency contraception; action supported by the BMA, the Royal College of General Practitioners, the RCN, the Royal Pharmaceutical Society and many other responsible bodies; and action which will encourage improved links between pharmacists and family planning services and help to ensure that under-16s and other women who need to see a doctor for contraceptive advice can be referred on quickly.

Surely women have the right to take advantage of the option of rapid availability from a pharmacist without the need for attendance at the GP or family planning clinic. Surely women and their partners have the right to make responsible choices about the size of their family.

I hope that the House will reject the prayer.

Lord Monson: My Lords, the noble Lord the Minister has said nothing about the Northern Ireland anomaly, although the noble Baroness, Lady Young, raised the point. The age of consent in Northern Ireland is 17, not 16. Is it not therefore the case that a chemist in the Province who supplies the pill to a 16-year-old may be guilty of aiding and abetting a criminal offence?

Lord Hunt of Kings Heath: My Lords, that clearly is a matter for the Northern Ireland Assembly and the Northern Ireland Health Department. But I can tell the noble Lord that the decision has the full support of the Northern Ireland Health Department, and, as the noble Baroness, Lady Young, suggested, was signed by the Northern Ireland Health Minister. That Minister raised no objections, and I do not believe that that point impacts on the decision made in the order.

Baroness Young: My Lords, I should first like to thank very much those who have supported me this evening, and, as always, to thank the noble Earl, Lord Longford, who speaks with great moral authority. I only wish that I were as good a Christian as he is. We should all take note of his courage and sincerity. I also thank my noble friend Lord Elton for what he said. He was the one speaker who drew attention to the importance in all this discussion of love, commitment, responsibility and marriage. It is extraordinary how those four words are left out of every debate.

The two right reverend Prelates who have spoken will not be surprised to hear that I am very disappointed by what they said. I am bound to say to the right reverend Prelate the Bishop of Southwark that to argue that the best can be the enemy of the good, and that therefore we should not have the best, seems to me an extraordinary moral argument. But I am not here to discuss that.

I was even more surprised to hear that the theological position of supporting the lesser of two evils is a good one to take up. When the Pope went to Ireland he was told that the IRA was protecting the Roman Catholic population against Protestant oppression, and his reply was quite simply ‘Murder is murder’. We need to keep a firm hold on moral principles when we are talking about these matters.

We have had a very full debate. I started my remarks by saying that I thought there had been a great deal of misunderstanding about the issue. As I listened to the debate, I realised that those words were rather truer than I thought when I wrote them.

We have heard a great deal, at great length, with great emphasis and great force, about the importance of contraceptives, about a woman's right to choose and that every baby should be a wanted baby. It was as though somehow I was arguing against any of these principles. As I made abundantly clear at the beginning of my remarks, I am well aware that the morning-after pill has been available since 1985; that emergency contraception has been available to women since 1985. It is not new. I made it perfectly clear that if my Prayer against the order carries this evening, that situation will be the same; nothing will change. Listening to many of the speeches today, one would think that I was saying that emergency contraception would never be available again. I have not said that; I do not think it; it is simply not the case.

We are talking about whether or not these emergency contraceptive pills should be available across the chemist's counter. At this point I remind your Lordships of what my noble friend Lord Howe said about the role of pharmacists. Of course I recognise that the Royal Pharmaceutical Society has laid down good guidelines--I would expect it to. I would expect pharmacists to do their best. But, as my noble friend Lord Howe pointed out, the reality is that we have all seen the queues in the chemist's shop. I do not know where all this consultation will take place. I looked into my local chemist in preparation for this debate to see where it might take place. There did not seem to be anywhere but the most public place, in front of the counter. Perhaps other chemists are different.

The questions that the chemist should ask are very important. We are putting at risk the health of young girls. I do not want that responsibility. We need to take these matters very seriously. The guidelines are correct but, as we all know, guidelines are not always adhered to, especially in a busy chemist's shop late in the evening. I ask the House to recall, very clearly, what my noble friend Lord Howe said.

Perhaps I may conclude by answering two or three points, which I believe to be important. I was very sorry that the noble Lord, Lord Hunt, kept referring to 16 year-olds and under as women. This illustrates the attitude of the Government. In law, they are not women, they are children--and we should recognise what we are talking about.

I am sorry that he thought there would be no increase necessarily in sexually transmitted diseases as a result of increased use of the morning-after pill. Of course the morning-after pill encourages unprotected sex--that is one of its purposes. That is one of the reasons why young people look to it.

Finally, I should like to make a point about parents. Some of the talk about parents has been rather casual. One of the reasons--not the only reason--that we have one of the highest rates of teenage pregnancies in this country is, of course, the high rate of marriage breakdown and the undermining of family life. Taking steps which undermine family life is very serious. I shall be perfectly frank, I do not like the fact that school nurses can provide the pill without parents knowing.

What is being said to parents is a kind of general, blanket question: ‘Would you like your children to be helped to understand sex, contraception and all the difficulties of growing up’? Most parents think it is a good idea. What they do not know is that the result of all this is that somebody, without telling them, is giving their child the morning-after pill and contraceptive advice.

We are contriving and conniving at undermining parents. Whatever I may think about it--and I have been a parent--I know that I would never want for other people's children what I would not want for my own. One thing we should have learnt is the importance of keeping teachers, parents and doctors all speaking with one voice to their children. One of the troubles that we have today is that they do not do so.

There are a lot of people in the country--I mention, once again, representatives of the Muslim community, who have been to see me on more than one occasion--who are very concerned about this matter. I would not have taken up the time of your Lordships' House today, or, indeed, on any other occasion, if I did not believe that in this world today--which, the debate has shown, is immensely confusing and uncertain for young people, with terrible tragedies waiting to happen, with the teenage pregnancy rate and so on--this move to give the right to chemists to supply the pill over the counter is an opportunity for one more ratcheting up of society. I do not believe it will help people. Women need the help; they have got the help. We should pray against this order today in the interests of young people.

On Question, Whether the said Motion shall be agreed to?

Their Lordships divided: Contents, 95; Not-Contents, 177.

Details of the division are available on request.

Parliamentary References on Reproductive Health is produced by British Pregnancy Advisory Service. For further information please contact Amanda Callaghan, Public Affairs Manager, Communications Department

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