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
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
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
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
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.
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
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
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
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
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
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
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.
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