Debate on Emergency Contraception
Emergency contraception in the House of Commons
Fifth Standing Committee on Delegated Legislation January
Only Medicines (Human Use) Amendment (No. 3) Order 2000
Dr Liam Fox MP: I
beg to move that the Committee has considered the Prescription
Only Medicines (Human Use) Amendment (No. 3) Order 2000
(S.I. 2000, No. 3231).
The most important aspect
of the debate is the quality of care given to the patient.
There has been criticism of the availability of emergency
hormonal contraception, with some patients finding it difficult
to gain access to their general practitioner in sufficient
time for its use. We understand the problem and have suggested
that EHC could be partially deregulated with practice nurses
able to prescribe it. That would allow greater flexibility
for patients, yet keep EHC in the context of the general
practice setting. It would allow access to patients’ notes,
enabling details of past medical history and any potential
drug interactions to be assessed. It would give greater
privacy for discussions about sexual contacts, sexually
transmitted diseases, and so on, and allow detailed planning
of future contraception.
The Government’s plans to
move straight to an over-the-counter status will increase
the risk of problems being missed. There is no question
about the competence of pharmacists—indeed, the Conservative
party believes that they should have wider prescribing powers—but
we would dispute whether a pharmacy is the most appropriate
setting for dispensing this type of contraception. Pharmacists
must satisfy themselves on several matters. Has there been
unprotected sex in the past 72 hours? Is the client present
in the pharmacy? Is the client 16 or over? Is EHC needed?
Could the client be pregnant already? Is the client taking
other medication that might interact with levonorgestrel?
Does the client have any medical condition that might affect
absorption of levonorgestrel? Does the client have liver
problems? Has the client previously had an allergic reaction
to levonorgestrel? Many pharmacists themselves have complained
that the further training recommended has not yet been undertaken
and that a busy pharmacy is not an ideal location for highly
In addition, we have already
had cases where EHC has been available over the counter
in a way that would not have been intended under the Government’s
proposals. An article from Saturday’s Daily Mail
To test how the guidelines,
which state that the pill—EHC—should only be sold to girls
and women over 16 we sent 15-year-old Chloe Elliot, from
north London, to a series of chemists. At Boots in Kensington
High Street, West London, staff failed to ask her age and
agreed to sell her the drug following a five-minute health
Calder chemists, in Notting
Hill, failed to ask Chloe’s age and took just two minutes
to hand over the prescription-only version after taking
£20 from her.
The article goes on to quote
Dr George Rae, chairman of the British Medical Association
prescribing committee, about some earlier examples of this.
‘The whole thing is turning
into a hit of a hotchpotch and it needs looking at again.
I do not think it is properly thought through.’
A health professional dealing
with unprotected sex in a teenage girl should be aware of
their age and it is hardly a step forward for prescribing
to proceed without asking it. There is the question of the
mental and physical well being of these girls who may, as
we now see, be going from pharmacy to pharmacy, using the
drug as contraception.
We must avoid the fragmentation
of healthcare which could be dangerous.
Indeed, there have been
numerous letters in the pharmaceutical press from pharmacists
themselves. One pharmacist from Birmingham said:
‘The most serious concern
I have with the announcement that Levonelle-2 was to be
deregulated was that it was made to the public before the
profession was made aware of it. Also, it gave the public
the view that it would be available from all pharmacies,
which I do not think will be the case if pharmacists object
to selling the product on religious or moral grounds. Pharmacists
have not been consulted about whether they would like to
see this deregulation and it would have made a lot more
sense to have a vote for it by those pharmacists who are
going to be in the front line of the supply chain.’
Another pharmacist wrote
from Cheshire to say:
‘I can foresee a situation
where, because of their lifestyle, the same women will return
time after time. I have witnessed this with ‘patients’ on
National Health Service prescriptions for EHC. So we have
a potential medical time bomb waiting to explode as steroids
are sold without control to girls and women of all ages.
How, as a busy community pharmacist, can I check their medical
history or age? What is there to prevent an over-16 purchasing
the drug for an under-age girl? The Society’s guidelines
on supply of EHC would be hilarious if they were not intended
as serious proposals!’
Dr Jenny Tonge MP:
As a fellow trained medical practitioner, will the hon.
Gentleman explain how a dose of levonorgestrel will lead
to a potential time bomb of steroids? I am confused, so
will the hon. Gentleman provide some scientific background.
Dr Fox: If the hon.
Lady would let me finish, I am quoting from a letter written
by a pharmacist in Cheshire. He continues:
We are supposed to obtain
information and render advice and counselling in more than
20 areas in a totally private section of the pharmacy to
ensure complete confidentiality for clients who may be under-age
girls with parents who are regular customers of the pharmacy.
I am not aware of studies
on the extensive and repeated use of EHC on girls under
16. If the hon. Lady is aware of such studies, perhaps she
will tell me. It is important to assess the long-term effects
of regular and repeated use of this new product among young
girls. I suspect that we do not yet have that information.
Another issue is whether
the Government’s wider policy is sending out the right messages.
The new product is not as effective as other methods of
contraception. On average, it has an 85 per cent. success
rate. I am worried about inadvertently sending out the message
that there is less need to use barrier methods of contraception—a
serious public health concern in an age of sexually transmitted
Conservative proposals for
retaining EHC as a prescriptions only medicine, but with
availability through the practice nurse as well as the doctor,
provide the best way forward. Our policy maintains safeguards
and provides enhanced access to patients. Making it an entirely
over-the-counter medicine would provide too few safeguards
and be inappropriate in such a sensitive and complex clinical
The Minister for Public
Health (Yvette Cooper): I am disappointed that the Opposition
decided to pray against the order and make it a political
issue. Levonelle is a licensed medicine that is assessed
by the Medicines Control Agency and the Committee on Safety
of Medicines as safe and effective for the purpose of emergency
When the company Medimpex
UK applied to change its legal classification to pharmacy
status, all the standard procedures were followed and there
was widespread consultation. The medical, safety and public
health arguments all support the change and the arguments
in favour of the order are strong. The arguments of the
hon. Member for Woodspring (Dr Fox) are not based on an
accurate assessment of the facts.
Let us start with the facts.
We amended the Prescription Only Medicines (Human Use) Order
1997 to allow 0.75mg of levonorgestrel for emergency contraception
to be sold in pharmacies without a prescription to women
aged 16 years and over. For pharmacists knowingly to supply
the product to women under 16 is an offence the Medicines
Levonorgestrel, a medicine
used for emergency contraception, has been assessed by the
Medicines Control Agency and the Committee on Safety of
Medicines as both effective and safe. It works prior to
implantation and prevents pregnancy. The accepted legal
and medical view is that emergency contraception is not
a method of abortion. It is more effective the sooner it
is taken, reaching 95 per cent. effectiveness if it is taken
within the first 24 hours after unprotected sex.
Under United Kingdom and
European Community law, the sale and supply of all medicines,
including emergency contraception, is regulated to protect
public health and medicines are legally classified as prescription-only
if the medicine 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 for prescription-only no longer applies.
Mr Desmond Swayne:
The hon. Lady may recall the then headmaster of Westminster
school, Dr John Ray, describing sexual intercourse while
wearing a condom as similar to the experience of eating
a Mars bar with the wrapper on. Does not it occur to the
hon. Lady that there will now be a means of avoiding such
barrier methods? If the product is sold over the counter
what safeguards will there be to enable any restraint on
young girls habitually having recourse to morning-after
contraception, and what will be the long-term consequences?
Yvette Cooper MP:
The hon. Gentleman was not listening to what I said earlier.
This is an application for the product to be given to women
over the age of 16. It is an offence under the Medicines
Act 1968 for pharmacists knowingly to supply the product
to women under 16. The chance of the measure having the
effect of increasing the amount that young women use emergency
contraception is highly unlikely. I shall deal with the
safety issues, and matters of age, later.
The standard procedure was
followed after Medimpex UK applied for the product to have
pharmacy status. First, the Medicines Control Agency assessed
the safety of the medicine in the light of the legal criteria
for prescription-only status. Then it was referred to the
Committee on Safety of Medicines for advice. That committee
recommended that the Prescription Only Medicines (Human
Use) Order should be amended to allow the non-prescription
supply of the product. The matter then went to public and
professional consultation; 138 organisations were consulted
and the Medicines Control Agency posted a consultation letter
on its website. All the main medical and pharmaceutical
bodies that responded were in favour of pharmacy supply.
The matter was referred to the Medicines Commission, which
advised that it was appropriate to reclassify the product
for emergency contraception for women aged 16 years and
above from prescription only medicines status to pharmacy
The Committee on Safety
of Medicines and the Medicines Commission carefully considered
all the available evidence on safety and effectiveness.
They advised that Levonelle can be safely supplied under
the supervision of a pharmacist for emergency contraception.
There has been considerable
experience of world-wide use. In the UK the active ingredient
has been available in other contraceptive and hormone replacement
therapy products for 30 years, though only more recently
as an emergency contraceptive. However, it has already been
used for emergency contraception in other parts of the world
since the 1980s. In France, it has been available from pharmacists
The side effects of the
medicine are usually mild and short-lived. The committees
therefore considered that the medicine had an acceptable
safety profile for supply under the professional supervision
of a qualified pharmacist and that women would be able to
use the product correctly.
In support of that change,
the Royal Pharmaceutical Society set professional standards
and developed comprehensive guidance for pharmacists on
the retail supply of emergency contraception. That guidance
is detailed and clear. Although pharmacists are already
familiar with the product, through prescription supply,
additional training is being provided. A distance learning
programme is being sent to pharmacists ahead of the product
launch and workshops are available. Although pharmacists
are expected to deal with requests personally, pharmacy
staff will also receive training to ensure that they respond
Dr Fox MP: Why did
not the Government wait until the training was completed
before the product was made available?
Yvette Cooper MP:
It is a matter for the Royal Pharmaceutical Society to put
the professional training in place and to set standards.
It is primarily for the Royal Pharmaceutical Society to
ensure that the Medicines Act 1968 is enforced and that
the product is supplied appropriately. Pharmacists are well
qualified health professionals who have long experience
of handling a range of medicines and medical conditions.
The hon. Gentleman spoke
earlier about pharmacists objecting to the measure, and
I have to tell him that, according to the Royal Pharmaceutical
Society, the majority of members in a couple of surveys
of 1,500 community pharmacists in 1999 showed that 75 per
cent. wanted to supply EHC as a pharmacy medicine. It is
important that the Royal Pharmaceutical Society ensures
that training is in place and that the guidance is followed.
The hon. Gentleman discredits the huge number of pharmacists
who do a fantastic job and are quite capable of handling
the product effectively, and working appropriately and with
discretion with women who need and want the product.
Mr David Drew MP:
My hon. Friend makes a strong case for what pharmacists
want. I should like to know what information, advice and
education they may offer to women who go to them for the
service, especially those who go regularly. For example,
will pharmacists be able to refer a woman to a general practitioner
if they feel that she needs further medical advice?
Yvette Cooper MP:
Yes. The guidance is clear. Pharmacists should, whenever
possible, take reasonable measures to inform patients of
regular methods of contraception, disease prevention and
sources of help. That includes ensuring that women who go
to a pharmacy for emergency contraception are aware of other
sources of advice on regular contraception, such as their
local family planning clinic or their local GP. Emergency
contraception is not an alternative to regular contraception—
women use it when regular contraception breaks down—nor
is it a protection against sexually transmitted infection.
That is why the Government’s work on health education and
sexual health, including the teenage pregnancy campaign,
ensures the distribution of essential information on sexually
Dr Fox MP: It is
clear from what the Minister said that EHC is not intended
to replace regular contraception, but does she understand
the anxiety of many people that it will be used in that
way if it is as easy to obtain as it would appear from some
of the cases quoted?
Yvette Cooper MP:
I am aware of that anxiety, but emergency contraception
is already available through family planning clinics, general
practitioners and other sources. Someone who is determined
to use emergency contraception can obtain it. Anyone who
wants to obtain emergency contraception from a pharmacy
will have to pay for the product and the pharmacists will
have to use their professional judgment and follow the guidance.
The important issue is that
emergency contraception is more effective the earlier it
is given. Waiting to see a doctor can cause delay and reduce
the chance of it working; providing direct sale through
pharmacies will be an important additional route, especially
at times when traditional services may not be available.
Huge numbers of women know the frustration of trying to
track down the morning-after pill at the weekend after regular
contraception has let them down. If they fail to obtain
emergency contraception and a pregnancy becomes established,
the risk to their health is far greater if they go ahead
with the pregnancy or seek a termination.
According to the Conservative
Christian Fellowship, the hon. Member for Woodspring asked
his party to pray that there would be a huge restriction
on our abortion law, if not abolition. What does he want
women to do? If he is so against abortion, why is he also
so determined to make it more difficult for women to have
access to the emergency contraception that could prevent
those abortions? He wants to block access to abortion, but
he also wants to block access to emergency contraception,
which could avoid the need for abortions. What is he saying
to women? Is it Conservative policy that every woman whose
regular contraception fails should be forced to have a baby?
He has made it clear to the Committee that his party’s policy
is to make it harder for women to get emergency contraception.
Will he confirm that his party’s view is that women should
not have access to abortion either?
Dr Fox MP: I am sorry
that the Minister has decided to go down that track in what
had been quite a rational debate. I want to make it perfectly
clear that the Conservative party’s view on abortion is
that it is an issue for individuals. It is subject to a
free vote in Parliament, and the party will continue to
decide on that basis. Abortion is not a party issue. I am
sorry that the Minister has introduced that note into what
had been a serious debate in which we were considering serious
Yvette Cooper MP:
The Committee will be grateful that the hon. Gentleman has
clarified the interpretation of his words in this morning’s
It is clear that both pharmacists
and women want access to emergency contraception through
pharmacists. A recent Mintel survey shows that nearly two
thirds of adults believe that pharmacists should be allowed
to prescribe emergency hormonal contraception without the
need for a GP’s prescription. Last year, 800,000 prescriptions
for emergency contraception were issued.
Research shows that studies
in which women had increased access to emergency contraception,
perhaps through advance prescription, have not suggested
that they change their sexual behaviour or their use of
other contraceptive methods in any way. The only difference
is that women have earlier access to emergency contraception.
As I have said, it is not an alternative to regular contraception.
The Royal Pharmaceutical
Society’s guidelines will make clear the way in which pharmacists
can provide the support and advice that women want and need
when they go to them, rather than to family planning clinics,
to get emergency contraception.
On under-16s, I am aware
of the report in the Daily Mail to which the hon. Gentleman
referred. The Royal Pharmaceutical Society has said that
it will investigate the cases in that report to ensure that
the proper guidelines and the Medicines Act 1968 are being
followed. It is not part of the licence that emergency contraception
should be supplied to people under the age of 16 through
pharmacies. The initiative is not part of the Government’s
teenage pregnancy strategy; it is about increasing access
and helping to reduce the number of unwanted pregnancies
The Government’s teenage
pregnancy policy is far broader and is about improving relationship
and sex education and about improving information for teenagers
about how easy it is to get pregnant, but how hard it is
to be a teenage parent. The measure is not a substitute
for the provision of free emergency contraception on the
NHS through family planning clinics and GPs in the usual
way, because the product will not be affordable for many
women, even in an emergency.
The product has been through
a standard and extremely sensible process. It has been assessed
as safe and effective by all the extremely experienced and
reputable bodies that regularly consider all such medicines
and applications. They have looked at the product in great
detail. The Royal Pharmaceutical Society has also worked
in great detail to support these sensible changes that women
want. It is right to make those changes.
Dr Jenny Tonge MP: Before
I join in the debate proper, I shall say a little about
my background, because it is very relevant. Before I became
a Member of Parliament, I was for more than 25 years in
general practice and then I specialised entirely in community
family planning and community gynaecology. In that capacity,
and as a member of the faculty of family planning for the
Royal College of Obstetricians and Gynaecologists, I organised
and implemented training courses for GPs and hospital registrars
to obtain their family planning training and qualifications,
so I have some experience in the field. During those 25
years, I saw many hundreds and thousands of patients of
all ages. Included in my experience was five years as the
medical adviser and practising doctor at what was then the
London youth advisory centre, where I saw many people, from
as young as nine years old to those in their mid-twenties.
I do not want to appear egocentric, I simply think that
it is relevant that the Committee should know that what
I say today is based on personal experience and the experience
of my colleagues, not just on scientific knowledge.
Much is said about the safety
of this particular product. The hon. Member for Woodspring,
referred to it as being a new product. It may be a new product
in this dosage, for this purpose, to a GP, but levonorgestrel
has been on the market for at least 20 years. Over the years,
it has been used as a progesterone-only contraceptive pill
by many hundreds of thousands of women. It is interesting
to note that if a toddler accidentally took mum’s month’s
supply of levonorgestrel, no action would be needed. A girl
baby might have a tiny amount of vaginal bleeding, but she
would then be all right, because levonorgestrel is not toxic.
That is the degree of safety of the substance; it is far
safer than aspirin. We need to bear that in mind when we
read hysterical comments about how dangerous it is to give
a drug to a patient without their seeing a doctor first.
People in Britain can now obtain up to 32 aspirin—fortunately
no more than that at a time—and while that amount of aspirin
could kill a number of babies, a similar amount of levonorgestrel
would have no effect at all.
What would happen if young
people were too disorganised and shy, as many of them are,
to go along to the GP or family planning clinic where they
might meet mum’s friend in the waiting room—young people
are shy about going for help on sexual matters and birth
control—and so just kept nipping into different pharmacies
week after week? First, young people would run out of cash;
their big sister, older friend or boyfriend, would become
tired of forking out for them to buy the product over the
counter. I do think that £20 is a large amount, but I am
all in favour of them paying something. Most young people
today can afford cigarettes and mobile phones, so if they
are in a hole they can certainly afford a dose of the morning-after
pill. A charge will in itself militate against them using
it too frequently. If they have an unlimited supply of cash,
or an endless supply of boyfriends to give them £20 every
week they need it, their periods will go haywire and they
will have breakthrough bleeding. A young girl ready to take
off on holiday to the Costa Brava will rush to her GP, furious
because her period has started. I assure hon. Members that,
after more than 25 years of practice, I know that nothing
engages the mind of a young woman more than unexpected vaginal
bleeding. Girls get very fed up; they hate it; it cramps
their style. We know that periods cramp young women’s style
because that is how sanitary protection is advertised. It
is important to realise that that in itself will stop them
using EHC too frequently. Young women will soon decide to
take the pharmacist’s advice and go to a proper clinic,
or to their GP for some proper form of contraception on
a long-term basis.
I have discovered during
years of experience that a doctor cannot be too questioning
or judgmental with desperately worried teenagers when they
first come to the surgery. They may have had sex for the
first time, or even the fifth, and fear they may be pregnant.
If the doctor is judgmental, he will never see them again.
However, if he can help them quickly, especially in the
way a local pharmacist can as an anonymous person who is
unlike their general practitioner, they can be pointed in
the right direction and told that the morning-after pill
may stop them getting pregnant, but that condoms are the
only things that will stop them getting infections. That
way, they are much more likely to come back on a regular
basis. I could cite numerous cases of young people with
whom I have had precisely that experience. It is good to
make it easy for young people, because that is the way to
get them into proper care.
Let us not also forget that
the measure is designed for older women. The Minister will
correct me, as that is not my brief, but I think the highest
abortion rates in this country are among women in their
20s. Women often become rather cavalier. At first, they
are careful. They have responsible parents and, if they
are lucky enough, they have had all their sex education
and they know what to do, but when they reach their mid-20s
they assume that, because they have not become pregnant
so far, precautions are not necessary. They may go away
and forget their pills, or fall sick. I could cite numerous
examples of why people accidentally fail to use proper contraception.
They do not want to have to go the doctor and tell him that
they have made a mistake, and they do not want to have to
wait 72 hours for an appointment. They want to be able to
go into the pharmacy for some pills to deal with the problem.
It would be sensible for an older woman to keep a supply
of the product in the bathroom cupboard alongside the paracetamol
and her regular form of birth control, providing a ready
means of preventing pregnancy if necessary. It is important
to remember older women and the freedom that they should
have in deciding what to do with their lives.
I know that my hon. Friend
the Member for Romsey (Sandra Gidley) would like to speak
for the pharmacist, so I conclude by saying that, for the
past 15 years, either as a doctor working in the field or
since entering Parliament, I have sought to have this measure
enacted. It represents a huge leap forward. It is a way
of getting people introducing people to good sex education
and good family planning advice. It is a gateway to the
services. It gives older women the freedom to control their
own lives. For them to have to control their lives, and
their sexual lives in particular, via the family doctor,
is something of an insult.
There are those who are
worried about the abortion angle, as I certainly am. I deplore
the abortion rate and the number of teenage pregnancies.
However, we must keep on reminding ourselves that the morning-after
pill acts before implantation of the fertilised egg, or
stops the egg being fertilised in the first place. Therefore,
legally, whatever the tabloid newspapers say, it does not
result in an abortion. Those who have strongly held religious
views will maintain that the soul enters the potential human
being when sperm meets egg. However, I commend to hon. Members
an excellent speech made by the Bishop of Oxford, Richard
Harries, in the other place on Monday, who points out that
for the Church to say when the soul reaches the egg is very
arbitrary, and was done for all sorts of reasons. There
is no absolute truth here. In any case, many people in Britain
do not believe that, or are not Christians, or are coming
from a different direction altogether. Therefore, it must
be emphasised that the morning-after pill is not an abortion
pill, but a liberation for older women, providing access
to proper services and education for many teenagers in this
country, and I commend it.
Mr Peter Luff MP: I
have some moral concerns about this issue, but it should
not be decided on the basis of those concerns as I have
no right to impose them on this decision. It is right that
we should look at the practicalities, as this debate has
done very well.
The Minister set out very
well the science that led to the conclusion that she and
the Government reached. I learnt as Chairman of the Select
Committee on Agriculture, Fisheries and Food not always
to trust scientists; they have their own agendas. But, more
importantly, politicians must reach judgments on the basis
of that science and not just allow those scientific conclusions
to dictate their own conclusions.
I was struck by the research
undertaken by one of my local newspapers about the attitudes
of young people in Worcestershire. The concerns expressed
by those young people encapsulate the points made by my
hon. Friend the Member for Woodspring. A group of 16 and
17-year-old pupils was asked about the availability of emergency
contraception in schools, not about availability over the
counter. The concerns that they expressed were those that
my hon. Friend described. The article states:
The group interviewed were
immediately concerned that their peers would stop using
barrier methods of contraception, which stop sexually transmitted
That is a major concern.
I respect what the Government are trying to do on teenage
pregnancy and education on such issues, but, in theory,
those schoolchildren are right that the increased availability
of emergency contraception will undermine that work.
This is a classic vox pop
survey. Barji Kumar says that having the pill so readily
available would encourage youngsters to have unprotected
sex. He added:
You are supposed to take
precautions beforehand and if people can just take this
pill the morning after, I don’t think they will bother.
We must keep that concern
at the front of our minds. It is interesting that those
children were concerned about their parents not being informed.
Not all 16-year-olds are fully mature, and there is an argument
for parents being informed of what happens to their children
up to the age of at least 18, but that is another debate.
[Interruption.] I am sorry that the hon. Member for Richmond
Park (Dr Tonge) finds that funny, but I think there is an
argument. Parents are legally responsible for their children
until they are 18, but not for their medical history at
that age. There is a debate to be had on that.
Dr Tonge MP: Does
the hon. Gentleman agree that, whether a young person is
mature, depends entirely on the young person?
Mr Luff MP: I have
a great deal of sympathy for that. Having a teenage daughter
myself, I know exactly what the hon. Lady means.
The group interviewed was
concerned—it is important that the Government reassure us
on this point—that the easy availability of contraception,
without access to medical history, would be a problem. It
If there was a family medical
history of blood clots and the child didn’t know, they would
be put at risk by taking the pill.
That concern may be addressable,
it may not be a fair concern, but it is one that this group
of young people has. The group also said that it feared
that the pill would be misused and that much better information
should be available through chemists. I have a high respect
for pharmacists, one is about to speak, my mother was one
and her father was one. However, there is a problem about
making information on sensitive and personal matters available
to a young person over a pharmacy counter. It would be much
better done in the privacy of a practice nurse’s room or
a GP’s surgery.
Finally, the group was concerned
about the number of times that the morning-after pill would
be available. The hon. Member for Richmond Park made a powerful
case about the cost and some of the practical implications
of excessive use of the pill, but we should be concerned
about using this particular method of contraception too
often. I understand that it is intended for older women,
but the practical reality is that it will reach younger
women. As my hon. Friend the Member for Woodspring said,
older women will buy for it for younger women, and younger
women will trick pharmacists into selling it to them. We
have to accept that the morning-after pill will, in practice,
be used by 14 and 15-year-old women, not just 16-year-old
women, and we must bear that in mind.
The balance was about right.
The pragmatic decision to allow practice nurses to prescribe
the morning-after pill would be a sensible next step. But
the work done by The Droitwich Spa Advertiser and others
convinces me that this measure is just one step too far.
Sandra Gidley MP:
Members of Parliament may not be aware that, in the past
few years, a steady stream of medicinal products that started
off as prescription only products have been deregulated,
in just the way that we are discussing, and they are now
fully available through pharmacists. Many of those products
carry with them protocols to which pharmacists must adhere,
but it is by no means uncommon for a pharmacist to have
to refer the patient to the GP. Patients do not always like
that; they think that, because a medicine is available from
a pharmacy, they should automatically be able to buy it.
However, all good pharmacists will adhere to the protocols
and refer back to the GP when necessary.
As we have heard, the product
has been discussed by the Committee on Safety of Medicines
and the proposal has been out to public consultation, at
which stage any pharmacist with an interest could have had
an input into the process; finally the Medicines Commission
has approved the deregulation of the product. Given that
the Conservatives’ mantra is that we should trust the teachers
to teach, I fail to understand why they do not trust the
health professionals to examine the health aspects of deregulating
Dr Fox MP: I am grateful
to the hon. Lady for giving me the chance to point out a
fact of which she may not be aware. It is Conservative party
policy to deregulate a wider range of medicines than are
currently deregulated; we are very much in favour of that.
The question is whether regulations are being followed in
the particular cases mentioned. She will be aware of the
cases that the Royal Pharmaceutical Society is to investigate.
In her opinion, exactly what level of investigation and
supervision of pharmacists should there be when this sort
of product is put on the market?
Sandra Gidley MP:
I did not quite understand the question. Pharmacists are
professionals and they will follow the protocols. We always
have people investigating to make sure that procedures are
followed properly and that there is no problem. The Royal
Pharmaceutical Society has inspectors who investigate what
is going on in pharmacies. I believe that we are a strongly
regulated profession. Despite the fact that I heard earlier
that there was no intention to cast aspersions on pharmacists,
I feel demeaned by the comments of the shadow Secretary
of State for Health. The strict protocols that are in place
will be followed, which will ensure that important information
is not missed.
It has been said that pharmacies
are not always especially private. Well, women do have a
right to choose: if they do not think they have enough privacy
at a pharmacy, they will not go to one. The truth is that
many pharmacies have quiet areas and some have private consulting
rooms at the side of the dispensary—I had one in the last
pharmacy in which I worked. It is easy to take someone into
a quiet confidential area and have a fairly in-depth discussion.
I will not go into it here, but the Committee would be quite
surprised to hear what some people are ready to admit to
a pharmacist. I cannot condone any pharmacist not following
the guidelines. I trust the Royal Pharmaceutical Society
to investigate any case in which there is evidence that
the guidelines have not been followed.
It has been said that usage
will increase, but I fear that those who say that have not
done their research correctly. In 1998, Glasier and Baird
showed that there was no increase in the frequency of use
of emergency contraception, even if kept at home; and that
women were not likely to stop using long-term methods of
contraception either. That research appeared in the New
England Journal of Medicine. More recently, in 2000, in
the British Journal of Family Planning published a called
‘Repeated use of hormonal emergency contraception by younger
women in the UK’, the conclusion of which specifically addresses
that point, saying:
The results of our study
disprove the notion of widespread repeated use of emergency
contraception and hopefully will reassure GPs and others
that provision of an emergency contraception service does
not result in failure to initiate regular contraception
or abandonment of regular contraception.
The writers support widespread
access to emergency contraception as an integral component
of a comprehensive family planning service.
The distinguishing feature
of the product that we are debating is that some people
object to its use on moral grounds, but we should not take
such considerations into account. The moral argument is
for another time and place. The product is available as
contraception and it does not make any difference whether
doctors are supplying it, nurses are supplying it or pharmacists
are supplying it. The outcry is just a mischievous move
to create media interest at a time when we should be allowing
the health professionals to get on with the job.
Yvette Cooper MP:
I welcome the points made by the hon. Member for Richmond
Park about the safety of the product, the importance of
improving access, especially for older women, and the product’s
potential to reduce the number of abortions. I also welcome
the points made by the hon. Member for Romsey about the
ability of pharmacists, as trained health professionals,
to do the job.
The hon. Member for Mid-Worcestershire
(Mr Luff) raised a number of concerns, the first of which
relates to access for under-16s and 16 to 18-year-olds without
parental consent. Access to contraception and emergency
contraception is governed by a legal framework that has
been in place for the past 15 years; that framework, rightly,
remains completely unchanged and by the order or by the
introduction of the product, which applies to over-16s.
The hon. Gentleman also
mentioned privacy and the importance of having a private
area in which to discuss these matters. I refer his attention
to the remark made by the hon. Member for Romsey that the
customer will choose where to go and decide what level of
privacy is required. I doubt that many pharmacists would
be embarrassed discussing these issues in the middle of
the pharmacy. The most recent survey of community pharmacies
shows that 90 per cent. of pharmacies have an area in which
advice can be given out of earshot of other customers, so
we should not underestimate existing provision.
Mr Luff MP: Did the
Minister say 90 per cent?
Yvette Cooper MP:
The information that I have been given comes from a survey
carried out by the Royal Pharmaceutical Society of Great
Britain which found that more than 90 per cent.of the community
pharmacies surveyed had an area where advice could be given
out of earshot of other customers.
The application from the
company to change the legal status of this product has gone
through all the proper procedures; it has been assessed
by all the proper bodies, as safe and effective. It is a
very sensible public health measure that improves women’s
access to a product that they want and need from time to
time and that they should be able to get. The order will
make it easier for them to do so, should they choose to
buy the product through the pharmacies. Ultimately, it is
their choice, but it will provide a way to reduce the number
of unwanted pregnancies.
It is important that the
Royal Pharmaceutical Society’s guidance is properly followed
and it will be the society’s responsibility to ensure that
the measure is implemented effectively. We should accept
the order and accept that it is sensible in terms of public
health and sensible for women right across this country
Dr Fox MP: We have
had a useful debate. I reiterate that the debate is not
about whether EHC should be available, nor about its moral
legitimacy. Those are not considerations to be taken into
account in this order. We are debating the practicality
of it being available over the counter, in the way proposed
by the Government.
I have great respect for
the hon. Member for Richmond Park and for her experience
of these issues. She will, of course, recognise that there
is a legitimate counter view to her own, but I in no way
doubt her sincerity and the value of her experience in bringing
her argument to the Committee.
I must tell the hon. Member
for Romsey that we are not casting doubt in any way, shape
or form about the ability of pharmacists to perform their
trained duty. There is a question about the training they
receive, and we have already had examples of where they
have not carried out in practice what they should have,
and that, of course, needs investigation. I must take complete
exception to the idea that this is a frivolous debate. I
would say most soberly to the hon. Lady, that it is the
role of the House of Commons to debate issues where there
are controversial elements. As Members of Parliament, it
is our job to ensure that those views are heard inside the
House, on behalf of those who have concerns outside and
cannot express them themselves. Perhaps, when she has been
in the House a little longer, she will give more weight
My hon. Friend the Member
for Mid-Worcestershire’s point about whether the Government
are inadvertently giving the wrong message about the need
for barrier contraception and the risk of transmission of
sexually transmitted disease needs to be considered. If
the Government proceed with this order, I hope that they
find ways to strengthen the message in any advice that is
given in guidelines to pharmacists, to ensure that greater
emphasis is placed on that.
It would be a great pity
if the order, which the Government want to see in place,
were to have the opposite result to that which they seek
in terms of public health policy and sexual health. I ask
the Minister to bear that in mind in future guidelines.
The Committee divided: Ayes
9, Noes 3.
Benn, Mr Hilary
Drew, Mr David
Fisher, Mr Mark
Henderson, Mr Doug
Jamieson, Mr David
Tonge, Dr Jenny
Fox, Dr Liam
Luff, Mr Peter
Swayne, Mr Desmond