A hard pill to swallow

By Ellie Levenson (THE GUARDIAN, 05/05/08):

The news isn’t good for the morning-after pill. A constitutional court ruling in Chile recently banned the public health system from distributing free emergency contraception. In some parts of the US, there are legislative attempts to make access to the pill more difficult on the grounds that it is an abortion-inducing medicine. And while doctors in Italy who refused two women emergency contraception may face sanctions, there is no shortage of political and religious leaders supporting them.

Compared with these examples, emergency contraception is pretty accessible in the UK, but pharmacists still fall short in helping women get the morning-after pill when it’s needed. The other day I went to the chemist to buy emergency contraception for a friend who couldn’t get to the pharmacist or doctors that day. In the first two I visited, I told the truth – that I was buying on behalf of someone else. They refused to give it to me. In the third I lied. The emergency contraception was for me, I said. A condom had split the night before. I was midway through my cycle. All textbook answers. I was given the medication and went on my way.

I had to lie because the Royal Pharmaceutical Society’s (RPS) guidelines say that other than in exceptional circumstances, pharmacists can only provide emergency contraception for the person who needs it. This is left to the pharmacists’ discretion, but being stuck at work or at school or at home looking after children does not tend to be deemed exceptional circumstances. This rule means mums cannot get it for their daughters; nor men for their partners. And friends cannot come to the rescue.

Neither will pharmacists usually provide the morning-after pill in advance of need. This is despite a 2006 statement from the RPS that it did not object to advance provision in principle. Given that the treatment is 95% effective if taken within 24 hours of unprotected sex but only 58% if taken 72 hours later, preventing easy access is ludicrous, leading to many more unwanted pregnancies than is necessary.

Many people, including some pharmacists, argue that restrictions to access are there because they need to ask certain questions of women before they can take it. This suggests that women are incapable of self-diagnosing and reading instructions, and ignores the fact that we habitually self-diagnose and self-medicate for other reasons. That is why I have called my campaigning website womenarenotstupid.co.uk. If we are clever enough to decide when we take a paracetamol, we are clever enough to have the morning-after pill in the bathroom cabinet for emergencies, and to read the instructions to decide whether or not we should take it. My site links to an online petition on the Downing Street website calling for better access to emergency contraception.

One woman I talked to about these proposals spoke with fear about her vision of a future in which emergency contraception is available in vending machines in pub toilets. I am not advocating that; condoms are a far safer and cheaper method of contraception that should be promoted where possible instead. But I would like to see emergency contraception on the supermarket shelves, or at the very least available over the counter in pharmacies in advance and to everyone.

Whatever choices we make, and whether the result of a split condom or a decision made in the heat of the moment, having access and using it when needed is far more responsible than allowing an unplanned pregnancy to continue, and far less traumatic than needing an abortion some weeks later. Every woman, and man, should keep a pack in their bathroom cabinet, because as everyone – including pharmacists – knows, accidents do happen.