Is it time for a change of prescription?

By Rachael McKeown

Emergency contraception is called emergency contraception for a reason. Women who want to obtain the morning after pill but fail to do so may end up with an unwanted, unplanned pregnancy.

And while family planning, contraception and sex have been hot topics in Ireland for decades, interestingly, there has been very little progress in facilitating easier access to something as crucial as emergency contraception.

Ireland is one of only two countries in the European Union that doesn’t have emergency contraception available over the counter, yet a 2006 survey concluded that 52 percent of men and 42 percent of women believe that the morning after pill should be available. Why isn’t it?

There are two very opposing sides to this debate. The Irish Pharmacy Union (IPU), that represents 1800 community pharmacies in Ireland, have sought to be able to offer their customers an over the counter service for emergency contraception and their desire to be licensed to sell emergency contraception is more than just a question of financial gain for the pharmacies.

Research by the Irish family planning association (IFPA) has shown that alarmingly, almost 50 percent of women obtaining the morning-after pill do so outside the optimal 24-hour time frame. The Cathal Brugha Street clinic conducted a study in 2008 finding that 54 percent of women took the morning-after pill within 24 hours, a staggering 35 percent took it between 24 and 48 hours, and 11 percent took it after 48 hours or more. Despite the fact that it is licensed for 72 hours, emergency contraception is at its most effective within the first 24-hour period and after that its effectiveness declines by the hour.

Critics argue that the entire point of women having to go through a GP is so they will receive proper counsel and have their options explained to them. The IPU however argues that Irish pharmacists have the skills to provide women with this appropriate advice.
In order for the morning-after pill to be sold over the counter it is up to the drug companies themselves to apply for an over-the-counter license from the Irish Medical Board, yet they continue not to do so. HRA Pharma, which distributes Norlevo, one of two contraceptive morning-after pills sold in Ireland, said that they felt there simply wasn’t enough demand. Bayer Schering Pharma who manufacture the second, Levonelle, said they had no plans to seek an over-the-counter license as they believe that despite its prescription-only status, access to emergency contraception was not limited in Ireland, a statement that perhaps many women will dispute. In the vast majority of cases, women need an emergency appointment at the weekend, when GP offices are closed, not at the favourable hour of a weekday morning. Women must then resort to trying to get an appointment at significantly more expensive weekend clinics.

Critics have argued that easier access to emergency contraception will encourage unhealthy sexual behavior, yet in the United Kingdom there is no evidence of this. According to the British Medical Journal, there has been no increase in use of emergency contraception since its introduction as an over-the-counter pill.

This polarised debate on whether emergency contraception should be available without prescription is likely to rage for a long time. Many are of the belief that having a GP as a vehicle to emergency contraception is both antiquated and another symptom of “rip-off Ireland”. Others feel it in the best interest of women’s sexual and reproductive health to discuss their situation with a licensed medical doctor.

In reality, whether the morning after pill will become readily available without prescription will depend on the Irish Medical Board and whether it will ever allow the pharmaceutical companies to obtain an over-the-counter license.