The Day after Sex

Article excerpt

Annabel Ferriman on why the makers of the morning-after pill don't want you to get hold of it too easily

Ann and Julie come from different worlds but both know what it feels like to worry about unwanted pregnancy. Ann, a 33-year-old professional woman from Scotland, feared that she might be pregnant after her partner's condom leaked; Julie, a 15-year-old schoolgirl from inner London, got in a panic after unprotected sex with her boyfriend. Both turned to the NHS for post-coital contraception and both discovered that getting a quick prescription from the NHS is almost as hard as getting a ticket for the World Cup.

Only one of them managed to get what she wanted, and there are no prizes for guessing which one. Ann, who had the age and confidence to surmount the obstacles, nevertheless had to spend six hours on her quest for help one Friday afternoon, and had to visit a hospital, a family planning clinic and a GP's surgery before she was successful.

She recalled: "I first approached the accident and emergency department at my local hospital and was told that, as it was not a bank holiday, no assistance could be provided and to contact my GP. This I duly did but no appointments were available."

The GP's receptionist told her to try her local family planning clinic, but when she arrived there, at 2.45 pm, she found that the session had just finished for the day.

Despite a lengthy phone call from the clinic, the hospital still refused to help. The clinic then contacted Ann's GP practice and the receptionist finally slotted her in for the end of evening surgery. "I think the system was appalling," said Ann. "I would hate to think about a teenager facing the red tape that I did."

Julie did not face red tape so much as her doctor's disapproval. She went to her GP with her partner, but the doctor refused to prescribe emergency contraception unless she returned with one of her parents. She turned to one of the Brook Advisory Centres, which specialise in contraceptive advice for teenagers.

By then it was too late, because 72 hours had elapsed since she had had sex. She turned down the centre's offer to fit an intra-uterine device, which can also prevent pregnancy after unprotected sex. The staff did not see her again and do not know whether she became another statistic in the abortion figures or a teenage mother, but felt that, in either case, she had been ill-served by the NHS.

The two stories illustrate a yawning gap in Britain's health services. Doctors discovered as far back as 1980 that women could substantially reduce the risk of pregnancy if they took four high-dose contraceptive pills (in two doses 12 hours apart) within three days of unprotected sex. But some women do not know about the pills, while others cannot always jump through all the hoops in time. The simple answer is to make emergency contraception available through chemists, without a doctor's prescription. It could move from what is known as a POM drug (a prescription-only medicine) to a P drug (one available from pharmacists). Ann and Julie could then have walked into Boots on their way to work or school and bought themselves out of their nightmare.

The very idea strikes horror into the hearts of the "moral majority", who do not like the idea of women being able to "get away" with "irresponsible sex". Yet emergency contraception is extremely safe, since the combined dose of four 50-microgram pills amounts to only a third of the oestrogen contained in a monthly supply of the standard low-dose contraceptive pill. Women took pills of 50-microgram strength every day of their lives in the 1960s, when the pill first came on to the market. Moreover, other medicines which were once prescription-only, such as pessaries for thrush, steroid creams for eczema and nasal sprays for hay fever, have all successfully moved to pharmacy drugs with no adverse consequences.

What is more, the entire medical, nursing and family planning establishments are in favour of the change: the Royal College of Obstetricians and Gynaecologists, and the Faculty of Family Planning and Reproductive Health Care called for a change in 1995 with the support of, among others, the British Medical Association, the Royal College of GPs and the Royal College of Nursing Family Planning Forum. …