A Bitter Pill For The Moral Majority

Ireland, not for the first time – and probably not for the last – is playing catch-up when it comes to sexual health. Let’s compare and contrast with, say, Britain.

Emergency contraception came on the British market in 1984, at a time when, in Ireland, condoms were only legally available with a prescription (thanks, Charlie Haughey). By the time the Irish Medicines Board got around to licensing emergency contraception as a prescription-only drug in 2001, the same product was available over the counter in Britain.
Now, 10 years later, emergency contraception is finally available over the counter in Ireland – thanks to a British company, Boots. Considering Ireland’s illustrious history of making contraception stupidly difficult to access, it’s not surprising that this move has met with a bit of backlash.
The Irish Independent’s ultra-Catholic, David Quinn, took the opportunity for a few pot-shots at “young, single women who were out on the tear over the weekend”, denouncing them as the category who are most likely to “show up at a family planning clinic on a Monday morning.”
Young, single women having sex!? How terrible. They’re probably even enjoying it, the filthy, boozed-up slags. Quinn went on to despair of “how we ever got to a point where there is such demand for a product like this.”
Answers on a postcard to Independent House, Talbot Street, Dublin 1: no need to enclose actual burst condoms.
Okay okay, it’s easy to take the piss out of the nut-bag religious right. In fact, the most determined opposition to Boots’ move has been much more nuanced, and has come from an apparently ‘secular’ source: the Irish College of General Practitioners (ICGP). This influential organisation’s spokesman, Dr Mel Bates, was all over the media for a couple of weeks there, explaining why Boots should be stopped in its tracks.
The impression that many radio listeners or newspaper readers may have come away with is that the GPs’ representative body was casting aspersions on either the safety of the ‘morning after’ pill itself, or on pharmacists’ ability to provide it.
When Hot Press caught up with Bates, after the dust had settled somewhat, he was at pains to point out that this was not the case. He said he had full confidence that Boots would provide a “very professional” and “high quality” service to women, while the drug itself was safe and effective and “should be more widely available.”
Asked whether he thought his statements in the media might have fed confusion about emergency contraception, Bates was honest to the point of abeing apologetic. “Yes,” he said, “and I would be the first to apologise if my lack of skill or otherwise meant that happened. This issue was sprung on us suddenly and we expressed concern. We felt we had to have a position because otherwise Boots would have an open field. So I tried to comment but it didn’t come across very well.”
The ICGP’s basic argument is that Boots is a large, commercial company that has “cherry-picked” a medical service, which it will now advertise and promote, in a way that will increase demand. Bates remains adamant that GPs do not oppose pharmacists selling contraception over the counter simply because this will hurt GPs own commercial interests.
“People love convenience,” he said. “I love convenience. What happens is, if you apply that to an area of health you will attract people in. What these initiatives aim to do is to target a soft group. There’s a difference between medical need and medical demand. I have no problem with meeting medical need. Medical demand is where I take issue.”
Now, at first glance, this is a persuasive argument. Maybe it’s due to a deep-rooted fear of being had, or maybe it’s just plain snobbery, but a lot of us tend to be a bit suspicious about what are often perceived as slick, multinational operations like Boots.
It’s pretty obvious that Boots are in the ‘morning after’ pill market to make money – nobody said they weren’t. But you can buy lots of things in Boots: vitamins; painkillers; granola bars; those terrifying ‘Girls Aloud’ own-brand fake eyelashes that make you look like there are spiders crawling out of your eyes. Just because these things are available doesn’t mean girls will rush out and buy them for the sheer fun of it. My own view is that emergency contraception is no exception.
Why? For a start, the ICGP’s suggestion that increased availability of emergency contraception through over-the-counter sales will lead to a corresponding increase in demand is simply not supported by the evidence. In 2005, the British Medical Journal published a study investigating women’s use of emergency contraception in Britain, before and after it became available over the counter in 2001. The authors concluded that the rate of use was much the same, regardless of availability. The only thing that changed was where women accessed the drug: after 2001, more women accessed it in their pharmacy than previously.
The Irish Family Planning Association (IFPA) has campaigned for over-the-counter sale of emergency contraception for many years. The organisation’s CEO, Niall Behan, is totally unconvinced by the ICGPs’ argument that selling emergency contraception in pharmacies will increase demand.
“Emergency contraception should be a back-up, a plan ‘B’ to regular contraception, and all the research that has been done, especially in the UK, shows that women know that,” says Behan.
“You don’t see an increase in the use of emergency contraception when over the counter sale is in place. What you will see is women accessing it more quickly – and it is much more effective in the first 24 hours than on the third day after unprotected sex.”
Behan says that the IFPA, which runs emergency contraception clinics, has found that “quite a few clients have difficulty accessing emergency through GP services.”
Previously, many women – particularly those living in rural areas – would have waited two days to access emergency contraception, by which stage the drug’s effectiveness is significantly reduced. The great thing about the over the counter service is that it’s going to be a hell of a lot easier and cheaper to find your way to a Boots store on a Sunday afternoon than to find an on-call GP.
Meanwhile, Kathy Maher, a member of the Irish Pharmacists’ Union executive, confirmed that the organisation is currently investigating how sales of emergency contraception can be extended to all 1,800 pharmacies in the country, using the same the legal framework employed by Boots.
Maher is pretty sanguine about GPs’ opposition to this major expansion of the pharmacist’s role. “Innovation in one profession always meets resistance in another,” she observed. “That is the pattern of innovation.”
Behan too takes a philosophical view of resistance to over the counter sales of contraception in Ireland.
“On this issue, women’s reproductive health, we’ve always been very slow to put in the best services,” he says.
“There’s a pattern there: we have always been very slow to embrace what is best for women’s health and well-being.”