Birth of an era in sexual health

It’s two years this month since the morning-after pill went on sale over the counter. How did our sexually active young people fare since? Suzanne Harrington reports

UH-OH. Contraceptive malfunction — and you have no plans to become a parent. Do you (a) freak out and hope you’re not pregnant (b) contact a UK abortion clinic or (c) keep calm and take the morning-after pill? Most women would opt for (c), since the morning-after pill, the MAP, has been available over the counter in Ireland since early 2011, without prescription. (It’s not literally for the morning after — it works up to 72 hours after sex, although a new MAP, which requires a prescription, works for up to five days after).

Prior to 2011, if you wanted the MAP — only legal in Ireland since 2001 — you had to go to your doctor. There was a case in 2010, reported in the Kerryman newspaper, of a doctor who refused on religious and ethical grounds to prescribe it. The patient had to travel to another city.

Boots chemist challenged the prescription-only status by selling it in their shops, providing you had a one-to-one consultation with their in-store pharmacist. This cost €45. The Irish Medical Board then approved over-the-counter sale of the MAP. With a medical consultation no longer required, the price dropped to as low as €9.99.

The anti-abortion group, Youth Defence, said the MAP was an “abortifacient” and that it “could have serious consequences on the health and safety of women and even the unborn”, as well as undermining parental consent if the MAP was sold to women under the age of 18 without the knowledge of their parents. The fear was the MAP would be used like a hangover cure on a Monday morning, encouraging sexual laissez-faire.

Irish teenagers are rather good at using contraception — according to figures from the HSE Crisis Pregnancy Programme, 90% use contraception the first time they have sex, and 80% use it every time. So what have been the results of the MAP being available over-the-counter? Sexual mayhem, or a drop in visits to the doctor for the prescription?

“We do know that the number of women visiting clinics for emergency contraception has significantly dropped — approximately 80% fewer women are presenting themselves at sexual health clinics to get the morning-after pill,” says Anne Sexton, sex columnist with Hot Press magazine.

“It is not hard to imagine that cost plays a significant role in whether a woman decides to use emergency contraception, particularly young women or those on low income or social welfare. A doctor’s visit is expensive. The Crisis Pregnancy Programme figures show that the number of teenage girls giving birth dropped during 2011. There has also been a decrease in the number of women giving Irish addresses at UK abortion clinics.

“It is impossible to say how much of a role the easier availability of emergency contraception has played here versus, for example, the contraception awareness campaigns run by the Crisis Pregnancy Programme.”

Because there is no central register of patients in Ireland, it is not possible to give exact figures with regard to sales and usage of the MAP. There has not been a spike in sexual debauchery.

“There has been no sharp sales increase,” says Kathy Maher, vice- president of the Irish Pharmacy Union. “Just easier accessibility. People are accessing it earlier, which means they can get it over the counter, especially at weekends, rather than having to make a doctor’s appointment before visiting the pharmacy to collect it via prescription. But it is emergency contraception — this does not mean that people have been going out and having extra, unprotected sex.”

Figures tend to be ‘guesstimates’. Alison Begas, director of the Well Woman Centre, says the organisation dispensed 4,500 MAPs per year prior to over-the-counter availability. Last July, the Irish Mail reported a “300% increase in usage” of the MAP, which was still only 5,000 units per year.

While the MAP can prevent an unwanted pregnancy, it cannot filter out sexually transmitted infections. There has been a 21% increase in chlamydia in Dublin among women aged 20 to 30; while this may not be related to MAP usage, the only effective way of avoiding STIs is condoms.

“We have mixed views about the MAP being available over the counter,” says Begas. “In terms of access and affordability, it’s far easier for women to go to their community pharmacy, especially at weekends. The concern we have is about longer-term sexual health. Women are very focused on avoiding pregnancy, but not always aware of STIs.

“When women came to us for the MAP, it was often their first time accessing sexual health care, and we could speak to them about holistic sexual health. I’m not sure these discussions are happening over the counter in pharmacies.”