The rise of the counter-culture

Following Boots’ plans to make the morning-after pill available over the counter, Colm MacEochagain looks at the attitudes towards women’s health and contraceptionLast month, amid a flurry of media attention, the Boots pharmacy chain announced imminent plans to make the morning-after pill available to Irish patients on an over-the-counter basis. The move marked the first time in the history of the Irish State that emergency contraception had been made available without the prior consultation and consent of a doctor.Despite the vocal disapproval of some Pro-Life and Catholic groups, public, professional and media reaction to the development has been generally positive, with one RedC/Irish Examiner poll showing 81 per cent supporting the measure. Dr. Catriona Henchion, medical director of the Irish Family Planning Association, who had campaigned extensively on the issue said: “This will just make access easier, there will be less of a delay in patients getting it, that’s the bottom line. Everybody is aware that the effect reduces as time elapses. Anything that means people can get it quicker and easier is a good thing.”The change was facilitated by the use of a controversial loophole discovered by Boots in a 2005 amendment to legislation. The legislation appears to allow the sale of certain drugs without prescription, provided they are sold in accordance with the ‘Patient Group Directive’ protocol, a set of internal rules drawn up and overseen by doctors directly employed by Boots. The same mechanism had previously been exploited by Boots to administer seasonal flu vaccinations without prescription.In response to the development, the Irish Medicines Board (IMB) quickly moved to challenge Boots’ interpretation of the ‘Patient Group Directive’ legislation, publicly claiming that Boots’ actions constituted a wilful misinterpretation of the law, and ordered them to stop all over-the-counter sales with immediate effect.In what the IMB describe as an unrelated development, NorLevo, one brand of emergency contraception, was formally delisted only days later, making way for its unrestricted over-the-counter sale by all pharmacists across the country.NorLevo is expected to retail at around €10. However, many pharmacists seem likely only to dispense it following a private consultation. Such consultations may increase the overall cost by as much as €30.NorLevo is currently licensed for sale in 48 countries worldwide, 30 of which have granted over-the-counter status to the drug. The move to delist the drug brings Ireland broadly into line with our closest European neighbours.In light of those findings, it is perhaps somewhat surprising that the Irish College of General Practitioners (ICGP), which represents over 90 per cent of Irish GPs, have strongly condemned the recent development. Dr. Mel Bates, Chair of the ICGP, said that over-the-counter sale of emergency contraception raises questions about the quality and continuity of care being afforded to the patient. Speaking to, Dr Bates said: “The ICGP has some concerns surrounding patient consultations. Our pharmacy colleagues just don’t have the same level of experience or training in this area as GPs.”Perhaps GPs are simply worried about their bottom line and the potential this landmark change has for the further erosion of their traditional territory. Likely incoming Minister for Health, Fine Gael’s Dr. James Reilly, has declared himself a firm supporter of “patients being dealt with in the community at the lowest level of complexity possible”.President of the Irish Pharmacy Union, Darragh O’Loughlin, agrees and said: “There are many medicines available from the pharmacist in other EU countries for which patients in Ireland currently require a prescription. These medicines have a good safety record and should be made available in the community from pharmacists who, it should be remembered, are qualified health professionals.”Contraception has only been fully legal in Ireland for the past 25 years. One GP, writing in the Irish Independent, recalled a time in the early 80s when young women were routinely subjected to intense moralising by doctors on the subject of their sexual health and activity. One Dublin based clinic was singled out for employing a doctor who regularly told patients that he “wasn’t going to provide an abortion for a slut”.Thankfully, such proselytizing may now be a thing of the past. The fact that many women choose to visit ‘Well-Woman’ clinics, rather than their own GPs, when accessing emergency contraception, highlights the desire many women share for non-judgemental advice when it comes to their sexual health. NorLevo’s new over-the-counter status simply facilitates that pre-existing demand for impartial advice and discretion.Also studies in Britain and San Francisco show that over-the-counter availability of the morning-after pill does not impact on a woman’s use of primary contraception, or lead to an increase in the prevalence of STIs.The ability of women to control their own fertility without outside interference has long been touted as one of the great steps society has taken towards enhanced gender equality. In their sexual health, as in all things, women deserve the right to decide for themselves. The expansion of these rights, even if it steps on the toes of some special interest groups, perhaps especially if it steps on the toes of some special interest groups, can only be welcomed.