Emergency contraception – from past to present

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The history of contraceptive rights in Ireland is particularly frustrating for anyone who values gender equality, human rights and reproductive freedom. Eamon de Valera’s 1937 Irish constitution has a strong Catholic foundation, referring to women only as ‘mothers’ in article 41.2 and asserting their place within the home. This stereotyping of women’s interests as heterosexual, domestic and subservient paved the way for a long and continued history of restrictive, misogynistic and damaging expectations of Irish women. Reproductive freedoms in Ireland which have been won have been the result of brave and hard working groups of women, of men and of individuals who considered women’s reproductive rights as paramount for an equal society – thank you! However we still have a long way to go.

To give a brief context of the morning after pill, here is a quick outline of other dates in the history of Irish contraception:

  • In 1963 the contraceptive pill is first legalised in Ireland (it was introduced however as a ‘cycle regulator’ not a contraceptive!)
  • In 1969 the Irish Family Planning Association (still around today and an excellent resource!) is first established, Ireland’s first family planning clinic
  • In 1979 the Health (Family Planning) Act legalises contraceptives (condoms and the pill) however both are only available by getting a doctor’s prescription.
  • In 1983 the eighth amendment is added to the Irish constitution guaranteeing the ‘equal right to life’ of a woman and her unborn baby and ensuring abortion cannot be legislated for, while in 1985 condoms may be sold without a prescriptions in chemists to people over the age of 18.
  • Throughout the 1990’s restrictions were lowered in accessing most contraceptives, there are little or no restrictions in buying condoms and although a prescription is still required for the contraceptive pill the reasons why a woman wants to access it technically should not be questioned (This does not mean that our experience with Irish doctors when accessing the pill are always pleasant, easy or cheap!)
  • In 2003 emergency contraception (the morning after pill) is legalised in Ireland, requiring however- a doctors visit and prescription. Unbelievably (and perhaps unknown by younger readers!) it was only in 2011 that the morning after pill, NorLevo, became available in pharmacies without a prescription!
  • In 2015, ellaOne, the form of emergency hormonal contraception that can be used up to 5 days after sex, is made available in pharmacies without prescription in Ireland, following a historic decision by the European Medicines Agency and the European Commission.

So where are we today? It’s fantastic that emergency contraception is available over the counter, but in reality, just how ‘available’ is it? Perhaps not as available as you might think. In fact, the next time you need the morning after pill, you may be surprised to find that the pharmacy is perfectly within their rights to refuse it to you. Yep, that’s right. The pharmacist can point blank refuse you access to a pill you need, not them. Under the Pharmaceutical Society of Ireland’s guidance in relation to the supply of Norlevo and ellaOne,  pharmacists may refuse to dispense the drug if it lies in contradiction with his or her moral standards. Though the pharmacist is required to refer you to another pharmacy, this simply is not good enough.

Don’t live in a big city? Whether it be for the morning after pill or a packet of Panadol, finding a pharmacy can be a pain for find on a Sunday, right?

According to the Irish Pharmacy Union (IPU), no current guidelines exist under the Community Pharmacy Agreement in relation to requiring pharmacies to open on Sundays. So, in theory, the pharmacist refusing you access to the morning after pill may be the only pharmacy open in your area. With Monday the most popular day for the morning after pill, (according to a recent study conducted by the IPU), you have to wonder if women are being faced with such a situation every weekend in Ireland.  Where’s the reproductive choice in that?

As well as this, the morning after pill ain’t cheap. Though the decision to drop the  ‘dispensing fee’ in 2011 meant NorLevo could be sold for as low as €9.99, in practice, pharmacists can charge what they like. Many other countries provide emergency contraception free of charge in all or certain circumstances. In the UK, for example, the morning after pill is free from some pharmacies and walk-in clinics. Should we really have to directly pay for our reproductive rights?

Also – hands up who finds having to get the morning after pill a little bit embarrassing? You might work up a sweat wondering if the other customers will catch you fervently whispering ‘morningafterpillplease’, you might avoid eye contact with the person at the counter. Whether they are or not, you’re just convinced they’re slyly raising an eyebrow at you. Plus, providing information on the morning after pill and how to use it correctly is great, but do pharmacists really need to ask all of those awkward questions?

Do they really need to bring you into that little consultation room? We need to figure out a) what causes this embarrassment in the first place and b) attempt to devise ways for pharmacists to help to make the process run a little smoother. We need to get it into our heads that both men and women have sex, and the reasons why we need emergency contraception are irrelevant to anyone but you.

Over the last few decades, Ireland has come far in terms of contraceptive rights. Nonetheless, the contraceptive train has a long distance to go before it reaches it destination – let’s stay on board.

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