|Prescription Only Medicines (Human Use) Amendment (No. 3) Order 2000
Dr. Fox: Why did not the Government wait until the training was completed before the product was made available?
Yvette Cooper: It is a matter for the Royal Pharmaceutical Society to put the professional training in place and to set standards. It is primarily for the Royal Pharmaceutical Society to ensure that the Medicines Act 1968 is enforced and that the product is supplied appropriately. Pharmacists are well qualified health professionals who have long experience of handling a range of medicines and medical conditions.
The hon. Gentleman spoke earlier about pharmacists objecting to the measure, and I have to tell him that, according to the Royal Pharmaceutical Society, the majority of members in a couple of surveys of 1,500 community pharmacists in 1999 showed that 75 per cent. wanted to supply EHC as a pharmacy medicine. It is important that the Royal Pharmaceutical Society ensures that training is in place and that the guidance is followed. The hon. Gentleman discredits the huge number of pharmacists who do a fantastic job and are quite capable of handling the product effectively, and working appropriately and with discretion with women who need and want the product.
Mr. David Drew (Stroud): My hon. Friend makes a strong case for what pharmacists want. I should like to know what information, advice and education they may offer to women who go to them for the service, especially those who go regularly. For example, will pharmacists be able to refer a woman to a general practitioner if they feel that she needs further medical advice?
Yvette Cooper: Yes. The guidance is clear. Pharmacists should, whenever possible, take reasonable measures to inform patients of regular methods of contraception, disease prevention and sources of help. That includes ensuring that women who go to a pharmacy for emergency contraception are aware of other sources of advice on regular contraception, such as their local family planning clinic or their local GP. Emergency contraception is not an alternative to regular contraception women use it when regular contraception breaks downnor is it a protection against sexually transmitted infection. That is why the Government's work on health education and sexual health, including the teenage pregnancy campaign, ensures the distribution of essential information on sexually transmitted infections.
Dr. Fox: It is clear from what the Minister said that EHC is not intended to replace regular contraception, but does she understand the anxiety of many people that it will be used in that way if it is as easy to obtain as it would appear from some of the cases quoted?
Yvette Cooper: I am aware of that anxiety, but emergency contraception is already available through family planning clinics, general practitioners and other sources. Someone who is determined to use emergency contraception can obtain it. Anyone who wants to obtain emergency contraception from a pharmacy will have to pay for the product and the pharmacists will have to use their professional judgment and follow the guidance.
The important issue is that emergency contraception is more effective the earlier it is given. Waiting to see a doctor can cause delay and reduce the chance of it working; providing direct sale through pharmacies will be an important additional route, especially at times when traditional services may not be available. Huge numbers of women know the frustration of trying to track down the morning-after pill at the weekend after regular contraception has let them down. If they fail to obtain emergency contraception and a pregnancy becomes established, the risk to their health is far greater if they go ahead with the pregnancy or seek a termination.
According to the Conservative Christian Fellowship, the hon. Member for Woodspring asked his party to pray that there would be a huge restriction on our abortion law, if not abolition. What does he want women to do? If he is so against abortion, why is he also so determined to make it more difficult for women to have access to the emergency contraception that could prevent those abortions? He wants to block access to abortion, but he also wants to block access to emergency contraception, which could avoid the need for abortions. What is he saying to women? Is it Conservative policy that every woman whose regular contraception fails should be forced to have a baby? He has made it clear to the Committee that his party's policy is to make it harder for women to get emergency contraception. Will he confirm that his party's view is that women should not have access to abortion either?
Dr. Fox: I am sorry that the Minister has decided to go down that track in what had been quite a rational debate. I want to make it perfectly clear that the Conservative party's view on abortion is that it is an issue for individuals. It is subject to a free vote in Parliament, and the party will continue to decide on that basis. Abortion is not a party issue. I am sorry that the Minister has introduced that note into what had been a serious debate in which we were considering serious matters.
Yvette Cooper: The Committee will be grateful that the hon. Gentleman has clarified the interpretation of his words in this morning's newspapers.
It is clear that both pharmacists and women want access to emergency contraception through pharmacists. A recent Mintel survey shows that nearly two thirds of adults believe that pharmacists should be allowed to prescribe emergency hormonal contraception without the need for a GP's prescription. Last year, 800,000 prescriptions for emergency contraception were issued.
Research shows that studies in which women had increased access to emergency contraception, perhaps through advance prescription, have not suggested that they change their sexual behaviour or their use of other contraceptive methods in any way. The only difference is that women have earlier access to emergency contraception. As I have said, it is not an alternative to regular contraception.
The Royal Pharmaceutical Society's guidelines will make clear the way in which pharmacists can provide the support and advice that women want and need when they go to them, rather than to family planning clinics, to get emergency contraception.
On under-16s, I am aware of the report in the Daily Mail to which the hon. Gentleman referred. The Royal Pharmaceutical Society has said that it will investigate the cases in that report to ensure that the proper guidelines and the Medicines Act 1968 are being followed. It is not part of the licence that emergency contraception should be supplied to people under the age of 16 through pharmacies. The initiative is not part of the Government's teenage pregnancy strategy; it is about increasing access and helping to reduce the number of unwanted pregnancies among over-16s.
The Government's teenage pregnancy policy is far broader and is about improving relationship and sex education and about improving information for teenagers about how easy it is to get pregnant, but how hard it is to be a teenage parent. The measure is not a substitute for the provision of free emergency contraception on the NHS through family planning clinics and GPs in the usual way, because the product will not be affordable for many women, even in an emergency.
The product has been through a standard and extremely sensible process. It has been assessed as safe and effective by all the extremely experienced and reputable bodies that regularly consider all such medicines and applications. They have looked at the product in great detail. The Royal Pharmaceutical Society has also worked in great detail to support these sensible changes that women want. It is right to make those changes.
Dr. Jenny Tonge (Richmond Park): Before I join in the debate proper, I shall say a little about my background, because it is very relevant. Before I became a Member of Parliament, I was for more than 25 years in general practice and then I specialised entirely in community family planning and community gynaecology. In that capacity, and as a member of the faculty of family planning for the Royal College of Obstetricians and Gynaecologists, I organised and implemented training courses for GPs and hospital registrars to obtain their family planning training and qualifications, so I have some experience in the field. During those 25 years, I saw many hundreds and thousands of patients of all ages. Included in my experience was five years as the medical adviser and practising doctor at what was then the London youth advisory centre, where I saw many people, from as young as nine years old to those in their mid-twenties. I do not want to appear egocentric, I simply think that it is relevant that the Committee should know that what I say today is based on personal experience and the experience of my colleagues, not just on scientific knowledge.
Much is said about the safety of this particular product. The hon. Member for Woodspring, referred to it as being a new product. It may be a new product in this dosage, for this purpose, to a GP, but levonorgestrel has been on the market for at least 20 years. Over the years, it has been used as a progesterone-only contraceptive pill by many hundreds of thousands of women. It is interesting to note that if a toddler accidentally took mum's month's supply of levonorgestrel, no action would be needed. A girl baby might have a tiny amount of vaginal bleeding, but she would then be all right, because levonorgestrel is not toxic. That is the degree of safety of the substance; it is far safer than aspirin. We need to bear that in mind when we read hysterical comments about how dangerous it is to give a drug to a patient without their seeing a doctor first. People in Britain can now obtain up to 32 aspirinfortunately no more than that at a timeand while that amount of aspirin could kill a number of babies, a similar amount of levonorgestrel would have no effect at all.
What would happen if young people were too disorganised and shy, as many of them are, to go along to the GP or family planning clinic where they might meet mum's friend in the waiting roomyoung people are shy about going for help on sexual matters and birth controland so just kept nipping into different pharmacies week after week? First, young people would run out of cash; their big sister, older friend or boyfriend, would become tired of forking out for them to buy the product over the counter. I do think that £20 is a large amount, but I am all in favour of them paying something. Most young people today can afford cigarettes and mobile phones, so if they are in a hole they can certainly afford a dose of the morning-after pill. A charge will in itself militate against them using it too frequently. If they have an unlimited supply of cash, or an endless supply of boyfriends to give them £20 every week they need it, their periods will go haywire and they will have breakthrough bleeding. A young girl ready to take off on holiday to the Costa Brava will rush to her GP, furious because her period has started. I assure hon. Members that, after more than 25 years of practice, I know that nothing engages the mind of a young woman more than unexpected vaginal bleeding. Girls get very fed up; they hate it; it cramps their style. We know that periods cramp young women's style because that is how sanitary protection is advertised. It is important to realise that that in itself will stop them using EHC too frequently. Young women will soon decide to take the pharmacist's advice and go to a proper clinic, or to their GP for some proper form of contraception on a long-term basis.
I have discovered during years of experience that a doctor cannot be too questioning or judgmental with desperately worried teenagers when they first come to the surgery. They may have had sex for the first time, or even the fifth, and fear they may be pregnant. If the doctor is judgmental, he will never see them again. However, if he can help them quickly, especially in the way a local pharmacist can as an anonymous person who is unlike their general practitioner, they can be pointed in the right direction and told that the morning-after pill may stop them getting pregnant, but that condoms are the only things that will stop them getting infections. That way, they are much more likely to come back on a regular basis. I could cite numerous cases of young people with whom I have had precisely that experience. It is good to make it easy for young people, because that is the way to get them into proper care.
Let us not also forget that the measure is designed for older women. The Minister will correct me, as that is not my brief, but I think the highest abortion rates in this country are among women in their 20s. Women often become rather cavalier. At first, they are careful. They have responsible parents and, if they are lucky enough, they have had all their sex education and they know what to do, but when they reach their mid-20s they assume that, because they have not become pregnant so far, precautions are not necessary. They may go away and forget their pills, or fall sick. I could cite numerous examples of why people accidentally fail to use proper contraception. They do not want to have to go the doctor and tell him that they have made a mistake, and they do not want to have to wait 72 hours for an appointment. They want to be able to go into the pharmacy for some pills to deal with the problem. It would be sensible for an older woman to keep a supply of the product in the bathroom cupboard alongside the paracetamol and her regular form of birth control, providing a ready means of preventing pregnancy if necessary. It is important to remember older women and the freedom that they should have in deciding what to do with their lives.
I know that my hon. Friend the Member for Romsey (Sandra Gidley) would like to speak for the pharmacist, so I conclude by saying that, for the past 15 years, either as a doctor working in the field or since entering Parliament, I have sought to have this measure enacted. It represents a huge leap forward. It is a way of getting people introducing people to good sex education and good family planning advice. It is a gateway to the services. It gives older women the freedom to control their own lives. For them to have to control their lives, and their sexual lives in particular, via the family doctor, is something of an insult.
There are those who are worried about the abortion angle, as I certainly am. I deplore the abortion rate and the number of teenage pregnancies. However, we must keep on reminding ourselves that the morning-after pill acts before implantation of the fertilised egg, or stops the egg being fertilised in the first place. Therefore, legally, whatever the tabloid newspapers say, it does not result in an abortion. Those who have strongly held religious views will maintain that the soul enters the potential human being when sperm meets egg. However, I commend to hon. Members an excellent speech made by the Bishop of Oxford, Richard Harries, in the other place on Monday, who points out that for the Church to say when the soul reaches the egg is very arbitrary, and was done for all sorts of reasons. There is no absolute truth here. In any case, many people in Britain do not believe that, or are not Christians, or are coming from a different direction altogether. Therefore, it must be emphasised that the morning-after pill is not an abortion pill, but a liberation for older women, providing access to proper services and education for many teenagers in this country, and I commend it.
|©Parliamentary copyright 2001||Prepared 24 January 2001|