Friday 1 April 2011

Evidence shows Welsh move to make morning-after pill available free over the counter to teenagers will badly backfire

I recently blogged on the fact, surprising to some, that morning-after pills don’t actually cut teen pregnancy rates and instead increase the incidence of sexually transmitted infections.

This morning we learnt that so-called ‘emergency contraception’ can now be obtained without charge from pharmacies across Wales, while still costing about £25 in the rest of the UK.

Community pharmacists in Wales can also give the ‘morning-after pill’ to under-16s, if ‘clinically appropriate’.

Health minister Edwina Hart (pictured) announced the move last November, saying she wanted professional advice available without appointment and ‘easily accessible within the 72-hour time span necessary for emergency contraception to be most effective’.

The morning-after pill is already free to women across the UK if it is prescribed by a GP or family planning clinic, but Wales is the first nation to offer emergency contraception without charge on the high street.

Many people (including many in government) mistakenly think that morning-after pills being made more freely available will actually help Britain’s growing problem of unplanned pregnancy.

So why do I think it is such a bad idea?

First, it is strategy based on no evidence at all. In fact the very latest research in Britain, published in the Journal of Health Economics (full text) just last December and reported in the Daily Telegraph in January, showed that morning-after pills don’t cut teen pregnancy and actually increase the risk of sexually transmitted disease.

I blogged at the time that these findings were the latest nails in the coffin of the Labour government’s teenage pregnancy strategy, dreamt up by the now defunct Teenage Pregnancy Independent Advisory Group (TPIAG) which was set up in 2000 to advise the government on how to cut teenage pregnancy. Part of its (failed) strategy was ironically to make morning-after pills free over the counter to teenagers.

The new research, by professors Sourafel Girma and David Paton of Nottingham University, compared areas of England where the scheme was introduced with others that declined to provide the morning-after pill free from chemists.

The academics found that rates of pregnancy among girls under 16 remained the same (ie that the morning after pill did nothing to improve things), but that rates of sexually transmitted infections actually increased by 12%.

The phenomenon whereby applying a prevention measure results in an increase in the very thing it is trying to prevent is known as ‘risk compensation’.

The term has been applied to the fact that the wearing of seatbelts does not decrease the level of some forms of road traffic injuries since drivers, feeling more secure, are thereby encouraged to drive more recklessly. In the same way making morning-after pills widely available encourages more sexual risk-taking and more sexually transmitted disease as a result. Any effect on decreasing pregnancy rates is cancelled out by rising levels of promiscuity.

But in addition to the fact that this strategy will simply not work as a solution I have other problems with it.

Second, this policy removes prescription of the pill from the safety of the doctor patient relationship. The pharmacy, school or supermarket, is the wrong context for a young distressed girl to make such a request and to receive counselling and care.
Exchange of essential medical and social information needs time and sensitivity. Issues include side effects (nausea and/or vomiting in 25%), what to do if the girl vomits within three hours of taking the tablet, and the ‘failure’ rate of perhaps 15% of all potential pregnancies. A discussion of the social context is equally essential (eg. Recognizing coercion by an older man, other abusive sexual relationships, concomitant alcohol and drug use).

Third, these arrangements remove all accountability of the child to the parents and other health professionals in the discredited belief that this has a negative effect on teenage conception rates. The evidence suggests otherwise. Accountability to parents, it seems, is not only a disincentive to pharmacy attendance but also to sexual activity! There are many communities in Britain (both ethnic groups and faith communities) where rates of teenage sexual activity are very low indeed. The government needs to be studying these communities and learning from them.

Fourth, the MAP can potentially work as an abortifacient. The Levonelle-2 preparation used in this initiative is a progesterone-only MAP whose makers acknowledge sometimes works by preventing implantation of the early embryo. At very least teenagers have a right to be properly informed about the pill’s mode of action.

Finally, this government strategy is underpinned by the dangerous assumption that there is no right or wrong in teenage sexual activity - just choice. This assumption has led to a values-free framework in which the rate of unplanned pregnancies and sexually transmitted disease amongst teenagers is the highest in Europe.

The best way to counter the epidemic of unplanned pregnancy and sexually transmitted disease is to promote real behaviour change through such programmes as Love for Life (Northern Ireland), Love2last (Sheffield), Challenge Team, Romance Academy or Lovewise (Newcastle). These are just the sorts of initiative that the government should be encouraging.

This latest move is sadly yet another unfortunate, ill-thought out knee-jerk government response to Britain’s spiraling epidemic of unplanned pregnancy, abortion and sexually transmitted disease amongst teenagers and will only make matters worse.

The latest UK evidence, as outlined above, shows that making the morning-after pill available in this way will result in no fall in unplanned pregnancy and will increase levels of sexually transmitted disease.

Instead of pursuing these tired flawed ‘ambulance at the bottom of the cliff’ policies the government should be focusing on evidence-based strategies aimed at bringing about real behaviour change.


  1. I heard an interview between a doctor and a pharmacist on the Today programme. I was quite worried that the medication concerned was described as contraception when it can be an abortifacient. I like the doctor to tell me precisely what the medication is meant to do for me (at least as far as I can understand!).

    If, as I understand, there is a leaflet produced by the Department of Health that informs teenagers they have a right to a happy sex life I am not surprised we have a high teen pregnancy rate. My very short introduction to Philosophy tells me that to assume that because one thing happened after another the second was the consequence of the first is not necessarily correct, but an enquiry into the possibility would surely be a sensible move before Government spends more money on an ineffective policy.

  2. I see that Frank Field and Nadine Dorries have put down an early day motion calling for the MAP to be available over the counter free in England as in Wales -

    This is not a move I would support for the reasons outlined above.

    The evidence suggests it will not improve matters and it does not deal with the real problem.

  3. I think everything starts and ends with education ... and contraptive pills are just one more tool , not the absolute answer , but it should be made avalable for teens (who will useually feel too embarresed to turn to theyr perents or proffetional doctor in these delicat matters, in addition to making the pilles more exessible teens should be refferred to informational sorces such as or yahoo answers

  4. Levonelle works differently depending on what time of your menstrual cycle you are presently in. It may stop a fertilized egg from attaching to the womb, it may prevent a sperm from fertilizing an egg or it may even prevent an egg from being released. Levonelle works only if the pill is taken within 72 hours of the intercourse.


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