Brook' s position on emergency hormonal contraception
Brook welcomes measures to increase knowledge about and availability of emergency hormonal contraception, as this safe, effective and reliable method of postcoital contraception is key in tackling the UK
However, it is crucial that young people are also taught how to protect themselves against unplanned pregnancy and the transmission of sexually transmitted infection, so that emergency contraception only has to be used as a last resort when a contraceptive method has failed or not been used.
Wider availability of emergency hormonal contraception through pharmacies is also welcome, particularly as studies show it is more effective taken in the first 24 hours after intercourse.
Brook, however, believes that it should be available free of charge to anyone who needs it, whatever their age. We are concerned that young people will become confused about their right to free contraception by charging for emergency contraception and its restriction to people over 16 in chemists.
Background information
Emergency hormonal contraception has been licensed for use in the
Emergency hormonal contraception can be taken up to 72 hours after intercourse, but evidence shows it is more effective the earlier it is taken. Taken on the first day after sex progestogen only emergency contraception will prevent 95% of pregnancies, by day three it will prevent 58% of pregnancies.
Emergency hormonal contraception works by suppressing ovulation, stopping fertilisation of an egg that has already been released or preventing implantation depending on the stage in the menstrual cycle at which it is taken.
Progestogen only emergency contraception will prevent 85% of expected pregnancies when treatment begins within 72 hours of intercourse. It has a failure rate of under 3% at mid cycle compared to a 25% risk of pregnancy without treatment. Side effects are few and minor - around 23% of users will feel nauseous and under 6% will actually experience vomiting.
Levonelle has been available to woman over the age of 16 without prescription from pharmacies since January 2001 for around £24. In some areas it is also available free to all women from pharmacists using patient group directions. Currently around 50% of women who use emergency contraception obtain it from a pharmacy without prescription.[1]
An official survey in 2004 found that 93% of women aged 16-49 have heard of emergency hormonal contraception and 7% have used it at least once in the previous year. [2]
During 2004/05 there were 31,093 requests for emergency hormonal contraception at Brook Centres, the primary purpose of 16% of all visits.
Research during 2000 found that 40% of first visits by young women to services after sex were to obtain emergency contraception. [3]
In 1983 the Attorney General ruled that emergency contraception is not a form of abortion because there is no established pregnancy to terminate. This was confirmed in 2002 during the course of a judicial review of the pharmacy provision of emergency contraception sought by the Society for the Protection of the Unborn Child. Justice Munby confirming the statement of the Attorney General said 'the word miscarriage today means the termination of an established pregnancy, and there is no established pregnancy prior to implantation… It follows that since the morning-after-pill (sic) is used before the process of implantation has begun, and because it cannot make an implanted egg de-implant, the morning after pill (sic) cannot as a matter of law bring about a "miscarriage".'
[1] I O’Sullivan et al, Contraception and Sexual Health 2004/05, A report on research using the ONS Omnibus Survey produced by the Office of National Statistics on behalf of the Department of Health, National Statistics, 2005
[2] I O’Sullivan, ibid
[3]Brook, Young people's sex advice services; delays, triggers and contraceptive use, Brook Publications, 2000
