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'Morning-after' pill debate reveals the need for open discussion about sex

By Natasha Cica - posted Monday, 14 July 2003

When the contraceptive pill first became available in Australia in the 1960s, a teenage cousin of mine wrote an article predicting exciting times ahead.

"This Pill," he wrote, "Will change our lives forever."

His Catholic school rewarded him with instant expulsion - no questions asked, or allowed. But how very right he was proven to be.


All that's ancient history - or is it?

Recently the National Drugs and Poisons Scheduling Committee announced its preliminary decision to allow pharmacists to dispense emergency contraception, which currently requires a doctor's prescription. The drug in question is Postinor 2 (levonorgestrel), often called the morning-after pill. It doesn't need to be taken "the morning after" - it's most effective within 24 hours, but works very reliably for around 72 hours. It stops pregnancy by delaying ovulation and causing changes to the uterus to prevent implantation of any newly fertilised egg.

Opponents of this move include Right to Lifers, the Australian Medical Association and the Australian Division of General Practitioners. Supporters include the Public Health Association of Australia, family planning organisations, the Royal Australian and New Zealand College of Obstetricians and Gynaecologists and - more cautiously - Trish Worth, the Federal Parliamentary Secretary for Health. The final decision on this pill won't be made until October but already key players and commentators are strongly polarised.

The controversy might seem surprising. Emergency contraception is already available without prescription in 27 other countries, including Britain, New Zealand, Israel and France. No opponent of the proposed change has explained why Australian pharmacists are somehow less trustworthy than their overseas peers - in terms of responsibly dispensing and providing appropriate information about this pill to women who request it, and in terms of respecting the rights and needs of these women. Pharmacists don't hand out medicines like lollies, with or without prescription. They're also well placed to offer women seeking emergency contraception referral to appropriate counselling about their sexual health, contraceptive behaviour and relationships. The Public Health Association of Australia recommends that pharmacists be provided with specific education and training about emergency contraception, and that the product should be distributed with a clear, concise information sheet.

Postinor 2 isn't called "emergency" contraception for nothing. When women seek it out, it's an emergency - they've stuffed up, or their bloke has, they don't want to be pregnant and they don't have much time on their hands to act responsibly. Try having a condom break on Friday night and getting a medical appointment first thing Monday morning. Last week I had flu-that-felt-like-SARS and couldn't get any doctor to see me for two full working days. And I know when I turn up with flu no GP I've encountered would guilt-trip me for anything more than working too hard … but I can't say the same about emergency contraception.

Australia currently has a high abortion rate by Western standards, estimated as the second highest after the USA. We also have a high teenage birth rate. No-one enjoys or encourages abortion, least of all the women who decide to have them, and adolescents are generally not well equipped to be parents. So it's clearly desirable that we do something better to stop unplanned pregnancies happening in the first place. One sensible approach is to make emergency contraception more readily available.


Allowing pharmacists to dispense Postinor 2 without prescription is an important first step. But we also need to take steps to ensure the Australian community is better informed about this option for controlling fertility - as one among many.

That's why debate on this jagged little pill is proving divisive. It taps into long-running battles over two thorny questions. First, how wide should be the range of fertility-control options available to women? Right to Lifers would allow just two - abstinence and, for marrieds only, the highly fallible rhythm method; the pro-choice camp wants the Western world's full range of best medical practice.

Second, who should be the procedural gatekeepers of those options? Doctors tend to think it should be doctors; the federal government seems to have other ideas on Postinor 2 (possibly influenced by disquiet surrounding declining numbers of bulk-billing GPs). Thus the dynamics of this debate resemble those of the abortion debate. Which is also about fertility control, and which also throws up the public policy challenge of balancing the respective rights, powers and responsibilities of women, men, doctors, churches and lawmakers in our society.

There might be no easy answers to those questions but one thing's clear: it's a really bad idea to mess up sex with guilt, repression and denial. Just ask Peter Hollingworth, and the victims of the sex abuse scandals currently rocking the Catholic and Anglican churches. The strong popular reaction to the airing of these destructive secrets suggests it's a good time for Australians to start talking more openly about healthier ways of exploring, managing and even celebrating our sexuality.

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This article was first published in The Courier-Mail on 9 July 2003.

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About the Author

Dr Natasha Cica is the director of Periwinkle Projects, a Hobart-based management, strategy and communications consultancy.

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