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The Lord Bishop of Southwark: My Lords, I can well understand the desire of the noble Baroness to prevent pharmacists selling the morning after pill over the counter. She has marshalled powerful arguments for her viewpoint. These stem from her deep humanitarian and religious sense of values and her concern for the welfare of young people.
The Church shares these values. There is no doubt that the gift of sex is a precious gift of God, to be used within a loving marriage relationship. That is what we
teach, have always taught and will continue to teach. However, that teaching is not always heard and, if heard, is not always accepted. Sexual intercourse is not confined to the marriage partnership and while, in these enlightened times, many might say that what adults do in their private lives is a matter for themselves alone, some of the figures concerning teenage sex must surely concern us all. Your Lordships are well aware of them, and they have been rehearsed this evening: the worst teenage pregnancy figures in Europe, appalling rates of teenage abortions and young teenage mothers, no older than children themselves sometimes, struggling to bring up a baby while losing education and training opportunities, being trapped into a spiral of poverty which gives the worst possible start in life for the new infant.How are we to respond? With this debate in mind, I consulted one or two teachers of teenage children in our inner city secondary schools. In their view, some teenagers will engage in sex and some will not. Those who will not have taken that decision because they respect what they have been taught by home, church or school. Or they will not because they believe that in the future they will have a happier and more loving relationship because sex is special and it will have a special place in their lives.
In my view, these young people are right. I wish that all teenagers believed and acted like them. Of course we should all do what we can through our teaching, our preaching and our parenting to strengthen their resolve and spread it to others. However, popular culture is against us. Judging by much of the media, sex is compulsory for all, at any age. So it is not surprising that another group of teenagers do indulge in sex from time to time. We may preach against it, and we do; we may teach against it, and we do; but it goes on happening.
The question then is: do we make the best the enemy of the good? The best is sex within marriage. The good is surely to enable all teenagers, even foolish weak-willed teenagers, to survive their teenage years without the burden of an unwanted baby, pregnancy or abortion. The availability of contraception has surely saved many teenage girls from this fate. I know there are those who believe that the availability of contraceptives has encouraged teenage sex, but that is not a universal view. The teachers I talked to believe that without contraceptives we would see an increase in unprotected teenage sex, with a consequential increase in pregnancy.
Many people view the morning-after pill as an emergency form of contraception--emergency because regular use might well bring health problems; emergency because the pill is expensive, certainly to the teenage pocket. But the one-off use of the pill might save a one-off abortion or a one-off birth of an unwanted child. Thirty-three community pharmacists in the health action zone where I live in south London have been involved in a pilot project testing out the procedures in the new order. The project has been part of a strategy for reducing unintended young pregnancies and it is reported that the response has been almost universally positive. It has proved to be
the case that the pharmacist's is a less threatening place for some vulnerable young women to approach than the doctor's surgery or clinic.There is no question that we must strengthen long-term methods of teaching morality, developing good sex education for boys and girls, and increasing hope and choices for girls in areas of deprivation. All these things we must continue to do, but in the meantime the morning-after pill provides an emergency last resort for those who have fallen through the sexual net. I believe it is right for us to be very uneasy about the right way forward in this debate. I, for one, am uneasy for I certainly do not believe that all the moral arguments are on one side. But speaking for myself, I believe that unwanted teenage pregnancies are such a great evil which blights lives that we must not let the best be the enemy of the good. So, with regret, I shall not be following the noble Baroness into the Lobby tonight.
Lord Davies of Coity: My Lords, it is well known in the House that I supported the noble Baroness, Lady Young, when she opposed the promotion of homosexuality in schools and we had a debate on Section 28. I spoke and voted in this House not to allow a reduction in the age of consent of homosexuality. But in all honesty I cannot support the proposition that has been put forward this evening. Of course I will support measures that I believe will reduce promiscuity. I will certainly support, as indeed we all will, any measure that reduces the transmission of sexual diseases. But I cannot accept the proposition that the taking away of a measure after the event somehow controls what happens when the event takes place.
The measure proposed by the Government is twofold: to prevent unwanted pregnancies and to prevent more abortions taking place; that is, to prevent the kind of things none of us wants to happen. We want to see family relationships established and built considerably. However, I cannot see how such relationships, those between teenagers and those between parents and teenagers, can in any way be conditioned by not having the measure of the morning-after pill. The reasons for the measure are sound and good. I believe that the House should vote against the proposition of the noble Baroness.
7.30 p.m.
Lord Patel: My Lords, I speak in support of deregulation of progesterone-only Levonorgestrel emergency hormonal contraception. I speak on the efficacy of this pill as an effective contraceptive and not on any procedural or constitutional issue. I had rather a long speech. However, it was considerably shortened after I listened to the notable speech given by the noble Baroness, Lady Walmsley. I cannot but agree with just about everything she had to say. She spoke as a teacher. I speak as a gynaecologist who has seen many unwanted pregnancies.
There are many reasons why this deregulation measure is necessary, not the least of which is as one of the many measures needed to reduce the rate of
teenage pregnancies in this country. We heard about the high rate of unwanted pregnancies which end in termination in the United Kingdom compared to the rest of the western world, except the United States. There were 173,000 in England and Wales alone in 1999.Evidence from smaller studies carried out in Scotland suggests that in women between the ages of 16 and 29 who take emergency contraception, the rate of unwanted pregnancy has been reduced. Larger studies are currently being conducted. The progesterone-only pill, Levonorgestrel, works by delaying ovulation and preventing fertilisation. It is not an abortifacient. The pill is safe and effective. I do not know what the noble Baroness, Lady Young, meant when she said that the pill is 50 per cent more powerful. It is certainly 50 per cent more effective.
In trials which have been reported, including those by the WHO, few complications have been reported, nausea and vomiting being the main ones. That, too, has been in far fewer women compared to those using the combined emergency contraceptive pill. No serious complications have been reported. There are practically no contraindications. In trials reported by the WHO, the rate of pregnancy was 1.1 per cent among the progesterone-only pill group. The effectiveness of the pill relates to the time of taking it following unprotected intercourse. The noble Baroness, Lady Gould, stated the correct figures, as reported by WHO. There has been a 95 per cent success rate in terms of avoiding unwanted pregnancy if the pill is taken within 24 hours of unprotected intercourse. That is the crux. The sooner the pill is taken after intercourse, the more effective it is. If taken inappropriately, or if pregnancy occurs, the trials reported no adverse foetal outcomes.
Therefore, the pill has to be easily available. Making it available only through general practitioners, family planning clinics, A&E departments of hospitals or even patient group directives--not all of which are funded for this--will delay women receiving the pill. Despite the low levels of complications reported, the Royal Pharmaceutical Society has issued guidance to pharmacists.
Concern has been expressed that women will use the emergency contraceptive pill as regular contraception or that there will be an increase in sexual activity in young people. As we have heard, and I concur, neither of those concerns is borne out by the evidence. The age group with the highest incidence of the use of emergency contraceptive pills is that between 20 and 29. The lowest incidence is in the group aged 16 to 19 and below 16. Evidence from trials in other countries and in the Lothian area of Scotland does not suggest repeated use of the pill. A small number of women used emergency contraception on more than two occasions in a year. Couples who normally rely on other forms of contraception, such as the pill, the inter-uterine contraceptive device or condoms, may, for a variety of reasons, need to use the emergency contraceptive pill where there is a risk of failure of the usual form of contraception.
In such situations, emergency contraception offers women peace of mind from unwanted pregnancy. Levonorgestrel is the safe choice. However, I agree that the cost of obtaining the pill from pharmacists, nearly £20, half of which I understand is the cost of the pill and half the dispensing cost, may reduce its use. It is interesting to note that the cost of a similar product in France is equivalent to £5. But that is no reason for us to stop Levonorgestrel being available through pharmacists. The progesterone-only emergency contraception pill, taken in 0.75mg tablets, 12 hours apart within 72 hours of unprotected intercourse, is safe, effective and free from complications. I hope that it will help to reduce the incidence of unwanted pregnancies. Anything that we can do to make it more easily available has to be good.
It is interesting to read the editorial comment in the New England Journal of Medicine, a prestigious medical journal. The conclusion states:
- "Making emergency contraception more easily obtainable does no harm and may reduce the rate of unwanted pregnancies".
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