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Medb Ruane: A very Irish solution to our morning-after pill dilemma

The sky didn't fall when Boots Chemists made the morning- after pill available over the counter this week. For the first time, women aged 18 and over will be able to access short-term emergency contraception without having to go through a GP.

Long-fought wars on all matters reproductive mean the measure is receiving much attention. And because anti-choice groups' strategy confuses preventative measures with pregnancy terminations, there's also confusion about how the pill itself actually works.

That historic weighting shades some of the social questions involved. What happens for girls aged under 18? Do parents have a right to be consulted when girls are under age? What about STDs? And, other than sexual assault and rape, what kind of behaviour or misadventure leads anyone to need this pill?

The pill isn't an abortifacient because it won't work if you're already pregnant. Provided it's taken within 72 hours of a crisis intercourse, it prevents pregnancy by stopping egg and sperm from meeting successfully or from implanting in the womb.

Older treatments could provoke unpleasant side effects. Now it's simpler. The latest Levonelle pills are administered in one-dose applications with few side-effects. A new five-day treatment (Ellaone) may be made available. None is 100pc reliable.

Opponents say that making the pill available over the counter will encourage risk-taking behaviour and promiscuity. There's no evidence for that claim. The British Medical Journal published a study six years ago about what happened after the morning-after pill became available over the counter there. It found that no significant change occurred afterwards in women aged 16-49 using emergency contraception or having unprotected sex.

So the morning after pill is exactly what it says on the label -- an emergency measure for exceptional occasions. No one is going to become promiscuous in return for ingesting big doses of hormones.

You could argue that having to take it once, especially after a sexual encounter you regret, will make you more careful in future. But regrettable sexual encounters tend to be driven by lowered inhibitions after alcohol or drugs, which blur your judgment and make you vulnerable to sexual predators.

Finding yourself worrying about a crisis pregnancy isn't all about one-night stands, as many adults know. If your contraceptive fails on a weekend -- say a condom bursts, for example -- it takes time to meet a doctor on call. Then you've got the extra cost of a GP fee as well as the medication, which makes it expensive. If you're young, you might find it awkward or embarrassing to locate a GP you can trust or afford. Or, quite simply, you mightn't know what to do.

Boots are taking a conservative approach to the issue, although their initiative is welcome. They'll offer professional advice in private, including information about STDs and about where to go if you're suffering trauma after assault. With 55 branches in the Republic, they're not readily accessible to everyone but the service is better than relying on ordering DIY stuff online.

A provision in a 2005 Act lets Boots operate. They've already used it to administer flu vaccines. Two companies who manufacture morning-after pills here could have gone through a process of making the pills more accessible by applying to the Irish Medicines Board. One began the paperwork but didn't follow through.

In real time, Boots's decision comes less than one month after the European Court of Human Rights decided against Ireland in a case of pregnancy termination, which was a sign to start getting real. But who'd make the running? An absence of legislation -- and guidelines -- on everything from emergency contraception to fertility treatments has paralysed action and made it extra difficult for individual doctors and licenced chemists to be clear and secure about how they practise within the law.

Piling confusion on more, there's a conflict between the age of consent for medical treatment, which is 16, and the consent age for sexual intercourse, which is 17. So a GP is left to flounder between their commitment to the patient and their position in law when a 16-year-old asks for the morning-after pill, or oral contraception. Their position becomes even less clear when an under-16 consults them but doesn't want her parents involved.

Dr Des McMahon led a survey almost two years ago asking GPs and parents what they thought.

Over 50pc of GPs said they felt exposed legally when an under-16 asked for contraception without parental consent. Predictably, only 10pc of parents agreed that the GP should make a decision based on the girl's maturity. Dr McMahon noted the lack of clarity round the whole issue.

If Boots can do it, will other Irish chemists follow their lead? Boots's UK-based medical director is the supervisor, and his authority works here because he's registered with the Irish Medical Council. So far, no Irish-based medical doctor has been willing to take up the same position, even for over-18s.

But isn't it ironic that a company as British as Boots is offering a service here that was introduced there over a decade ago -- and is paid for by the NHS in some areas?

Another Irish solution to a very human debate.

Indo Review