Hot potato

Over-the-counter emergency hormonal contraception remains a hot potato. There are increasing numbers of studies being published that indicate that in broad terms pharmacists are more than willing to take on the additional responsibility. Of course, there are still some gaps in knowledge and training, but these are being addressed. The paper in this week's issue (p293), although based on a study conducted just over two years ago, makes encouraging reading. There are still outstanding areas of concern for some pharmacists — particularly for those who have conscientious objection to the supply of emergency contraception of any sort, let alone its supply to under-age girls.

Nevertheless, it must be remembered that these are side issues. The main reason for the introduction of OTC emergency hormonal contraception is to tackle the high rate of teenage pregnancy prevalent in the United Kingdom, and the Government's target is to halve the rate of conceptions in the under-18s by 2010. We may deplore the fact that young people are sexually active at a much younger age than we were, but, for whatever reasons, they are, and "accidents" happen.

Although preliminary research suggests that at the moment it is women in their twenties and thirties who are buying or being prescribed emergency contraception OTC, it is still early days and information takes time to filter down to teenagers who may be intimidated by anyone in authority. The profession must stand firm and ignore the unacceptable moralising tone that has been set and is continued this week by the Daily Mail, which is confusing the needs of its readers (middle class mothers) with the desperate plight of the socially disadvantaged.

The pilot study in Manchester, where emergency contraception was first made available under a patient group direction, has yet to be evaluated. However, if any impact on the teenage pregnancy rate is found there, it is unlikely to be achieved nationwide because of the cost element. However disappointing that may be, that does not mean the scheme should be abandoned.

In the long term, anything that the profession can do to help break the cycle of deprivation that inevitably develops when a teenage girl (quite possibly with a mother who is only in her late twenties or early thirties) becomes pregnant, should be supported. The burden to society of looking after these families is the damaging one: enabling a generation of children to reach adulthood before they have their own children may be the best outcome for us all and something that pharmacists should take credit for assisting.

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