Is a culture clash preventing women from obtaining the morning-after pill?

It could be you or your girlfriend. For whatever reason, you’ve had unprotected sex and, if the appearance of a baby and subsequent launch into nappies and sleepless nights nine months later is not on your to-do list, the morning after pill is needed right away.

With little time on your hands, you decide to visit a high street pharmacy to buy it, assuming you will able to purchase it for £25 and an unplanned pregnancy will most likely be off the cards.

But what if this scenario stops at the counter as soon as you ask for the pill? What if it is in stock, but the pharmacist refuses to dispense it because the notion of termination and unprotected sex before marriage violates his personal beliefs?

This has been the reality since the morning-after pill, marketed as Levonelle One Step, was removed from prescription only on 1 January 2001 and made available on the high street. Attracting a wide amount of controversy when it was first announced, the decision led people to fear that it would lead to increased promiscuity and unsafe sex among young people in particular.

On the other hand, the news was welcomed by groups such as the Birth Control Trust, with director Ann Furedi arguing that “the resistance to making it available for sale is partly because women are seen as being incapable and not competent of making a sensible judgement.”

The debate as to Levonelle’s availability was one thing, but a fresh argument soon erupted as it emerged that pharmacists were not obliged to sell the pill if they did not want to. The code of ethics for the Royal Pharmaceutical Society of Great Britain (RPSGB) allows pharmacists the right to refuse a service if it is contrary to their religious or moral beliefs. Where necessary, the code also instructs pharmacists to “refer patients to other health or social care professionals” so that they may receive the right treatment.

The issue has sparked intense debate and, particularly in the US, political battles deciding whether to pass laws to protect pharmacists or to force them to do their job. The argument lies in the fact that women may feel embarrassed and judged at being refused outright, may not find an alternative pharmacist before the 72 hour time limit is up and teenage girls may give up altogether.

“It is all about how the pharmacist handles the situation, that they don’t make the customer feel awkward”, says Rebecca Findlay, press and campaigns manager for the Family Planning Association (fpa), “it is also really important that if pharmacists feel they can’t dispense Levonelle that they direct the customer to another supplier as soon as possible. The clock is ticking against these women and it’s important they don’t delay.”

Levonelle is 95% effective if taken within 24 hours of unprotected sex but the percentage drops as this time increases. A progestogen-only pill (progestogen is a synthetic version of the natural hormone progesterone that is produced in women’s ovaries), it works in three ways: It stops the egg from being released from the ovary; it prevents sperm from fertilising an egg that may have been released and it stops a fertilised egg from attaching itself to the lining of the womb.

Put simply, it is a way of stopping pregnancy before it has begun and Levonelle’s availability on the high street allows women to buy it on the go without the necessity of doctor’s appointments.

Yet, while Levonelle is not an abortion pill and will not work if you are already pregnant, there are those that view the concept of ‘stopping pregnancy’ itself as abortion and believe it advocates ‘immoral’ pre-marital sex.

The Christian Institute has published two books on the availability of the morning after pill, arguing that it “gives the green light to sleep around”, leads to sexually transmitted diseases and “fosters the belief among young girls that they can have sex without consequences.”

Fuaad Aidarus, a 2nd year pharmacy student at Kingston and vice president of the Islamic society, explains the position of Muslim pharmacists: “Although the morning after pill is not an abortifacient and a means of contraception, scholars have said that you are not allowed to sell them if you know that the people who are using them are people who want to avoid getting pregnant because they committed zina (unlawful sexual relationships).”

He continued: “Because it is difficult for a Muslim pharmacist to ask the patient if they committed zina due to maintenance of patient integrity and respect, a Muslim pharmacist can refuse to dispense. And Allah Almighty knows best.”

According to Asier Badirkhan, head pharmacist at Boots on Union Street in Kingston, this is precisely why some pharmacists feel that they cannot participate. “I haven’t seen it happen at this store but I do know some pharmacists that have refused” she said.

Yet one woman was not so fortunate and found that not one but two Boots stores turned her down. Twenty-eight-year-old Tiffany Berton is allergic to the regular birth-control pill and decided to use Levonelle as an extra precaution. She visited a Boots store in Ealing Broadway and was told that the owner and manager of the pharmacy did not sell it at all, based on moral and religious views.

Tiffany was pointed towards a second Boots store in Ealing’s shopping centre, known by the pharmacy assistant to stock Levonelle. After arriving, she was asked to fill in a form but the second assistant then returned to tell her that the pharmacist was using her right to refuse to sell.

“By that time, you can imagine the state I was in”, Tiffany said, “I felt judged and humiliated, like I was being branded ‘immoral’ by someone who had absolutely no idea who I was.”

She went on, “The implications of this issue are vast. Science and religion never mix well and one must wonder at the excesses which we may face in the future if this attitude continues: refusal to sell HIV drugs to homosexuals, pre-natal drugs to pregnant teenagers? This issue is especially important since the over-population issues recently raised by Sir David Attenborough.”

In response to Tiffany’s situation, a spokesman for Boots referred back to the Pharmaceutical code, stating that “All our pharmacies carry stocks of Emergency Hormonal Contraception, however each pharmacist can refuse to dispense a product on ethical or religious grounds. We are sorry that in this instance the customer was not satisfactorily directed to an alternative source.”

Tiffany’s decision to use Levonelle as an extra precaution is supported by Dr Patricia Lohr, medical director of the British Pregnancy Advisory Service (BPAS), the leading provider of abortion services in the UK.

Dr Lohr emphasised that, while BPAS advocates choice and respects that some pharmacists may have ethical objections, emergency contraception (EC) remains a useful backup to regular methods of contraception.

She said: “It is important that women are able to access it as quickly as possible. Women seeking EC are taking the responsible course of action in the event of unprotected sex or contraceptive failure and should be supported by medical professionals”.

Despite the fact that Levonelle is also available, free of charge, from GPs, family planning clinics and NHS walk-in centres, it seems that its wide availability over the counter will continue to attract criticism.

It was advertised for the first time ever on TV on 23 April 2009 after the 9am watershed, prompting Tory MP and pro-life campaigner, Anne Widdecombe, to argue that “we know that many teenagers are watching television well after 9pm. The result of this will be even more teenagers engaging in unprotected sex with all its consequences.”

On top of that, Lloyds Pharmacy has become the first high street chemist in the UK to sell the morning-after pill online, at prices ranging from £27.99 to £74.99. The idea is that women can have an advanced supply of the pill at home.

The increase in the marketing of Levonelle and the many organisations that promote its availability is what makes pharmacists’ right to refuse all the more surprising. 

There are those who do not think personal beliefs should infringe on a professional environment; as Tiffany emphasised, “I would like to see the day where people are not judged for what they do.” But it seems that the clash between reproductive rights, the right to obtain medicine and the personal rights of individual pharmacists will continue to crop up in high street stores everywhere.