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Prescription-free or not

Stephanie Höppner / bkMarch 13, 2014

European health officials may soon scrap the prescription requirement for the "morning after" pill. But whether that means they will be freely available is another matter - and gynecologists have concerns.

A person holding up a 'morning after' pill
Image: picture-alliance/dpa

The case sparked headlines in Germany a year ago: a young woman, going for treatment at two Catholic hospitals after being raped, was refused a "morning-after" birth control pill. A heated debate ensued - not only about the Church's controversial attitude to birth control, but also the rights and wrongs of a prescription requirement for the so-called morning after pill. Critics have long called for the pills to be freely available from pharmacies.

Germany, Poland, and Italy are the only EU countries where the morning-after pill requires a doctor's prescription. Now, the European Medicines Agency (EMA) is considering scrapping this requirement for all EU member states.

The emergency birth control pill in question comes under the brand name "EllaOne" and contains the active ingredient ulipristal acetate. The EMA maintains that it has the power to decide for the whole of Europe whether a prescription is required for this particular brand, since, unlike the earlier drug, "Pidana" (with the active ingredient levonorgestrel), it had granted the license for EllaOne to be sold. Politicians in Germany have been debating Pidana's prescription requirement for years and is an issue that still divides the current governing coalition.

Every day counts

While levonorgestrel must be taken within 72 hours of sexual intercourse, ulipristal is still effective up to 120 hours later, and can prevent ovulation at a follicular size of up to 18 millimeters. Though with both pills the same rule applies - the earlier you take them, the more likely they are to be effective.

Prof. Dr. Daphne Hahn
Hahn says the law needs to be changedImage: pro familia Bundesverband

"Since most emergencies happen over the weekend or on public holidays, this makes access to the pill much more difficult for women," explains Daphne Hahn, head of Pro Familia, Germany's main family planning association. Women can lose precious time trying to get a prescription, especially in rural areas. It is also unclear to what extent the morning after pill is even prescribed in areas where hospitals are church-run.

In addition, it is much more difficult for women to find a gynecologist on weekends, who then often end up being examined by doctors who specialize in other areas of medicine. "The doctors frequently have no clue," said Hahn, which means that many women feel like they receive condescending or even contemptuous treatment. "We know that many woman have bad experiences when they go into clinics," said Hahn, even though nowadays birth control is 100 percent safe.

Compulsory consultation

What's more, gynecologists, for the most part, are opposed to scrapping the prescription requiremen because it cuts into their business. "A consultation should not be carried out by anyone other than a gynecologist or a doctor on call," says Christian Albring, president of Germany's gynecologists' association. He says that the morning-after pill is not suitable for every woman. Its effectiveness is negated, for instance, if a woman is taking anti-depressants, or medication for epilepsy.

Ultraschall Untersuchung Schwangerschaft
Women must take ulipristal within 120 hours to avoid pregnancyImage: Sven Bähren/Fotolia

The pill is also ineffective if a woman weighs more than 70 kilos (for levonorgestrel) or 90 kilos (for ulipristal). On top of that, says Albring, an already existing pregnancy should be ruled out. For these reasons, a checklist has been developed for emergency clinics so that non-specialist doctors can safely prescribe the pill.

Scrapping the prescription requirement would deprive women of this consultation, argues Albring, and it would be more expensive, since women under 20 years of age can be prescribed the pill for free, but would have to pay the full price for it if they went to a pharmacy without a prescription.

While the debate continues, many German women have begun to find small loopholes. The online portal Dr. Ed, based in London, for example, offers a morning after delivery service, including online consultation. Around 15,000 women have reportedly sought out the service since the website was set up in 2011. But for Hahn this too isn't a viable alternative - the delivery is much too slow to guarantee that a pregnancy will be prevented.