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Should girls have access to the pill over the counter?

Rowenna Davis and Jill Kirby

Two writers take differing views on an Isle of Wight scheme allowing young girls to receive the pill direct from pharmacists ...

YES: Rowenna Davis

'Younger women deserve access to the autonomy offered by the pill'

Should 13-year-old girls be given access to the contraceptive pill? The Isle of Wight has announced that young people coming forward for emergency contraception should be given the option of going on the pill by their pharmacists, bypassing the normal practice of going through GPs. There are at least three reasons why this extension of choice is a good idea.

The first is that young people already have access to contraception via condoms, which are available at any age. So when Conservatives such as Andrew Turner – MP for the Isle of Wight and a notorious anti-sex-education campaigner – get on their high horse about the plans, you have to wonder whether they support cutting free condoms, too, or whether they just can't handle putting contraceptive rights in the hands of young women as well as men. Boys with a sheath we can handle; women with more private sexual control we can't. NHS data shows that the younger you are, the more likely you are to use condoms rather than the pill. But in a world when the average age of first sexual encounter is under the legal age of consent, younger women deserve access to the autonomy offered by the pill.

The second – and more important – reason for supporting this policy is that it prevents unwanted teen pregnancy and, by association, cuts the number of abortions. This is why I can never understand why anti-abortion campaigners are against such policies. Conservative campaigners will tell you that they denounce the Isle of Wight's initiative because it's a "licence to have sex" that will only encourage it; but it's only being offered to those who are already sexually active. Surely it's better to send young people away with long-term protection so it doesn't happen again, instead of giving them a one-off emergency job and await a potential round two?

Again and again we've seen that young people don't have sex because they have access to contraceptives; they have sex because they are ignorant (it's not a coincidence that the UK has one of the highest rates of teen pregnancy and that 40% of our teenagers describe their sex education as "poor"). Underage sex is also driven by deprivation, vulnerability or “ heaven forbid “ because young people have a natural sexual curiosity and/or love of a partner. If teen pregnancy was driven by contraceptive access and sex education, could opponents please explain why the last government's policy brought teen pregnancy down by doing just that?

The final reason to support this policy is because it is likely to serve those young people who are most vulnerable. There may be some women who are in abusive or emotionally pressured relationships they can't escape. Of course, emergency contraception is not an answer to that, but it can buy a young girl some valuable private security while she seeks help and/or the authorities take time to intervene. Young people who are given emergency contraception on the Isle of Wight are only given a month's supply before they have to go back. After one trusted interaction, they may have the confidence to speak out on their return.

There is only one caveat to supporting the policy. By giving access to the pill through pharmacies, you remove the advice and information link that is offered by contraceptive centres and GPs. It might be right to offer contraception over the counter, but it's not enough “ not least because the pill does nothing to protect women from sexually transmitted infections. The latest survey from the NHS shows fewer 15-year-olds are going to sexual health centres, and the numbers going to them for emergency contraception dropped when it became available over the counter in 2001. We should support the policy for what it's designed to be – a supplement, not a substitute for proper sex education, advice and support.

NO: Jill Kirby

'There are practical reasons for increasing parental awareness'

This is a remarkably irresponsible decision on the part of a primary care trust whose function should surely include a protective health remit. Increasing the availability of contraception is unlikely to achieve the PCT's declared objective of reducing teenage pregnancy rates, particularly among very young teenagers – yet this objective has been allowed to override concerns about adverse health consequences.

Easy access to contraception tends to increase levels of teenage sexual activity, with its attendant exposure to sexually transmitted infections. Whereas barrier methods can at least reduce the risk of such infections, the pill carries no such protection. Nor is the pill free of long-term health harms. By offering the pill over the counter, the PCT will bypass both GPs and parents, removing two important potential sources of health advice and guidance. GPs will be concerned that their ability to assess the overall health needs of their young patients are being sidelined; responsible parents will be even more concerned that their under-age daughters will be given the pill without their knowledge.

Quite apart from the principle of undermining parental responsibility, there are practical reasons for increasing, rather than reducing, parental awareness. The "Gillick experiment" in 1985 demonstrated that parental involvement was more likely to cut teen pregnancy rates than contraceptive access: in the year in which contraception could not be prescribed to under-age girls without parental knowledge, pregnancies among under-16s fell, rising again after the ruling was reversed on appeal. Since teenagers tend to be erratic in their use of contraception – including remembering to take the pill – the Isle of Wight is quite likely to find its teen pregnancy figures heading in the wrong direction.

A 2009 evaluation of a government-backed youth intervention programme designed to reduce under-age pregnancies (including improving access to contraception and advice on sexual health) found that sexual activity and pregnancy rates actually rose among participants in the programme. Such are the dangers of schemes that accept and normalise premature sexual encounters, rather than focusing on the protection of children.

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