Hélène Hofman looks at the issues surrounding the morning-after pill, following a major survey on Irish attitudes to sexual behaviour last week, which found significant support for making it more widely available.
Many women in Ireland still have difficulty accessing the emergency contraceptive pill, according to groups offering advice on dealing with unplanned pregnancies.
The emergency contraceptive pill (ECP) or "morning-after" pill, Levonelle, is currently available only on prescription in Ireland.
The Crisis Pregnancy Agency and the Irish Family Planning Association (IFPA) say this means that a number of women, particularly those living in rural areas, may have problems obtaining it when they need it.
According to figures from the Crisis Pregnancy Agency, about 29 per cent of women have taken the ECP at some point in their lives. The Irish Study of Sexual Health and Relationships published last week also found that 90 per cent of people surveyed thought it should be available, with 52 per cent of men and 42 per cent of women saying it should be available to buy over the counter.
The IFPA operates a daily walk-in service for women who require emergency contraception. Since December 2004, its Dublin centres in Tallaght and on Cathal Brugha Street in the city centre have opened on Sundays solely to accommodate women who need emergency contraception.
They now see about 15-25 women between the ages of 12 and 55 every Sunday.
"We've known for some time that there is a demand for an out-of-hours emergency contraception service, but we were taken aback when we opened our Dublin centres on Sundays," says IFPA chief executive Niall Behan.
"We thought the Tallaght centre would attract women from Tallaght - we didn't realise that we would also get women from Carlow and Meath and all other parts of the country. It shows that for some women there is still a huge access problem."
Since its agm in June, the IFPA has been calling for the emergency pill to be made available to women over the counter in pharmacies. It argues that pharmacies may still be open when GPs are not available and that the drug is completely safe.
"There are no risks with this pill. It can even be given to breast-feeding mothers. The only side effect is the possibility of nausea," says IFPA medical director Dr Alyia Rahim.
"It works in three ways. First, it inhibits ovulation if it has not already occurred; two, it stops the sperm going up and fertilising the egg and, three, it causes shedding of the womb," she says.
"We should not really call it the morning-after because really you can take it up to 72 hours after unprotected sex. But it is 80-90 per cent [ safe] if you take it within 24 hours and only 60-70 per cent within 48 hours," she adds.
"There is a stereotype out there surrounding going for emergency contraception," says Dr Stephanie O'Keeffe, the Crisis Pregnancy Agency's director of research.
"But women who go for it, know about it, know where to go for it and know that a risk has happened. They're doing the responsible thing.
"Our research shows they're just as likely to have used contraception but that the method has failed, and no more likely to have consumed alcohol", she says. "It's protective behaviour and it should be encouraged."
The Irish Study of Sexual Health and Relationships points out that in the 25 countries where the emergency contraceptive pill has already been made available over the counter, it has led to greater availability and use.
However, there are also concerns that it has led to more sexual risk-taking, especially among young women, and argues they are less likely to use more effective barrier methods that would protect them from sexually transmitted infections at the same time.
This is one reason why the Irish Medical Organisation (IMO) is opposed to making it available without prescription.
"In the UK, the NHS has gone down the route of making it available over the counter for the past five years and it has made no difference," says Dr Martin Daly, chairman of the IMO's GP committee.
"We believe that the vast majority of women who seek it are in their late teens and early 20s and the opportunity should be taken to explain that emergency contraception is just that. It's a last resort.
"It should not be the only form of contraception and we should take the chance to explain alternative methods of contraception and the implications of being sexually active and how to protect against sexually transmitted diseases," he says.
"Most of the country is covered by 24-hour GP services, which are far more available than out-of-hours pharmacies and a GP does not refuse to see someone if they are within the 72-hour time limit required to take the pill. If there was clear-cut advantage to making it available over the counter, I would consider it but so far there has been none," he says.
Health Minister Mary Harney, speaking last week following publication of the Irish Study of Sexual Health and Relationships, indicated that she was not currently in favour of making the morning-after pill available over the counter.
"Clearly, it can only be done if it's medically safe to do so and until we get the advice of the regulatory body that has responsibility in this area, I wouldn't be in a position to make a decision," she says.
For Levonelle to be made available over the counter, an application must be made by its manufacturers, HE Glissmann & Schering, to the Irish Medicines Board.
A spokesman for HE Glissmann & Schering say they cannot do this until the legislation banning evonorgestrel, which is found in Levonelle, from being sold over the counter is changed by the Department of Health.
Discussions on this are continuing.