The morning-after or post-coital pill, often misleadingly referred to as emergency hormonal contraception, can be taken up to 72 hours after unprotected intercourse. The two types of morning-after pill licensed in the UK are Schering PC-4, which has been available since the 1980s, and Levonelle-2, which is also manufactured by Schering and was licensed in 1999. Levonelle-2, which contains 0.75mg of levonorgestrel, was made available to over-16-year-olds from pharmacists without a doctor’s prescription throughout the UK from 1 January 2001.

The morning-after pill can work by:

• preventing or delaying ovulation
• thickening the mucus of the cervix which impedes the progress of the sperm
• slowing down the tubal transit time of the ovum by altering the motility of the fallopian tubes¹
• affecting the lining of the womb (endometrium) so that the embryo cannot implant.

The first three actions may impede conception, but the fourth is abortifacient.

Whereas PC-4 had only a 57 percent success rate in preventing or interrupting a pregnancy, Levonelle-2 is said to have a success rate of 85 percent². It also has fewer, and less acute, side effects,³ although there are still a number of them which Schering lists⁴. Whereas PC-4 contains both oestrogen and progestogen, Levonelle-2 contains only progestogen and is therefore thought to be far more likely than PC-4 to work as an abortifacient.

Use of the morning-after pill became very widespread in the 1990s. Nearly a million courses of the morning-after pill were supplied to women in the UK in 2000, and the total for 2001 is expected to exceed one million⁵. It is thought that about eight percent of women who take the morning-after pill are pregnant⁶. Its dosage is of concern. A woman who uses Levonelle-2 must take one tablet containing 750µg of levonorgestrel and another such tablet 12 hours later. In less than a day, Levonelle-2 thus delivers 50 times the daily dose (which is 30µg) of the Norgeston daily mini-pill.

Morning-after pills provide no protection against sexually transmitted diseases (STDs) and increased reliance on them could well result in an increase in the incidence of such diseases. STDs are already spreading fast. In Scotland in the year 2001/2002, the age group 15-19 accounted for 13.5 percent of those attending sexual health clinics. In addition, of all females diagnosed with an STD 8.3 percent were under the age of twenty⁷. Between the years 1997/1998 and 1999/2000 the number of females in the 15-19 age group presenting with chlamydia rose by 44 percent, from 444 to 640, and for males rose 70 percent, from 107 to 182.

Advocates of morning-after pills argue that their use is better than allowing unwanted pregnancies to continue, yet increased availability of morning-after pills might actually lead to more surgical abortions. The 1990s saw a five-fold increase in prescriptions of morning-after pills yet the overall rate of abortion also rose. The pills are not always effective and they contribute to a less responsible attitude to sexual activity. The morning-after pill fails to meet the government’s much-vaunted standard of evidence-based medicine, as there have been no trials on the long-term effects of the morning-after pill. Availability of morning-after pills without prescription to over-16s will lead to children under the age of 16 obtaining the drug, either by deception or through carelessness on the part of pharmacists. Women will be able to obtain the drug repeatedly and/or more than 72 hours after unprotected intercourse. Pharmacists cannot check patients’ medical records to ensure that they are not in a high-risk group for taking the morning-after pill, nor can they ensure that women and girls receive adequate after-care. Thus pharmacists may also find themselves legally liable for the outcome of supplying the drug when they have been misinformed.

1 Source: A Consumer’s Guide to the Pill and other drugs, John Wilks, TGB Books, 1996
2 Schering Health Care Ltd leaflet on Levonelle-2 entitled Tell me about emergency hormonal contraception
3 Confirmed in the FPA/Contraceptive Education Service leaflet entitled Your Guide to Emergency Contraception
4 The Schering leaflet on Levonelle-2 lists the following possible side-effects: nausea, vomiting, later or earlier period, irregular bleeding, tender breasts, stomach pains, diarrhoea, dizziness, tiredness.
5 Source: Mail on Sunday, 18 March 2001
6 Women are only fertile for two or three days in each menstrual cycle.
7 Scottish Health Statistics www.show.scot.nhs.uk/isd/.

'A Way of Life' The Society for the Protection of Unborn Children March 2002

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