Older women are more foolish than teenagers when it comes to safe sex

Making the Pill available over the counter isn't good for either group

THERE were predictable headlines this week over the Government's pilot scheme making the Pill available over the counter from chemists without a prescription. A common theme to the stories was an attempt to combat Britain's grim teenage pregnancy rate, six times that of The Netherlands.

But the stories threw up many myths. One was that it is teenagers who need better access to the Pill. Actually, the majority of unintended pregnancies occur in older women. Of the 198,500 abortions in England and Wales in 2007, 10 per cent were for those under 18, but all the rest were for women who were presumably old enough to know better. Yet they still got pregnant. It shows that you don't have to be a virgin or a teenager to get caught out.

Many working women have trouble getting to see their GP and then picking up a prescription, so they don't start the next set of pills when they should. That means they extend the pill-free interval, which is much more likely to get you pregnant than missing the odd day in the pill-taking cycle. So will providing contraception over the counter prevent unwanted pregnancies for this group, as well as for younger people?

It was certainly the right way to go for the morning-after pill, made available over the counter in 2001. It is extremely safe, has almost no medical contra-indications, and needs to be easily available, particularly over festive periods like Christmas. But the same can't be said for the Pill.
One reason is that dishing out all forms of contraception requires some expertise. There are 14 different types, and what's right depends on age, medical history and lifestyle. For teenagers, the Pill could be well down the list, with implantables and condoms more appropriate. I don't believe that pharmacists are qualified to give this advice, even with training.

Other medicines have gone from prescription-only to over the counter, but these raise the same worry. Getting the right drug for the right person is not always a simple matter. It's now easy, for example, for a man with chronic indigestion to get proton pump inhibitors, which reduce gastric acid, from the chemist.

But if these are used over a long period, and the man goes to a different chemist each time, who will ask whether this continuing indigestion indicates stomach cancer?

There are also potential problems about over-the-counter statins. People who buy them may not take them as directed, but the average pharmacist is in no position to monitor this.
Supporters of over-the-counter medicines say that consumers can be trusted to medicate themselves if they have a minor complaint. But people aren't always good at diagnosing these themselves and pharmacists aren't always as helpful as they should be. A Which? report earlier this year revealed that less than 30 per cent of pharmacists gave good advice when presented with a standard query.

There's another problem. Many chemists do not yet have private consulting areas so people are left to ask for advice in front of a large queue waiting for prescriptions. Older women might be prepared to ask for advice on contraception, but I can't imagine that a teenager will do so. Much better to take a risk than to go through such embarrassment.

At least if they go to their GP and sit in the waiting room, no one can be sure why they are there. The GP may also be able to offer other information and signpost services that may be needed, such as a sexual health clinic.

I'm all for improved access, but making the Pill available through chemists isn't the way to go. It certainly isn't a teenage-friendly option.

What they need is more teenage-geared websites to equip them with the information they need to make informed choices, plus more accessible healthcare premises where they can get a range of non-judgmental advice in confidence on the things that trouble them.