Elaine Edwards says the rising demand for emergency contraception is cause for concern.
When one of the Dublin Well Woman clinics recently began opening its doors on Sundays to provide emergency contraception, it was responding to a clear demand from women who found themselves at the worrying end of a weekend pregnancy scare.
In the first week alone, 15 women attended the drop-in clinic; in the second, there were 24; and in the third, 19. The clinic took the decision to open after it noticed a back-up of appointments on Mondays and Tuesdays with women seeking the morning-after pill.
At that point, up to 72 hours after the intercourse, the medication's efficacy is somewhat reduced, although there is still a good chance it will prevent a pregnancy. While the figures don't seem huge, they represent just a three-hour period in one Dublin clinic on a Sunday.
Around the country, many clinics see the same backlog every Monday morning as frantic women of all ages, from teenagers to women in their 40s, seek a "remedy" for an episode of unprotected sex or an accident with their conventional method of contraception. Dublin Well Woman Clinic says the age groups in which emergency contraception is in most demand are the 20to 24 and 25 to 29 categories.
One family planning clinic in Limerick has prescribed more than 1,000 doses of the morning-after pill since the beginning of the year. Other clinics said they prescribed up to 70 doses a week.
Although the pattern doesn't seem to be widespread, some clinics notice a number of women making "repeat" morning-after pill visits. This gives doctors cause for concern, not only about potential unwanted pregnancies, but about the potential transmission of sexually transmitted infections (STIs).
There is clear evidence, according to some clinics, that girls as young as 15 are seeking the morning-after pill in greater numbers. Many of them, according to one doctor, are so uninformed about contraception that they come in seeking "the after-morning pill".
Surprisingly, there is only one product licensed here for use as a morning-after pill. Levonelle, manufactured by Schering, was only licensed last year. Prior to that, the product used to obtain the same result was Ovran 50, which was licensed only as a contraceptive.
Official figures are not available, particularly given the short time-frame for which Levonelle, a 750mg dose of progesterone taken in two tablets, has been available. But informed estimates suggest that 4,000 to 5,000 doses a month (or 50,000 to 60,000 doses a year) are prescribed to Irish women - that's a huge number of potential unwanted pregnancies.
This is a problematic area, however, as there is almost no way of knowing how many of those requesting the morning-after pill would actually have become pregnant as a result of their scare.
Alison Begas, chief executive of the Dublin Well Woman Centres, suggests the failure rate of the morning-after pill is 1 to 3 per cent. The pill is much more effective if used earlier, rather than later, she adds. The medication is, she estimates, 95 per cent effective in the first 24 hours. But this falls to just above 50 per cent if taken within the next 48 hours. "There may be some women who do have unprotected sex while drunk and who don't come in for fear of being reprimanded," she says.
Begas says that with so many new methods of contraception - including implants and injections- becoming available in recent years, many women are simply not aware of them. It may, she says, very well be to their benefit to discuss these different types with a doctor, particularly if they find it hard to remember to take a pill every day.
"There are no contra-indications against using [the morning-after pill] three or four times a year. Once a month would not be damaging, but it's far better to be using a reliable, regular form of contraception."
Emma Keenehan, a nurse at the Limerick Family Planning Centre, says she doesn't believe she has seen more than 40 cases where the morning-after pill has failed in her 22 years there.
Dr Sheila Jones, medical director of the Irish Family Planning Association, says there are no dangers to a woman's short- or long-term health from the morning-after pill. But she says that, at around €50 for a visit and the prescription, most women will not consider using the morning-after pill as a regular option. "You are not going to do it that often if you can avoid it," she adds.
Like other clinics, Dr Jones uses the opportunity to speak to women about contraception generally. Up to two-thirds of women seeking emergency contraception claim to have been using a primary method they believe may have failed. Some clinics express scepticism about this. One professional reckons most women will say a condom "split" rather than simply admit they hadn't been using any contraception at all. Some clinics don't see the point in discussing regular contraception with a woman while she is in an understandable state of distress.
Nurse Mary O'Toole says Galway Family Planning Centre offers a cheap (€10) return visit to encourage women to return for such a discussion at a later date. The clinic has prescribed more than 1,000 doses of the morning-after pill this year.
A number of clinics suggest it may be beneficial for some women to carry a spare pack of emergency contraception with them - for example, when they go on holidays. Some will prescribe spares. But ready availability of such medication over the counter, as in Britain, is yet to become a reality here and may be some time off. Dr Jones says she doesn't see it becoming available over the counter because there was "such a fuss" about it becoming available here in the first place.
Useful contacts:
Dublin Well Woman Centre on Liffey Street, Dublin, operates a drop-in clinic for women seeking the morning-after pill from noon to 3 p.m. each Sunday. No appointment is necessary. Telephone: 01-8728051/8728095.
Galway Family Planning Centre can be contacted at: 091-562992.
Limerick Family Planning Centre: 061-312026.
The Irish Family Planning Association can be contacted at: 01- 8727088.