The Morning-After Pill May Not Be Illegal After All

This discussion may have to be aborted quicker than we think

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Is the morning-after pill really illegal in Malta, or do we just think it is? 

The only law that comes close is the one prohibiting abortion. The ‘illegal’ status of the morning-after pill is in fact based on the understanding that it is abortive in nature.  

Two questions must be asked at this point: How easy is it to use other perfectly legal contraceptives for the same purpose? And how often is emergency contraception abortive, if ever?

Let’s start with the first.

Not all morning after pills contain the same substances or work in the same way. Any debate about the morning after pill should focus on the active ingredients, effects and mode of action of specific drugs, and not morning after pills in general. 

Two morning-after pills that are readily available overseas are Levonelle One Step and EllaONE. 

Levonelle One Step is a drug that contains 1.5mg of the active ingredient levonorgestrel. A quick search in the Medicines Authority database returns five drugs which have levonorgestrel as the main active ingredient.

One of them, Microgynon 30ED, contains 0.15mg of levonorgestrel, meaning 10 tablets contain the same amount of the active ingredient levonorgestrel as one Levonelle One Step tablet. 

Similarly, ellaONE contains ulipristal acetate at a concentration of 30mg per tablet. According to the database, one drug containing ulipristal acetate is currently licensed for sale in Malta – Esyma 5mg. One Esyma 5mg tablet contains 5mg of ulipristal acetate, making six of these tablets is equivalent in dose to one tablet of ellaONE.

It is therefore clear that there are currently drugs on the market that use the active ingredients in the morning-after pill and can therefore be used to the same effect. 

Banning drugs like Levonelle while allowing ones like Microgynon is the equivalent of banning big jars of coffee and only allowing the sale of sachets on the basis that consuming a whole jar of coffee at one go could kill you. 

"Banning drugs like Levonelle while allowing ones like Microgynon is the equivalent of banning big jars of coffee and only allowing the sale of sachets on the basis that consuming a whole jar of coffee at one go could kill you."

Emergency Contraceptive

The current ban on the morning-after pill ensures that it is only available to couples who can obtain a prescription for certain types of contraceptive pills and are willing to take an overdose, and those who are willing and able to obtain the morning-after pill illegally from overseas, either by having a friend or relative send it to them or by ordering it through a website. 

Onto the second question: Is it correct to classify these two drugs, and others using similar modes of action, as abortive drugs?

Levonelle acts in three ways: stopping or delaying ovaries from releasing an egg, preventing sperm from fertilizing an egg and, in some cases, preventing implantation of the fertilized egg in the womb. While the first two modes of action are without a doubt non-abortive since they simply prevent the sperm and the egg from meeting, the third mode of action is considered by some to be a very early abortion. 

In order for it to act in this way, however, the couple in question would have had to have had unprotected sex within approximately 24 hours of ovulation. 

If we assume that women are fertile for roughly six days in their cycle – the five days leading up to ovulation and up to 24 hours after ovulation - then the use of this drug could have a potentially abortive effect on one day out of the six when women are fertile - about 15% of the time.

There is, however, strong evidence that suggests levonorgestrel does not interfere with any postfertilization events - this would bring that percentage down even further. 

"If, as seems to be the case, the international scientific community does not classify this drug as abortive, the most pertinent question now becomes: Is there a scientific advisory board or some other officially recognised body that has given a recommendation to the Maltese authorities that this drug is to be classified as abortive?"

Some might argue that even if there is the smallest of chances that an emergency contraception pill will prevent a fertilized egg from being implanted in the womb this is enough for it to be considered an abortive pill. But laws, especially those regulating specialised fields, are not based on what some people argue but on the recommendation of a technically qualified board or entity. (The Church does not qualify, which is probably why its explanation was recently removed from the government’s information page on contraception.) 

If, as seems to be the case, the international scientific community does not classify this drug as abortive, the most pertinent question now becomes: is there a scientific advisory board or some other officially recognised body that has given a recommendation to the Maltese authorities that this drug is to be classified as abortive? 

In the absence of such a recommendation one must conclude that there is nothing in the law that prohibits the licensing and distribution of this product and that many women are being forced to misuse other drugs or even being pushed to eventually having an abortion for no legally based reason. 

If an official recommendation has in fact been made, then the authorities need to make this clear and publicly available, including the scientific basis for such a recommendation.

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Written By

Yannick Pace

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