We are pleased to welcome this guest post from the wonderful people at Re(al)-Productive Health.
Re(al)-Productive Health is a working group, launched in October 2013, which actively campaigns on issues concerning reproductive care in Ireland. Our initial campaign has focused on the availability of and access to over the counter emergency hormonal contraception.
In April 2011, Levonorgestrel (available in Ireland as HRA Pharma’s ‘NorLevo’) became available over the counter in Irish pharmacies. Our work intends to promote accessibility of the drug whilst mapping the implications for individuals seeking emergency contraception in Ireland in terms of this over the counter availability, and aiming to tangibly improve accessibility.
We believe that the full availability and access to the morning after pill for those living in Ireland is hugely significant for securing those real reproductive rights which have often been overlooked.
Our website features details of our campaign to facilitate access to emergency hormonal contraception in pharmacies in terms of factors such as availability, cost and social stigma.
For example, many people are unaware that a pharmacist may legally object to dispensing emergency hormonal contraception, if it happens to lies in contradiction with his/her ‘personal moral standards’ (PSI, 2013). Such pharmacists may defer to the Pharmaceutical Society of Ireland (PSI) Code of Conduct on the dispensing of medication in general in order to conscientiously object to a woman’s request. Though pharmacists are required to refer individuals to another pharmacy this is often physically and financially impossible, not to mention quite possibly very shaming.
Furthermore, despite being, according to swathes of research, ‘safer than aspirin’ (Grimes, 2002: 1536), the consultation process that is presently mandatory to access over the counter medication is often a site of unnecessary, disrespectful and morally loaded questions. In addition, the cost of the drug is unregulated, ranging from prices such as €10 to €45.
The site features a platform from which individuals can upload their morning after pill experiences, in terms of location, availability and cost, onto a map of Ireland, helping others seeking the drug and building a better picture of collective experiences. Also featured are individual accounts of attempting to access the morning after pill, helpful tips on how to practically access the drug and what to expect. The social stigma which often surrounds issues of reproductive and sexual health is sought to be highlighted here, and as such, alongside other measures, reduced.
The research we have compiled on the issue represents input from those who have sought emergency contraception in Ireland, medical and academic literature concerning the subject, consultation with groups and organisations working within the realm of reproductive rights in Ireland and comparative analysis of regulations governing emergency contraception in an international context. This research has informed our policy document ‘Emergency; Contraception in Ireland’ , outlining proposals regarding current Pharmaceutical Society of Ireland guidelines as well as HSE and Department of Health policies, which affect access to NorLevo. The document reflects issues of inaccessibility to emergency contraception experienced in Ireland and the methods by which this inaccessibility may be addressed in order to provide for an equitable provision of this vital aspect of care within the Irish state – or in other words, to shift our priorities.
But why are our priorities so skewed? In the 1880s, Elizabeth Cady Stanton of the US Women’s Rights Movement proclaimed, ‘The first great work to be accomplished for woman is to revolutionise the dogma that sex is a crime’ (Schneir in Shulman, 1980: 591).
Over 130 years later, it is evident that this, in Ireland, has yet to be accomplished. The obvious questions are thus; why do we need to promote the accessibility of a drug that’s ‘safer than Aspirin’, that does not lead to infertility subsequent to the third occasion of use, that is not the ‘irresponsible’ choice?
The history of female sexuality in Ireland is one littered with examples of oppression and punishment, of shame and stigma. From the eighteenth to the late twentieth century we excluded ‘penitents’ and unmarried mothers from society. The very founding document of the Irish state presents women as one-dimensional and valuable only in terms of her adherence to strictly defined ideals.
However, still today there exists the deviant woman, her supposed failings casting a shadow upon the moral vitality of the nation. We have the ‘slut‘ – shamed for having sex, and especially sex that lies within the murky surroundings of what is considered normal. We have the women who ‘take the boat’, forced, due to legislative cowardice and apathy, to travel overseas in order to avail of a reproductive right. It is clear that there exists within Irish society a continued exertion of punishment of women – women seeking to separate pleasure from procreation, sexuality from reproduction. Contraception represents the ultimate symbol of such decoupling of these concepts.
It wasn’t until 1979 that we saw the legalisation of contraception. It wasn’t until 1993 that condoms were available in vending machines. And it wasn’t until 2001 that emergency contraception became available in Ireland. It’s taken us a long time to garner these achievements – but the graft is certainly far from over. With prices of emergency contraception ranging from €10 to €45, it is clear that contraception falls neatly within the remit of the free market. Our pharmacies are private. Free sexual and reproductive health clinics are few and far in between. Over the counter emergency contraception is not covered under the medical card. And good luck finding a pharmacy on a Sunday in rural Ireland!
We need to start asking more, expecting more. We should refuse to accept our healthcare as a product, as a pawn in a game of chess which society as a whole can inherently never win. We can never claim to have achieved reproductive justice if reproductive justice is only for some. Ultimately – we need to refuse to accept our reproductive healthcare as an apolitical concept.
Thus, we demand that emergency contraception be something;
- For which the price is limited – that it is fully covered under the medical card.
- That we should be allowed to simply take off a pharmacy shelf and pay for it – no questions asked.
- For which pharmacists are properly trained to deal with.
- That is not subject to the private moral beliefs of individuals, of pharmacists.
- That any of us, in any town, village or city in Ireland should be able to reasonably access emergency contraception.
- That we should be able to keep a supply of emergency contraception in our medical cabinets like Paracetamol – just in case.
- That all of us, of all genders, sexes, sexual orientations and ages should have access to.As we launch into the latest struggle to repeal the Eighth Amendment in Ireland, this a time for solidarity, a celebration of how far we’ve come and taking collective stock of how far we have to go. We need to listen to real experiences, everyday manifestations of healthcare policy, and seek to improve all aspects of reproductive and sexual health. AReferences
- Above all, we need to remember this – that no matter how minimal our resources, no matter how powerless we may feel, we can actually make a difference, and we should try.
Grimes, D. (2002) ‘Emergency contraception and fire extinguishers: a prevention paradox’. American Journal of Obstetrics and Gynecology 187(6):1536-8
Pharmaceutical Society of Ireland (PSI) (2013) Supply by pharmacists of non-prescription medicinal product containing levonorgestrel (’NorLevo’ 1.5mg tablets) as emergency hormonal contraception
Shulman, A. (1980) ‘Sex and Power: Sexual Bases of Radical Feminism’ Signs, 5 (4): 590-604 The University of Chicago Press