I have provided thousands of morning-after pills to young women over the years and, frankly, I am sick of the lack of responsibility the majority of these women take. Indeed, they see themselves as merely the victims of ‘accidents’.
I suspect that the probability of women becoming randomly pregnant through no effort of their own is quite low. Choosing to get drunk or stoned and not knowing or caring how many blokes you have had sex with is a different matter.
Anecdotally, excuses for having unprotected sex are boringly predictable. The rate at which women report ‘the condom split’ should have put that industry into receivership years ago.
The fact is these ‘accident’ victims have unprotected sex because they can, safe in the knowledge that someone like me will bail them out.
Emergency hormonal contraception encourages people to have unprotected sex. The link between it and the rise in sexually transmitted infections is clear: if sperm gets out, so can germs.
But why, given the amount of Levonelle 1500 I dish out, do the termination figures continue to climb? There were 193,700 terminations in 2006, compared with 186,400 in 2005 – a rise of 3.9%. The answer: the patient knows the game and lies.
Rather than using emergency contraception after they have had sex, they intend to use it beforehand. Consequently, the medicine fails and pregnancy occurs.
Emergency contraception should be administered within 72 hours of unprotected sex. A woman may only admit to one ‘accident’ in that time frame when there have been several, with some accidents outside the official time limits. What’s more, having swallowed the pill, she also intends to have another accident that night, thinking she is covered to do so.
As a nurse, being lied to by patients is soul destroying: how can you help someone if they are not being honest, least of all with themselves? Like a pimp, my business thrives on providing ‘protection’ to facilitate sex, albeit for the enthusiastic amateur.
There is now some debate about whether we should just provide longer-acting and less reversible contraception to our young women – for example Depo-Provera, which lasts three months or implants which last for three years. As the mother of a daughter, the idea of filling young women up with chemicals so that they can have sex with men without the mutual inconvenience of condoms makes me nauseous.
If we were using publicly funded drugs to dope up our sons the way we are doping up our daughters, I wonder if society would be as tolerant. We cannot know what the long-term results of such huge doses of hormone on a regular basis will have. Will we see a rise in ovarian cancer in the next 20–30 years? After all, we used to think HRT was a good idea.
Ultimately, an unwanted pregnancy is a self-limiting condition and the need for emergency contraception will diminish
as the reproductive organs of young women who use it so regularly scar up and cause infertility.
Darwinian theories on natural selection notwithstanding, can this be right? In the future, as our birth rate plummets, will the law change to encourage pregnancy in pubescent girls as they will be the only females able to reproduce naturally? Reflective practice is, indeed, a double-edged sword.
The Mental Capacity Act 2005 provides some solace. It makes clear that a competent patient has the right to mess up their life.
Informed consent demands that the nurse tell the patient what is known about a drug and, in so doing, will highlight that which cannot be known – the long-term effects of abusing morning-after pills.
The human instinctual drive to reproduce is many thousands of years old and neither law nor medicine has made much of a dent in it. Maybe we need the expertise of anthropologists and psychologists to answer the question: why do so many young women aspire to a quick shag in a drunken stupor?
Meanwhile, we have to uphold the competent patient’s right to be wrong but we also have a duty to remind them about the consequences of their behaviour.
Maria Gough is senior nurse practitioner at Harlow Walk-in Centre