Unplanned and therefore unwanted?

This week in our staff meeting, we had a brief talk from a local charity which provides counselling for women in crisis pregnancies. Our patient population has a very high number of women who have had abortions, and many of these have had more than one abortion (this, despite the fact that of the 7 doctors I work with, only 2 will refer for terminations). This charity is, I would say, pro-choice but their approach to choice is that it should be a considered choice, and they do play an important role locally in identifying women who are being coerced into abortion (at the point where the woman has already checked into hospital for the termination) and supporting them in keeping the baby should they decide to do so. They also provide counselling to those suffering the consequences of abortion: women, men and family members. One of the reasons I do not mention their name here is that I do not wish to endorse them - yes, some of the work they do leads women to choose not to have an abortion, and too often the long-term consequences of abortion are ignored or denied - but the fact is that they support a 'woman's right to choose' rather than recognising the evil of abortion for what it really is.

However, something very interesting (or possibly horrifying) which was mentioned during the presentation, were some statistics around abortion, namely:

- 34% of women under 30 have had an abortion

- 10% have had more than one

- one third of pregnancies end in abortion

and then the one which struck me as most interesting

- 50% of pregnancies are unplanned.

It wasn't so much that the proportion is fairly high (given our contraceptive mentality in this country) but that the person giving the presentation felt that this was a surprise, as she said, 'given everything we know'. Well, the fact is, that we surely must know by now that babies never come when they are planned. I don't know anyone who can say, yes, our baby arrived exactly when we wanted it to. I know couples who have waited years (regardless of whether they had previously used hormonal contraceptives or NFP and really wanted children), I know couples who decided not to and then went through IVF and still didn't end up with children, I know a couple who got pregnant having slept together only once, the fact is that what we actually should know is that the contraceptive mentality is not working. If it was, then there wouldn't be so many abortions and so many unplanned pregnancies. And the fact that whilst 50% of pregnancies are unplanned, only (God help us, it's still horrific) 34% are terminated means that an unplanned baby is not necessarily and unwanted baby, therefore why this conviction that planning is everything, that we must be in control of absolutely everything? 

I generally think that abortion debate comes down to the fact that people don't recognise that the unborn child is a person. But from these figures, and the accompanying attitude, it is presumably about our desperate desire to be in charge of the universe.

Whose conscience is it anyway?

I was browsing my September issue of Regula+e, published by the General Pharmaceutical Council, which is the regulatory body for pharmacies, pharmacists and pharmacy technicians, when I came across this article about a pharmacist who had had conditions placed on his practice, by the Fitness to Practise (FtP) committee, for 'imposing his beliefs on patients' (pp24-25).

The pharmacist, during the course of supplying the morning after pill (EHC), told a patient that it was "a chemical abortion, was ending a life, and that this would be on her conscience". The patient was shocked and felt "rotten and horrible". He did not give her the option to go to another pharmacy.

Recently I blogged, among other things, about the weirdness of the fact that while pharmacists do not have to supply EHC, they do have to tell the patient where they can obtain it. This pharmacist didn't tell his patient where they could get EHC, because he did not decline the supply. Yes, apparently he was in the habit of giving what the FtP committee deem 'an embarrassing and distressing lecture' and then giving the patient the morning after pill anyway.

 

There seems to be a whole lot of weird stuff going on here. The FtP committee, for their part, merely have to judge whether a pharmacist has breached the code of ethics and, if so, whether conditions should be imposed or the individual removed from the register, so I'm going to ignore them. It's the behaviour of the pharmacist in question which puzzles me. If it was for moral or religious reasons that the pharmacist gave these speeches to his patients, why did he then supply EHC? What was he hoping to achieve? Was he trying to absolutely prevent evil (ie the patient does not terminate her pregnancy) or just avoid co-operating (the patient gets upset and goes to another pharmacy instead). But if the latter, why did he then supply? It is a mystery to me (although I recogise that I don't have all of the information about the case). And then there is the patient, who reported the pharmacist because he made her feel "rotten and horrible". I'm not saying the pharmacist shouldn't have been investigated, as his actions come across as a bit odd, to say the least: was this his usual manner of advising patients? But as taking the morning after pill causes side effects of headache, nausea, abdominal pain, bleeding and fatigue (very commonly), and dizziness, diarrhoea and vomiting (commonly), the 'rotten and horrible' feeling was somewhat inevitable, if only on a physical level.

 

Whether you, healthcare professional, go with a straight refusal to supply or a slightly more in depth explanation as to why not, or an attempt to engage the patient in discussion as to the rights or wrongs of EHC (or whatever other substance), do so with charity and professionalism! Haranguing the inidividual is unlikely to achieve anything, and following the harangue with supply even less.

 

Interestingly, one of the conditions imposed is that the pharmacist is not to supply EHC in the future. Sounds like good news all round.

 

PS My viewing stats passed the 10,000 mark this week. The list of referring sites may suggest to me that a lot of these views are not real people, but to those actual people who are reading: thank you :-)

In co-operating with evil, where is the line between reality and paranoia?

Yesterday, my brother Andy* and his girlfriend sat down and filled out a mortgage application. Every so often I was asked my opinion about what I thought certain questions were getting at. I did my best to answer them but mostly, given my total ignorance of mortgages, credit cards and money in general, I pointed them in the direction of more reliable answers. I found myself wondering whether I should refuse outright, be rather more non-comittal or launch into a lecture on how co-habitation is not in God's Plan for them, despite the fact that my big-sisterly-omniscience apparently doesn't extend to morals. Andy and Gertrude** plan never to marry (G wouldn't mind if A insisted, I am told, but A is against it) or have children (A would secretly like to but G is vehemently against) and wish to buy a house together so that they can live happily ever after. My other brother, Chris, married Adele*** earlier this year, and prior to this they had been cohabiting for two years in the house they bought together. Now, when Chris told me the two of them were moving in together I expressed my concern and talked about it with him. He was unreceptive, but there was no animosity. Chris and Andy are extremely different in their openness to different ideas, and Chris at least has some basic appreciation for Christian morals. It was worth a try. With Andy there would be no point.

This issue of what counts as co-operation has been on my mind for some time, and I have a tentative plan to follow up my post on healthcare professionals and the law with one on conscience. Here's the deal: Pharmacists have a conscience clause in our Code of Ethics. We can refuse to do something if it is against our moral or religious beliefs. However we must "make sure that if your religious or moral beliefs prevent you from providing a service, you tell the relevant people or authorities and refer patients and the public to other providers". In general, among pharmacists, it is agreed that a conscience clause is a good idea because healthcare professionals constantly have to make difficult decisions about what the best course of action may be. However, the fact that we have to refer the patient to another provider rather makes a nonsense of it: I won't give you the morning after pill but my colleague here/over the road will.

 

I often have conversations with people about how we should handle these ethical dilemmas. For practical purposes I think it is virtually impossible for a Catholic pharmacist to work in community pharmacy (ie a shop) because although 'Emergency Hormonal Contraception' is not an essential service under the NHS community pharmacy contract, it is locally commissioned by PCTs and unless you have the luxury of owning your own pharmacy its unlikely that you would be in a position to say that the pharmacy won't have anything to do with it, and in any case you would still have to tell the person where to access said service. In hospital pharmacy it is a bit easier to pick and choose what field you work in. Most hospitals do not supply contraceptives to in-patients (for obvious reasons), but if a patient is usually takes hormonal contraceptives, you still need to clinically check that prescription. So then what? Is clinically checking when you aren't going to supply a problem? Even if you work in geriatric medicine there is still the dispensary slot, the on-call time when you can't hand over to a colleague. Leaving scripts to one side for other pharmacists to handle is practically a hanging offence. One friend and I were shocked to hear that a consultant simply passes over the ethically problematic patients. For us, that is not how it works. Some people would say they wouldn't dispense Viagra, in case the person was not married, or having an affair, or other immoral behaviour...but surely there comes a point when you have to give someone the benefit of the doubt. What if the person is married and erectile dysfunction is placing a huge strain on their relationship? How far can we go down this line of thought: should we even be working in the NHS?

 

What should we be doing as Catholic pharmacists or other healthcare professionals? Where should we go and work? I don't think the answer is for us to seek out fields of healthcare without ethical dilemmas, because that would also limit our opportunity to transform all of the temporal order which is in contrast to the Gospel (always supposing such fields exist). And I think we definitely need Catholic healthcare professionals. Must we just accept that our career options will be limited, our colleagues will mistrust or despise us and that we end up doing an unfulfilling job because we need to provide for a family?

 

Answers on postcard, please.

 

*Not his real name; if I use a psuedonym myself I'm hardly going to reveal his identity.

**Obviously not her real name, but follows a pleasing pattern known only to myself.

***Likewise.

A trip to the egg bank

On Tuesday the Mirror reported that an egg donor bank had opened in London; it has been operating on a trial basis since the beginning of the year. In my health news email digest, it stated that women would be able to choose characteristics of the baby, such as eye colour. (It has got a little more difficult to review these stories since the newspapers realised that people were accessing their articles free online and that they were clearly missing out and should start charging.)

 

Choosing eye colour might seem harmless enough, and I understand that a woman might well want a baby to bear some slight resemblence to her, but we have already seen the tragic consequences of sex-selection of babies, and allowing and encouraging any sort of picking and choosing definitely sets us on the path to designer babies. Having children is not a right, it is a privilege. Babies are not convenient: they do not sleep or smile or eat when we want them to, they are hungry and tired when we don't want them to be. They are people, and like all people they are creatures. We are created. We are fragile. We are dependent. There are some things that we don't get to choose because we are not in charge.

 

This was as far as I got when I actually went and read the Mirror's article. I was struck by the fact that the director talked about the 'needs' of people 'needing' donor eggs. Need is not the right word - children are a privilege, not a necessity. It would be more accurate to talk about desire and want. I also took note of the 53 year-old woman who said that she'd always wanted to have children but had never met the right person. There is in that statement a clear understanding that the 'right person' is a necessary part of the process of having children. There is no mention that she has now met that person, but she's decided to have a child anyway. In the same way that we have separated sexuality and procreation (see Humanae vitae and if you haven't read it, then read it) we have also separated the concepts of children and family. Sometimes there are ways of doing things which are just different. Other times there are right ways and wrong ways, and being created and finite we also don't get to choose what is right and what is wrong. We can choose whether to do right or wrong, between good and bad and frankly that is a complete misuse of the precious gift of our freedom. Right use of our freedom is using it to choose between good and better, not between good and bad.

 

It was at this point that I discovered the Telegraph's article on the same subject and realised how incredibly naive I am. It may be couched in terms of altruism, but this is not some benvolent institution, set up because of tragic needs which we cannot ignore (like, say, a food bank). The donors (something of a misnomer) will receive £750 for providing eggs. How long before we see young women funding their way thorough university by selling their eggs? And the profit margin is presumably quite high, as treatment (purchase of eggs) costs £10,000.

 

Whilst I have thrown words like right and wrong around, and asserted that children are a privilege and not a right, I do empathise with older women. And I do not wish to generalise or assume that it is only single women who seek IVF in later life, I know women who did not meet and marry their husbands until they were in their 50s and 60s and therefore never had children. My great uncle's second wife told me cheerfully that she had no regrets over not having met her husband sooner as he, a widower, had been married to someone else. There are also couples who are sadly, persistently infertile. Women are called to be mothers, whether biologically or spiritually, and the inability to answer that call for whatever reason must bring heartache. But we also need to remember that our actions always have consequences. The consequences of delaying children by prolonged, repeated use of contraceptives in order to advance a career, go on holiday more often and generally 'enjoy life' might be infertility. We are not in charge and we cannot have it all.

Keeping up with life

The Daily Mail (not my favourite source of healthcare/science, or indeed any other kind of news, but anyway) reports a worrying trend in the number of women taking stimulants in order to cope with life.

Aside from the fact that Ritalin and friends are not licensed for the treatment of ADHD in adults (ie their safety and efficacy in this group of patients is not proven) and that buying medicines on the internet is a stupidly dangerous thing to do there are some other concerning aspects.

The women taking these drugs are obviously experiencing extreme pressure to perform and conform, but more seriously still we can see a tendency to measure people by what they do. We are not ourselves, or what we eat, but what we do. This is massive problem because if you cease to "do" then you also cease to "be". In the case of the students using these drugs, their measure of themselves is how well they perform in exams: I am only as good as my exam results. Others struggle with the demands of juggling work and family life, or long hours and pressure to meet targets. But where is the weakness in admitting that something is hard? There is also, as so often with mental health, a reduction of the human person to the merely biological.

According to the article, women aged 25 to 34 are the most stressed demographic group in the country. No surprises there: we are the group who first experienced student loans, SATs at 7, 11 and 14 years, league tables, contraceptives for all, abortion virtually on demand... We have grown up being encouraged to turn down children in favour of career success, with the advice that giving up work for motherhood makes you a failure, that instant gratification is our right and we are also the generation whose parents lapsed in their religious pratices meaning that many of us have never stepped foot inside a church. We started life with the understanding that, as women, we would have to fight tooth and nail to be recognised as good enough and we have arrived at adulthood finding that most of the work has been done.We have moved on from the time where everything was blamed on our parents not giving us enough attention. Now we are our bodies. We have been formed by secularism and individualism and taught that an expensive pair of shoes can solve all our probelms.

We were promised the world, and the world turned out to not be worth the paper it was written on. Only God's promises are worth trusting, and the majority of this group have no idea what they are.

Something this simple shouldn't take two decades

For H: Keep up the good work!

Recently (with my Catholic Link hat on) I have been trying to find short videos or animations which explain the Church’s teaching on contraception. There is a huge want of apostolic resources on this topic and it has been something of a struggle. I was telling my brother (or unsuspecting apostolic guinea pig, as I like to call him) about this lack of videos on the topic and his response was, “Of course not, no-one wants to think about that stuff!” Eventually, I found something and then I sat down and tried to write a post. I ended up with a reflection on my own experience which was completely wrong for that site, but I decided to post it here instead.

In every parish I attended as a child there was always one family with more than four children who were regarded by the rest of the parish as more Catholic than everyone else at mass. Nobody ever explained why this was, but they were generally viewed with a mixture of superiority and guilt-fuelled admiration. Apparently being more Catholic meant that you were usually late for mass and were unable to get your children to sit still for 45 minutes.

At (my non-Catholic) secondary school that I learned that “Catholics believe that contraception is wrong”. There I also learned that contraception was the answer to pretty much all the world’s problems (and this was before the AIDS epidemic!). I had one conversation at home on the subject in which I was informed that “NFP probably works for clever people” and the clever couple cited had about five university degrees between them (and three children). I had a friend at school who was one of nine children. I used to hear people saying that they must be Catholic, which always mystified me as I knew they weren't.

In short, by the time I was 15, what I had learned about family planning was this:

• The Church is against contraception (apparently for no reason).
• Catholics themselves know better (and mostly ignore the Church).
• NFP is very complicated and difficult (and ineffective).
• Having children turns your life into chaos.
• Contraception will allow me, an intelligent woman, to have the life and career I deserve (and should want). Without contraception, this will not be possible. I am capable of making the world a better place and if I have children this will be impossible.

What a devastating combination! The world tells me all the disadvantages of children. The Catholics I know tell me nothing, in word or deed. (This sounds like poor me, I am a sad victim of the big, black formation hole, and that is not the point I am trying to make.) The world has got louder since then. It now assumes I want to have casual sex and assures me that there is no problem with that, in fact I should probably be encouraged in that line.

Now we have to fast forward almost ten years to the time of my personal conversion. Through prayer, formation and endless patience on the part of those who did apostolate to me I discovered that I believed in the Faith and that I wanted to live by the teachings of the Church. But I was still really stuck on the subject of contraception. I ended up feeling that I would have to go along with the Church even though there was no reason for what she said. I would have to suspend my own intelligence out of some sort of blind obedience to the Church and for this I would suffer: I would be unlikely to be able to find a sane man who would marry me under these conditions, and if I did I was going to have fifteen children (and probably die young, worn out from childbirth and never being able to afford a holiday). It took a lot more years of prayer and formation for me to understand and love the wisdom of the Church, a loving Mother who cares for her children and knows what is best for them.

It has taken nearly 20 years to undo the brainwashing I underwent at school. And it still isn’t completely done. (Interestingly, the undoing hasn’t come from having endless conversations about the merits of NFP over contraception but from understanding Catholic anthropology and the dignity of the human person.) I have a fairly constant mental battle with myself every time I read about sexually transmitted diseases, teenage pregnancy etc. I know that trying to address these problems with contraceptives is like sticking a plaster on a gaping, infected wound and expecting it to heal all by itself. But the world's roots go deep.

I am not surprised that “no-one wants to talk about that stuff”. There is a wall of silence surrounding the subject that probably stems from a fatal combination of “no sex please: we’re British” and abject ignorance on the part of the majority. I finally begin to understand the weirdos people (see what I mean about brainwashing) I knew at university who wouldn’t shut up about NFP: if people, and especially young people, don’t hear about the Church’s teaching from those faithful to the Church they are going to hear about it from somewhere else. And those other people who tell them about it are not going to have the integral wellbeing of the human person as their motivation and the inate dignity of that same human person has the foundation for all their reasoning. Because of this they will, however well-intentioned they may be, get it completely wrong.

Update: Contraception Can't: We need to talk!

Weighing risk and benefit: audacious or reckless?

Prescribing is all about weighing up risks and benefits. The weighing up may be explicit (helpfully already carried out by the licensing authorities and NICE guidelines etc.) or implicit (carried out by the doctor at the bedside) and everyone makes some sort of judgement when self-medicating. It is half a millenia since Paracelsus said that the only difference between a medicine and a poison is the dose.

However, it does seem that lately this process of weighing up risk and benefit seems to be going a bit squiffy. I see two contributing factors to this. On the part of the presciber we have the loss of the personal, an absence of a holistic view of the patient leading to, or due to, the emphasis of explicit over implicit. On the side of the patient there is a tendency to subjectivism, giving an additional weight to the inconvenience of the illness rather than the reality of the treatment. Reduced inconvenience in the here and now weigh more on the scale of risk and benefit that the long term effects of a medicine. And it is not just the healthcare professionals who have lost their holistic view: patients too are inclined to reduce everything to the biological. I'll take a tablet and it will all be better.

First up: drug cocktails. I do think that evidence-based medicine is a good thing. We should be using medicines to help people have improved health and quality of life and it is important that everyone has access to the benefits of knowledge regardless of location and how switched on your GP is. From this point of view, guidelines, recommendations and national standards are no bad thing. But sometimes the guidelines seem to come before the patient. If you have a heart attack, for example, you will be prescribed 4 different medicines straight off, no questions asked to reduce your chance of having a second. As someone who was, until recently, taking 6 tablets a day I would say that the mere fact of taking a lot of medicine makes you feel ill. Physically I feel no better since we changed everything round a bit so I could take only 2 tablets a day, but psychologically it makes a world of difference. If this person who had a heart attack had nothing else wrong with them, they've just gone from zero to four, but the chances are that if they're an older person they might have diabetes (at least 1 more medicine), moderate pain of some kind (paracetamol, codeine and two laxatives for the constipating side effects), anxiety (brought on or compounded by the amount of medicines they now have to take)...

If the number of tablets taken is our main concern then 'polypills' could be the answer. Instead of taking 4 different pills after your hypothetical heart attack, you would just get one which contained all 4 medicines. Easier to remember, less psychological impact,  might be a good thing. But there are problems... If you need to increase the dose of one of these medcines (because following your hypothetical heart attack, you have started taking your medicines and your cholesterol is now under control but your blood pressure is still going through the roof) what do you do? If you need to stop taking one of them (becuase the aspirin gives you an ulcer) what happens then? In fact, prescribing has moved away from combination painkillers in recent years. I believe Such polypills, with their one-size-fits-all approach, possibly lead us yet further in reducing the patient to the merely biological

From the patient point of view I would like to cite the example of hormonal contraceptives, a supposed panacaea for women's health problems as well as the terrible disease of fertility. Contrary to popular belief these are medicines. The benefit (I don't need to worry about what I do) comes from such a narrow vision of what a person really is that immediately half of the risks are discounted (STDs, and then all the non-biological ones) as is the fact that this "benefit" can easily spill over into other aspects of life: I can do what I like with respect to behviour which might lead to pregnancy swiftly becomes doing what I like with respect to commitment (and no, I am not saying that the pill causes infidelity). And the short-term benefit of not getting pregnant becomes a long-term risk of not getting pregnant: very few people think about the fact that when they finally do decide that they want a family they might find that they can't. We also shouldn't ignore the reports of extremely serious consequences: death and permanent disability.

Acne is one of those conditions where the risk:benefit calculation seems to be working out a bit strangely. Above is the report of a girl who died after taking the pill for acne, likewise Roaccutane (OK, the report is from newsbeat, but BBC3 recently broadcast a documentary) can cause extremely serious problems (incidently I don't know why Roche say there is no link between the drug and depression as their own SPC for Roaccutane says there is...?!). I realise this is not a black and white situation. If you have severe acne (and if you are seeking such drastic measures presumably your acne is severe) then you might well be depressed (or so fed up that you think you are depressed), believe your life is over, etc and I don't want to belittle that in any way. But I can't help thinking that the choice of acne or death, or acne or permanent untreatable depression, is a no-brainer. So on what basis are we making these decisions?

Sterilizing our children

This week there have been two articles worth mentioning in the news about contraception and teenagers.

The first is from the Telegraph and gives the details of girls as young as 13 being given contraceptive implants (effective for 3 years) and injections (3 months) at school, or in clinics, without parental knowledge or consent. First of all, I believe that patient confidentiality is essential, regardless of the age of the patient. However, confidentiality is intrinsically tied to consent: the person consenting is entitled to confidentiality. All medical treatment (legally this includes contraception - Medicines Act 1968) requires informed consent, and those under 16 can only give informed consent if they are deemed to be Gillick competent. Competence varies with every individual and intervention and I do not believe that any teenager, however smart can be deemed to be competent where a long-acting contraceptive is concerned. We see enough adults who struggle to conceive after years on the Pill; I cannot see that a teenager, who is unlikely to be considering the probability that they will one day want to have a family, would be able to give informed consent. Actually, come to think of it, there probably aren't many adults capable of giving fully informed consent to such an intervention, but unfortunately we aren't subject to the same criteria. If you are consenting to contraception, that assumes that you are consenting to sex, and that requires a level of psychological and spiritual maturity, not just intelligence. As such, not being competent, they cannot consent and therefore they are not entitled to confidentiality.

Secondly, we have an age of consent in this country which is 16. Why do we bother if promiscuity is going to be encouraged in this manner? Who are these 13 year olds sleeping with? Granted, there may be a small proportion who seek contraception as a badge of honour (a GP I knew who also worked in a Family Planning Clinic told me that she was somewhat plagued by teenagers who wanted contraceptives for the purpose of having them rather than using them), a rite of passage if you will. But given all the concerns over internet grooming and child abuse should we not be asking more questions? Teenage girls are not usually interested in boys their own age; even if a girl is 15 and her boyfriend is 16 that is still illegal.

This strategy is derived from the desire to decrease the incidence of teenage pregancy (I get it) at all costs (I don't). Given the current rates of STDs, especially the chlamydia epidemic, why aren't we thinking outside the box? What we need is a culture of openess: parents should not be their childrens' best friends or their worst enemies, but children should be able to talk to their parents. And the only guarenteed way to prevent pregnancy and STDs is through abstinece and I do not think we can promote abstinence without teaching young people about their own intrinsic dignity. Of course we have a problem in that we are now in the 2nd generation of permissive behaviour, the belief that freedom is all about doing what you want when you want, and the total absence of God which leads to seeking value in pleasure.

The other article states that girls are choosing the pill over condoms. Around 2006, the student newspaper in Manchester published the results of a survey which found that female students didn't want to go on the pill because they didn't want to be considered "easy". (It also discovered that a significant proportion of students believed that it was not possible to conceive whilst standing up, which says something about the level of education they had received, but I digress.) This suggests that they were not considering the pill because they were already in a sexual relationship but because they were expecting to have what I think could be termed 'random' sexual encounters. Someone who knows you is not likely to be judging you on being easy.

What am I bothered about? Well, firstly, these articles are about girls. No-one is talking about boys. Granted there are not so many contraceptive options available to them, but it appears that the current strategy is completely targeted at young women, and comes from an anti-life basis rather than the promotion of health and well-being. There was recent outcry when it was proposed that girls be taught abstinence. I agree that it is rather ridiculous, because boys also need to know about their dignity and worth (and sadly, teaching only one half of the population about abstinence would likely lead to an increase in the use of prostitutes). It could be argued that girls choosing these longer-acting forms of contraception are sleeping with their long-term boyfriends. But I think it could equally be argued that actually what is happening, extrapolating from the prevailing attitude of Manchester undergraduates, is that at least some girls are effectively sterilizing themselves in the expectation of casual sex. It is time that sex education was based on something real (anything! but preferably good anthropology) rather being completely out of context and taking sex out of context. Bring on existential sex education.

Help required

EllaOne, the morning after pill which works for up to 5 days after (er...the 5 day after pill?), is now available from Co-op pharmacies without a prescription, the Telegraph reports. I'm feeling a bit out of the loop because I didn't know anything about this and apparently it's been around for a while now. I did a little googling and found that the Mail reported on it a couple of years ago.

The article in the Mail says that the manufacturers state that EllaOne can 'help stop an accident from becoming something more life-changing'. This is the first thing I would like explaining: how is having sex is an accident? I know that's not what they mean. It seems our brains are completely broken in this pleasure-seeking society. For one thing, accidents should make you stop and think, and then see how you can stop them from happening again, whether that means looking before you cross the road, fitting a stair gate or padding the corner of the cupboard where you always bang your head (maybe that's just me).
The Telegraph says that 250,000 women use emergency contraception every year. In 2011 there were around 190,000 abortions which is very slightly down on 2010. The morning after pill became available over the counter in 2001 since which time there has been a general upward trend in the number of abortions, which peaked in 2007 and seems to have remained stable for the last few years (although the number of abortions for non-residents is falling off, so actually the number of abortions for residents is increasing). However, considering that the goverment strategy of throwing contraceptives around is supposedly for the purpose of reducing abortion one has to ask what is going on: yes, the number of abortions has decreased slightly in women under 20, but this is more than compensated for by the increase among those in their 20s and 30s. AND 250,000 women take the morning after pill every year. It is clear then that increasing the availability of the morning after pill is not really affecting the number of abortions carried out.

Here are some reasons why this might be:
(1) It doesn't work. However, we should probably discount this one as it is demonstrated to be effective.
(2) The women who took the morning after pill weren't pregnant anyway. We have no way of knowing this.
(3) People have stopped using other forms of contraception. Difficult to say for sure without other prescribing data but would explain why chlamydia rates are rapidly increasing.
(4) Increased promiscuity - as postulated beforehand, and likewise explains STD rates.

 As STD rates are increasing so fast, I have to say that, sadly, (4) seems the most likely, which is reinforced by the general sexualisation of society which surely influences sexual behaviour. It would be interesting to see a breakdown by age of women taking the morning after pill.

As a final note 255,000 women died in 2010 in the UK. That means that EVERY YEAR APPROXIMATELY THE SAME NUMBER OF WOMEN TAKE THE MORNING AFTER PILL AS DIE! I grant you that there may be women who take the morning after pill more than once, and those who died are definitely exclusive, but still...doesn't anyone else find this a bit worrying?

Sometimes there are no shades of grey

A couple of weeks ago pro-abortion campaigners delivered 600 coathangers to the Department of Health in protest at Jeremy Hunt's supposedly pro-life views. Their concern is that if the abortion limit is reduced (not that anyone seems to have plans to do so) that abortion will become "illegal and unsafe".

As a young adult, I had rather contradictory views on abortion. I was convinced that the unborn child was a person, and arguments at what point exactly it became a person seemed deeply flawed to me. However, I also believed that it was inevitable that women would have abortions and therefore it was better for them to have legal access to abortion so that they didn't die in back-street abortions. In short, I subscribed to the 600 coathanger view.

I have long since changed my mind about this. I realised that if the unborn child was a person (and furthermore, if we cannot say definitively that it is not) then there can be no justification for abortion. The "people will do it anyway so lets make it legal" argument has long been applied from everything from prostitution to speeding and doesn't hold water: if something is objectively wrong then making it legal doesn't make it objectively right.

After reading about the coathanger delivery I started thinking about it again, and I realised that what really worries me is what it is that drives women to seek an abortion at all costs. Things have changed since the Abortion Act was first introduced. Single mothers, although obviously they have extremely difficult lives, are not ostracised from society. And if she really doesn't want to or can't look after a baby, then there are hundreds of couples out there going through IVF and surrogacy who do want to have a child.

I was reading a friend's column in El Colombiano yesterday, in which she explains that being pro-life isn't just about mindlessly shouting about something you disagree with, but that it is important to inform your conscience about why abortion is wrong. I then read the comments section. I try not to do this, it generally annoys me. What I found was that whilst the comments where anti-abortion, quite a lot of them said things like "there's no need for abortions in this day and age because we have contraceptives". (That is something that I still struggle with. I am 100% with the Magisterium on this, but it has been so well drummed into me throughout school and university here in the "geopolitical epicentre of the culture of death" that contraceptivees are the solution to all the world's evils that often it is the first answer to pop into my head. I choose to reject this answer, but it is still there.)

What we have lost here is love. Love of a mother for a child is surely the most fundamental kind, and if a mother can argue that her child is not a child, or puts her right to what she considers life over his or hers then we have lost something fundamental. And for those women who have abortions because they are desperate and struggling and genuinely see it as the only solution, well, they are also called to make a great act of love, and so are the rest of us, to support them (practically, spiritually, psychologically) in that love. And if, horrifyingly, a child has been conceived in rape then that woman is also a mother and she too is called to make a sacrificial act of love. Acts of love are not easy. We must die to ourselves, say no to our own comfort, our own plans, in order to love. And "dying to ourselves" is not just a nice turn of phrase: Jesus really died on the cross out of love. And that is the measure for which we must strive.

Harm reduction: Relativism in action?

Many of our healthcare strategies are based on harm reduction. We use methadone to treat drug addiction, substituting long-acting methadone for short-acting heroin. Many people live stable lives on methadone, but very few of them manage to get off the methadone. We have simply substituted one addiction for another, but we accept this because it reduces crime and anti-social behaviour. It does have some benefit for the individual as well, they are not committing crime or anti-social behaviour, but the benefit to society as a whole is much greater than the benefit to the person in question. They are still an addict; their dealer is now the government.

Pharmacies provide needle exchange services. Clean needles and sharps bins are given to drug users and dirty needles can be exposed of. Users do not need to share or reuse needles and therefore they have a reduced risk of contracting blood-borne diseases and other infections, using drugs is made safer. The NHS spends less money treating them and there is a clear public health benefit. But the individual is still an addict.

These strategies are not a total waste of time, and do bring some other benefits to users in terms of physical health. They are brought into contact with a health care professional whom they see regularly and/or frequently, and thus are enabled them to access other medical services. The problem is that that both these strategies are based on the premise that people will always take drugs (being intrinsically bad), an assumption that the person will not and is not able to change, and the reduction of the person to their body. We think we are choosing a lesser evil, but actually we are settling for a lesser good.

We were created good, and whilst are capable of misusing our freedom and choosing the bad, we are also capable of exercising that freedom in the way that it was intended and choosing the good. Choosing between good and bad is not the best use of our freedom: even a lab rat is capable of doing the same. The proper use of our freedom is choosing between good and better. Obviously our ability to exercise our freedom is serverely impaired by behaviour such as drug misuse and abuse, but it is not gone.

Reduction of the person to the physical is also seen in the way we attempt to address the epidemic of sexually transmitted diseases and teenage pregnancy: again, on the basis of harm reduction we throw contraceptives at the problem. Once again it fails to address the root of the problem which is a lack of understanding of what a person really is. Made in the image and likeness of God, we have an inherent dignity, a dignity further raised by the incarnation: God became man. The Lord Jesus worked with human hands, thought with a human mind, acted by human choice and loved with a human heart (GS 22). 

We have a body but we are not our bodies. We also have a soul and a spirit, and in the hierarchy of body, soul and spirit, the body is the least. We are capable of entering into relationships on more than a merely physical level. Understanding of this dignity leads to respect of self and others, a better basis for decision making and surely a change in the way we choose to behave. Quick-fix solutions of short-term harm-reduction are not the answer to problems which come from a disordered desire for instant gratification on a physical (and psychological) level and a wrong undestanding of the human person. They are much easier to measure which is good for government statisticians, but that is a topic for another day.

Completely missing the point. As usual.

BBC news reports that a potential non-hormonal male contraceptive has been discovered. Proteins are responsible for pretty much everything that goes on in our bodies, so targetting the synthesis of the protein responsible for sperm motility could certainly be a way to cripple them. Aside from the pharmaceutical issue that said product is probably years, if not decades, away from the market (but hey, Male contraceptive pill a step closer is much more newsworthy than Male contraceptive pill still a really long way off) there are two statements which bear further comment.

"There is undoubtedly," quotes the article, "an urgent need for additional contraceptive options". Really? There is? This puts me in mind of a meeting I was once invited to sit in on in which it was decided whether new products would be funded by the NHS in that region. In the meeting I happened to attend, the contraceptive vaginal ring (NuvaRing) was up for discussion. In the red corner, a representative from the Family Planning Association. In the blue corner...oh wait...there wasn't anyone in the blue corner. "They need another form of contraception: they don't want to go on the pill and they don't like condoms," asserted the representative. A placebo was passed around for inspection and somehow the motion was carried, despite the fact that the faces of the majority showed that they couldn't get past the intrinsic ickiness of the ring: even if no-one's going to use it, we'd better make it available to them. I don't know who "they" are, but they weren't to be allowed to have children at any price. This brings me on to the second comment in the article which drew my attention: "it has been argued that the lack of a male contraceptive pill has contributed to the number of unplanned pregnancies".

Is that so? A few years ago "they" got NuvaRing: now (or supposedly all along) "they" need male contraceptives. Hmmm...something tells me that throwing contraceptives at "them" isn't working. And why not? Because unwanted, unplanned pregnancies are not due to a lack of access to contraception. Maybe if we take a few steps back from teenage pregnany and the chlamydia epidemic, it's more obvious that a lot of problems we see are due to a lack of understanding of, or belief in, the dignity of the human person, which is the logical consequence of not believing in God. Without God, without absolute truth, it's a challenge even to get people to admit something is a problem: apparently underage, extramarital sex is OK as long as it doesn't result in unplanned pregnancy. Dosing the population is easier to measure, and potentially quicker, than allowing faith out in public instead of confining it to the private sphere, teaching Catholic anthropology, teaching abstinence and chastity (to both sexes), promoting marriage etc, etc and it's well known that unless you can draw a graph you can't have funding.

In the film 17 again there is a scene in which three girls, who have been competing for the attention of Zac Efron's character, tell him that they've decided that he doesn't need to choose between them, he can have all three of them. He asks them how they expect anyone else to respect them if they don't respect themselves. To which they respond with something approaching horror that they don't want to be respected. That, I think, is somewhat nearer the root of the problem.