Beware the health risks of an over-the-counter morning-after drug

A new morning-after pill may soon be available without a doctor's prescription, and women's health will be the loser.

The way the drug works is also being obscured in a debate where its supporters are loath to acknowledge its abortion-causing effect.

In June the National Drugs and Poisons Schedule Committee gave preliminary approval to allow over-the-counter sales in pharmacies of Levonorgestrel, marketed as Postinor-2.

Until now it has been available only with a doctor's prescription. The committee will make a final decision this week.

The issue is not whether Postinor-2 should be available. It has unfortunately been on sale in Australia for well over a year. The issue is to ensure that women know how Postinor-2 works and have access to medical advice to minimise its risks if they do use it.

The application to move Levonorgestrel from being prescription-only to being freely available over the pharmacy counter is not unexpected. Drug companies have an interest in turning a profit and less restricted access to the drug would obviously assist them to make more money.

But the interests of pharmaceutical companies are not always the interests of consumers, especially women. There are a number of public health concerns that would arise if this drug were available without prescription.

The morning-after pill is a hormonal preparation 50 times stronger than the mini pill. Prescriptions are necessary for the mini pill and many other hormonal drugs.

Pressure for Postinor-2 to be available without a script is not because this hormonal preparation is any safer than the others. It's to ensure the drug is taken as soon after sexual intercourse as possible to be effective. This 72-hour deadline has caused some people to throw care and caution aside.

When Postinor-2 was initially approved for sale, a spokesperson for Schering said it was only to be used as an emergency contraceptive and one of the reasons it was available on prescription only was so that doctors could regulate how patients used it. The requirement for a prescription ensures a doctor can consider the woman's medical history and carry out a medical examination before making a judgment as to whether Levonorgestrel is a suitable drug for her.

The drug's own product information lists a number of contraindications and recommends that the risk-benefit ratio (of using Postinor-2) should be assessed by the practitioner in discussion with the patient. This involves doctors undertaking a medical examination for each patient.

The manufacturer also states the drug should not be given to pregnant women. The doctor can check if the woman is already pregnant, or whether the woman suffers from a range of conditions such as unexplained vaginal bleeding or hypersensitivity to any of the ingredients of the drug.