Inclusion of the so-called morning-after pill on the list of required medicines in Mexico’s public health clinics has provoked threats of excommunication from the Catholic hierarchy. Users and health professionals applaud the move.
MEXICO CITY (WOMENSENEWS)–Gabriela Flores has used emergency contraception twice: once with fear and once without.
The difference? The first time, she had to guess what to do by remembering a magazine article she had read. The second time, she had a brochure and a counseling hotline.
"I felt normal; my period arrived," the 24-year-old said of her second time, comparing it to four years earlier, when her boyfriend’s condom had broken and she’d downed four birth-control pills that made her nauseated and delayed menstruation.
That second time, Flores didn’t have to rely on a memory. Instead of fashioning her own emergency contraception by taking extra birth-control pills and hoping for the best, she obtained a bona fide emergency contraception pill. A friend passed Flores a brochure explaining exactly how to use it and how she would feel, with a phone number to call if she had questions. "I was much calmer," Flores said.
As the United States falters about the distribution of the morning-after pill over the counter, Mexico’s Ministry of Health in this overwhelmingly Catholic country has quietly made it widely available by approving it for sale and then requiring its use in public health clinics.
Since a health department ruling 20 months ago, the pill–marketed under the trade names Vika, Postinor-2, Ovral, Eugynon, Nordiol and Neogynon and widely known here as the morning-after pill–has been sold, as many medications are, over the counter in pharmacies. Before that, women had to rely on word-of-mouth information as Flores did and guess at how many extra birth-control pills would prevent a pregnancy after unprotected sex.
In July, an additional step of requiring clinics to stock the emergency contraception pill makes it available to users of public health services and family planning clinics, a group usually too poor to afford private health care and pharmacies.
Widening Access
The new guidelines allow all women of reproductive age, including adolescents, to receive the emergency-contraception pill. They were part of a 60-page document published in the government’s official gazette revising family-planning measures. The move actually regulates use and makes it safer, says Mexico Health Minister Julio Frenk, by giving women access to it from professionals who can tell them how to administer it–in contrast to Flores’ experience the first time she used it.
The move caused an uproar in the rest of the government, leading to accusations of schizophrenia against President Vicente Fox’s conservative administration and eliciting warnings of excommunication for emergency-contraception users from the country’s highest clergy.
Anti-abortion activists and clerics quickly filed a legal challenge with the Mexican Supreme Court over the issue, and the case is under judicial review.
Under pressure from anti-choice groups and its own National Action Party, the government has hinted it is considering further analysis. Contraception is available over the counter at Mexican pharmacies.
Frenk Calls Debate Over
Health Minister Frenk, however, calls the debate closed and reiterates his determination to make the pills available in health clinics nationwide. He also noted that the decision merely gives all of Mexico’s population access to what is already available to those who can afford pharmacies and private doctors.
The country’s top Catholic official, Cardinal Norberto Rivera, has been quoted by Notimex, the official news agency, as saying that dispensing the pill is like putting a gun in people’s hands and giving them the means to kill.
Countering that charge, Frenk says that emergency contraception is not an abortion pill such as RU-486 and that it actually reduces the number of abortions. "The scientific evidence is overwhelming that it does not interfere with the implantation of the fertilized egg in the uterus," Frenk told reporters in July. He also said the measure had undergone a three-year review with input from 100 health and civic organizations.
Frenk, who has a forward-thinking reputation internationally, pointed out that decreasing the need for abortion will improve rather than compromise women’s health, since women will be able to avoid unsafe procedures. Abortion is only legal in cases of rape in Mexico.
Thus the only figures on the number of abortions annually are estimates, according to GIRE (Grupo de Informacion en Reproduccion Elegida), a Mexico City-based nongovernmental organization that lobbies for the right to choose. GIRE cites a 1990 study by the New York-based Alan Guttmacher Institute saying 533,000 are carried out annually in Mexico, while the Mexican government’s National Population Council released a figure of 102,000 in 1997.
The federal National Institute for Women (Inmujeres) has called for more study of secondary health effects of the emergency-contraception pill. Patricia Espinosa, director of the Mexico City-based institute, said she was concerned that it be used responsibly, that is, in true emergencies and not as a routine method of contraception.
Some Local Applause
Reproductive-rights groups have applauded the decisions.
"Since hormonal contraceptives were already included in the (list of basic medicines), the inclusion of this product represents an advantage," GIRE wrote in an official statement. "It’s important to emphasize that emergency contraception is especially useful in cases of rape."
Emergency contraception can cut the risk of pregnancy if taken within three days of unprotected sex by preventing ovulation or fertilization of an egg. Some research indicates the method may also prevent a fertilized egg from implanting in the uterus, which is why those opposed to it consider it abortion.
Abortion is legal in cases of rape, but conservative authorities often balk at providing it. Although Mexico’s 19,000 public clinics have three months to comply with the order to stock and offer emergency contraception, patients at clinics in outlying rural areas could face similar opposition about the pill.
All the publicity about the morning-after pill is increasing awareness among teens and other women, says Dr. Guillermina Mejia, who runs The Adolescent Clinic, a privately-funded health clinic for teens in Mexico City. In conjunction with New York City-based Population Council, Mejia has conducted two surveys of teens between 13 and 19 and found that awareness and use of this option is increasing steadily.
Theresa Braine is a freelance journalist based in Mexico City.
For more information:
Grupo de Informacion en Reproduccion Elegida (GIRE)
[in Spanish]:
http://www.gire.org.mx/
Instituto Nacional de las Mujeres (Inmujeres)
[In Spanish]:
http://www.inmujeres.gob.mx/pprincipal/index.html
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