San José, Costa Rica, since 1956

Emergency Contraception Debate Reaches Assembly

DEBATE over the controversial “morning-after pill” has continued in recent weeks, with a Legislative Assembly decision to exclude mention of emergency contraception from a health reform bill drawing criticism from pro-choice and feminist organizations.In Costa Rica, no law specifies whether emergency contraception is prohibited or permitted, according to Rodolfo Delgado, legislator for the Social Christian Unity Party (PUSC). Proponents of the method say it should be considered a right and be part of the nation’s family planning strategies, while its opponents argue its acceptance would open the door to the legalization of abortion.A bill to reform the country’s General Health Law promised to fill the legal void surrounding the issue by defining access to emergency contraception as a right. However, the Social Affairs Committee, charged with discussing the bill, removed the clause three weeks ago before sending the bill to the assembly floor.The deleted clause would have been an important step toward making emergency contraception available in Costa Rica, according to Adriana Maroto, spokeswoman for a coalition of 29 organizations that recently met in San José to promote the method (TT, Oct.7).AT present, the only emergency contraception available in the country is the so-called Yuzpe method, which involves high doses of regular oral contraceptives after unprotected or inadequately protected sexual intercourse. However, regular birth control usually contains estrogen, which can cause nausea and vomiting when taken in high doses.Dedicated emergency contraception, specifically for that purpose, contains only the synthetic progesterone product levonorgestrel, and lacks the side effects associated with the Yuzpe method. It is not yet available here.Health professionals dislike the commonly used term “morning-after pill,” since it conveys an impression that such measures must be used the morning following unprotected intercourse. In reality, the first tablet can be taken any time within 72 hours after the fact, and the second tablet 12 hours later.WITH four opportunities to present motions to change the bill, and the Assembly divided by the issue, the debate surrounding the pill seems far from over. At the heart of the discussion: whether the method simply prevents fertilization of an egg, or if it prevents implantation of a fertilized egg, and hence, could be considered abortive.“Some (committee members) say it is like legalizing abortion; others say it is a right women have,” said Delgado, who chairs the committee and thinks the bill should be left as it is now – without presenting emergency contraception as a right.CARLOS Avendaño – committeee member, presidential candidate representing the National Restoration Party in next year’s election, and an Assembly of God pastor – proposed eliminating part of the bill’s section on emergency contraception.The clause originally read, “All people have the right to receive information about emergency contraception.In cases of unprotected sexual relations or rape, women have the right to access emergency contraception in an agile, opportune and efficient manner.”Avendaño proposed the removal of the second sentence, and the committee approved the motion before sending the bill to the assembly for study on Oct. 18.AVENDAÑO, an adamant abortion opponent, says he has scientific evidence to prove the morning-after pill is abortive.“The mechanism of this pill opens the doors to abortion. Including it in the (Health) Law would be like legalizing it, and there is no way we can allow that,” the legislator said in a statement from his party’s press office. “This practice is a crime against human life and the life of an innocent (baby) who cannot defend himself.We all have a right to life and must ensure this right is guaranteed.”According to the statement, Avendaño and other opponents of emergency contraception consider the pill abortive because when its hormonal substances reach the bloodstream, high doses upset the balance necessary for the conceived embryo to implant itself in the endometrium – the lining of the uterus.In Costa Rica, abortion is illegal. The country’s penal code punishes women who terminate unwanted pregnancies with up to three years of prison.A 2002 survey conducted by the Central American Population Center, affiliated with the University of Costa Rica, revealed that 42% of health professionals agree the method induces abortions.But several national women’s groups and pro-choice organizations dispute that assertion in a jointly published booklet “Emergency Birth Control: General Aspects for Decision- Making,” and use data from the World Health Organization explaining that emergency contraception prevents ovulation, thereby inhibiting sperm from meeting egg – rather than implantation of the embryo – and has no detectable effect on the endometrium.Some emergency contraception proponents argue abortion is not the real problem for opponents. “It’s not a question of being against abortion,” Paola Brenes, communications director for the Association of Women in Health said of opponents of emergency contraception. “They also oppose the use of condoms.”LUIS Rosero, director of the Central American Population Center, said the Catholic Church plays a major role in the opposition.“There is an enormous, permanent political fear of offending the… church,” Rosero said, recalling that the struggle for approval in Chile in 2001 was enormous, but he remains optimistic that a levonorgestrel product will eventually be approved here.Rosero cited statistics showing that some 40% of pregnancies in Costa Rica are unplanned, a figure that is higher among young people, among whom sexual relations are often unanticipated.“There is also that darker zone of violence and rape against women,” he added. Not only is there lack of access to a product, there is scarce information available, Rosero explained. In a poll conducted by the University of Costa Rica (UCR)-affiliated center in 2000, only three percent of women had heard of emergency contraception. By 2004, that number had risen to 20%.DESPITE the legislative debate and disagreement over abortion, it appears the only missing link for dedicated emergency contraception in pharmacies is initiative from a pharmaceutical company.Health Minister Rocío Sáenz said that from the ministry’s perspective, if a medication meets the requirements established to be marketed here, there is no reason not to accept it.“Some people consider that emergency contraception is like giving young people permission to be promiscuous,” she told The Tico Times. “But from the health perspective, (emergency contraception) is recommended by the World Health Organization to be incorporated to the national family planning strategy.”According to the minister, no firm has requested permission to market emergency- contraception methods from the Health Ministry to date. Its availability at the country’s pharmacies is up to anyone who might be interested in commercializing the drug, she said.THE Tico Times contacted several pharmaceutical companies to find out if they have any interest in distributing emergency contraception and received mixed responses.Schering Central America will not bring it into Costa Rica for ideological reasons. “We want to distribute responsible, safe contraception … not (emergency contraception),” said Schering representative Gabriela Zúñiga.Bayer Costa Rica pharmacist Jorge Trejos said the company does not carry birth control products at all, while Carlos Calderón, pharmaceutical manager of Farmacia Fischel, said the pharmacy chain would have no problem selling the product if it obtains the Health Ministry’s registration permission.Emergency contraception is presently available in 13 Latin American countries (Argentina, Brazil, Bolivia, Chile, Cuba, the Dominican Republic, El Salvador, Mexico, Nicaragua, Paraguay, Peru, Uruguay and Venezuela), with 10 products marketed variously around the region specifically for that purpose. All except Argentina require a physician’s prescription to obtain the product.Plan B is the only such levonorgestrel product marketed in the United States, and requires a doctor’s prescription in most states. Proposals to make the product available over the counter nationwide have generated contentious debate there.EL Salvador approved a dedicated emergency contraceptive, Vermagest, in 2002.“We find the same dilemma in any country in which we begin marketing the product,” explained Mónica Rodríguez, director of marketing for Vijosas Laboratorios, the manufacturer of Vermagest, in San Salvador. Despite a few protests, the drug was approved for sale there with a minimum of debate, she said.“We have the backing of the U.S. Food and Drug Administration, the World Health Organization and Planned Parenthood,” Rodríguez insisted, citing renowned agencies and organizations that approve the use of emergency contraceptives and do not consider them methods of abortion.Vijosas conducts seminars for health professionals on the benefits and proper use of emergency contraception in countries where it sells the product. The cost to the patient is about $13, but is always donated in the case of women of scarce means, Rodríguez said.IT appears the debate will continue here.Feminist legislator Gloria Valerín said despite opposition from other legislators, she will present a motion to establish the morning-after pill as a right.“I think this is a discussion and struggle that women at the Assembly must support,” she said, adding: “It is not possible that men exist at the Assembly who want to prohibit it.”

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