Below is the Chamber’s response to questions sent by the Malta Independent.

The Malta Chamber of Pharmacists notes the present debate on Emergency Contraception (EC) or Morning After Pill (MAP) on which several statements have been made in public in the various media.

The Chamber bases its views on evidence based, peer reviewed literature together with reference to the Ethical Code of the Pharmacy Profession issued by the Pharmacy Council.

On the one hand, one has to view the matter from a purely scientific angle; indeed studies have shown that it is not scientifically possible to exclude that the MAP does not preclude implantation of a fertilised ovum in the endometrium; at the same time women should be informed that there are explanations on the mode of action of the MAP which can be explained by methods that do not interfere with post fertilisation activities (Trussell et al,

Levonorgestrel (LNG) is already available in Malta in oral contraceptive preparations (OCP), but at much lower doses (than as in the preparation for EC). It is also to be noted that LNG is replaced by safer OCP combinations in preparations containing for example, drospirenone and ethinyl oestradiol.

Ulipristal is also available in Malta in a 5 mg dose.  It is a relatively new medicinal product belonging to the class of second generation antiprogestins, a selective progesterone receptor modulator with anti-progesterone activity used for its therapeutic indication. Its structural relationship with mifepristone, an abortifacient, causes it to be treated with caution as EC (at a much higher dose) as it cannot be scientifically excluded that it is not also so.

Pharmacists as independent healthcare professionals are guided by the ethical code of the Pharmacy Council which is based on the principle of beneficence and abhors maleficence.  Pharmacists may refuse to dispense prescriptions which would mimic the action of the MAP on the basis of conscientious objection. They may do this without being judgemental and indicating another pharmacy where the client may receive the service.

With reference to the question of supply on the Maltese market, that is a matter for suppliers to decide.  In the final analysis, it is the remit of the Licensing Authority after consulting the appropriate bodies, to legally approve or not a Marketing Authorisation for MAPs.