A Tough Pill to Swallow

Although the age of consent for young women in the Cayman Islands is 16 years of age, minors can have access to oral contraceptive pills at any age with parental permission, and access to emergency contraception at the discretion of the pharmacist on duty.

“Presently, there are no laws governing the sale of contraceptives in the Cayman Islands,” said a statement made by Minister of Health Mark Scotland.

Minors seeking regular and emergency oral contraceptives seem to be the ones affected most by the gray area caused by this lack of explicit legal guidelines.

Emergency Birth Control
Known as the morning-after pill, emergency contraceptive pills prevent pregnancy if taken within a specified time period after sexual intercourse.

The morning-after pill is not to be confused with a medical abortion-inducing pill since it prevents, rather than terminates, a pregnancy.

In the Cayman Islands, depending on the pharmacy and the pharmacist on duty, the distribution procedures for emergency contraception varies significantly.

In most pharmacies around the island, minors are able to buy the morning-after pill without parental permission and without a prescription. But, while some pharmacists follow age limits of 18 or 16, others claim to base their distribution on professional discretion.

“The emergency contraceptive pill, known as the morning-after pill or Plan-B, is sold at the judgment of the pharmacist on duty at any given location,” confirmed Mr. Scotland.

Although the morning-after pill is distributed by pharmacists, most countries around the world do not treat it as a prescription-only drug. While this is standard practice around the world for adults, minors seeking emergency contraception are treated differently in many countries.

In the United States, for example, emergency contraception pills are sold to minors only if it has been prescribed to them.

This may be to ensure proper usage of the pharmaceutical: The morning-after pill is not suitable for everyone, nor is it recommended for repeated use because it is not suited for long-term pregnancy prevention.

Aside from gynaecologists at the public hospital who say they treat all contraception methods except condoms as prescription-only, no such regulations are in place formally in the Cayman Islands.

Oral Birth Control
Daily oral contraceptive pills are one of the most common forms of birth control utilised by women around the world.

Due to the fact that some women may not be eligible for this form of contraception for health reasons, oral birth control pills are usually prescription-only pharmaceuticals.

“There are medical reasons some women should not be on a birth control pill,” said Dr. Barry Richter. “Also, women need to be counselled how to use it properly and given the opportunity for sexually-transmitted disease screening.”

Although there are no legal guidelines that explicitly state age restrictions, the general consensus among local gynaecologists is that minors are able to be placed on a birth control regimen if their parents give their consent.

“From what I understand, most doctors like to have the parents around until 18,” said Deputy Director of Health Regulatory Services and Registrar of Health Practice Commission Angella Glidden.

Some doctors, however, will allow 17 year old girls to access birth control without parental permission because they are legally over the age of consent.

In addition, some pharmacists will sell “emergency” packs of birth control without a prescription, provided the customer is able to prove that they had previously been on birth control by bringing in an empty box, for example.

Outdated Laws
The discrepancies within the medical community regarding the prescription and distribution of contraceptives arises due to the lack of legislation: The Pharmacy Law of 1991, which should have established legal guidelines for the distribution of such pharmaceuticals, was passed but never put into effect.

While policies within the medical community are certainly aimed to reflect the best interests of the patient, Dr. Glidden said that the lack of effective legislation has to be addressed.

“It is much more appropriate to have a law in place,” she said, “especially when you have new [drugs] coming out.”

In order to bring consistency and regulation to this area, the Pharmacy Council and the Cayman Islands Pharmacy Association have been working towards a new Pharmacy Law.

According to Mr. Scotland, representatives of the Ministry of Health met with the Pharmacy Council in November of 2009, and the council submitted a report recommending updates to the law in April of this year.

“As a top priority, the report is now under review by the Ministry,” said Mr. Scotland. “The Ministry recognizes the need for an updated Pharmacy Law to ensure that patients are provided with the best standards of care in the 21st century.”

There is no guarantee, however, of a date by which the law will be updated.

“I optimistically look to the end of this year, but you know how legislation is,” said Dr. Glidden, “we just do our best.”

“Presently, there are no laws governing the sale of contraceptives in the Cayman Islands,” Minister of Health Mark Scotland

The Morning after pill

* Emergency Contraception is often referred to as “The Morning After Pill,” but it actually is a dosage of a few pills combined.

* Emergency contraception contains high doses of certain types of the birth control pill, made up of oestrogen and progestin or progestin only.

* It works through high doses of the synthetic hormones of oestrogen and progestin, or progestin only, which help regulate ovulation and fertility similar to the way the natural hormones works.

* The first dose of pills is taken as soon as possible, followed by another dose 12 hours later.

* The manufacturers of both Preven and Plan B encourage you to take the emergency contraception within 24 hours for maximum effectiveness.

* The possibility of pregnancy  is decreased by 75% -89% depending on the type of medication taken. This method is most effective the earlier it is taken.

* Emergency contraception is not as effective as other uses of contraception and should not be used as replacement of other methods.

* Side effects are  similar to those experienced by users of oral or other hormonal types of contraception.

* Emergency contraception may affect your next menstrual cycle by making it earlier or later, or causing blood flow to be different than normal.