KSLP's position on the acquisition of a ‘day after’ tablet from 15 years of age as part of pharmaceutical advice

Position of the Mazovia Branch and Radom Catholic Association of Polish Physicians
on a draft regulation by the Ministry of wellness allowing the availability of a ‘day after’ tablet from 15 years of age in pharmacies as part of pharmaceutical advice

Warsaw April 10, 2024

The Catholic Association of Polish Physicians opposes the sharing of tablets “day after” to teenagers after 15 years of age as part of pharmaceutical advice. specified actions will impair the procreative wellness of children and young women, their psychophysical and social development, will deprive parents of the right to rise their children.1

1. Published on April 3, 2024, a draft regulation to start in force on May 1, 2024, as "Pharmaceutical pilot care programme for patient reproductive health", examines the responsibilities of a pharmacist for procreative wellness of a teenager bringing him only to a short interview in the back of the pharmacy and to issue prescriptions for hormonal agents, without the anticipation of diagnosing the wellness position of a teenage child, recognizing the presence of co-existing diseases or pregnancy, and deficiency of access to medical records. The pharmacist will receive PLN 50 for specified advice, while the midwife's advice on the prevention of maternal wellness disorders in the perinatal period is valued at just over PLN 30. The Ministry of wellness allocates more resources to advance "safe", unordered sexual intercourse of children than to wellness of future generations of Poles.
2. From the summary of product characteristics of ulipristal 30 mg acetate contained in EllaOne (day after) we know that “shall not be utilized in children before puberty in the event of abrupt contraception.’[1] The usage of hormonal preparations that work powerfully on the body is not indifferent to the wellness of a woman, especially teenagers during puberty of reproductive and hormonal systems, which lasts at least until the age of 18. Care for fertility must not be limited to preventing pregnancy.
3. Emphasis by the Minister of wellness that ‘pharmaceutical service is not a wellness service’ means that people from 15 years of age may receive a prescription for a hormonal tablet ‘day after’ without the cognition of a legal guardian, which leads adults and young people into mistaken reasoning that a teenager may take any hormonal medicine without parental or medical supervision.
4. We remind you that at the request of the president of the Office for Registration of Medicinal Products, Medical Products and Biocidal Products, the preparation of ulipristal at a dose of 5 mg, by the decision of the Chief Pharmaceutical Inspector of 13.03.2020 was stopped in Poland after the advice of the hazard Assessment Committee in the Pharmacovigilance Framework due to the occurrence of a case of severe liver injury resulting in liver transplantation.[2]
5. Multiple assurances by the Minister of wellness that ‘accessible emergency contraception, alleged ‘day after’ tablet, is safe’ erstwhile a period does not alter the fact that the hormonal preparation given in a high, sometimes repeated dose impairs the appropriate functioning of the body of the kid and young woman. The Ministry of wellness has made available a list of dozens of adverse reactions following the usage of EllaOne, reported to the European Database for Unwanted Action Reports from 1 January 2015 to 30 April 2020.[3] Vaginal haemorrhage, abdominal and headaches, nausea, vomiting, dizziness and fatigue, and chills, fever, irritability, insomnia, visual disturbances, menstrual cycle disturbances, somnolence and concentration disturbances have been reported commonly.[4]
6. It has been proven that easier access to "day after" measures leads to an increase in the frequency of sexual relations, possibly expanding the incidence of unplanned pregnancies.[5]’[6] Although the day after pill can prevent unintended pregnancy in a peculiar female or destruct an embryo, the usage of this medicine does not affect abortion rates at population level.[7] Dissemination of tablets is so not the right way to reduce abortion rates.
7. Easy access to “day after” pills will undoubtedly contribute to reducing the age of sexual initiation, expanding the frequency of unordered sexual relationships, sexually transmitted infections, which may increase the incidence of fertility disorders, premature births, genital cancers and chronic abdominal pain in the future.
8. The Minister of wellness persistently, in spite of the position of the president of the Republic of Poland to supply teens with ‘day after’ pills, ignores the mechanisms of EllaOne's actions, which consist in inhibiting or delaying ovulation, affecting the thickness of the endometrium, affecting its maturation and structure, which may prevent the embryo from nesting in the membrane of the uterus leading to its death.[8] EllaOne does not prevent ovulation if it is taken on the most fertile days of the cycle.[9] Ulipristal relieves peristaltic contractions of the ovum muscles, thereby expanding the incidence of ectopic pregnancies that endanger the life of women.

The Catholic Association of Polish Physicians believes that:

1. It is unethical to make the acquisition of ‘day after’ pills available to teenagers, endangers their future procreative wellness and deprives parents of work for the wellness and life of their underage children.
2. The proposed pharmaceutical service burdenes the conscience of pharmacists with the decision to issue a prescription for a ‘day after’ tablet, exposes them to conflicts with their parents, destroys household relations, teaches the young generation of this approach to conceived life.
3. The mass release of “after” tablets to teenagers will foster egoistic attitudes, especially among boys, moral depravity of children and young people, will teach deficiency of work for themselves and others and for the conceived human life.

We powerfully request the immediate withdrawal of the Ministry of wellness from the proposed project, which we consider to be destructive on the basis of current medical cognition for the physical and intellectual maturation of young people and very harmful to current and future generations.

Prof. dr hab. n. med. Bogdan Chazan, specialist in gynecology and obstetrics, Vice president of the Catholic Association of Polish Physicians (www.kslp.pl)
Dr Grażyna Rybak, a specialist in pediatrics, president of the Mazovia branch of the Catholic Association of Polish Physicians. (www.kslpmazowisz.pl)
Dr Andrzej Niemirski, doctor of interior diseases, specialist in household medicine, president of Radom Catholic Association of Polish Physicians

They shall be informed of:
Minister of wellness Isabella Lestin, president of the Republic of Poland Andrzej Duda,
President of the Chief Medical Council Łukasz Jankowski, Marshal of the Polish Sejm Simon Hołownia, media

[1] chrome-extension://efaidnbmnnnibpcajpcclefindmkaj/https://ec.europa.eu/health/documents/community-register/2016/20160502134849/anx_134849_en.pdf
[2] Drug index applicable medicine – https://index.mp.pl/drugs/desc.php?id=7936
[3] https://mgr.farm/ up-to-dates/blood-from-vaginal-of-the-common-action-unadequate-pigulki-day-after/
[4] chrome-extension://efaidnbmnnnibpcajpcclefindmkaj/https://ec.europa.eu/health/documents/community-register/2016/20160502134849/anx_134849_en.pdf
[5] Atkins D. Association between created availability of Emergency conceptual pills and the sexual and conceptual behaviors of women. diary of Public wellness Policy. 2014, Aug 35 (3), 292 – 310 doi: 10,1057/jphp.2014.3
[6] Polis CB, Grimes DA, Schaffer K, Blanchard K, Glasier A, Harper CC,. Advance provision of Emergency concept for precision prevention (full review). Cochrane Database Syst Rev. 2010, Issue 3.
[7] Michie L, Cameron ST. Emergency concept and impact on abortion rates. Best Pract Res Clin Obstet Gynaecol. 2020 Feb;63:111–119. doi: 10.1016/j.bpobgyn.2019.06.008. Epub 2019 Jul 3. PMID: 31362908.
[8] Miech RP. Immunopharmacology of ulipristal as an emergency conceptual. Int J Womens Health. 2011;3:391–7. doi: 10.2147/IJWH.S25887. Epub 2011 Nov 22. PMID: 22140327; PMCID: PMC3225469.
[9] Mozzanega B, Nardelli GB. UPA and LNG in emergency concept: the information by EMA and the technological evidences indicative a prevalent anti-implantation effect. Eur J Contracept Reprod wellness Care. 2019 Feb;24(1):4–10. doi: 10.1080/13625187.2018.1555662. Epub 2019 Jan 18. PMID: 30656992.