New Options for Your Body
Part II: The
Morning-After Pill
Dateline: January 15, 2000
by Tamar
Love
Popular culture may have dubbed it
the "morning-after pill," but your doctor would rather you use the
medically correct name: emergency contraception (EC). By any name
it's the same idea—emergency contraception is a high dosage of birth
control pills recommended for use after sexual intercourse
when unwanted pregnancy may have occurred.
In February,
1997, the Food
and Drug Administration (FDA) declared EC to be safe and
effective for use in the United States. As might be expected, pro-lifers were incensed,
insisting that EC is only another form of abortion, and pro-choice proponents and Planned
Parenthood spokespeople were elated at the prospect of women
having easier access to a safe form of post-coital pregnancy
prevention. However, even today many women aren't aware that this
pregnancy prevention option exists. For more information, read
on.
How Does
it Work?
Emergency
contraceptives are not the same as RU-486,
a form of non-surgical pregnancy termination recently approved for
use in the US. EC is actually a series of high-dosage hormone pills,
estrogen and progesterone, given in two doses twelve hours apart, as
soon as possible after the unprotected intercourse
occurred—preferably within 24 hours and no later than 72 hours.
Currently, several series of pills are on the market, including
Previn and Plan B, both of which have been approved for use in the
US in the last two years.
There is some
controversy over exactly how EC actually works. Pro-life propaganda
claims that EC has three possible effects: inhibiting ovulation,
altering a woman's normal menstrual cycle, or irritating the lining
of the uterus so that if the first and second actions fail, and the
woman does become pregnant, the "tiny baby" will die before it can
actually attach to the lining of the uterus. In other words, if the
third action occurs, EC would be a form of chemical
abortion.
Planned
Parenthood has a
far different take on the situation. They state outright that EC
only works by preventing ovulation, and insist that there is no
evidence that EC prevents the implantation of a fertilized egg, as
many pro-lifers claim. To quote, "originally that was thought to be
the way it worked ... but researchers who look specifically at the
way these drugs act don't think that's the way it works now. In
fact, studies in rats say that the dose of hormones needed, per
kilogram of body weight, to prevent implantation is far greater than
the amount present in EC, which is just four ordinary birth control
pills." Planned Parenthood also states that EC does nothing to
affect a pregnancy that's already established.
According to the
AMA, studies
have shown that EC works by inhibiting ovulation. Studies have also
suggested that EC might prevent implantation by altering the
endometrium; however, the evidence is mixed and test results have
not been definitive. EC may also prevent fertilization or transport
of sperm or ova, but no concrete data exists regarding these
possible mechanisms. The AMA also states that EC does not interrupt
an established pregnancy.
A Brief
History
Named for
Canadian Professor A.
Albert Yuzpe, who published the first studies demonstrating the
method's safety and efficacy in 1974, the most common method of
emergency contraception is the Yuzpe Regimen, which uses two doses
of oral contraceptive pills that combine estrogen and certain
progestin hormones. Many common oral contraceptive pills can be used
as EC; although their manufacturers do not usually label the pills
for this use, "off-label" use of approved medications is legal and
commonplace in American medicine.
In February
1997, the FDA declared EC use following the Yuzpe regimen to be safe
and effective. At that time, six suitable pill brands were available
on the US market. Currently, 11 brands of pills can be used as EC;
however, the most common prescriptions are for Previn and Plan B. In
July 1997, a pilot project was launched in Washington to increase
public awareness and distribution of EC. In the first 13 months of
the project, 9,333 EC prescriptions were provided, preventing
between 504 and 2,100 pregnancies, about half of which would have
been likely to end in abortion. At least 13 other states are
considering implementation of such projects.
In January 2000,
France's Deputy Education Minister, Segolene Royal, granted school
nurses the right to dispense EC in both junior and high schools. The
initiative, which received widespread support from students, health
practitioners, and the union of school nurses, was accompanied by a
nationwide sex education campaign that included information on
emergency contraception. However, in July 2000 the Council of State,
France's highest administrative court, overruled Royal's decision,
citing a 1967 law that says hormonal contraception may only be
distributed under prescription by pharmacies. The ruling followed a
strong show of opposition by the Catholic Church and was lauded by
the National Confederation of Catholic Family
Associations.
Currently in the
US, emergency contraception is available everywhere on a doctor's
prescription—theoretically. That is, no states have regulated
against it, despite the efforts of pro-lifers and pharmacists who
refuse to dispense the drug; South Dakota has in effect a law
allowing pharmacists to refuse to fill EC prescriptions, and in 1999
New Jersey tried to pass one. The American Pharmacy Association and
several state pharmacy organizations have endorsed the right of
individual pharmacists to refuse to dispense the pills, but only if
women have some other way to get their prescriptions filled.
Wal-Mart made headlines in May 1999 when they refused to carry
Preven; however, they backed down somewhat under protest, and now
will give four ordinary birth control pills to women with a
prescription for Preven. Under existing law in most states, doctors
can refuse to prescribe EC. There has also been an issue with
Catholic-run hospitals refusing to offer EC to rape
victims.
In December 2000
the American
Medical Association (AMA) appealed to the FDA to allow
over-the-counter sales of EC, a policy the AMA approved without
discussion during a recent convention. The FDA has not ruled on the
decision yet, but more publicity for EC means more public awareness
and, eventually, more support.
What Are
the Advantages and Disadvantages?
Although
scientists and lobbyists are divided on how EC works, they've
managed to agree on some basic advantages and disadvantages to using
EC:
Pros
- Prevents
unwanted pregnancy with 75% effectiveness.
- Does not harm
the developing fetus, should a woman already be pregnant when
taking the regimen.
- Offers a
safe, noninvasive way to prevent pregnancy in emergency
situations.
- Serves
women's health needs and advances reproductive
self-determination.
Cons
- Offers no
protection against sexually transmitted diseases, including
AIDS.
- No long-term
studies to show whether women will be permanently damaged, or risk
such diseases as cancer, from chemicals being given in such high
doses.
- Side effects
include nausea, vomiting, infertility, breast tenderness, blood
clot formation and ectopic pregnancy, which can be life
threatening.
- Because EC is
comprised of high-dose female hormones, it's not a good choice for
women with a history of stroke, blood clots or high blood
pressure.
How Do I
Get It?
As mentioned earlier
in this article, emergency contraception is available with a
doctor's prescription. If your doctor refuses to prescribe EC, you
can contact Planned Parenthood at 1-800-230-PLAN. For a list of
other nearby emergency contraception providers, call the national
Emergency Contraception Hotline, operated by the Reproductive Health
Technologies Project, at 1-888-NOT-2-LATE. Provider information is
also available on the Emergency
Contraception Website. Emergency contraception may also be
available in health clinics, the offices of private physicians, and
in hospital emergency rooms.
What
Kind of Response Has Emergency Contraception Received?
Doctors & Scientists
Many prominent
health and professional organizations have established protocols for
emergency contraception. The American College of Obstetricians and
Gynecologists published a Practice Pattern on EC in 1996, Planned
Parenthood's protocol for emergency contraception includes advance
provision of EC for later use and prescription by phone for
established clients, the International Planned Parenthood
Federation's Medical and Service Delivery Guidelines include
protocols for EC, and the World Health Organization's Essential
Drugs List includes emergency contraception.
Pro-Choice and Feminist
Groups
Planned
Parenthood and other pro-choice organizations feel that making
emergency contraception more widely available is one of the most
important steps we can take to reduce the unacceptably high number
of unintended pregnancies in the United States. They feel dispensing
EC would substantially reduce the need for abortion, which would
have a positive impact on the emotional and physical well-being of
the women and men involved. They also argue that emergency
contraception is cost-effective in that reducing the number of
unintended pregnancies will also reduce medical costs associated
with pregnancy and birth or spontaneous or induced abortion.
Pro-Life Groups
Major
anti-choice organizations such as the American
Life League, Human
Life International and Stop
Planned Parenthood International oppose emergency contraception
and have launched national and international campaigns claiming that
EC is an abortifacient. In addition, they assert that testing has
not been done to confirm the safety of EC, they underreport
statistics on the efficacy of emergency contraception, and they
dismiss evidence of decreased side effects of progestin-only EC.
Remember...
Whichever form
of birth
control you choose, please see your doctor on a regular basis
and practice safe sex. And remember, emergency contraception
should not be used as a regular form of birth control. EC
should only be used when no other birth control method was used or
when the usual method failed. If there is any risk of pregnancy
after unprotected sex, after a condom breaks, or in cases of rape or
sexual assault, then the use of EC may be appropriate.
Read
More
Planned Parenthood Emergency Contraception Fact
Sheet
Consortium
for Emergency Contraception
About.com's
Women's Health Fact Sheet: Emergency Contraception
Emergency
Contraception is a Woman's Right
Emergency
Contraception Training for Healthcare
Professionals
New
Options for Your Body, Part I: RU 486
New
Options for Your Body, Part III: IUDs
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