Everything you ever wanted to know about Emergency Contraception
Below is a ton of information compiled by Amanda from Planned Parenthood about Emergency Contraception.
What is the difference between the “morning after pill” and the “abortion pill?”
Emergency Contraception (EC), also known as the “morning after pill”, is a high-dose hormonal birth control method (a strong form of ordinary birth control pills). Many confuse the “morning after pill” with medical abortion, also known as the “abortion pill,” mifepristone, or RU-486. Both come in pill form, but that is where the similarities end.
EC is very effective at preventing pregnancy if taken within 72 hours of unprotected sex, but can be taken up to five days after unprotected sex and can reduce unwanted pregnancy by 89% (http://www.agi-usa.org). Because EC is a concentrated dose of ordinary birth control pills, it works in the same way. Usually EC inhibits ovulation, but depending on a where a woman is in her cycle it may also work to prevent fertilization or prevent implantation by altering the lining of the uterus. EC will not terminate an established pregnancy under any circumstances; if a woman is already pregnant (a fertilized egg has been implanted in the uterus) and takes EC, she will remain pregnant.
“Some extreme anti-choice groups oppose EC by equating it with abortion, which they also oppose. These groups are out of step with the mainstream medical community, and their views find almost no support in laws and policies at the state and federal level. The attacks against EC are unwarranted and must therefore be seen as part of an agenda to ban all contraceptives.” — Center for Reproductive Rights
Mifepristone, “the abortion pill,” does just that: it causes an abortion. Mifepristone will abort a pregnancy that is not more than 49 days gestation. This method involves no surgery and offers women the ability to terminate their pregnancy in the privacy of their homes and with the comfort of their own physician.
Anti-choice advocates have worked to exploit confusion between EC and Mifepristone and have succeeded in large degree. “The biggest challenge remaining with respect to emergency contraception is that women don’t know about it, and they don’t know how or where to get it,\rdblquote says Kirsten Moore, director of the Reproductive Health Technologies Project. The Kaiser Family Foundation and Lifetime Television conducted a telephone survey, consisting of 500 women in 2000 and discovered that “only 2% of women aged 18-44 have ever used [EC], and one in four had never heard of the method” (http://www.guttmacher.org/pubs/tgr/04/3/gr040304.html). Many of the women who had heard of EC, believed it was not available in the United States.
How long has EC been available to women in the United States?
By the 1960’s physicians understood that you could prevent pregnancy, after unprotected sex, by taking more birth control pills. And it wasn’t until the 1970’s that it was understood that inserting an IUD, after unprotected sex, could prevent unwanted pregnancy. This information was usually only shared with women who had been victims of sexual assault until the 1980’s when many European countries began to approve this use of birth control pills for any woman who did not want to become pregnant after unprotected sex. It was not until 1997 that the FDA finally caught up with the times and approved specific regimens of birth control pills for use after unprotected sex. These regimines were still not labeled as emergency contraception and it was up to the physician to continue to prescribe them “off-label.” EC is sold under the brand names Preven and Plan B. In 1998, the FDA approved the Preven for use as an emergency contraception; Plan B was approved in 1999.
What’s the delay with the FDA?
Although physicians have been prescribing ordinary birth control pills as EC on the low for decades, it took the FDA until 1994 to step up to the plate. The Center for Reproductive Rights petitioned the FDA and in response they announced (1997) that several brands of common birth control pills could be used as EC. In 1998 Preven, and then in 1999 Plan B, were approved by the FDA, with a prescription, for specific use as EC.
This was a huge gain for women across the country. Unfortunately, it became apparent that to be most effective women would have to access this medicine in a very timely manner and with little cost. By making EC available by prescription-only women would have to make an appointment with a physician, travel to the doctor’s office, request an EC prescription, travel to a pharmacy and fill the prescription all within 72 hours of unprotected sex. Now we can all do the math, that requires a lot of steps in a very limited amount of time; especially if you have no car, no insurance, or the restrictions of a job. The makers of Plan B, recognizing these complications, petitioned the FDA, in 2003, to make EC available over-the-counter. With the backing of several diverse organizations (including The American Medical Association, American College of Obstetricians and Gynecologists, National Black Women’s Health Project, Planned Parenthood) and the FDA’s own experts saying that EC was safe for over the counter use, (in addition EC met all four guidelines for issuing an over-the-counter approval), it was a sure thing, or so we thought (http://www.reproductiverights.org/pdf/EC_petition.pdf).\par
In 2004, the application to make Plan B available over-the-counter was denied by the FDA. In January 2005, the Center for Reproductive Rights filed suit against the Acting Commissioner of the Food and Drug Administration in federal court for failing to approve the emergency contraceptive product Plan B for over-the-counter status (http://www.reproductiverights.org/pdf/crt_012105_fdacomplaint.pdf).
Department of Justice
In September 2004 the United States Department of Justice issued its first ever protocol for victims of sexual assault to be used in hospitals (http://www.ncjrs.org/pdffiles1/ovw/206554.pdf). It is 131 pages and is to act as a comprehensive guide for law enforcement personnel and health care providers who have contact with the victim. Although it is estimated that 25,000 women become pregnant as a result of sexual assault each year, and the protocol mentions that this is a very real concern for women, the document refrains from mentioning EC at all. Of these 25,000 pregnancies, a full 22,000 could be prevented if women were given EC in the hospital. A 2002 national study of emergency rooms found that only 21 percent of sexual assault victims were given EC; this illustrates the importance of a national protocol and yet underscores the serious injustice that was committed by the omission of such valuable information (University of Medicine and Dentistry of New Jersey).\par
Members of Congress, in both chambers, raced to protest this brutal attack against women at their most vulnerable time. They issued informative letters, urging the Department of Justice to amend the protocol by adding information about EC.
What’s up with Washington?
Six states (Washington, California, Alaska, New Mexico, Hawaii, and Maine) allow, either through legislation or regulatory action, pharmacists to dispense EC without a prescription from a physician. By doing this, these states have offered us great insight on how easier availability to EC will improve women’s lives.
Women living in Washington State have been able to access EC at their pharmacies since 1998. Between 1998 and 2002 over 50,000 women have taken advantage of this and Washington State has witnessed a dramatic decrease in abortions. It is estimated that in the first four months of increased access to EC, 103 abortions were prevented. Prior to increasing access, one major chain reported filling an average of one EC prescription a week; now it has increased to 61 a week. Underlining the point that if you make EC accessible to women, they will use it and it will be effective in preventing abortions. These women have also expressed they found that obtaining EC directly from a pharmacist helped alleviate many of the challenges they face by having to obtain a prescription. Forty-two percent said that if EC had not been available through their pharmacist they would have waited to see if they became pregnant; 16% percent reported that they wouldn’t have known what to do (http://guttmacher.org/pubs/journals/3028898.html).\par
When California law began permitting pharmacists to prescribe EC they found huge support for the program and interesting (and telling) results from a few pilot studies. Anti-choice forces and others who are against making EC more accessible to women cite several reasons for their positions, often that it will encourage unprotected sex and also encourage teens to have sex. The pilot studies in California dispel these claims. They found, for instance, that the average age of a woman seeking EC is a little over 21 years old and that 45% of women had experienced a contraceptive failure. The study also underscores the need for EC to be more accessible to women, without the time restrictions of having to see a physician (during their limited office hours) to obtain a prescription. The study points out that 30% of women seeking EC, did so on a Monday. Thus, women were experiencing the need for EC during the weekend when most physicians are not available to see patients. Pharmacist-access to EC allowed women to take control of their reproductive health in an efficient and timely manner (http://www.guttmacher.org/pubs/journals/3416202.html).\par
Last year eight states (Illinois, Kentucky, Maryland, New Hampshire, New Jersey, New York, Texas, and Vermont) attempted to pass similar legislation to allow pharmacists the ability to dispense EC without a prescription.
So, what can you do?
- Talk to your friends about EC. Make sure everyone knows about it and that everyone knows where to get it.
- Obtain EC through your primary care physician or ob/gyn or from Planned Parenthood. Be sure to ask at your next annual exam for a prescription to keep on hand in case you need it.
- http://www.go2ec.org
- http://www.backupyourbirthcontrol.org