1-888-NOT-2-LATE: The Debate Over Emergency Contraceptives

Off Our Backs, Jul/Aug 2004 by Strickler, Karyn

Those who oppose abortion should work to make it less necessary. There is a way to avoid the 1.7 million annual unintended pregnancies nationwide and reduce the number of abortions by as much as half. This method averted 51,000 abortions in 2000 and accounted for a 43 percent decline in abortions between 1994 and 2000, according to studies published in Perspectives on Sexual and Reproductive Health.

The method is available today but not without a prescription. It's safe and effective and is known as emergency contraception. More than 80 medical, public health and women's organizations filed a citizen's petition urging the Food and Drug Administration to switch emergency contraceptives to non-prescription status.

In December of 2003, an FDA scientific advisory panel unanimously agreed that emergency contraception, also know as Plan B, is safe. It also voted overwhelmingly that the drug should be available without a prescription. On May 6, 2004, going against precedent, the FDA gave in to right-wing politics over science. It overruled the advisory panel and blocked over-the-counter availability of emergency contraceptives.

If anti-abortion advocates are serious about reducing the number of abortions, they should help create common ground in women's reproductive health. Currently, access to emergency contraception is severely limited, partly because in most states women can only obtain it with a doctor's prescription. And people are largely unaware of its availability. Education about availability would help increase access to emergency contraception, dramatically reducing the need for abortion. Anti-abortion advocates should mobilize and help.

Emergency contraceptive pills are ordinary birth control pills taken in a higher-than-normal dose. They prevent pregnancy by preventing ovulation, fertilization or implantation, depending on when the drugs are used in the menstrual cycle. Emergency contraceptives do not induce abortion. The Alan Guttmacher Institute says that emergency contraception has no effect once a pregnancy has been established by implantation of a fertilized egg in the womb, so it is not an abortifacient like RU-486 (mifepristone).

Emergency contraception has an effectiveness of 75 percent to 89 percent if used within 72 hours of unprotected intercourse, after contraceptive methods fail or in the case of rape. Some, including Ronnie Lichtman, author of the updated Alan Guttmacher book Pregnancy, Birth and Family Planning believe that emergency contraception can be effective up to 120 hours after intercourse. This five-day window of effectiveness makes the term "morning after pill" misleading and is the reason it is better called a form of emergency contraceptive.

Allowing women access to emergency contraceptives without a prescription would break down some of the barriers women face in obtaining contraceptives. Over-the-counter availability is necessary partly because access to contraception in most states today is abysmal. Thirty-two states in the United States receive a grade of "F" for the extent to which they impede women's access to contraception, according to NARAL Pro-Choice America's state-by-state report card.

Thirty-two thousand women become pregnant each year because of rape or incest. Tragically, only 6 states in the United States mandate that emergency room treatment for women who have been raped must include some services related to emergency contraception (California, Illinois, New York, Ohio, South Carolina and Washington). At a minimum, every state in America should require hospitals to provide information on emergency contraceptives. Better yet, hospitals should be required to provide these medications to women who have been sexually assaulted.

The public overwhelmingly supports the availability of emergency contraceptives and opposes "denial" or "conscience" clauses, which permit pharmacists to refuse to fill prescriptions on moral grounds.

Twenty-seven foreign countries as diverse as Sweden, Albania, Madagascar, Togo, South Africa and Tunisia make emergency contraceptives available without a prescription.

By contrast only three states in the United States-Alaska, California and Washington-allow women to get emergency contraception without a prescription.

In France, officials decreed that minors could obtain emergency contraceptives from a pharmacy, after counseling, at no charge and without requiring authorization from a parent. Widespread availability of emergency contraceptives in France has caused no adverse effects and has spurred interest in all methods of contraception.

Women are entitled to easy access to emergency contraceptives; it's basic health care. Emergency contraceptives expand reproductive health options. Since emergency contraceptives are a higher-than-normal dose of birth control, they are only meant for short-term use to prevent imminent pregancy. Still, it is simply not necessary to require a prescription. Family Health International says emergency contraception "is nontoxic, there is no danger from overdose or potential addiction and the dose is the same for all women." The National Women's Health Network is one group that has taken a position in favor of making it available without a prescription. It and the National Black Women's Health Project call emergency contraception a safe and effective way to prevent pregnancy.