Emergency Contraception (EC): A Safe and Effective Way to Prevent Unplanned Pregnancy

It is estimated that over three million American women have unplanned pregnancies each year, and over half of these end in abortion. Emergency contraception (EC), sometimes called the "morning-after pill," is an effective method of preventing unwanted pregnancy.1

EC is Safe and Effective to Use
EC prevents pregnancy via a course of hormonal contraceptive pills taken in one- or two-dose regimens. EC is most effective if the first dose is taken within 24 hours after unprotected sex; however, it can be effective up to 5 days after intercourse. If the regimen is started within 24 hours, EC can be 95% effective.

EC is well tolerated by most women, including those who have had trouble using oral contraceptives regularly. Reported side effects are generally mild, including headache, nausea and stomach discomfort, and vary with the brand used.

Because EC can be used at all stages of a woman's menstrual cycle, its mode of action varies. After intercourse, EC may prevent pregnancy by preventing ovulation, blocking fertilization or possibly preventing implantation of a fertilized egg.

 

EC comes in two formulations:

  • Combined Emergency Contraceptive Pills – ordinary oral contraceptive pills containing estrogen and progestin hormones

     

  • Progestin-only Emergency Contraceptive Pills or "minipills" – regular oral contraceptive pills, taken in higher doses and containing progestin only. These have been used as EC for 30 years.

Today there is also a pre-packaged, specially-designated EC kit on the market, Plan B.

EC Is Not Abortion
According to both medical science and legal convention, pregnancy begins only after implantation of a fertilized egg in the uterus. EC therefore acts to prevent a pregnancy. Studies show that EC has no effect on established pregnancies.

 

EC is Not RU-486 or medical abortion. Unlike RU-486 (mifepristone), EC is not an abortifacient. EC prevent pregnancy after sexual intercourse, while RU-486 ends an unwanted pregnancy at an early stage.

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.

EC is Supported by the FDA and Medical Associations
The Food and Drug Administration (FDA) has deemed the use of EC safe and effective in the prevention of pregnancy. The Center for Reproductive Rights petitioned the FDA in 1994 on behalf of medical associations to improve access to EC. In response to the petition and other advocacy efforts, in 1997, the FDA announced that six brands of oral contraceptive pills were safe and effective for use as EC. This announcement put the FDA's explicit "stamp of approval" on agency reviewed EC regimens. Since then, in 1999 the FDA also approved Plan B, oral contraceptive pills packaged, sold, and marketed specifically for use as EC.

Increasing Access to EC

Access to EC will improve nationwide if the FDA approves a change of status and makes EC available over-the-counter.
On January 21, 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. On February 14, 2001, the Center had petitioned the FDA, on behalf of more than 70 medical, public health, and other organizations, to change the status of EC from prescription to over-the-counter, based on the fact that EC is safe and effective for use without a prescription. In 2003 and 2004, the company that manufactures Plan B also petitioned the FDA for over-the-counter status for EC. Both the American Medical Association and the American College of Obstetricians and Gynecologists approve of a change to over-the-counter status, recognizing that over-the-counter availability may be the only way for some women to obtain EC in time to prevent a pregnancy. EC is now available either over-the-counter or directly from a pharmacist in many countries, including Canada, France, Portugal, Great Britain, and Finland, and increasing availability is part of a world-wide trend .

Partnerships Between Healthcare Providers
Some states authorize certain pharmacists to prescribe medications pursuant to collaborative agreements with physicians or other healthcare professionals, clinics or HMOs. Pharmacists in these states may be able to develop collaborative agreements that will allow them to provide EC to particular patients without an individual prescription. For example, in the state of Washington, women are able to obtain EC from a pharmacist, avoiding a potentially costly and time-consuming visit to a physician's office or hospital. From 1998 until June 2001 Washington pharmacists prescribed and filled nearly 35,600 prescriptions for EC. The project prevented an estimated 2000 pregnancies, of which about half would have ended in abortion. Through legislative and regulatory efforts, other states, including Alaska, California, Hawaii, Maine, Massachusetts, New Hampshire, New Mexico and Vermont, are establishing similar programs to improve access to EC.

Obstacles to Women's Access to EC
Despite the recognized value of EC, EC is not always made available to women.

Refusal clauses (or so-called "conscience clauses") are provisions in state and federal legislation that permit doctors, other medical personnel, and sometimes pharmacists, to refuse to perform any procedure or dispense medication that conflicts with the provider's religious or moral beliefs. Advocates are exploring ways to reduce the scope of refusal clauses in order to protect access to EC and other reproductive health services, and to ensure that such provisions are not added to new laws.

Additionally, Catholic healthcare systems and other hospital networks also try to avoid providing EC in their hospitals, even to sexual assault survivors who seek treatment in their emergency rooms. As Catholic healthcare providers increasingly merge with their secular counterparts, the restrictions on access to the fullest range of reproductive health services become more and more troubling. Reproductive rights advocates in the states are working to pass legislation to ensure that all hospital emergency rooms that treat women after a sexual assault inform women about EC as part of this care and provide EC upon request.

A final obstacle to women's access to EC is a lack of awareness about EC. For example, one study found that only 68% of women are aware that they can prevent pregnancy after intercourse, and only 6% have ever used EC.2 In order to increase awareness about EC, the U.S. Congress and state legislators are considering bills that would increase public awareness about EC and encourage healthcare providers to inform their patients about EC.

 


1 See e.g. Henshaw, Stanley K. Unintended Pregnancy in the United States, 30 Family Planning Perspectives 24-29, 46, (January/February 1998); see also Rachel K. Jones, Jacqueline E. Darroch and Stanley K. Henshaw, Contraceptive Use Among U.S. Women Having Abortions in 2000-2001, 34 Perspectives on Sexual and Reproductive Health (November/December, 2002) (estimating that EC is responsible for up to 43% of the 11% decline in abortion rates between 1994 & 2000).
2 See Kaiser Family Foundation/SELF magazine, National Survey of Women on their Sexual Health (June 2003); see generally Kate Zernike, Use of Morning-After Pill Rising and It May Go Over the Counter, New York Times, May 19, 2003, at A1.