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Support Builds for Emergency Contraception
Doctors Asked to Prescribe Morning-After Pill 'Just in Case'
 Listen to Richard Knox's report.
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Once a World War II icon, Rosie the Riveter is now the posterwoman for new campaign on emergency contraception awareness. Poster © Reproductive Health Technologies Project |
March 18, 2002 --
Every year, three million American women get pregnant without meaning to. Half of all unplanned pregnancies end in abortion. Specialists say many of these pregnancies could be avoided with emergency contraception -- the morning-after pill. But very few women use it. As NPR's Richard Knox reports for Morning Edition, a big push is on to change that.
Alaska is one of the frontiers of emergency contraception. Soon, women there will be able to skip a visit to the doctor and get morning-after pills directly from pharmacists.
"We're right on the precipice of success," says Dr. Colleen Murphy, a gynecologist in Anchorage.
"We've got some tremendous, tremendous potential for decreasing the rate of unintended pregnancy."
The Alaska program was modeled after those in Washington state and California, where doctors are allowed to delegate authority to pharmacists to prescribe morning-after pills. Across the country, the need arises every day, says Murphy.
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Getting Access
The American College of Obstetricians and Gynecologists encourages women to develop a plan beforehand with their physicians about what to do if an emergency arises. Some doctors will provide an advance prescription for emergency contraception or will phone in one as needed. Others require an office visit. Other options for women if their doctor isn't comfortable with emergency contraception:
Locate a local provider through Not-2-Late.com, operated by Princeton University.
Provider information is also available at the 24-hour, toll-free Emergency Contraception Hotline, 1-888-NOT-2-LATE.
Some pharmacies in California, Washington state, and soon Alaska, directly provide EC.
For a fee, several commercial Web sites will make an over-the-phone patient evaluation and fax a prescription to a local pharmacy.
Doctors are not required by law to notify a minor's parent when prescribing EC.
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"If a condom breaks, or a diaphragm gets dislodged, or you miss too many birth control pills, you can still use emergency contraception. And likewise for those women who quote, 'get carried away,' and don't use any form of contraception -- you know, emergency contraception certainly can be useful."
Emergency contraception is nothing more than large doses of the hormones in regular birth control pills. It's not the same as RU-486, the abortion pill; the morning-after pill works before pregnancy begins. The first pill must be taken within 72 hours of unprotected sex, and a second pill follows 12 hours later.
Experts say emergency contraception could make a huge difference. "It's our best guess that if emergency contraception were widely available," says James Trussell, a population scientist at Princeton University, "then the incidence of unintended pregnancy could probably be halved, and the consequent need for abortion could probably be reduced by about half as well. But the bottleneck now, the real problem with emergency contraception now, is that women don't know about it."
Surveys show four in five American women aren't aware of it. That's partly because the two companies that make the pills don't have big marketing budgets -- and most health care providers don't bring it up.
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How it Works
Emergency contraception pills contain the hormone progestin or a combination of estrogen and progestin. The pills, usually given in two doses, ultimately work to prevent implantation of a fertilized egg into the uterus.
EC is most effective when taken within three days after having unprotected sex.
Depending on when the pills are taken during the menstrual cycle, EC can block or delay ovulation, interfere with fertilization or prevent implantation.
EC, often called the morning-after pill, is not the same as RU-486 or mifepristone, the so-called abortion pill. Once implantation occurs, EC is useless. Abortion pills, however, work after implantation by killing an embryo, and then expelling it.
Controversy is ongoing over the definition of pregnancy. The ACOG says pregnancy only occurs with the implantation of a fertilized egg. But right-to-life groups argue pregnancy occurs with fertilization.
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One exception is the Codman Square Health Center in Boston. Three years ago staff members began telling patients about what they call back-up contraception. Nurse Cynthia Johnson-Smith says the health center now has a steady stream of women anxious to get it: "We may get anywhere from eight to 12 calls a week from women who are requesting this method. They realize there's a short window to use this for it to be effective. And so for the most part, they are panicky."
In most places, women aren't asking for it. Last week two congresswomen introduced a bill to educate Americans about emergency contraception. But lack of knowledge is not the only obstacle, says Dr. Paul Blumenthal, an expert on contraception at Johns Hopkins Medical School.
"There's often a delay between the time a patient perceives her need and the time she can actually get the medication," Blumenthal explains. One way to reduce this delay, he says, is by allowing women
to keep morning-after pills in their medicine cabinet, just in case. Doctors would simply write a prescription in advance. Forty thousand doctors got letters last week from the American College of Obstetricians and Gynecologists urging them to do just that. ACOG's president also urged members to ask drugstores to stock morning-after pills.
But Blumenthal favors even freer access -- without any prescription. A petition currently before the FDA argues that morning-after pills should be available over the counter. "The science is there. It's safer than aspirin. And why shouldn't it be available over the counter?"
Its safety is being questioned by some anti-abortion groups. But mainly they object because the morning-after pill sometimes works after conception, which is when they believe life begins. In that case, the pills prevent the fertilized egg from attaching to the wall of the uterus.
But others who oppose abortion have so far decided not to take a position on emergency contraception.
In Depth
 Browse for other NPR stories about contraception.
Other Resources
• Read Kaiser Family Foundation research on attitudes about emergency contraception.
• Read frequently answered questions from Not-2-Late.com.
• Read more about efforts to make EC more accessible at the Reproductive Health Technologies Project Web site.
• Read the U.S. Conference of Catholic Bishops' position on emergency contraception.
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