September 5, 2003

Make the ‘Morning-After Pill’ Available the Morning After

By Alison Regan, Esq.

The makers of Plan B emergency contraception (EC) submitted an application to the U.S. Food and Drug Administration to switch Plan B’s status from prescription to over-the-counter. EC treatments such as Plan B are a concentrated dosage of daily birth control pills that dramatically reduce a woman’s chance of becoming pregnant if taken as soon as possible after unprotected sex and at least within 72 hours. Unfortunately, many women still do not know about this important option, and barriers to access EC still exist.

Time of the essence when it comes to emergency contraceptives. EC is still effective if used within 72 hours (and may even be effective up to five days after unprotected sex), but the probability of pregnancy increases with time. EC (or the “morning-after pill”) prevents pregnancy by inhibiting ovulation, fertilization, or implantation. Once a pregnancy is established, the use of emergency contraception is harmless and ineffective; it will not terminate a pregnancy.

Nor surprisingly, the demand for EC is typically greatest on the weekend, but a couple faced with a broken condom on Friday night whose doctor’s office is closed on the weekend may have to wait until the following Monday - three days later— to obtain a prescription for EC. By contrast, where EC is available over the counter, women use it sooner, increasing its effectiveness and eliminating the worry and added expense and delay of a doctor’s visit.

In California and Washington, EC is available “at the counter” or at participating pharmacies without a doctor’s prescription, which greatly increases a woman’s ability to obtain EC when she needs it. Alaska has adopted similar programs and soon New Mexico will make EC available at the counter in pharmacies. The results from these programs only strengthen the argument for nationwide over-the-counter status of EC. The experience of pharmacists shows that women who use emergency contraception are highly motivated to prevent pregnancy, which undercuts the argument that the more expensive and less effective EC will replace more routinely used contraception.

Widespread use of EC could prevent 1.7 million unwanted pregnancies a year in the United States, thus greatly reducing the need for abortion. The Alan Guttmacher Institute’s recent study showed that the use of emergency contraception may have averted as many as 51,000 abortions in 2000. It is safe, effective, simple to use, and not associated with any serious or harmful side effects, thus meeting the FDA’s criteria for over-the-counter drug status. The American Medical Association (AMA) and the American College of Obstetricians and Gynecologists (ACOG) recognize the importance of expanding access to EC and have endorsed the proposal to make EC available over-the-counter.

In order to maximize its effectiveness, EC must be accessible 24 hours a day, 7 days a week without having to wait for a doctor or a pharmacist’s assistance. Making EC available over-the-counter will give more women a last chance to avoid pregnancy. It’s no substitute for ordinary contraception, but contraception -and people- aren’t foolproof. We should give couples every opportunity to avoid unwanted pregnancies. The FDA should approve Women’s Capital Corporation’s over-the-counter application and make the “morning-after” pill actually available the morning after.

Regan is a Policy Officer at the Pacific Institute for Women’s Health in Los Angeles.

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