The use of emergency contraception is very low in the United States (only one out of three women even know about it) compared to other countries. So low in fact, that a bill has just been introduced in Congress to establish a public education program to inform women and their health care providers about the its use, safety and availability. Similar bills were introduced in 2002, 2005 and 2007, but they never made it out of legislative hearings.
Why the ignorance about emergency contraception? And the resistance of law-makers to dispel that ignorance? There are a couple of factors at work here. One is that the FDA has been slow to approve emergency contraception even when it has been available and legal in some countries for several years. The FDA was also resistant to allowing emergency contraception to be sold over the counter. I’m not sure why the FDA drags its feet when it comes to emergency contraception, but part of the reason is probably politics.
Why politics? Because law-makers in this country are extremely sensitive about the abortion issue and there is a widespread, but erroneous, belief that emergency contraception causes abortion. This belief stems from the controversy about RU-486, otherwise known as the abortion pill. Basically, what RU-486 does is cause a medical, as opposed to a surgical, abortion. It is quite expensive, not just for the pills themselves, but for the required doctor visits both before and after taking them. Because it induces abortion, the patient has to be checked afterward to make sure that the abortion is complete. If it isn’t, a medical abortion must still be performed.
Emergency contraception, on the other hand, does not induce abortion. Instead, it works to prevent a pregnancy from happening in the first place. Some anti-abortionists will tell you that this is still an abortion, just as they will say that the birth control bill and IUDs cause abortion because they may prevent a fertilized egg from being implanted in the uterus. But the medical profession does not consider a fertilized egg as the same as a pregnancy; pregnancy doesn’t start until implantation.
The form of emergency contraception currently available in the United States is known as Plan B. It is also known as the post-coital or “morning after” pill and is meant to provide contraception after unprotected sex or the failure of other methods of birth control. (One good reason for the use of emergency contraception is in the case of rape, but amazingly enough, not all hospitals will offer it.)
Plan B works like other birth control pills to prevent pregnancy. Plan B acts primarily by stopping the release of an egg from the ovary (ovulation). It may prevent the union of sperm and egg (fertilization). If fertilization does occur, Plan B may prevent a fertilized egg from attaching to the womb (implantation). If a fertilized egg is implanted prior to taking Plan B, Plan B will not work. The pregnancy will continue. (For more answers to questions about Plan B, go to the FDA web site here.)
Plan B is only available from a licensed pharmacist because the woman’s age has to be verified. Women 17 and under require a prescription from their doctor. Women over 17 can get it without one, but they still have to ask the pharmacist for it. Some people are pushing for it to be available off the shelf, so that it can be sold at gas stations and convenience stores like other forms of over-the-counter birth control, (meaning mainlycondoms). However, one thing that does make Plan B a little more accessible is that men are also allowed to purchase it.
There is also a Plan B ® One-Step now available which only requires one pill instead of two, taken 12 hours apart, as in Plan B. It is also only available through a licensed pharmacist and requires proof of age. Both Plan B and Plan B® One-Step have to be used within 72 hours of the unprotected sexual intercourse and cost anywhere from $35 to $60. However, Planned Parenthood will usually provide Plan B on a sliding scale or even free if you don’t have insurance or have a low income.
There is a new form of emergency contraception that has just been recommended for approval in the U.S. by a FDA advisory panel. To be known as Ella, its advantage is that it is effective up to 120 hours (or five days), two days longer than Plan B. Unlike Plan B, it does not contain progestin but is rather a progesterone blocker, which means that it could have an effect on the few pregnancies that do commence when taking it. This makes it similar to RU-486, although its function is not to induce a medical abortion. Because it is a bit more complicated than Plan B, it will probably be available only by prescription, no matter what the age of the woman.
For more information, see The Emergency Contraception Website.