The U.S. Food and Drug Administration announced February 24 that certain combined oral contraceptives are safe and effective as an emergency contraceptive commonly called the "morning-after pill." The FDA took the unusual step of inviting drug companies to apply for permission to market oral contraceptives for this use. Subsequently, the American College of Obstetrics and Gynecology (ACOG) and reproductive health organizations announced campaigns to educate women and their doctors about emergency contraception and encourage its wider use.
Administration of larger-than-normal doses of oral contraceptive pills within 72 hours of unprotected intercourse reduces the chance of pregnancy by about 75%. Oral contraceptives have been used as post-coital emergency contraceptives in Europe for more than two decades. Contraceptive pills are sold and specially packaged for this purpose in countries including Germany, the Netherlands, Great Britain, Canada, Australia, New Zealand, Finland, Sweden, and Switzerland, as well as in eastern Europe. Lack of knowledge (on the part of women) and fear of litigation and harassment by abortion opponents (on the part of drug companies) have prevented their widespread use for this purpose in the United States. In this country, the off-label use of oral contraceptives for emergency contraception has mostly been limited to family planning clinics and small numbers of college health centers and emergency rooms.
Approximately 60% of all pregnancies in the U.S. are unplanned and unintended. Many of these end in abortion, and it is estimated that nearly 45% of all live births result from unintended pregnancy. According to the Association of Reproductive Health Professionals (ARHP), one reason unintended pregnancy rates are higher in the U.S. than in other developed countries is that emergency contraception is seldom used here. ACOG estimates that widespread knowledge of and access to emergency contraception could prevent 1.7 million unintended pregnancies per year in the U.S. and reduce the number of abortions by 800,000 annually. The ARHP suggests that couples using other contraceptive methods should keep an emergency supply of oral contraceptives in their medicine cabinets in case a daily pill is skipped or a condom or diaphragm breaks, slips, or is "forgotten."
There are several mechanisms by which high-dose oral contraceptives prevent pregnancy, including inhibiting ovulation and interfering with the implantation of a fertilized ovum. High-dose hormones are not considered abortifacient. Medical authorities point out that under natural conditions there are about 58 clinically undetected spontaneous abortions -- due to circumstances such as implantation failure -- out of every 100 conceptions. High-dose contraceptives do not increase the risk of tubal pregnancy and do not result in an increased rate of birth defects in cases where pregnancy does occur. Many women do experience nausea and vomiting as side effects of emergency contraception.
So far, drug companies have shown little interest in marketing emergency contraception. Abortion opponents have denounced the FDA announcement and ACOG's educational campaign, calling emergency oral contraception a form of abortion. Judy Brown of the American Life League was quoted as saying: "It is criminal to claim that mega-dosing on birth control pills will somehow reduce the number of abortions. The whole emergency contraception' concept is built on a lie . . . that life begins at implantation." The National Conference of Catholic Bishops labeled ACOG's efforts "the mass selling of abortion." Meanwhile, there have been media reports of instances of pharmacists refusing to fill prescriptions for emergency contraceptive pills, citing their personal moral beliefs.
Public information on emergency contraception is available on the Internet from a web site maintained by Princeton University (http://opr.princeton.edu/ec/ or follow the link on TFC's web site) or by a toll-free phone call to 1-888-NOT-2LATE.
Last Modified October 26, 1997