This month, the federal Food and Drug Administration is slated to consider whether emergency contraception (EC) should be changed from prescription-only to over-the-counter. It's a move supported by a long list of groups, including the American Medical Association and the American College of Obstetricians and Gynecologists, because over-the-counter distribution would increase women's access to EC.
In 1997, the FDA approved emergency contraception, also called "the morning-after pill," as a way for women to prevent pregnancy after sex. EC provides higher doses of the hormones found in birth-control pills. Most commonly, it is dispensed in a two-pill regimen, with one pill taken as soon as possible after unprotected sex and the second pill 12 hours later. If taken within 72 hours after sex, EC can reduce a woman's risk of becoming pregnant by 75 to 99 percent.
If 100 women have unprotected sex in the second or third week of their cycle, eight will become pregnant. If they all took EC, those eight pregnancies would be reduced to one. It follows that greater availability and use of EC would lead to fewer abortions. Data for unintended pregnancies generally show two things: half of all unintended pregnancies are the result of contraceptive failure, and half of unplanned pregnancies end in abortion. In 1999, the most recent report available, states reported 861,789 induced abortions to the Centers for Disease Control and Prevention (CDC). Louisiana reported 12,008 for that year. Some experts project that widespread use of EC for cases of contraceptive failure could cut the number of abortions each year in half.
So why isn't EC used more? Part of the problem is that EC is often confused with RU486 -- commonly known as the "abortion pill" -- a completely different prescription drug used to cause an abortion in the first seven weeks of an established pregnancy. EC and RU486 are distinctly separate pills, and they are used for distinctly separate purposes.
We should note that not everyone agrees on a definition of "pregnancy." According to medical science, EC prevents a pregnancy by delaying ovulation, inhibiting fertilization, and -- if the ovum has already been fertilized -- thickening the uterine lining to prevent implantation. In medical terms, no pregnancy exists until the ovum implants in the uterus. But a conflict arises because some faiths, including Catholicism, teach that stopping a fertilized ovum from implanting in the uterus is an abortion.
For women who have no religious or moral objections to EC, barriers still exist. In order to take EC within 72 hours after unprotected sex, a woman currently must call her doctor, get a prescription and locate a pharmacy that carries EC. Women may not have quick access to a doctor or an open pharmacy, especially on weekends or holidays. For this reason, some states now offer EC directly from pharmacists, through an arrangement with physicians.
Some doctors also offer an EC prescription to their patients who are trying to avoid pregnancy. One gynecologist compares EC in a woman's medicine cabinet to a fire extinguisher in the kitchen: "She may not be planning to cook carelessly, but if something happens, she's prepared." For these women, EC is a way to deal with both contraceptive and human error. Access to EC at such times can be crucial.
Access to EC is also vital in the emergency room at New Orleans' Charity Hospital, where nurses who specialize in sexual-assault cases offer EC to rape victims. This has become standard practice in many emergency rooms, and rightly so. But a 1999 survey of 589 Catholic hospital emergency rooms, conducted by the abortion-rights group Catholics for a Free Choice, found that, nationwide, 82 percent of those hospitals don't offer EC to rape victims; in Louisiana, all eight Catholic hospitals don't.
As we reported last week ("Conceiving Differences," Dec. 2), the Catholic Church's health directives make a narrow exception allowing Catholic hospitals to offer EC to rape victims, because a woman in those cases has the right to reject her violator and his sperm. That being the case, we hope that local Catholic hospital administrators will reconsider their policies and begin offering EC to rape victims who enter their hospitals.
The final barrier to widespread EC use may be a lack of public awareness. A recent survey by the Kaiser Family Foundation found that one out of three women did not know that they could prevent pregnancy after intercourse. Only one in 20 had ever used EC. Kaiser also found that women's doctors often didn't discuss EC with their patients. Only one in four gynecologists and about one in 10 family doctors said that they always or usually discussed EC with their patients.
To foster greater awareness, the Reproductive Health Technologies Project started a campaign titled "Back Up Your Birth Control With EC." The group hopes to encourage women who want to prevent pregnancy to have both a regular method of birth control and a backup plan such as EC. Taking both pills, when circumstances call for it, is a choice we can agree with.