Advertisement

Archive for Tuesday, February 27, 2001

New step in pregnancy prevention

February 27, 2001

Advertisement

— For many years, there was a legislator in my hometown who ended every speech on the female reproductive system and trust me, there were many with a warning to women: "If you're gonna play, you gotta pay."

He always seemed quite cheerful transforming the joy of sex into the anxiety of pregnancy. He must have considered motherhood as a proper kind of penitence.

In any case, this was back when women had just one course of action in the early hours and days after unprotected sex. They could wait and see. At the drug store, the only recourse available was a pregnancy testing kit.

But now we have the ability to prevent pregnancy after sex. And we have a chance to lower the rate of unintended births without raising political ire.

Sixty medical and women's groups including the American Medical Assn. have filed a petition asking the Food and Drug Administration to allow the sale of emergency contraception over the counter, without a prescription. Now the FDA has 180 days, roughly two trimesters, to answer.

Emergency oral contraception, known colorfully and incorrectly as the morning-after pill, has been around for almost 30 years. In its rudimentary form, EC is no more complicated than what most women do when they forget to take a pill. The next day they take two.

But as one advocate says, "women don't know about it, doctors don't talk about it, health care providers don't mention it." Remarkably, only 25 percent of American women have any idea that it even exists in this country.

Some of the blame for this well-kept secret rests on fuzzy biology. As Dr. Paul Blumenthal of Johns Hopkins University says, "People have the idea that once you've had sex there is nothing you can do. They think sperm travels at the speed of light and you're on your own until you do or don't get your next menstrual period."

Contrary to this image of the incredible swimming sperm, it takes up to 24 hours for an egg to be fertilized, if it's even going to be fertilized. It takes more than three days for the fertilized egg to make the rugged and uncertain trip to the uterus, if it gets there.

So, as they say at the hotline: 1-888-NOT-2-LATE. Emergency oral contraceptives taken within the first 72 hours can prevent anywhere from 75 percent to 95 percent of unintended pregnancies.

Of course, fuzzy politics is also to blame for the secrecy. The 72-hours-after pill has been caught, erroneously and sometimes willfully, in the abortion debate. One headline on the FDA story, for example, asked, "RU Ready?" a deliberate play on the abortion pill RU-486.

But ECs like Preven or Plan B that prevent fertilization or implantation are not abortifacients. They don't even work if you're already pregnant. The sooner you take them, the better the odds you won't get pregnant.

Here we get to the tricky part. Accidents happen. We have no idea how many "uh-oh" moments occur every year. But nearly half of all American women have an unintended pregnancy in their lifetime. There are 3 million such pregnancies every year, half due to contraceptive failure.

Ever try to find a doctor in an emergency? Ever try to find a doctor the Sunday morning after the Saturday night before? ECs are as safe as aspirin, but you can't get them as fast or as easily. They're not on the same shelf.

So far France, Norway, Portugal and the United Kingdom have moved to dispense ECs without a prescription. The state of Washington allows pharmacists to dispense them out from behind the counter. And Virginia may soon follow suit. But only the FDA could make these pills available nationally to consumers wherever a pack of gum or a condom is sold.

Politically, this should be what Kirsten Moore, who heads up the Reproductive Health Technologies Project, calls "a win-win." Tommy Thompson, the head of Health and Human Services where the FDA resides, has positioned himself as pro-life and pro-birth control. So has President Bush. The only serious opposition to EC has come from those extremists who also oppose birth control. "If you are serious about wanting to reduce unwanted pregnancies and abortions, this is the way to go," says Moore.

Today there is still much talk of "playing" and "paying," much judgment about sex and irresponsibility. But in the long-stalemated argument over women, sex, and abortion, this is a chance to prevent unwanted pregnancies by as much as 1.7 million and abortions by as much as 800,000. It's really NOT-2-LATE.

Commenting has been disabled for this item.