Administration of larger-than-normal doses of oral contraceptive pills within 72 hours of unprotected intercourse significantly reduces the chance of pregnancy. Oral contraceptives have been used as post-coital emergency contraceptives in Europe for more than two decades, and contraceptive pills have long been sold and specially packaged for this purpose in many countries. Lack of knowledge (on the part of women) and fear of litigation and harassment by abortion opponents (on the part of drug companies) long prevented their widespread use for this purpose in the United States. Until 1997, when the FDA approved the sale and use of oral contraceptives for emergency contraception, the off-label use of oral contraceptives for emergency contraception was mostly limited to family planning clinics and small numbers of college health centers and emergency rooms.
There are two types of emergency contraceptive pills. The first type is nothing more than ordinary birth control pills that contain the hormones estrogen and progestin (but not all brands of birth control pills can be used for emergency contraception). The brand name Preven is especially packaged and labeled for emergency use. Use of this type of emergency contraception pill cuts the chance of pregnancy by 75%. This means that if 100 women had unprotected intercourse once during the second or third week of their cycle, normally about 8 would become pregnant, but Preven and its equivalents reduce this to only 2%. Emergency contraception does have side effects: about 50% of women who use this type get nauseated and 20% vomit. Preven kits are available to Title X family planning clinics at about $4 to $5 per unit, if purchased by the case.
The other type of emergency contraceptive pill contains only the hormone progestin. This type is specially packaged and labeled for use as the brand name Plan B. It is more effective than the first type, and the risk of nausea and vomiting is also lower. If the same 100 women used Plan B, only 1 would get pregnant: an 89% reduction.
Emergency contraceptive pills have been popularly called "morning after pills," but their use is not limited to the "morning after." A woman can start the pills right away or up to three days after unprotected sex, although the pills are more effective the earlier they are started.
There are several mechanisms by which high-dose oral contraceptives prevent pregnancy, including inhibiting ovulation, inhibiting tubal transport of the egg or sperm, and interfering with the implantation of a fertilized ovum by altering the lining of the uterus. High-dose hormones cannot end an established pregnancy, so they are not considered abortifacients. 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.
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 has seldom been used here. In 1997 the American College of Obstetricians and Gynecologists (ACOG) estimated 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."
- Compiled by Tennesseans for Choice, 11/99, from various sources