Getting the Word Out About Emergency Contraceptive Pills: Benefits for Women's Mental and Physical Health
By Linda J. Beckman, Ph.D.
April, 2003

In January 2004 I was watching the late night news on the local network affiliate of a major television network in Los Angeles when the male news anchor announced a story about the "abortion pill." The story turned out to involve a "controversial" recommendation of a US Food and Drug Administration (FDA) panel about over-the-counter use of emergency contraceptive pills (ECPs). The panel of experts recommended that a progestin-only ECP (PlanB) currently marketed in the U.S. be made available over-the-counter, a recommendation already supported by five major professional medical associations including the American Medical Association (Sherman, in press). As I listened to the newscast I grew incredulous; obviously a major mistake had been made. This national affiliate, which has the largest viewing audience for late night TV news in the greater Los Angeles Metropolitan area, had just provided an estimated over 7 million households ("Mediaweek top 50", n.d.) with incorrect information about ECPs insinuating that this contraceptive method is a form of abortion. The news anchor, a respected reporter who has won many awards, was totally unaware of the problem with his lead-in to the story.

Somewhat later that same month I spoke with a science reporter from a newspaper in the Midwestern United States who was writing a story about research on abortion. In the course of our conversation I determined that she also was unaware of the distinction between ECPs and medical abortion. Of course, there are many well-informed members of the media. Shortly after the FDA panel report, Patricia Neighmond, a health policy correspondent at National Public Radio, provided a wonderfully concise, yet detailed overview of ECPs, their differences from medical abortion, and the controversy surrounding increased access to them. Yet misinformation among those responsible for disseminating accurate information is all too common.

If a significant number of members of the media cannot correctly distinguish between ECPs and medical abortion, how can we expect the general public to know the difference? Despite all the publicity received in the United States, many people, perhaps a majority, confuse ECPs with medical abortion (Boonstra, 2002). To increase knowledge, this article provides a brief overview of this contraceptive method, its modes of action, effectiveness, side effects and differences from medical abortion.

A Contraceptive Method that Works After Intercourse

In contrast to most contraceptive methods that must be used before or during intercourse, ECPs, sometimes incorrectly called the "morning after pill," are high doses of common oral hormonal contraceptives (estrogen plus progestin or progestin only) that are usually taken within 72 hours after unprotected intercourse or a contraceptive accident to prevent pregnancy. They are the most common of the emergency contraception (EC) methods that work after rather than before intercourse and the only method approved and marketed exclusively for this purpose in the United States. The sooner after intercourse the dosage is taken the more effective the method. Usually one dose is taken as soon after intercourse as possible and the other dose taken 12 hours later (American College of Obstetrics and Gynecology [ACOG], 2001; Grimes, Raymond, & Jones, 2001). ECPs do not prevent the transmission of HIV or other sexually transmitted diseases.

Effectiveness and Side Effects

It has been estimated that use of ECPs after an episode of unprotected intercourse reduces the risk of pregnancy by at least 75% (ACOG, 2003). Initially approved in 1997 as a designated product by the FDA, ECPs may have already reduced the number of abortions in the U.S. (Jones, Darroch & Henshaw, 2002). Medical experts agree that ECPs are safe for most women (ACOG, 2001; Grimes, Raymond, & Jones, 2001). Their most common side effect is nausea reported in 20-50% of women. Other side effects include cramps or lower abdominal pain, fatigue, headache, dizziness and temporary menstrual changes (heavier or reduced bleeding), with a smaller percent of women reporting vomiting (Grimes, Raymond, & Jones, 2001; Harvey, Beckman, Sherman, & Petitti, 1999). Progestin only ECPs have fewer side effects than estrogen plus progestin pills (Grimes, Raymond, & Jones, 2001).

Modes of Action and Differences from Medical Abortion

ECPs act by one of three modes. The way in which they work depends on the timing of their use during the menstrual cycle. The most common actions appear to be to delay ovulation or interfere with fertilization, but ECPs can also act by blocking implantation of the fertilized egg in the wall of the uterus (Sherman, in press; Croxatto, et al., 2001). Leading medical organizations such as the American College of Obstetricians & Gynecologists believe that a woman becomes pregnant only after the fertilized egg has been implanted in her uterus. ECPs are designed for use before a woman can know whether or not she is pregnant and are not effective if taken after implantation.

In contrast, medical abortion is used after a woman misses her period and up to seven (or in some protocols nine) weeks after her last menstrual period. The most common medical abortion method, often called the "abortion pill" or the "French abortion pill," is mifepristone marketed in the U. S. as Mifeprex and in many other countries as RU 486. Mifepristone when used in conjunction with another drug misoprostol causes the uterus to contract and expel the implanted egg. (For more information about mifepristone see Harvey, Sherman, Bird, & Warren, [2002]). Medical and other health organizations and the great majority of health providers believe that ECPs prevent pregnancy whereas mifepristone induces an elective abortion. However, those individuals who believe that life begins at the moment of fertilization consider ECPs to be an abortion method. These anti-choice forces have attempted to restrict the availability of ECPs in the US through introduction of legislation to allow providers to refuse to prescribe this contraceptive method and require parental notification before minors can receive it (Sherman, in press).

Benefits to Women of ECP Availability

Surveys indicate that most users report high levels of satisfaction (Harvey, Beckman, Sherman & Petitti, 1999) and most providers are aware of ECPs and have favorable attitudes toward their use (Sherman, in press). Although few studies examine cultural differences in acceptability in the U.S., there is some evidence suggesting that women of different nationalities, socioeconomic statuses and health settings find this method acceptable (Sherman, in press). If ECPs were to be widely available over-the-counter at one's local drugstore, the number of unintended pregnancies in the U.S. might be greatly reduced, perhaps by as much as 50% (ACOG, 2003; Grimes, Raymond, & Jones, 2001). Unintended pregnancies are associated with increased stress and anxiety for women, and unwanted births often have negative psychological consequences for women and their offspring (Barber, Axinn, & Thorton, 1999; David, Drytrch, & Matejcek, 2003). An unwanted pregnancy that results from sexual assault is particularly stressful. ECPs used as a backup to regular contraception can improve women's mental and psychological health. Therefore, it is essential that this contraceptive method be made readily accessible to all women of childbearing age.

References

ACOG (December 15, 2003). ACOG to testify before FDA in support of over-the-counter emergency contraception. Retrieved March 6, 2004 from http://www.acog.org/from_home/publications/press_releases/nr12-15-03.cfm?printerFriendly=yes

ACOG (April 30, 2001). New ACOG leader promotes widespread advance prescriptions for emergency contraception. Retrieved March 26, 2004 from http://www.acog.org/from_home/publications/press_releases/nr04-30-01-1.cfm

Barber, J. S., Axinn, W. G., & Thorton, A. (1999). Unwanted childbearing, health, and mother-child relationships. Journal of Health and Social Behavior, 40: 231-257.

Boonstra, H. (2002). Emergency contraception: The need to increase public awareness. The Guttmacher Report, 5(4), 3-6. Retrieved March 28, 2004 from http://www.guttmacher.org/pubs/journals/gr050403.pdf

Croxatto, H. B., Devoto, L., Durand, M., Ezcurra, E., Larrea, F., Nagle, C., et al. (2001). Mechanism of action of hormonal preparations used for emergency contraception: A review of the literature. Contraception, 63(3), 111-121

David, H.P., Drytrch, Z & Matejcek, Z. (2003). Born unwanted: Observation from the Prague study. American Psychologist 58: 224-229.

Grimes, D. A., Raymond, E. G., & Jones, B. S. (2001). Emergency contraception over-the-counter: The medical and legal imperatives. Obstetrics & Gynecology, 98, 151-155.

Harvey, S. M., Beckman, L. J., Sherman, C. A., & Petitti, D. B. (1999). Women's experiences and satisfaction with emergency contraception. Family Planning Perspectives, 31(5), 237-240 & 260.

Harvey, S. M., Sherman, S. A., Bird, S. T., & Warren, J. (2002). Understanding medical abortion: Policy, politics and women's health (Policy Matters Paper # 3) Center for the Study of Women in Society, University of Oregon: Eugene.

Jones, R. K., Darroch, J. E., & Henshaw, S. K. (2002). Contraceptive use among U.S. women having abortions in 2000-2001. Perspectives on Sexual and Reproductive Health, 34, 294-303.

Mediaweek top 50 market profiles: No. 2 -Los Angeles (n.d.). Retrieved March 28, 2004 from http://www.mediaweek.com/mediaweek/top50/losangeles.jsp

Sherman, C. (in press). Emergency contraception: The politics of post-coital contraception. Journal of Social Issues.

For more information about emergency contraception please see the Emergency Contraception Website at http://www.not-2-late.com