By Charles L. Rulon
Emeritus, Life & Health Sciences
Long Beach City College
Q. What is emergency contraception?
A. Since the 1970′s, rape victims have often been immediately given several ordinary birth control pills to avoid pregnancy. This worked most of the time and became known as the “morning after pill”. Today, there is a specifically formulated “pill”, a high dose of a synthetic hormone that can be used by women within 72 hours after unprotected sex to prevent pregnancy (www.GoToPlanB.com). EC is about 75% successful in preventing a pregnancy that would have occurred otherwise.
EC was finally approved by the U.S. Food and Drug Administration (FDA) in 1999 for women 18 and over with a doctor’s prescription. In 2006 it became available without a prescription and in 2009 the age was lowered to 17. Girls under 17 can obtain a prescription.
Q. How does emergency contraception (EC) work?
A. Depending on when they are used during a woman’s monthly cycle, EC works by preventing the release of an egg from the ovary, or by blocking sperm from fertilizing the egg, or by inhibiting the implantation of the blastula in the endometrium or inner lining of the uterus. The blastula is a ball of cells smaller than a pin head that will eventually become the embryo.
Q. How safe is EC?
A. The World Health Organization and the U.S. Food and Drug Administration have reviewed the scientific data on EC and found it quite safe. Although regular use is not recommended, there have been no reported deaths or serious complications in over three decades of use. In addition, studies have shown no increased risk of birth defects or other problems with women who accidentally took high dose birth control pills after they were already pregnant.
Q. Can EC interrupt an early pregnancy and cause an abortion?
A. No. It takes about five days after fertilization for the developing blastula to reach the uterus and begin to implant in the endometrium. EC is ineffective once the implantation process has begun. The American College of Obstetricians and Gynecologists, the World Health Organization and the National Institutes of Health all define pregnancy as beginning with the successful implantation of the blastula in the uterus. So even as long as two decades ago, polls revealed that 85% of physicians in the U.S. who opposed abortion did support EC.
Q. Should EC be available to minors without a prescription?
A. Of course! Because of the short time factor for using EC, because so many teens are into pregnancy denial and careless when they have sex, and because they refuse to discuss their private sex life with their parents, the ready availability of EC becomes critical. Remember, condoms, foam and the sponge are already available to minors without a prescription.
France made EC available to minors without a prescription years ago. The French Government says it’s just being pragmatic. Teens have sex. They make mistakes. Pregnancy shouldn’t be one of them. So nurses in public high schools throughout France have been authorized to distribute EC to some 1.7 million French girls by request. Free of charge.
Q. Do we really want to copy the French?
A. In this area, why not? Consider: Every year in the U.S., over three million unintended pregnancies occur. Half are from contraceptive failure and about half of these end in abortions. Furthermore, over one million of these unplanned children are being born to teens at a taxpayer cost of billions of dollars a year. In addition, over two million children in the U.S. are physically abused each year by their mostly young parents. And finally, over 15 million American kids now live in poverty, with hundreds of thousands abandoned to the streets. The emotional, physical, social and financial costs of unwanted pregnancies to all these girls and women, to their kids, to their families, and to society at large are staggering. So of course EC should be widely advertised on TV, covered in all high school sex education classes, available without a prescription in pharmacies, and freely handed out to all girls and women during their routine family planning visits to keep for an emergency!
Q. But if EC becomes too easy to obtain, won’t teens use it instead of contraceptives?
A. Some might, but at least they would be using something! Besides, EC can have unpleasant side-effects including nausea, vomiting, headaches and cramping. It’s also less effective in preventing pregnancy (75% effective) than are most contraceptives. And, of course, EC provides no protection against AIDS and the other two dozen or so sexually transmitted diseases. This is the main reason why condom usage is so important with casual sex.
Q. Won’t giving teens EC encourage even more sex and more unwanted pregnancies?
A. Numerous studies have already shown that in-depth sex education classes and the easy availability of contraceptives do not result in more sex. But they do result in more responsible contraceptive usage. Also, most contraceptives are not fool-proof. The condom has a 15%/year failure rate with typical use. Even the pill has an 8% failure rate with typical use. Teens are careless and make mistakes. So with EC as a backup, unwanted pregnancies can be greatly reduced.
In most Western European countries, teens are just as sexual as here. But because of widespread availability of sex education, contraception and EC, plus less sexual guilt, the teen pregnancy rate is one-half to one-tenth of ours! Also, the spread of sexually transmitted diseases is viewed as a serious public health problem, not a sign of dirtiness and immorality.
Q. Still, isn’t abstinence preferable for teens?
A. Arguably, certainly for young teens. But in the U.S. only 7% of males and 20% of females are currently holding out for their honeymoon. So for those teens who’ve chosen to be sexual, shouldn’t our society do everything possible to avoid unwanted pregnancies?
The importance of EC
Q. Could EC really make that big a difference worldwide?
A. Absolutely! Globally, literally millions of families are devastated year after year as women with small children die from illegal botched abortions, or from pregnancy complications, or suffer chronic debilitating pain from massive infections, perforated uteruses and punctured intestines from botched abortions.
Furthermore, there are now one billion teenagers worldwide who are (or soon will be) having sex. Most lack any sex education, or any access to family planning services. In addition, tens of millions of abandoned children now wander the streets of its major cities and over ten million children continue to die every year from preventable causes.
But with EC the number of unintended pregnancies could potentially be cut in half. In HALF! Thus, the widespread easy availability of EC could constitute one of the most important advances in birth control in the last 30 years. The ability of women to have reproductive control over their own bodies has long been an essential goal in the never-ending battle for global female equality and stronger families, plus reduced poverty and disease.
In addition are sobering environmental realities. Our planet continues to pile up over 75 million additional humans every year, roughly half of whom were never planned in the first place. Because of human activity, invaluable forests and topsoil are disappearing at alarming rates. Water tables are seriously dropping in many areas. Deserts and wastelands are rapidly expanding. Species extinction is accelerating. Massive, destabilizing ecological migrations to already overcrowded cities continue to occur and global warming has now become a major concern. If this environmental deterioration is allowed to continue, famines, riots and even social disintegration can’t be far behind.
Opposition to EC
Q. Why haven’t I heard more about EC?
A. Because of strong religious opposition from fundamentalist Protestants and, in particular, from the Roman Catholic Church. God has “told” them that once fertilization has occurred, a sacred, precious, innocent, new human life has come into existence, a life to be protected above all else. So “EC pills are abortifacients that murder innocent pre-born babies!” reads the anti-abortion literature. Thus, to vigorously oppose EC is to do “God’s Will.”
Also, anti-abortion activists are claiming that EC encourages promiscuity, which leads to more unwanted pregnancies, which leads to more abortions! These religious beliefs, coupled with patriarchal power motives and moral zealotry have largely fueled the anti-abortion, anti-EC, anti-contraception and anti-sex education efforts in the United States.
As a result, few family doctors until recently have been informing their patients and few health education instructors have been teaching their students about EC. In addition, drug manufacturers were slow to market EC fearing lawsuits, boycotts and major financial backlashes from religiously conservative mutual funds. Also, dozens of states have introduced bills that allow pharmacists to refuse to fill prescriptions for EC.
Q. How about advertising EC on TV?
A. Good luck! Even modern effective contraceptives (representing some of the most important scientific advances in the history of civilization) are still not being widely advertised on American television. In 1986, 50 years after it became legal to advertise contraceptives in the U.S., the first condom commercials appeared on television—but not because we had the highest teen pregnancy rate of all developed nations. Instead, it was a long overdue response to the deadly AIDS epidemic. Yet, even then the uproar, political pressure and threatened boycotts from the Christian Right squashed most ads. Contraceptive education and advertisements, they believed, encourages non-marital sex. Even the mention of responsible contraceptive use in most network programming has been censored for decades.
Q. Wouldn’t the Catholic Church be opposed to EC regardless of the abortion issue?
A. Yes, since the Church is already strongly opposed to all forms of “artificial” contraception. Until 2011, the pope was even opposed to condoms for married couples in which one partner was HIV positive. U.S. bishops also have been vocal and consistent opponents of EC (plus opposed to all domestic and international family planning programs). At the United Nations, Vatican officials have aggressively used their Church’s official governmental status (which no other religion has) to block programs and policies that would make contraception and EC more accessible in the poorer parts of the world.
Q. Hasn’t there also been a problem with Catholic hospitals in the U.S. when it comes to EC?
A. Absolutely. One in six hospital admittances are to Catholic hospitals. That’s 50 million patients a year. About 80% of these hospitals don’t offer EC to rape victims brought in. Nor do they refer rape victims to hospitals that do supply EC. To make matters worse, in recent years an increasing number of non-sectarian hospitals and HMOs have been taken over by Catholic health organizations.
The American public and EC
Q. Do most Americans agree with those opposed to EC?
A. No. Few really consider fertilized eggs and microscopic blastulas to be so valuable or sacred that women should be forced to stay pregnant against their will. Remember, even the majority of anti-abortion physicians in the U.S. support EC. The Religious Coalition for Reproductive Choice represents several dozen religious groups in this country. It argues that since major Christian faiths strongly disagree as to God’s position on contraception, EC and abortion, this entire issue is not (and never has been) a struggle between the God-fearing and the Godless, as the Christian Right has characterized it.
Q. Where do Catholics stand on these issues?
A. The majority of American and European Catholics are using modern means of contraception in about the same measure as are Protestant and Jewish couples. And by the late 1980s, Catholic women in the U.S. were actually having abortions at a slightly higher rate than were Protestants.
The Office of Population Research at Princeton University operates the EC Web site, http://opr.princeton.edu/ec/.
Trussell, J., Stewart, F., Hatcher, R., 1992, “Emergency contraceptive pills: A simple proposal to reduce unintended pregnancies,” Family Planning Perspectives, 24: 269-273.
Ellertson, C. et. al., 1998, “Should emergency contraceptive pills be available without prescription?’ Journal of the American Medical Women’s Association 53 (suppl 2) 226-229.
See my article “The Roman Catholic Church & Emergency Contraception posted on this web site.
For updates see the reproductive health links to the American Civil Liberties Union website: