C Rulon: Emergency Contraception

By | September 12, 2011

By Charles L. Rulon
Emeritus, Life & Health Sciences
Long Beach City College

Emergency contraception

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.[1]
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.[2]

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.[3]
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.[4] 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.[5] 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.[6]

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.

[1]The Office of Population Research at Princeton University operates the EC Web site, http://opr.princeton.edu/ec/.
[2]Trussell, J., Stewart, F., Hatcher, R., 1992, “Emer­gency con­tra­ceptive pills: A simple proposal to reduce unin­ten­ded pregnancies,” Family Planning Perspec­tives, 24: 269-273.
[3]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.
[4]See my article “The Roman Catholic Church & Emergency Contraception posted on this web site.
[5]For updates see the reproductive health links to the American Civil Liberties Union website: .

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