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