Group Backs Emergency ContraceptionGroup Backs Emergency Contraception

The American College of Obstetricians and Gynecologists (ACOG) has launched “Ask Me,” a campaign to educate women about emergency contraception and to encourage them to get an advance prescription from their physician in case they ever need it.

Leaders from ACOG, who launched the campaign in May, say emergency contraception is an important component of family planning and better access to it may help reduce the number of unplanned pregnancies and abortions in the United States. According to ACOG, nearly half of all US pregnancies are unplanned and more than half of the women who have an unplanned pregnancy were using a form of contraception when they became pregnant.

“Accidents happen. No form of contraception offers women 100% protection,” said ACOG president Michael T. Mennuti, MD. The campaign encourages women to ask about emergency contraception, and their OB-GYNs to provide information and a prescription to either hold and fill in an emergency or to fill immediately to have the medication on hand. Such prescriptions should be valid for about a year after they are written, though this may vary from state to state, according to ACOG. Currently, Plan B (levonorgestrel), the only dedicated emergency contraceptive sold in the United States, is available by prescription for $25 on average, though pricing may vary among pharmacies, according to Duramed Pharmaceuticals, a subsidiary of Barr Pharmaceuticals Inc, the drug's manufacturer. The drug's shelf life is 48 months between manufacture and expiration. Twenty other brands of oral contraceptives can be used as emergency contraception at doses that are higher than those employed for regular use, according to ACOG's Emergency Contraception Practice Bulletin (Obstet Gynecol. 2005;109:1443-1452). The bulletin, which provides guidelines for physicians on emergency contraception, can be ordered by sending an e-mail request including a complete mailing address to resources@acog.org.

“We hope to make EC [emergency contraception] a forethought, not an afterthought,” Mennuti said. Iffath A. Hoskins, MD, a representative of ACOG's committee on Health Care for Underserved Women, emphasized that any woman could find herself in need of emergency contraception, not just teenagers or those who are promiscuous. For example, women who have been raped, those who have a young infant or are nearing menopause may want to use emergency contraception to prevent a pregnancy.

The campaign was developed to help eliminate the logistical and political barriers that currently make it difficult for women to access emergency contraception, according to ACOG. Emergency contraceptives contain high doses of the same hormones used in birth control pills and may prevent pregnancy if used up to 72 hours after unprotected sex; they are most effective if used within 24 hours.

However, it may be difficult for a woman who has had unprotected sex or has been raped to contact her physician and obtain a prescription in time. Even women who seek treatment in an emergency department after a rape may not have timely access to emergency contraception. An analysis of the National Hospital Ambulatory Medical Care Survey for 1994-1999 found only 21% of the eligible women who were seen for rape treatment received the drugs (Rovi S and Shimoni N. J Am Med Womens Assoc. 2002;57:204-207). Efforts to address this time crunch by making the drugs available over-the-counter have been stalled, in part, by political pressure from groups that argue that emergency contraception would increase promiscuity or that it is tantamount to abortion.

In December 2003, an FDA advisory panel voted 23-4 to recommend that the agency approve over-the-counter sales of Plan B, citing the drug's safety and potential public health benefits of making it more readily available. But the agency denied the application, citing inadequate evidence for safety in young teens. The FDA has yet to make a decision on a second application by the manufacturer to make the drug available to women aged 17 years or older.

Meanwhile, ACOG and a number of medical organizations, including the American Academy of Pediatrics and the American Medical Association, have announced their support of making Plan B available over-the-counter. These groups cite evidence of the drug's safety, evidence that it cannot terminate an established pregnancy, and the potential public health benefits of reducing unintended pregnancies. Additionally, evidence has emerged that emergency contraceptive use does not increase promiscuity (Raine TR et al. JAMA. 2005;293:54-62).