Policy Prescription

Every time a condom breaks, a woman has to endure an anxious, nail-biting month before she can know for sure that the coast is clear. But thanks to the advent of emergency contraception—what has appropriately been deemed “the morning-after pill”—women now have a safe and effective way of preventing pregnancy when mistakes and accidents happen. That is, of course, unless they happen to have sex on the weekend.

In the vast majority of states, women seeking emergency contraception must first set up an appointment and make a trip to the doctor’s office to obtain the necessary prescription. But many doctors are unavailable to write prescriptions on weekends and some pharmacies do not carry the drug. Since people tend to be more sexually active during weekends and holidays when doctors’ offices are closed, this can be a significant problem. The morning-after pill must be taken within a narrow window of time to be effective—ideally within 24 hours after intercourse. By the time a woman jumps all these hurdles, it might be too late.

Depending on the method used, emergency contraception can reduce a woman’s risk of becoming pregnant from a single act of intercourse by between 75 and 99 percent. It works similarly to regular birth control pills; it contains the same hormones and likewise prevents ovulation or fertilization of an egg. If fertilization has already occurred, the hormones prevent the egg from implanting into the uterus—which is the medical definition of pregnancy. Although research over the past 30 years has shown that the morning-after pill is safe and effective, the many barriers to obtaining a prescription undermines its potential. A Kaiser Family Foundation survey found that currently only six percent of women of childbearing age had ever used the drug.

The Food and Drug Administration (FDA) has finally decided to consider alleviating these obstacles by putting emergency contraception on pharmacy shelves without a prescription. Given that both the American Medical Association and the American College of Obstetricians and Gynecologists have both supported this proposition as medically safe, it seems reasonable to assume that the change would be relatively uncontroversial. But then again, what would America be without its anti-choice, sexually conservative ideologues?

Critics—employing the same hackneyed argument they use for opposing increased access to abortion—argue that making the pill easier to obtain will cause it to be abused as regular contraception. “You will have people...falling back on this idea we’ll all just go to the drugstore in the morning and get a morning-after pill,” argued Wendy Wright of Concerned Women for America (CWA) in an Associated Press article. CWA is a conservative organization that is opposed to many reproductive rights and has misleadingly linked emergency contraception to abortion.

This concern couldn’t be more paternalistic. If a woman wants to prevent becoming pregnant, it’s her prerogative to have every medically viable preventative measure available to her. And given the 30 years of research devoted to this issue, the prediction that this policy change would encourage a lazy reliance on the morning-after pill is just plain inaccurate. According to Dr. Felicia Stewart, a member of the University of California, at San Francisco’s Center for Reproductive Health Research and Policy, there is no evidence that increased access to emergency contraception makes women more careless about regular contraception.

In fact, the wider availability of the pill is something flag-toting, poster-brandishing right-to-lifers should be celebrating. The Alan Guttmacher Institute estimates that 51,000 abortions were prevented in 2000 due to better access to and better knowledge of emergency contraception. And over-the-counter availability is predicted to result in 1.7 million fewer unwanted pregnancies and 800,000 fewer abortions each year in the United States.

The positive effects of increased access can be seen in France, where emergency contraception has been available since the early 1970s. In 1999, the French parliament made the medication available without a prescription. And a year later, high-school nurses were given permission to provide the drug without parental consent. France’s abortion rate is now one of the lowest in the world—and half the U.S. rate.

The morning-after pill increases a woman’s control over her own reproduction and it is medically safe to offer it over-the-counter. Dr. Paul Blumenthal, an obstetrician who heads contraceptive research and programs at Johns Hopkins University’s Bayview medical center, told the Associated Press that “It meets all the criteria that would ordinarily have to be met by any other over- the-counter drugs. You could probably argue this is safer than aspirin.”

The current FDA policy is unnecessarily inconvenient and the United States is embarrassingly behind the rest of the world in offering this pregnancy prevention option. Emergency contraception was already available over the counter in 26 countries by 2000, ranging from Britain, Israel and Switzerland to Sri Lanka, Albania and Madagascar. If women around the world can handle the daunting task of taking a pill all by themselves, why can’t we? For a country that professes to be a leader in the global fight for women’s rights and access to birth control, we certainly drag our feet when it comes to our own reproductive choices.

By making the morning-after pill over-the-counter, the FDA will improve widespread access and availability for all women and help to reduce unwanted pregnancy. In a society where the right to choose is increasingly scrutinized, an opportunity to prevent the problem before it starts cannot be passed up.

Lia C. Larson ’05 is an economics concentrator in Adams House. Her column appears on alternate Fridays.