Medicine / Emergency
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April 14, 2007

Matthew Vasey, MD



Availability of nonprescription emergency contraception has developed into quite a controversial issue. To date, emergency contraception in the United States is available by prescription by a licensed practitioner only. (It just so happens since the conception of this article Plan B is now available at a pharmacy without a prescription for women age 17 and older. Women 16 and under still require a prescription for the medication.)

Emergency contraception secondary to doses of hormones began around the 60's and has since been fine tuned about as many times as there are drug companies (1). The issue of utmost importance for all emergency contraception is of course, primarily, safety for the potential mother and secondarily, keeping the potential-mother from becoming, well, mother.

All emergency contraceptive medicines are focused on preventing implantation of the fertilized egg into the wall of the uterus, occurring about seven days after the "ind(s)ex date". These medicines are, therefore not considered to be an "abortifacient" a.k.a. an abortion. One drug, however, Mifepristone works after the egg finds its home in the wall of the uterus. Mifepristone is obviously, a very controversial method of contraception.

In 1996, the Food and Drug Association gave their coveted "safe and effective" blessing to four emergency contraceptive brands of combined estrogen/progestin to be distributed by prescription only in the United States. In some countries, women can obtain emergency contraception from a pharmacist (2) or even off the shelves. (3)

People who are for increased availability argue (4):
1. demonstrated safety
2. a need for it
3. high costs of unwanted pregnancy and prescription contraception
4. absence in increase of pregnancy and sexually transmitted disease

People who are against increased availability argue, aside from moral objections (4):
1. health concerns secondary to misuse by predominantly youthful audience
2. social benefits predicted are full-of-it
3. disregard for primary contraceptive measures
4. lost opportunity for medical oversight of emergency contraception and safe-sex counseling

Should you find yourself in this situation, put a call to schedule an appointment with your primary care provider for emergency contraception. If a prompt appointment proves to be an unconquerable feat, head to your nearest Emergency Room.

References:

1. Ellerston C. History and efficacy of emergency contraception: beyond coca-cola. Fam Plann Perspect. 1996;28(44-8).
2. Center for Reproductive Rights. Governements worldwide put emergency contraception into women's hands: a global review of laws and policy. Briefing Paper, September 2004(1-20).
3. Trussell J, Ellertson C, Stewart F, et al. The role of emergency contraception. Am J Obstet Gynecol. 2004;190(4 suppl):(S30-S38).
4. Ranney, ML, Gee, EM, Merchant, RD. Non-prescription availability of emergency contraception in the united states: history, current status, controversies and impact on emergency medicine practice. An Em Med. 2006;47:5(461-71).
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