by Brenna Munro, NOW Intern
Coming to the United States from Britain, I am struck by how little people here know about the so-called "morning after pill." It is a practical form of emergency -- not alternative, but emergency -- contraception that is socially sanctioned and ready available to all women in England. Awareness is growing here, with groups like the National Women's Health Resource Center working hard for change, but women are still receiving neither the medication nor the facts.
Family planning experts estimate emergency contraceptive pills (ECPs) could reduce unplanned pregnancies here by 1.7 million a year. In Holland, where the use of ECPs is accepted practice, the abortion rate is one-fifth that of the United States.
The ECPs prescribed to women here are contraceptive pills, of which there are concentrated and lighter versions -- Ovral or Lo-Ovral, for example. Women take a double dose of Ovral or a quadruple dose of the lighter pill, Lo-Ovral within 72 hours of unprotected sex. This procedure is repeated 12 hours later, with the women taking either another double dose of Ovral, or quadruple dose of Lo-Ovral. This procedure has a 70 to 80 percent effectiveness rate. Women may suffer from nausea, vomiting, cramps and breast tenderness, but there appear to be no harmful long-term effects.
ECPs prevent a fertilized egg from being implanted in the lining of the uterus, rather than dislodging it once the process of growth has begun, as in the case of abortion. Some doctors call this process "interception," placing it somewhere between contraception and abortion, but it is still controversial.
Since contraceptive pills were legalized in the United States, doctors have prescribed them for the secondary purpose of post-coital contraception. They have been done so routinely for rape victims over the last 10 years.
However, as birth control pills are not FDA-approved for this secondary purpose, drug companies cannot label and market them as ECPs. To change the status of these drugs with the FDA would take a pharmaceutical company about 15 years and millions of dollars for testing and trials.
Not only does the public need to be educated, but the medical practitioners do as well. One of the reasons the morning after pill is so rarely prescribed here is that this method of fertility control is not highlighted in doctors' training. Doctors may also have punitive attitudes about female sexuality or fear being targeted by anti-abortion organizations.
Meanwhile, poor women who need ECPs the most are least likely to get them. Federally supported Title X clinics avoid prescribing them because of the legal grey area they occupy. Catholic hospitals refuse to prescribe them, despite the fact that abortions would thus be prevented.
The anti-abortionists and the Bush administration effectively prevented the use by women in the United States of another option for emergency contraception, the drug RU486. In 1992 the New England Journal of Medicine reported on a study in Scotland that found that RU486, though more well known as an abortifacient, actually works like the ECPs -- a single dose prevents implantation if taken within 72 hours. It had a zero failure rate and none of the side effects of the other methods. Clinical trials are underway for FDA approval of RU486, also known as mifepristone.
Althouth ECPs are available in many countries, women in India and Sri Lanka have another solution. They have been using the papaya fruit as a form of post-coital contraceptive for centuries. Researchers found that the enzyme papain in the papaya interacts with progesterone so that eating one papaya a day for a week will bring on menstruation with no side-effects. Perhaps U.S. women should start planting papaya trees, until the day a woman-friendly administration facilitates the use of other ECPs.
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