That decision though is generally influenced by which methods are socially acceptable within an individual's community, and which methods are most completely understood. It is important, then, for educators and physicians to not only inform women that the pill exists, but they must also explain how it works and why it should be used.
Emergency contraception in pill form is a dose of estrogen and/or progestin, generally taken in two doses twelve hours apart following intercourse. Currently the IUD method of emergency contraception has been largely replaced by pill regimens either a combination of estrogen and progestin or progestin only (Grimes, & Raymond 2002). Depending on the timing of administration the mode of action of these oral regimens differs. Taken before ovulation, emergency contraceptives prevent ovulation. There is also a possibility that the hormones affect the mucus of the cervix effectively trapping semen, or possibly even affecting the mode of transport of sperm to ovum (Grimes, & Raymond 2002). If the emergency contraceptive is taken after ovulation it is possible that the hormones result in an alteration of the biochemical makeup of the endometrium and the function of the corups lutem which inhibits fertilization. There is no evidence though of long-term alteration following treatment with oral emergency contraceptive (Trussell, et al., 1997).
One of the most significant and resilient controversies surrounding the use of emergency contraception is the fear that an oral contraceptive regimen is actually early medical abortion. It is this fear which accounts in large part for many individual's hesitation in use. This fear however is unfounded. Emergency Oral Contraceptive is ineffective once a pregnancy has been established (Grimes & Raymond, 2002). The "pill" as it is commonly called works only in the time between intercourse and establishment of a pregnancy which is a window of approximately one week. The preemptive biochemical alteration resulting from the oral hormone prevents conception from taking place, thus it is not actually interrupting or terminating a pregnancy simply preventing one from beginning. There are however, a number of religious and political groups who promote the idea that emergency contraception is chemical abortion. It is this stigma along with similar erroneous beliefs which prevent those individuals who need the medication from actively seeking it.
The direct correlation between misinformation regarding oral contraception and the number of abortions in an area is supported by the 1995 scare that certain birth control pills were responsible for doubling an individual's risk of developing potentially life threatening blood clots. In the aftermath of this scare which was later shown to be unfounded, the UK alone saw a 9% increase in the number of abortions (Harper & Ellerton, 1995). Such concerns have historically become widely circulated and have been fairly resistant to debunking because so little is known conclusively about the oral contraceptives mode of action as well as the potential long-term side effects of years of hormonal manipulation.
This misconception of how oral emergency contraceptives work as well as the lack of open discussion regarding regimens such as the popular "Morning After Pill" make it difficult for women to acquire the pills. These oral regimen are also not specifically labeled by the FDA for emergency contraception and as such their wide spread availability has been restricted (Harper & Ellerton 1995). These lingering ambiguities though are ultimately extremely detrimental in that oral emergency contraceptive is a viable and effective alternative to traditional medical abortion or child bearing.
The lack of FDA label and approval also indicates that the emergency contraceptives cannot be marketed for specific emergency use. This inability to advertise the product or market it widely ultimately means that it is up to individual pharmacies and physicians to stock the medication or even prescribe it. Although a patient may ask for emergency contraception it is within a physician's rights to refuse prescription barring genuine physical risk. The lack of publicity also indicates that it is left to individual physicians, citizens, pharmacies, and educators to fully inform themselves and other about emergency contraception. The primary impediment to application of the FDA for a label is that there is simply not enough clinical empirical evidence regarding the contraceptive's mode of action as well as any potential long-term side effects.
In addition to the FDA linked inability to market emergency contraception is an individual's dependence on the opinion of their immediate peer group to seeking such medical treatment (Harper & Ellerton, 1995). If an individual's peer group is uninformed or feels negatively about emergency oral contraception, even at risk members of that group are very unlikely to actively seek out emergency contraception, or even take it should they have easy access to it.
Ultimately, emergency oral contraception is a medical treatment which individuals must choose to acquire. A lack of federal labeling makes the acquisition of information regarding the product more difficult to locate as well as making debunking negative rumors much more difficult. The issue is larger than simple access to the medication, it is more fundamentally access to knowledge about the medication which will have the greatest impact on abortion rates. If sex education were compulsory, and within that sex education information not only about contraception but emergency post coital contraception was available then many of the negative connotations associated with "the morning after pill" would be dispelled by authority figures. Further, a statistical reassessment of abortion rate accounting for abortions that do not result from an unplanned or unwanted pregnancy would likely provide more accurate information regarding the severity of the problem. While it is likely that the majority of abortions result from unplanned pregnancies, it is patently untrue that all of them do. Emergency contraception pills currently do not have a significant impact on the abortion rate in the United States or in Scotland, however as information becomes more widely available and many associated negative rumors are dispelled it they likely will.
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