Emergency contraception: methods, effectiveness, and access

¶ … Emergency Contraceptive Pills in the United States

This chapter will discuss the use of Emergency contraceptive pills in general. The chapter serves as an introduction to the ECPs, their rate of unwanted pregnancies and effects of the pill on pregnancy.

Emergency contraception is commonly known as the morning after pill. The name comes from the fact that these methods of birth control are used after a person has had unprotected sex. Unplanned pregnancies are common around the world and it is believed that 50 million unwanted pregnancies are terminated every year globally. [1]in the United States alone, 1 million and more abortions could be prevented with more widespread use of emergency contraceptives. [2]

Background of the problem:

The use of emergency contraceptives pills is not as common as we would like to believe. It is found that unwanted pregnancies occur in 33% times per cycle if intercourse took place on alternative days. The chances come down to 15% if unprotected sex occurs once a week. While the sperms released from one sexual activity remain in female genital area for up to five days but eggs appear capable of being fertilization for only 24 hours.

The use of ECPs gained popularity when in December 2000; American Medical Association (AMA) supported the decision by Food and Drug Administration (FDA) for over-the-counter (OTC) sale of emergency contraceptive pills. [3] but despite continued supported, the decision was aborted in May 2004 when FDA prohibited over the counter sale due to lack of data on the effects of these pills for girls under the age of 16. FDA was accused of coming under political pressure. These contraceptive pills are also known as the Plan B. And the manufacturers pressurized FDA to allow over the counter sale one year later. However the deadline of January 2005 passed and there was no decision from FDA. It was then in August 2006, only very recently, that FDA allowed over the counter sale for those 18 and older. Girls under 18 will still require a prescription and the pills will not be made available in gas stations or convenience stores

Discussion:

Emergency contraceptive pills are useful if they are taken within 48-72 hours after having sex. While not every couple using this would be having unprotected sex, it is found that Plan B. is required when a couple notices breakage in condom. In a recent study, it was found that 4 to 7% of couples using condoms noticed a leakage, breakage or slippage during a three-month period. [4]

The question then arises, how effective are these pills? The efficacy of ECPs is not easy to measure. While many women report using the pills, their subsequent treatment of pregnancy cannot be attributed to pills alone. Some of these women may not have conceived even if they had not used the pill. For obvious reasons, no control groups can be used for studies and most available studies include large groups of young women whose fertility had not been determined.

The Yuzpe regimen is considered the most effective in this regard. This is a combination treatment where estrogen-progestin regimen consists of two doses of a combination of 100 g of ethinyl estradiol and 0.5 mg of levonorgestrel each. The first dose is taken within 72 hours followed by the second dose 12 hours later. This method was first developed by Yuzpe and Lancee in 1977 and hence the name.

The most common problems associated with these pills are minor side effects such as nausea and vomiting reported in 50% and 20% of women respectively. [5] the long-term effects are unknown since not much data is available however it is believed that consistent long-term use may cause both arterial disease (myocardial infarction and cerebrovascular accident) [6] and venous disease (deep venous thrombosis and pulmonary embolism). [7]

Emergency contraception pills are more widely available in developed countries compared to developing countries where access to these pills is still limited. Not all of these pills are yet licensed in the United States as well but the FDA approved the six common brands since they were found effective for emergency use.43 very interesting fact that appeared from the research is that manufacturers are not very keen to enter the market for emergency contraceptive pills. It was found that in the U.S., no drug manufacturer had sought an approval from FDA for manufacturing of Plan B. even though they had been requested to come forward..48