Search

The Online Encyclopedia and Dictionary

 
     
 

Encyclopedia

Dictionary

Quotes

   
 

Morning-after pill

Emergency birth control also known as the morning-after pill, or emergency contraception or , is a pill regimen that a woman can take up to three days after she has had sexual intercourse to prevent the implantation of a fertilized egg in her uterus. The term morning-after pill is a misnomer that is falling out of use (replaced by emergency contraceptive pills or ECPs) due to the fact that it is effective for up to 120 hours after sex. Its availability is limited by its controversial status; its use as a contraceptive is held to be immoral by some groups including the Catholic Church. Others who oppose its use classify its potential to prevent implantation of a fertilized egg as an abortion.

The morning-after pill, however, operates in a manner different from that of abortifacient pills such as RU-486.

Contents

Types of emergency birth control

Emergency hormonal contraception is available in two main forms; the original version is the combined or Yuzpe Regimen which uses large doses of both estrogen and progesterone taken as two doses at 12 hour intervals. This technique is believed to be approximately 75% effective when taken within 24 hours of unprotected intercourse. Examples of Yuzpe Regimen emergency contraceptive pills include Preven (United States), Schering PC4 (United Kingdom) and Tetragynon (France). This regimen is known to be associated with severe side effects, especially nausea and vomiting, and has largely been superceded by the progesterone-only method. The progesterone-only method usually uses the progesterone levonorgestrel in a dose of 1.5 mg, either as two 750microgram doses 12 hours apart, or more recently, as a single dose. This method is now known to be more effective (up to 95 percent if taken soon enough), safer and better tolerated than the Yupze method, and is available in the U.S. and Canada as Plan B, in the UK as Levonelle, and in France as NorLevo.

Products such as Preven, Plan B and Levonelle are specifically designed and marketed as emergency contraceptive pills. It is also possible to obtain the same dosage of hormones, and therefore the same effect, by taking a number of normal birth control pills; see Yuzpe Regimen for some examples. Note: Preven is no longer in production as it is less effective and has more intense side effects than other emergency contraceptive pills.

Use as a birth control method

Emergency birth control cannot be recommended as the main means of birth control because of its strong side effects and relatively low reliability. It also does not protect against sexually transmitted diseases. However, it is used by some as a back-up when other means of contraception have failed—for example, if one has forgotten to take her birth control pill or when a condom is torn during sex.

An alternative to emergency birth control is the intrauterine device which can be used up to 5 days (In some cases 7 days [1]) after unprotected intercourse.

Emergency birth control and abortion

Emergency contraception's only proven mechanism of operation is preventing ovulation in the same way as the normal birth-control pill, so that fertilization never occurs. This would explain why the morning-after pill is not effective all of the time, and why its effectiveness increases the sooner it is taken after intercourse. It is a common misconception that fertilization always occurs immediately during intercourse. There is only about a 24-hour window for fertilization in each menstrual cycle, so sperm have the ability to stay alive for several days after intercourse, waiting for an egg to be released.

There is also a theoretical possibility that emergency birth control could prevent the implantation of a fertilized egg in the uterus; this has not been shown scientifically or reliably. The same risk would also apply to the normal birth control pill and to certain anti-inflammatories like Vioxx. It is also possible that the morning-after pill could prevent an already released egg from being fertilized. Theoretically, the predominant mechanism would vary according to the stage of the menstrual cycle in which the pill is taken.

Whether emergency contraception counts as an abortion depends on several factors. First, if it prevents ovulation, then no fertilization has occurred and hence there cannot possibly be an abortion. If it prevents implantation of a fertilized embryo, there is a difference of opinion as to whether this would qualify as an abortion. Medically speaking, the morning-after pill is not classified as an abortifacient, since medically that term relates only to an established pregnancy where implantation has already occurred. In common usage, though, the death of a fertilized embryo could be called an abortion regardless of its implantation status.

Emergency birth control is somewhat controversial: opponents, often social or religious conservatives, object to it since it may prevent the implantation of an already fertilized egg. Others hold that it is emergency contraception which reduces the number of unwanted pregnancies and surgical abortions, and is therefore beneficial. The pill's supporters stress prevention of ovulation as its primary effect, although many would also have no moral objection to preventing the implantation of a fertilized egg.

Emergency birth control is not to be confused with RU-486, an undisputed abortifacient which ends a pregnancy by inducing a chemical abortion of an implanted embryo.

International availability

In January 2000, France decided to dispense Emergency birth control in junior and high schools by school nurses without prescription, because of high rates of undesired pregnancies among teenaged girls; after strong opposition from the Catholic Church, and much debate around the fact the teenager could later suffer from the doubt of not knowing whether fertilization had occurred or not, the decision was overruled by a court in July 2000. The French parliament changed the relevant law in October 2000 and now school nurses are again able to dispense the drugs. The pill NorLevo is now available in France without prescription, without parent authorization and for free for teenagers under the age of 18 since the 9th of January 2002 to insure urgency contraception.

As of early 2001, women of age 16 and higher may obtain the morning-after pill in the United Kingdom without prescription. This was challenged by an anti-abortion group, but the High Court of Justice of England and Wales let the rule stand in April 2002.

In the United States, the American Medical Association issued a non-binding recommendation in 2000 that morning-after pills be available over the counter without prescription in the U.S. On December 16, 2003, an advisory committee to the Food and Drug Administration (FDA) recommended that the pill be made available over the counter. [2] The committee voted 23 to 4 that the drug should be sold over the counter and 27 to 0 that the drug could be safely sold as an over-the-counter medication. However, in May of 2004 the FDA went against this strong recommendation and prohibited over-the-counter sale. The FDA claimed that this was due to limited experimental data on the effects of such pills on girls under 16 years of age, but critics have accused the FDA of basing the decision on political pressure. [3]

The American retailer Wal-Mart announced in May 1999 that it would not sell emergency birth control pills in its 2,400 pharmacies; it fills prescriptions for regular birth control pills to be used as emergency contraceptives but does not stock Preven or Plan B. Many smaller pharmacies in the United States have also followed suit.

At about the same time (May 2004) Canada's Health Minister announced that Plan B would soon become available from pharmacists in all provinces without a prescription, although this has yet to occur. It is currently available without a prescription in Québec, British Columbia and Saskatchewan. The new system would still require the person to buy the pills directly from the pharmacist.

Emergency contraception is available without prescription in Albania, Belgium, Denmark, Finland, Israel, Morocco, Norway, Portugal, South Africa, Sweden and Switzerland.

External links

  • Planned Parenthood information on emergency contraception: http://www.plannedparenthood.org/ec/
  • Princeton website with information on emergency contraception: http://ec.princeton.edu
  • Information on morning-after-pill in Germany: http://www.profamilia.de/pille_danach_englisch.html
  • The Emergency Birth Control Organization information on emergency contraception: http://www.emergencybirthcontrol.org

Last updated: 05-07-2005 11:23:05
Last updated: 05-13-2005 07:56:04