emergency contraceptionthe morning after pill

Emergency Contraception/ The Morning After Pill According to the United States Supreme Court decision in the landmark case of Roe v. Wade, every woman has the right to regulate her own reproductive health. Pretty cut and dried, right? Apparently less than we would like to think, since the issue of Emergency Birth Control has become a hotly debated issue.

The most recent end result of this debate is that only eight states (Alaska, California, Hawaii, Maine, New Mexico, New Hampshire, Washington, and Massachusetts) have passed legislation permitting trained pharmacists to dispense emergency contraception without a doctor’s prescription. (Ginty, 2005). House Bill 4229 was introduced in November of 2005 and subsequently referred to the Subcommittee on Health in February of 2006. It seems that because of the controversy surrounding the “morning-after” pill, it is being handed off like a hot potato from one group to the next in hopes of avoiding the inevitable controversy.

The issue of emergency contraception is a critical one for every woman in America. The problem, simply stated, is either we have the right to control our reproduction, or we don’t. It seems there is little room for an “in-between” solution.If women are not allowed to use emergency contraception, is it only a matter of time before birth control pills, diaphragms, IUD’s and contraceptive foams are made inaccessible to women as well? Will the day come when condoms require a doctor’s prescription, are available only in certain states, and the pharmacist behind the counter has the right to refuse to sell them (even with a prescription) based solely on his own moral beliefs? An analysis of the issue would tend to show that women in America have become somewhat apathetic toward issues such as this one.

After all, the majority of us grew up in an age when the right to decided if we wanted children or not was a given; more than that it was a personal decision, one that the Supreme Court was not privy to. Most of us thankfully have little memory of back-street abortionists who often time ended up scarring the woman and leaving her infertile, or even worse, killing her. The time has certainly come for American women to stand up and make their voices heard before the Subcommittee on Health proceeds with their decision-making process, perhaps ending up with a result we are less than happy with.This issue has far-reaching contexts, beyond each of our individual feelings about contraception and abortion.

Considering that over one third of all pregnancies are unplanned and over 20% of all pregnancies end in abortion, it is an issue we should all be following closely. (Whitfield, 1995). So how exactly did this issue evolve? As we are all well aware the abortion issue is one that is hotly debated and one that can be a “make or break” for candidates running for office. There are pro-life groups abounding as well as pro-choice.

The pro-lifers are equating the morning after pill to an abortion, a comparison that is far from the truth in reality. If the objection to the morning-after pill is a moral one, the question comes down quite simply to when a human life begins. This is a question that should be answered by human embryologists rather than philosophers, preachers, politicians, movie starts, obstetricians or gynecologists. Technically speaking, the “fusion of the sperm (with 23 chromosomes) with the oocyte (egg) which also has 23 chromosomes at fertilization results in a live human being; a single-cell human zygote, with 46 chromosomes—the number of chromosomes characteristic of an individual member of the human species.

” (Irving, 1999) If we agree with this scientific explanation, then there is no doubt that the immediate product of fertilization is a human being—not a potential or possible human being, but an actual human being.The flip side of this argument would be of course that until that fertilized zygote has the potential to live outside the womb on its own, it can not be considered a person. Therefore, the issue of abortion will go on and on, with proponents for each side. The morning-after pill, however should not in any way be confused with abortion.

In the majority of cases, Preven, or the morning-after pill works by delaying ovulation or by blocking fertilization altogether. In a much smaller number of cases, Preven prevents the fertilized egg from attaching to the womb. Pro-lifers point to the latter as akin to a chemical abortion, therefore something they are strongly opposed to. (Boston Globe, 2005).

There are several combinations of oral contraceptives that make up the morning after pill; some are a combination of progestin-only oral contraceptives, danazol, synthetic estrogens, conjugated estrogens, antiprogestins as well as the insertion of an intrauterine device.The most frequently used method is the progestin-only oral contraceptive because their safety is fairly well documented. (American, 2002). The statistics (compiled by EBC proponents) in favor of making Preven and others like it an over-the-counter drug include:? Widespread use of EBC (emergency birth control) could prevent 1.

7 million unintended pregnancies and 800,000 abortions each year in the Unite States alone.? EBC is not the same as the French abortion pill RU-486, which produces an abortion in a woman through the first trimester.? A woman does not become pregnant until 5-7 days after having sex. EBC works after a woman has sex, but before she becomes pregnant.

? EBC pills can be taken up to 3 days after having unprotected sex, and 95% effective if taken within 24 hours.? The majority of medical science defines the beginning of pregnancy as the successful implantation of a fertilized egg in the uterus. Medication that works before pregnancy is then, by definition, not abortive.? EBC prevents pregnancy by interfering with the biological process at four different stages: ovulation, tubal transport, fertilization and implantation.

? EBC’s are safe for most women to use and have no long-term negative effects. ? If a woman takes EBC and still becomes pregnant, her baby will not be harmed. (Fast Facts, 2006). Socially the morning-after pill becomes an issue related to bringing unwanted or unplanned children into the world.

As any sociologist of social worker will tell you, the horrors they see on a daily basis in children who were born to parents unprepared or unwilling to have children is a huge problem in the United States. Surely an emergency contraception that could potentially prevent a substantial amount of child abuse and neglect can be nothing less than a good thing? Economics also play a huge role in bringing unwanted children into the world.The amount of children currently living below the poverty level is appalling, and bringing more of them into the world to suffer the same fate just doesn’t make sense. Ethically the issue comes down to each person’s own moral beliefs regarding when a life begins.

Politicians attempt to control women’s reproductive choices as a platform for their elections, and the legal issue stems from the political debate. Unfortunately, palms are greased and deals are made, (overwhelmingly by men) behind closed doors that limit or prevent women’s choices. Any politician knows that the issue has almost nothing to do even with his own personal beliefs, but rather an assessment of his constituents’ beliefs. From that determination the politician uses the information to win the election and essentially do whatever he chooses anyhow.

Should politicians have the right to use our freedom of choice to gain office, or should the issue of women’s reproduction be and remain an intensely personal choice, known only to the woman herself, her doctor and her own conscience or moral beliefs? Ultimately, in a perfect world, the only ones voting about this issue would be the ones affected—women. Dr. Susan Wood, former director of the FDA Office of Women’s Health offered this opinion: “I feel very strongly that this shouldn’t be about abortion politics. This is a way to prevent unwanted pregnancy and thereby prevent abortion.

This should be something we all agree on.” (Emergency Birth Control, 2006). Dr. Wood subsequently resigned from her position in protest of the FDA denying over-the-counter status to EBC.

Consider this: After a sexual assault a young Tucson woman spent three frantic days attempting to obtain the drug to prevent a pregnancy. She knew that each passing day lowered her chances that the drug would work. She called numerous pharmacies only to find that the majority did not stock it, and when she finally found a pharmacy that did stock the pill, she was shocked to find that the pharmacist on duty would not dispense the drug because of his own religious and moral objections. Although women who report sexual assaults are immediately offered emergency contraception in their hospitals, many sexual assault victims do not report the crime for a variety of reasons including trauma and guilt that they are somehow responsible for what happened.

(McClain, 2005).Therefore, the women who choose not to report their sexual assault may find it difficult, if not impossible, to obtain emergency contraception after her assault, furthering her trauma. Certain religious groups, most especially Catholics, as well as others who strongly oppose abortion went through a similar issue in the late 60’s. When the original birth control pill was introduced, doctors and pill manufacturers “realized that the abortifacient aspect of the Pill needed to be disguised.

” (Reardon, 2005). For those who accepted birth control but were opposed to abortion, the Pill could present a definite problem. At this time population controllers began to “redefine the medial meaning of conception. According to this new definition which is widely used in medical textbooks, conception occurs at the moment of implantation rather than at fertilization.

” (Reardon, 2005). This “tortured logic,” worked quite well, and thousands of Catholic doctors sighed in relief and pulled out their prescription pads. “Indeed, even many pro-life groups were unwilling to blow the whistle on this deception.” (Reardon, 2005).

Going on the theory that ignorance can sometimes truly be bliss, women have enjoyed some forty years being able to easily and legally prevent unwanted pregnancies. In fact, regular birth control pills can be taken in high dosages in the same way Preven or other emergency contraception pills can, however this use of the Pill was not sanctioned by pharmaceutical companies because of possible side effects. Those who oppose the use of emergency contraception state that if it were made readily available, women would use it “too often.” In an effort to determine whether this argument had merit, Anna Glasier, M.

D., and David Baird, D.Sc. studied two groups of women in Scotland.

A total of 1083 women were studied, all of which had either previously used emergency contraception or who had gone through a surgical abortion. While this study did indeed show that this group of women used emergency contraception at a higher rate than the control group (who had to first obtain a doctor’s prescription) the results can be considered somewhat skewered. After all, This group of 1083 women were far from a representative group since all of them had either had a surgical abortion or already used emergency contraception. The study on this particular issue needs to be performed on a much more representative group of the population.

(McGovern, 1999).Something many people are unaware of is that the insertion of an IUD within 120 hours of unplanned or unprotected intercourse substantially reduces the risk of pregnancy. IUD’s have been used for this purpose for over twenty-five years, yet because they are not available over the counter, it has apparently never become an issue. The Bush administration blocked implementation of a bill which would have made emergency contraception an over-the-counter private matter because it “offends anti-abortion forces.

” (Center, 2006). This is illogical, however, because emergency contraception is the same medicine as the one-per-day birth control pills that some 82 percent of American women have taken at some point in their lifetimes. (Center, 2006). To further show that the issue of emergency contraception goes beyond the usual FDA switch of drugs from prescription to OTC, consider this: The FDA oversees the switch of drugs from prescription to OTC.

“Generally, prescription drugs are drugs that are safe for use only under the supervision of a health care practitioner. Approved prescription drugs that no longer require such supervision may be marketed OTC.” (Government Accountability, 2005). The FDA authorizes such a switch only after it has been determined that the drug has an acceptable safety profile, has a low potential to be abused, has a positive benefit-risk assessment, and is needed for a condition that is self-recognizable, or self-limiting and “requires minimal intervention by a health care practitioner for treatment.

” (Government, 2005). Although Plan B, or emergency contraception met all the requirements the recommendation was rejected. In itself, this is telling about the political ramifications of approving the drug for OTC use. Another issue on the table in the quest to make Preven an over-the-counter drug revolves around the age at which women (or girls) should be allowed to obtain the drug should it become readily available.

Many opponents believe that allowing girls younger than 17 to obtain the drug would show an increase in sexual promiscuity because essentially the “consequences” would have been taken away.With the advent of more and more serious sexually transmitted diseases, this becomes a serious consideration, and one the Subcommittee of Health is looking at. At what age is a young girl mature enough and responsible enough to use the drug responsibly? At this point in the research for better contraception and emergency contraception methods, there is no comparable drug to Preven. Ideally, a drug would be developed that both blocks ovulation and delays fertilization, but does not interrupt implantation.

If a drug existed that accomplished the first two objectives while specifically not doing the third, there would be little to argue about, and it certainly would be approved, giving women another choice in their reproductive cycles. The resources necessary would entail going back to the drawing board to study and test the drug with the end result of a new drug that everybody was happy with. This, of course is the ideal, and not a particularly realistic choice. Starting all over on testing and developing a drug is incredibly expensive and it is unlikely the objectives stated could actually be obtained.

Women are the absolute stakeholders in this issue; after all it is our bodies the decisions are being made about. If we all just sit back and choose to do nothing on this issue, the reality is that the current bill in place could languish for months or even years, bouncing from one committee to another until such time as a particular group decides to brave the fallout and make a decision one way or another. Politicians are certainly involved in the end result, much more than we would like or even believe, and barring a huge group of women banding together and taking a stand, it is unlikely to be resolved any time soon. In retrospect, this is actually a fairly reasonable solution to the issue.

Politicians are elected by women as well as men. If women were making their voices heard regarding the morning-after pill, both aspiring politicians as well as those already in office would have no choice but to sit up and take notice. The voices are quiet at present, hence the judges and politicians are making the decision for us. Should the drug be approved for OTC use, the pros are that there will be a substantial decrease in unwanted pregnancies and abortions, and women would take a step forward in the quest to be responsible for their reproductive health.

On the flip side it is possible that with a “backup plan” in place women could become lax about birth control.The feeling that there would be no possibility of getting pregnant could also lead to increased promiscuity and ultimately an increase in sexually transmitted diseases. Even with those possibilities in sight, I believe an evaluation of the entire issue would still yield the decision that in the case of unplanned intercourse or a sexual assault, women should be able to obtain the morning-after pill from their local pharmacist, with no more legislation or debates involved. Works Cited: American College of Obstetricians and Gynecologists Journal, August, 2002, 78(2):191- 8.

Emergency Oral Contraception, accessed July 7, 2006. Boston Globe, July 26, 2005. Romney vetoes law on pill, takes aim at Roe v.Wade.

[Online] Accessed July 1, 2006 from: http://www.boston.com/news/local/articles/2005/07/26/romney_vetoes_law_on_pill_takes_ Center for Policy Alternatives, 2006. Emergency Contraception—Collaborative Practice.

[Online] Accessed July 2, 2006 from: http://www.stateaction.org/issues/issue.cfm/issue/EC-CollaborativePractice.

xml Emergency Birth Control, 2006. Morning-after pill. [Online] Accessed July 1, 2006 from: http://en.wikipedia.

org/wiki/Morning-after_pill Emergency Contraception, 2006. Emergency Contraception: The morning-after pill. [Online] Accessed July3, 2006 from: http://www.morningafterpill.

org/mapinfo1.htm Fast Facts, 2006. Emergency Birth Control. [Online] Accessed July 1, 2006 from: http://www.

emergency.birthcontrol.org/ Ginty, Molly M., November 4, 2005.

State Opens Back Door to Emergency Contraception. [Online] Accessed on July 5, 2006 from: http://www.womensenews.org/article.

cfm/dyn/aid/2515 Government Accountability Office, November 2005. Decision Process to Deny Initial Application for Over-the-Counter Marketing of the Emergency Contraceptive Drug Plan B Was Unusual. Available from Food and Drug Administration Report to Congressional Requesters Pamphlet. Irving, Dianne N.

, M.A., Ph.D.

, 1999. When Do Human Beings Begin? “Scientific” Myths and Scientific Facts. [Online] Accessed on July 1, 2006 from: http://www.morningafterpill.

org/whendoes.htm McClain, Carla, October 23, 2005. Rape victim: ‘Morning after’ pill denied. [Online] Accessed on July 2, 2006 from: http://www.

azstarnet.com/dailystar/dailystar/99156.php McGovern, Celeste, December 6, 1999. Just A Little Bit Pregnant? [Online] Accessed on July 1, 2006 from: http://www.

prolife.com/MorningAfterPill.html. Reardon, David C.

, PhD, 2005. The Best Kept (ugly little) Secret in America. [Online] Accessed on July 5, 2006 from: http://www.afterabortion.

info/PAR/V6/n4/birthcontrol.htm USCCB, 1998. Life Insight-Emergency Contraceptive Pills. [Online] Accessed on July 6, 2006 from: http://www.

nccbuscc.org/prolife/publicat/lifeinsight/sept98.htm. Whitfield, M.J., and Smith, L.F., Department of Social Medicine, University of Bristol, December, 1995 45(401):691-2 Accessed on July 7, 2006 from: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=Abstract

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