If common sense and rationality prevail, soon the so-called morning after pill - a two-pill regimen that prevents pregnancy if taken within the first few days of unprotected sexual intercourse - will be available through over-the-counter sales. The change would help women to avoid unwanted pregnancies and reduce the number of abortions.
The decision to move the pills to over-the-counter status is currently in the hands of the Food and Drug Administration's commissioner, Dr. Mark McClellan. A recommendation in favor of status change was made recently by two FDA advisory committees. By a vote of 23-4, the medical and pharmacological experts on the committees found that emergency contraception is safe, effective and easy to use.
These kinds of strong advisory recommendations typically hold quite a bit of sway with the FDA.
But in this case, the Bush administration's endemic hostility toward birth control and abortion may color McClellen's judgment. He is expected to decide over the next weeks or months.
There is nothing dangerous or different about emergency contraception. It is essentially a concentrated dose of the oral contraceptives that millions of American women utilize routinely. The simple process of preventing pregnancy after unprotected sexual intercourse involves taking one pill within 72 hours and a second dose within 12 hours. While these are easy directions to follow, the short window of opportunity makes procuring a prescription difficult.
In response, a number of states have passed laws allowing pharmacists to sell emergency contraception without a prescription. But this piecemeal system isn't working in some places. In California, for example, where the drugs are supposed to be available without a prescription, only 14 percent of pharmacies offer the pills that way. A nationwide change is needed.
The pocket of opposition to over-the-counter emergency contraception comes from a small group of religious conservatives who object to contraception in general. Dr. W. David Hager, an opponent of birth control pills, was one of those voting against the move to over-the-counter access. He believes it will encourage sexual activity, especially among adolescents.
But that result is not indicated by the studies. When the pills are readily available, young women do not increase their level of sexual activity and older women do not suddenly become irresponsible and stop utilizing regular birth control.
Another objection comes from extreme opponents of abortion who see emergency contraception as a form of abortion. It is possible for the drugs to interfere with the implantation of a newly fertilized egg, but this is relatively rare. More typically, emergency contraception prevents ovulation in the first place.
It is hard to understand why anyone who opposes abortion would want to limit access to emergency contraception, since it is likely to substantially reduce the number of surgical abortions. Estimates are that up to 89 percent of unwanted pregnancies could be prevented by making emergency contraception available over the counter.
If one removes the religious considerations, there are few reasons to object. Studies have found that women have little trouble following the two-pill regimen, and when taken properly the pills are extremely safe and highly effective. Emergency contraception should be available to American women who want to avoid pregnancy.
