EMERGENCY CONTRACEPTION: Promoting and Protecting Women's Health and Rights

March 6, 2006

Emergency contraception (EC)—also known as Plan B—is a concentrated dose of the same hormones found in safe and legal birth control pills. It has been approved as a medically safe method to reduce the risk of pregnancy when taken within 72 hours of contraceptive failure or unprotected intercourse. The sooner EC is administered after sexual intercourse, the more likely it is to prevent a fertilized egg from attaching to the uterine wall. For women in their childbearing years, EC must be an option for those who would otherwise face a crisis pregnancy and it must be accessible in a timely manner. Emergency is the operative word. Studies show that women do not rely on emergency contraception as a regular method of birth control and that 1.7 million unintended pregnancies and 800,000 abortions a year could be prevented through increased access to and use of Emergency Contraception.

• EC does not cause an abortion and is officially classified as a contraceptive by the medical community. It prevents a fertilized egg from implantation, but once the egg attaches itself and the pregnancy has begun, EC has no effect.
• After years of medical research and trials, EC was approved by the Food and Drug Administration in 1999 for prescription use.
• In December 2003, a joint hearing of the FDA Nonprescription Drugs and Reproductive Health Drugs Advisory Committees voted 23 to 4 to recommend that the FDA make EC available over the counter.
• Virtually all major medical and health care organizations, including the American College of Obstetricians and Gynecologists and the American Public Health Association, support making EC available without a prescription. FDA Controversy: After an unusually protracted review period and against the recommendations of two of its own advisory panels, the FDA rejected Plan B's application for universal over-the-counter sale.
• The American College of Obstetricians and Gynecologists (ACOG) called this "morally repugnant" and "a dark stain on the reputation of an evidence-based agency like the FDA."
• Congress's bipartisan Government Accountability Office (GAO) issued a report exposing a number of anomalies in the Plan B review and approval process. Most remarkably, the application to sell Plan B over the counter was the only one of 67 proposed prescription-to-OTC applications over the previous ten-year period that was not approved after the advisory committees recommended approval.
• Currently, the status of over-the-counter EC is in limbo as the FDA systematically ignores scientific and medical consensus in order to deliberate arbitrary and harmful age restrictions.

Barriers to EC access include:

• Pharmacist refusal: In pharmacies across the country, rape survivors have been denied EC, married women have been subjected to moralistic lectures for using birth control, and safe, legal prescriptions have been arbitrarily confiscated. Four states (Arkansas, Georgia, Mississippi, and South Dakota) even allow pharmacists to refuse to dispense contraceptives altogether.
• Contraceptive Coverage Restrictions in Insurance and Medicaid Plans
• Emergency Room Policies: In instances reported nationwide, hospital emergency rooms have failed to provide survivors of sexual assault with information about and access to EC - in many cases despite state laws mandating the prompt dispensation of EC upon request.

THE PREVENTION FIRST ACT OF 2005 (S. 20/H.R. 1709)

This legislative package, introduced in the Senate by Harry Reid (D-Nev.), and in the House by Louise Slaughter, (D-N.Y.), is a landmark collection of proposals to expand and improve reproductive health care services to girls and women of childbearing age. It focuses on public education and promotes preventative measures designed to improve the reproductive health of girls and women. It expands access to family planning services, ends insurance discrimination against women, provides sexual assault survivors with access to emergency contraception (EC) and improves medically accurate awareness about contraception—all with the goal of improving women's health and reducing unintended, unplanned and unwanted pregnancies.

This bill is an essential, proactive measure intended to counter the various attacks on women's access to health care. Opponents continue to push proposals to: undermine contraception; allow pharmacists to refuse to fill prescriptions for contraceptives and EC; bully the FDA into keeping Emergency Contraception inaccessible to most women; deny EC access or even information about EC to rape survivors; promote abstinence only education; and oppose condom use even as girls' and women's health, safety and futures are jeopardized. The Prevention First Act is an important tool for helping women and families as they seek health care, victim services, birth control and information about childbearing, and its purposes transcend the politics of the abortion issue.

1. Title X of the Public Health Service Act: An increase of $355 million for the national family planning program—Title X of the Public Health Service Act—so that total funding is at $643 million. Title X clinic services prevent unintended pregnancies, reduce abortion rates, lower STD rates, and promote early detection of breast and cervical cancers
2. Family Planning State Empowerment: Allows states to expand Medicaid family planning services to women with incomes up to 200 percent of the federal poverty level, without a waiver from HHS.
3. Equity in Prescription Insurance and Contraceptive Coverage: Requires private health plans to cover FDA-approved prescription contraceptives and related medical services to the same extent that they cover prescription drugs and other outpatient medical services.
4. Emergency Contraception Education and Information: Provides $10 million in annual funding to implement important public education initiatives about emergency contraception (EC) and its benefits and uses to both women and medical providers.
5. Compassionate Assistance for Rape Emergencies: Requires that hospitals receiving federal funds promptly provide EC upon patient request, in addition to medically, factually accurate and unbiased written and oral information about EC to women who survive sexual assault.
6. Teenage Pregnancy Prevention: Provides $20 million in annual funding for competitive grants to public and private entities to establish or expand teen pregnancy prevention programs.
7. Accuracy of Contraceptive Information: Requires information about the use of contraception (provided as part of any federally-funded program) to be medically accurate and include information about the health benefits and failure rates of contraception.

• Currently, federally-funded abstinence-only programs are precluded from discussing contraception except to talk about failure rates.
• A recent study found that these programs distort public health data and misrepresent the effectiveness of contraception.