Emergency Contraception: U.S. Out of Step

By NOW Foundation Intern Jesse Mesich

October 26, 2005

Find a Facility that Dispenses Emergency Contraception Near You

The Food and Drug Administration's unwarranted delay in approving over-the-counter (OTC) sale of emergency contraception (EC) has been much in the news lately. Against the advice of two FDA advisory committees and contrary to the endorsement of some 70 respected medical associations, several FDA officials have suggested that availability of EC to women age 16 and under would lead to promiscuity. There is no evidence that EC use by adolescents increases their level of sexual activity, and there is specific evidence that it does not. Many close observers believe that this fallacious assertion is pandering to the administration's extremist anti-birth control activists.

A 2001 study conducted by the Alan Guttmacher Institute concluded that emergency contraception, if readily dispensed, could cause a 43% reduction of the approximate 1.37 million abortions that occur each year in this country. If EC was dispensed OTC world-wide, it would dramatically cut the approximately 46 million abortions worldwide each year. Of the 210 million women around the globe who become pregnant each year, about 80 million of their pregnancies are unplanned, according to the Center for Reproductive Rights.

Opponents of EC often assert that prohibiting a fertilized ovum from implantation in the uterus, which sometimes happens with EC use, is tantamount to an abortion. While this debate drags on in the U.S., millions of women are denied easier access to a proven safe drug that is available to women in many other countries.

39 Countries have OTC Access - Many other nations not only have EC available in prescription form, but also provide it over-the-counter. Around the globe, there are approximately 39 countries that facilitate access to EC without prescription, including: Albania, Belgium, Canada, Denmark, Finland, France, India, Israel, Morocco, Norway, Portugal, Republic of Congo, South Africa, Sweden, and the United Kingdom.

One of the countries that provides emergency contraception without a prescription is France, where it has been available since the 1970s. In May of 1999 it was packaged specifically as the "morning-after pill". One month later, France made EC a nonprescription drug, allowing women to get it directly from the pharmacist as France does not have over-the-counter drugs like in the U.S. The French government also reimburses over 65% of the cost of the drug, and minors are allowed to receive it free of cost and without parental notification. Furthermore, since December 2000, minors have been able to receive EC from their high school nurses. Since EC has been made available in nonprescription form in France, over 1.5 million treatments have been dispensed, 97% with no prescription. As a result, France has an extremely low abortion rate.

India is the latest country to allow EC OTC. The Indian Health Minister announced on August 31 that his country had approved the sale of emergency contraception over-the-counter, and expressed hope that allowing EC OTC will reduce the number of unsafe abortions in India, which kill 20,000 women annually. The health minister said that having the emergency contraception available without prescription would be important in alleviating women's distress about seeing a doctor for this reason.

States Expedite Availability - It is not only foreign countries that see the practicality in providing emergency contraception over-the-counter, a few U.S. states have also made access easier. In 1988, Washington was the first state to allow women to get EC directly from a pharmacist, without first going to a doctor. This pilot plan was based on a collaboration between doctors and pharmacies that set specific screening criteria women must meet in order to receive EC. There were almost 35,600 prescriptions filled for EC from February 1998 until the trial expired in June 2001, preventing thousands of unwanted pregnancies. Washington's pilot program opened the door for other states to explore their own EC OTC policies. Currently, Hawaii and Alaska allow EC to be sold OTC using the Washington model of collaboration between doctors and pharmacists. Additionally, California, Maine, and New Mexico allow EC to be sold OTC through their specific state-approved protocol. Two other states, Massachusetts and New Hampshire, have also passed laws allowing easier access to EC, however they are still trying to implement them.

Massachusetts is the most recent state to pass legislation allowing EC to be sold over-the-counter. The bill initially sailed through the state's Senate and House of Representatives and passed overwhelmingly. However, Massachusetts Governor Mitt Romney vetoed the bill on July 29 in keeping with (he claimed) his campaign pledge not to change any state "abortion laws." Legislators were able to override the veto on September 15 of this year, thus enacting the law. The Massachusetts law is based on the Washington state legislation, and also guarantees that emergency rooms will offer EC to rape victims.

Despite these advances by the states in dispensing EC OTC, there is also a counter-movement by pharmacists who are refusing to fill prescriptions for EC and even for birth control pills. These pharmacists claim moral or religious objections to filling the prescriptions and therefore refuse to fill them even though their female customers received their prescriptions from a doctor. This recent campaign has been instigated by a number of well-known anti-abortion rights organizations and political religious organizations.

Pharmacists' Refusals Alarming - The Alan Guttmacher Institute reports that during a six month period in 2004 more than 180 pharmacists refused to fill prescriptions for EC. In fact, four states - South Dakota, Arkansas, Mississippi, and Georgia - have policies that allow pharmacists to refuse to dispense a prescription if they personally disagree with the practice. What is even more alarming is that eight more states are considering similar legislation. We must counter this alarming trend that threatens to deny effective and needed medicine to women.

This decision by individual pharmacists to limit women's reproductive rights has brought outrage from many quarters. Supporters of over-the-counter EC have lobbied legislatures to ensure availability through mandated pharmacist referrals and other means. Two states, Illinois and Nevada, have laws ensuring a patient's access to this legally-prescribed medicine by making it illegal for a pharmacy to refuse to fill a prescription for EC. Five additional states and the U.S. Congress have had similar bills introduced. The federal bill is H.R. 1539, sponsored by Rep. Carolyn McCarthy (D-N.Y.), which stipulates that if a pharmacist refuses to fill a prescription, the pharmacy must arrange to have another pharmacist fill the prescription within four hours of the initial refusal. One of the important advantages of over-the-counter availability is that it would completely bypass pharmacists' refusals. Perhaps that is why right-wing anti-birth control activists are fighting so hard to stop EC OTC.

Officials Resign over EC Delay - The Food and Drug Administration's foot-dragging has prompted several officials to speak out. Two top FDA officials: Dr. Susan F. Wood, who was Assistant Commissioner for Women's Health and Director of the FDA's Office of Women's Health, and Dr. Frank Davidoff, who was a consultant to the FDA's Nonprescriptive Drug Committee, have stepped-down from their respective positions in protest of the government's delay in providing EC to the women of this country. Davidoff voiced this frustration in his letter of resignation: "I can no longer associate myself with an organization that is capable of making such an important decision so flagrantly on the basis of political influence, rather than the scientific and clinical evidence."

Furthermore, many in Congress are becoming increasingly more frustrated with the delayed FDA ruling and growing reports of pharmacist refusal. On October 7, a bipartisan letter was sent to the FDA Acting Commissioner Andrew von Eschenbach urging him to stop the delay and allow EC to be sold over the counter to all women.

Another challenge for women's reproductive rights advocates lies in what appears to be a significant gap in public awareness. A 2003 poll conducted by the Kaiser Family Foundation revealed that 32% of women aged 18-44 were not aware that there is a method of contraception that is effective after unprotected intercourse has already occurred. Additionally, only 6% of women have ever used EC. A successful educational campaign about what emergency contraception is and how it works, as well as information about the need for EC availability without prescription, would help immensely. Also, when EC is made available over-the-counter in the U.S., there must be an education campaign to ensure that women — especially young women — know about this safe and effective contraceptive option.

CHECK IT OUT: Find a Facility that Dispenses Emergency Contraception Near You.

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More from NOW about emergency contraception.

For more information:

• Alan Guttmacher Institute - Emergency Contraception: Improving Access
• Center for Reproductive Rights - EC Legislative Trends
• Kaiser Family Foundation - Fact Sheet on Emergency Contraceptive Pills (PDF)
• Pharmacy Access Partnership - EC Over-the-Counter Status