In an effort to make emergency contraception more broadly available, the incoming president of the American College of Obstetricians and Gynecologists (ACOG) is calling on physicians to offer advance prescriptions for emergency contraceptive pills (ECPs) during routine gynecologic check-ups. "If most women had [emergency contraception] in their medicine cabinet, or a prescription for it, we could help cut the U.S. rate of unintended pregnancy in half," says ACOG President Elect Thomas F. Purdon, MD. "Ob-gyns--indeed all primary care physicians--can help make that happen."

Citing what he calls an "abysmal and inexcusable" rate of unintended pregnancy and subsequent abortion in this country, Dr. Purdon adds, "A major step is for ob-gyns to discuss emergency contraception with the women they see and offer an advance prescription for their emergency needs.... If enough of us are talking about this fallback method, we may find emergency contraception to be as common in most women's homes as a first aid kit."

What is emergency contraception?

Emergency contraception is an elevated dosage of birth control pills that can prevent pregnancy if taken within 72 hours of unprotected sex. This includes instances when no contraception is used as well as times when a condom breaks, a diaphragm slips, or a woman realizes she has missed her regular birth control pills. The availability of emergency contraception is also crucial to women who have been sexually assaulted.

An alternative method of emergency contraception is to insert a copper-releasing intrauterine device (IUD) within five days of unprotected intercourse, but IUDs are expensive, and in many cases, a woman in need of emergency contraception will be a poor candidate for an IUD because she may also be at risk for sexually transmitted infection (STI), e.g., a woman with a new sex partner or a woman who has been raped. IUDs should never be inserted in a woman who may be at risk for STIs because of the threat of subsequent pelvic inflammatory disease.

According to ACOG, the effectiveness of ECPs in reducing pregnancies ranges from 75% with combination birth control pills (estrogen plus progestin) to 85% with progestin-only pills. In real-world terms, this means that if 100 women had unprotected sex at their most fertile time of the month, eight would become pregnant without ECPs, but with ECPs only two would become pregnant.

Not a form of abortion

ECPs prevent implantation in the uterus of a fertilized egg; they do not induce abortion of an already implanted embryo. Dr. Purdon sees improving access to emergency contraception as a cause that could unite both sides of the abortion debate. "Emergency contraception is an option that should be acceptable to many on both sides of the abortion conflict," he says. "This is a last chance method of oral contraception, which helps prevent abortion. Unlike abortion, if a woman is already pregnant, [emergency contraception] will not terminate her pregnancy."

Part of a growing movement

Half of all pregnancies in the U.S. (about 3 million) are unintended, and about half of those end in abortion. According to Dr. Purdon, widespread availability of emergency contraception could potentially prevent more than a million of these pregnancies and hundreds of thousands of abortions. Earlier this year, more than 60 medical and reproductive rights groups petitioned the U.S. Food and Drug Administration (FDA), urging the agency to make ECPs over-the-counter (available without a prescription). The American Medical Association and ACOG also support this effort.

Several states have launched programs allowing pharmacists to dispense ECPs without a prescription, and there is now an online service (www.not-2-late.com) and a 24-hour toll-free hotline (1-888-NOT-2-LATE) to help a woman locate a healthcare provider or facility that will give her a prescription for ECPs. However, a recent study showed that this service succeeded in referring callers to ECP provision in only 76% of cases.

Getting the word out

According to ACOG, only 20% of the nation's 40,000 obstetricians and gynecologists report that they include information about emergency contraception in their routine contraceptive counseling; 34% of women of reproductive age have never even heard of emergency contraception; and only 1% of women in the U.S. have ever used it.

"Although over-the-counter approval by the FDA would be the broadest step to increase women's access to emergency contraception," says Purdon, "we can't afford to delay other steps while we wait for this scenario to occur. We need to pursue all avenues to increase women's awareness of emergency contraception and their ability to get it within 72 hours."