Making the "morning-after" pill more readily available to women does not cut the rate of either abortions or pregnancies, a British reproductive health expert contends. After much controversy and three years of delay, the US Food and Drug Administration in August approved over-the-counter sales of the pill, also called Plan B, for women 18 years of age and older.
In an editorial in the Sept. 16 issue of the British Medical Journal, Anna Glasier, director of family planning and well woman services at Lothian Primary Care National Health Service Trust, in Edinburgh, Scotland, said the pill does help some women avoid unwanted pregnancy.
"While emergency contraception sometimes prevents pregnancy for individual women who have had unprotected sex or whose contraceptive method has let them down, such as a burst condom, there is a growing body of evidence which suggests that increasing use of emergency contraception does not have any effect on the rates of unintended pregnancy and abortion," Glasier said.
Use of the "morning-after" pill has grown in Britain in recent years. In 1984, just 1% of women requesting an abortion said they had used it to try to prevent pregnancy. By 1996, that number risen to 6%, and, by 2002, it was 12% of women.
Abortion rates increased
Although emergency contraception has been touted as the solution to rising abortion rates, abortion rates in Britain have increased from 11 per 1 000 women aged 15 to 44 in 1984 (136 388 abortions) to 17.8 per 1 000 women in 2004 (185 400 abortions), even though use of the pill has increased.
Ten different studies found that giving women a supply of emergency contraception to keep at home increased its use twofold to threefold but had no measurable effect on rates of abortion or pregnancy, Glasier noted in her editorial. "So, despite significant increases in the use of emergency contraception in the UK over the past 20 years, abortion rates continue to rise, and in Sweden and France the same holds true," she said.
Opponents of the "morning-after" pill in the United States felt that over-the-counter sales would lead to an increase in teen promiscuity. Glasier said most women don't recognise when they have put themselves at risk of unintended pregnancy, and so they don't use emergency contraception even when they have it in the bathroom medicine cabinet.
"Emergency contraception is not going to be the quick fix solution to rising abortion rates," Glasier said. "The message to individual women should be, if you want to avoid getting pregnant, you should be using a method before you have sex or certainly while you are having sex, and that leaving contraception until after you have had sex is the least good option."
'Not a substitute for effective methods
"For governments," Glasier said, "the message is that emergency contraception is useful when women don't use contraception or when something goes wrong, but it is not a substitute for more effective methods, and the recent emphasis on increasing the availability of emergency contraception will probably not reduce abortion rates."
One expert thinks the reason that emergency contraception hasn't had an impact on abortion or pregnancy rates is that it isn't used enough. "There is clear evidence that increased availability does increase use," said James Trussell, director of the Office of Population Research at Princeton University.
"Moreover, there is also evidence that increasing use does not do what the opponents have claimed. It does not increase risk-taking. It does not decrease regular contraceptive use. It does not increase sexually transmitted infections. It does not decrease condom use," he said.
"However, studies have also found that, despite increased availability and use of emergency contraception, there is no decrease in pregnancy rates," Trussell said. "The problem is that although women have the pill, they don't use it," he said. "Clearly, it's not going to work if you don't use it."
"The reason many women don't use the pill is that they don't think they're at a high risk of getting pregnant," Trussell said. "The problem that we have is simply that emergency-contraception pills are not used enough to have a major public health impact," he said.
Trussell thinks the best way to prevent unwanted pregnancies and abortions is the widespread use of contraceptives, particularly IUDs and implanted contraceptives. -(HealthDayNews, September 2006)
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