Critics' focus on morning-after pill may spur use

Knight Ridder Newspapers

(KRT)

PHILADELPHIA - The Bush administration's opposition to emergency contraception seems to be doing wonders for awareness and use of the method.

Health activists have promoted the so-called morning-after pill for 15 years as a way to reduce unplanned pregnancies and the need for abortions. But only now is it catching on, partly due to media coverage of the Bush administration's efforts to thwart easier access to it.

"It has generated a ton of publicity, and that almost surely has a consequence of increasing awareness - and awareness is still the biggest barrier to use," said Princeton University economist James Trussell, a longtime proponent of emergency contraception.

Annual prescriptions for Barr Laboratories' brand, Plan B, have doubled to 1.6 million during the two years that Food and Drug Administration leaders have refused to approve nonprescription sales of the product. FDA advisers and staff, as well as major medical organizations, have endorsed over-the-counter sales.

Barr spokeswoman Carol Cox said, "We've had more interest from reporters on Plan B than anything else we do," including Seasonale, the company's new birth-control pill that reduces monthly periods to four a year.

There also has been fallout from the U.S. Department of Justice's exclusion of emergency contraception from its first national guideline for treating sexual-assault victims. A coalition of medical and advocacy groups - many of whom helped develop the 141-page protocol - asked the department to correct the "glaring omission," but the department has not responded.

Heather Cox (no relation to Barr's Carol Cox), 31, of Tallahassee, Fla., took emergency contraception in a hospital after a neighbor raped her five years ago. "I can't begin to explain how important it was to my recovery that I was able to make a choice to protect myself from a potential pregnancy," she said.

Emergency contraception - a two-dose regimen that contains the same hormones as regular birth-control pills - reduces the chance of pregnancy by from 75 percent to 89 percent, but only if started within 72 hours of unprotected sex. The constraint stymies many women who must find a doctor, get a prescription, and have it filled.

The method has become embroiled in the politics of abortion because, while it usually prevents ovulation or fertilization, it may also work after conception, by preventing a fertilized egg from implanting.

Social conservatives also argue that making Plan B available over the counter would enable statutory rapists to cover up their abuse, expose women to medical problems, and encourage promiscuity and risky sexual behavior, especially by teenagers.

Concerned Women for America, which opposes over-the-counter sales, declares on its Web site: "Easy access to the morning-after pill encourages frequent use and will cause sexually transmitted disease rates ... to increase."

These contentions are not borne out by most studies in states and countries with nonprescription access. Even so, at the FDA's suggestion, Barr revised its original application so that over-the-counter sales be allowed only for women 17 and older. Younger women would need prescriptions.

Nicotine smoking-cessation products, as well as cigarettes and alcohol, already have age restrictions.

In late August, then-FDA Commissioner Lester Crawford announced the agency needed another 60 days to get more public comment on Barr's application, even though he had promised Congress to decide by Sept. 1. The comment period ended this week.

That unexpected delay led to another blast of news coverage, especially when Susan Wood, the FDA's assistant commissioner for women's health, promptly resigned in protest, and Crawford resigned weeks later for unclear reasons.

Wendy Wright, executive vice president of Concerned Women for America, said this week that an age restriction would be "meaningless."

"There is absolutely no way for the FDA to enforce it," she said. "And there is nothing to stop an 18-year-old from buying it and giving it to a 13-year-old."

She also defended the omission of emergency contraception from the Justice Department's new guidelines, saying Catholic hospitals and physicians with moral objections to the method should not be compelled to offer it.

The U.S. Conference of Catholic Bishops has said emergency contraception can be ethically administered, as long as the patient is given a test to ensure that she is not pregnant. That is why New Jersey's Catholic Conference and Catholic HealthCare Partnership helped develop and endorsed that state's seven-month-old "EC in the ER" law.

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(c) 2005, The Philadelphia Inquirer. Distributed by Knight Ridder/Tribune News Service.