Some basic questions and answers about Plan B emergency contraception follow. This is a companion story to a Colorado Confidential investigation of where it is available in Colorado, and how much it costs. While the cost varies only a little from place to place, it is not available at many Colorado pharmacies.
What is Plan B?
Emergency contraception has the same active ingredient as progestin-only oral contraceptive pills. Two doses are taken 12 hours apart, each of which is equivalent to 20 ordinary oral contraceptive pills (i.e. birth control pills).
It must be taken within 72 hours of sexual intercourse, and it is more effective if it is taken sooner.
What is the intended use of Plan B?
Emergency contraception is intended for use when a woman who does not want to get pregnant has unprotected sex for some reason, for example, she was raped, a condom broke, or she forgot to take a birth control pill. It is not a good choice for regular contraception because it is less effective than the alternatives and has more intense side effects.
Is emergency contraception new?
No. The first study of using high doses of oral contraceptives as a post-sex form of contraception was in 1967, not long after the oral contraceptive was invented. The approach used in Plan B was invented in 1975, and by the 1980s became a standard treatment for rape victims and a widely used form of postcoital contraception.
Prior to 1999 in the United States, emergency contraception was an “off label” use of oral contraceptives. Physicians were aware of the proper way to use the drugs for emergnecy contraception, but the drugs were only approved by the United States Food and Drug Administration (FDA) for ordinary oral contraceptive use. Physicians are allowed to prescribe a drug for an “off label” use, but drug companies aren’t allowed to market the drug for that purpose.
When FDA regulations changed in 1997, a consortium was organized to obtain FDA approval to market emergency contraception on a prescription basis. Two years later, this approval was obtained. Barr Laboratories manufacturers the drug and distributes it through a subsidiary.
Prior to 1999, most people learned about Plan B through Planned Parenthood, a student health service at a college or university, or groups such as women’s health cooperatives.
What is new?
On August 24, 2006, the FDA approved over the counter sales of Plan B to women aged 18 and over. Women under age 18 still need a doctor’s approval. Proof of age or a prescription is required to obtain Plan B, and it is sold only at locations which have pharmacies authorized to fill prescriptions and clinics with physicians.
The FDA approval letter comes with a number of conditions which are unique to an over the counter drug. The most notable of these is that the manufacturer’s initial experience with the distribution of Plan B will be carefully monitored and re-evaluated in March of 2007.
This follows a prolonged state and federal legislative and regulatory battle heavily influenced by anti-contraception political groups. In an unprecedented move, approval for full fledged over the counter status for Plan B was denied over the objections of an FDA advisory committee, largely based on the minority objections of an anti-abortion physician on the committee.
Newly elected State Senator Betty Boyd of Lakewood, Colorado, a Democrat, when she was a representative in the state house, introduced legislation in 2005 to require hospital emergency rooms to inform rape victims of the availability of emergency contraception, and in 2006 to allow pharmacists to voluntarily provide Plan B to women without a prescription. Both bills passed the Colorado General Assembly and were vetoed by Republican Governor Bill Owens. A physician testified in hearings on the 2006 legislation that Plan B posed a smaller health risk than asprin.
Why is over the counter status such a big deal?
Plan B is a very time dependent drug. It works best only if taken within 12 hours, and must be taken within 72 hours. This is a very short period of time to discover that Plan B exists, decide to seek a prescription of the drug, obtain a prescription from a doctor, and find a pharmacy that will sell the drug.
Do all pharamacies sell Plan B?
No. No pharamacy is required by law to sell any particular drug, but most pharamacies keep almost all drugs potentially used by a signficant number of customers in stock.
Some pharamacies have chosen not to stock Plan B. Many pharmacies (outside Illinois where a pharmacist cannot refuse to sell a drug based on a personal moral objection to it) have taken the position that if an individual pharmacist has a moral objection to Plan B, that a pharamacist may veto a customer’s decision to buy Plan B based on the pharmacist’s personal moral values alone.
Women concerned about obtaining Plan B in a timely fashion may obtain it before they actually need it.
Does Plan B work?
Yes. The odds of a woman who has unprotected sex once at the most fertile part of her monthly cycle getting pregnant is about 8%. If Plan B is taken within 12 hours of unprotected sex, that probability drops to about 2%. Plan B is less effective after twelve hours, but still provides meaningful reductions in the chance that a woman will get pregnant for about 72 hours.
Are there side effects?
Sometimes. About a quarter of women who take Plan B feel nausea and other “feel like shit” side effects in the first twenty-four hours after taking it. It also often screws up the menstrual cycles of women taking it.
When Plan B doesn’t work, about 1 in 20 resulting pregnancies are ectopic pregnancies. When no contraception is used, about 2% of pregnancies are ectopic pregnancies. Ectopic pregnancies are a serious health risk that requires medical attention.
Is Plan B an abortion pill?
No. Emergency contraception works by both preventing ovulation or fertilization and by possibly preventing post-fertilization implantation of a fertilized egg, just as oral contraceptives do. If you do not believe that taking oral contraceptives is abortion, then you should not consider Plan B to be an abortion pill.
People sometimes confuse Plan B with Mifepristone, also known in the United States as RU-486. In women up to 7 weeks pregnant, RU-486 induces a chemical abortion 92% of the time, something that makes it possible for a woman to obtain an abortion without going to an abortion clinic. Plan B is not effective once a fertilized egg has implanted itself in the uterus.
Countries like Mexico, which have near total bans on abortion, do not ban emergency contaceptives like Plan B.
Many anti-abortion groups feel that all forms of oral contraception, including emergency contraception, cause abortions, because they take the minority view that if a fertilized egg is not allowed to implant, that this is an abortion. At least one medical ethicist has noted that the rhythm method, which is the only method of pregnancy prevention most anti-abortion contraception opponents favor, may also have this effect.
Is the Plan B debate over?
No. The group of women who are least well positioned to quickly obtain a prescription for Plan B, women under eighteen years of age, are also the only people who need a prescription. This requirement is contrary to the recommendations of the relevant FDA advisory panel and is not based on scientific evidence or studies that indicate that women under eighteen years of age of helped by the prescription status of the drug.
There are about 64,880 sexually active teenagers in Colorado. According to the Guttmacher Institute there are:
12,130 teenage pregnancies each year in Colorado, 62% result in live births and 23% result in abortions. Colorado’s teenage pregnancy rate declined by 26% between 1992 and 2000.
There is also no requirement in Colorado that rape victims be informed of the availability of Plan B, something that is standard medical practice in most non-Catholic hospitals, and is required in Massachussetts. A bill that would have required this was vetoed in Colorado.
Finally, pharmacists in Colorado (and almost every other state except Illinois), are permitted to override a doctor’s orders prescribing a drug such as emergency contraception to a patient, imposing the pharmacist’s own moral values on his or her patients. A number of pharmacists, including some in Colorado, are morally opposed to providing this drug to patients. And, nothing prevents a pharamacy from refusing to stock this drug entirely.
Is Plan B the only form of emergency contraception?
No. A copper-T intrauterine device (IUD) can be used up to 5 days after unprotected intercourse to prevent pregnancy and is more effective than Plan B. It is only inserted by a physician, so it may be more difficult to obtain one in time for use as an emergency contraceptive. Once inserted, an IUD can then be used for long term, reversible contraception.
IUDs are controversial in the United States because an early version called the Dalkon Shield, introduced in the United States, was defective and some caused serious health problems for hundreds of thousands of women who used them. Newer versions introduced in the 1970s are used more widely than oral conceptives worldwide and lack the health risks present in earlier IUDs.
Is there a place that my emergency contraception story can be shared that could make a long term policy difference?
Yes. Planned parenthood is collecting personal stories. See the link for more information.