Birth Control Archive

September 2005: Birth Control

Canada Approves Morning After Pill (M.A.P./EC) Over-The-Counter (OTC)

Argentina and M.A.P.

Oral Contraceptives and the Risk of Cancer: International Doctors’ Group Echoes Warnings of the World Health Organization (WHO)

Plan B

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CANADA APPROVES MAP/ EC OTC – formalizing an order making the MAP/EC available in pharmacies over-the-counter and without a prescription. The document itself states that so-called emergency contraception “prevents the fertilized egg [sic] from attaching to the wall of the uterus”. [Rt to Life of Greater Cincinnati, 8/05]

ARGENTINA & MAP – Argentina has only 39.5 million people, with a fertility rate of 2.19 children per family – ZPG. The current national gov’t promotes “reproductive health” aggressively. The introduction of the MAP/EC sparked court battles which the pro-life side won; 2 companies, representing 90% of the market of MAP, have since stopped producing MAP. This has affected neighboring countries as well [Argentina is a major pharmaceutical producer/exporter]. The most dramatic pro-life victory came when federal judge Cristina Garzon de Lascano in Cordoba ruled in 2003 that all abortifacient birth control methods violated Argentina’s constitution and must be banned from the country. Like the US federal ban on Partial-Birth Abortion, however, this excellent pro-life measure has been challenged in the courts and is still being appealed. The ministry of health in Argentina is actively opposing the ruling. [HLI Special Report, no.248, 8/05]

ORAL CONTRACEPTIVES AND THE RISK OF CANCER: DOCTORS’ FEDERATION ECHOES WARNINGS OF WORLD HEALTH ORGANIZATION An int’l medical federation has echoed a warning by the World
Health Organization about the increased risk of cancer linked to oral contraceptives. More than 50 national associations, representing 30,000 doctors worldwide, make up FIAMC (the group’s French acronym).
 * * *
The International Agency for Research on Cancer, the Lyon-based cancer research agency of the World Health Organization, in its press release of  29 July 2005, announced the publication of a monograph on the possible carcinogenicity [of] combined estrogen-progestogen oral contraceptives and combined estrogen-progestogen menopausal therapy, based on the conclusions of an international ad hoc working group of 21 scientists from 8 countries. Previously, combined oral contraceptives had been determined to be
carcinogenic to humans, but only primary liver cancer was specifically implicated. The
Working Group, after a thorough review of the published scientific evidence, concluded that combined oral contraceptives alter the risk of several common cancers in women.
Estrogen-progestogen oral contraceptives were classified in the Group 1 of carcinogenic agents. This category is used when there is sufficient evidence of carcinogenicity in humans.
These conclusions are of enormous public health importance, since it is estimated that worldwide, more than 100 million women — about 10% of all women of reproductive age — currently use combined hormonal contraceptives. In addition, there has been widespread use of hormonal menopausal therapy: approximately 20 million women in developed countries.
For all these women, the message is that the use of oral contraceptives increases the risk of breast, cervix and liver cancer. On the contrary, the risks of endometrial and ovarian cancer are decreased in women who used combined oral contraceptives.
Regarding combined estrogen-progestogen menopausal therapy, WHO warns that it increases the risk of breast cancer and endometrial cancer (at least when progestogens are taken fewer than 10 days per month) and that there is not sufficient evidence to conclude that hormonal therapy has a protective effect at any cancer site. The WHO experts call to a rigorous analysis to demonstrate what can be, at the end, the overall net public health outcome of the use of oral contraceptives. In addition, each woman who uses these products is now invited by WHO to discuss the overall risks and benefits with her doctor, taking into consideration her personal circumstances and family history of cancer and other diseases.
     FIAMC invites all health care providers to attentively consider the results of the WHO study… and encourages … doctors to spread the methods for natural family planning also in Western affluent societies.  [Gian Luigi Gigli, MD President ZE05090723; ROME, 7Sept05; http://www.zenit.org/; The World Federation of Catholic Medical Associations ]

IS PLAN B ‘UNSAFE’?    The FDA [Food/Drug Administration] decision to defer a ruling to allow over-the-counter (OTC) sales of the emergency contraception drug Plan B has generated debate over the agency’s independence from political pressure.  But opponents of broader access to the so-called morning-after pill often cite safety issues as a primary concern. They say there is no research in adolescents showing safety of the treatment, which consists of high doses of the hormone progestin. Opponents also note use of the pills leads to higher incidence of sexually transmitted infections (STDs/STIs) and promiscuous behavior, which can carry its own dangers. A Swedish study published in 2002 reported that STIs [specifically Chlamydia, rose 30%] among adolescents who had OTC access to emergency contraception and other forms of contraception [Chlamydia can lead to PID and sterility].
Many groups oppose OTC status including American Association of Pro-Life Obstetricians & Gynecologists, and Concerned Women for America, a public policy organization. Since birth control pills, which contain lower doses of progestin, are available only by prescription, said Wendy Wright [senior policy dir, Concerned Women for America] “it’s crazy that we’re even discussing that the high dose of the drug be available without a prescription”…
What has stalled FDA approval of the drug for over-the-counter (OTC) sale is controversy over whether Plan B should be sold without a prescription to those ages 16 and under. Plan B was approved by the FDA in 1999 as a prescription-only medication… Plan B contains a high dose of a synthetic form of progestin, which has been used in birth control pills for more than three decades — both in progestin-only formulas and in combination with estrogen, another female hormone. (The combination pill, especially in formulations stronger than those currently on the market, is associated with increased risks of nausea, vomiting and blood clots in the legs and lungs. The combination pills may also increase the risk of breast cancer, liver tumors and endometrial cancer. It is not known if progestin-only contraceptives increase risk for those conditions.) Progestin works by preventing the release of an egg from an ovary, and it may also “prevent the union of sperm and egg (fertilization),” according to an FDA statement listing common questions and answers about Plan B. If fertilization occurs, Plan B “may prevent a fertilized egg [sic] from attaching to the womb (implantation). If a fertilized egg is implanted prior to taking Plan B,” the drug will not prevent pregnancy. [Preventing implantation of the 100-cell ‘blastocyst’ embryo would cause it to be expelled from the mother’s body – an early abortion.]
Wright said her group opposes OTC emergency contraception because the pill would have side effects similar to those found in birth control pills.
  “Any of the complications you can have [with birth control pills], you obviously could have with” Plan B, Wright
said. She cites the need for
a doctor to evaluate a woman’s health and medical history before writing a prescription. Women should not take Plan B if they have undiagnosed, unusual vaginal bleeding or a sensitivity to progestin. Traditional progestin-only birth control pills increase risk for tubal pregnancies — when a fertilized egg implants outside the uterus, and the fetus and placenta start to form there, most often inside of a fallopian tube. It is not known if Plan B increases this risk, according to the drug’s label, which adds that women who experience severe abdominal pains should see a doctor immediately because that can be a warning sign of tubal pregnancies. Plan B’s label advises that women may experience heavier or lighter bleeding than normal soon after taking it. After taking the drug, 87 percent of women get their next period within a week of when it was expected, the label states. Birth control pills are intended for extended use, while Plan B is meant for one-time or episodic use. [Sep. 12, 2005 The Washington Post, J. Payne]