Emergency Contraception (Plan B / Morning After Pill)

“Emergency Contraception” is receiving a huge publicity push from the American College of Obstetricians and Gynecologists.  In March, 2002, ACOG President Thomas Purdon sent a mailing to all ACOG members which urged them to make EC patient education a top priority, and which even included sample prescriptions and a sample letter to the local pharmacies urging them to stock the product. In the US Congress, the Emergency Contraceptive Education Act has been introduced to educate health care providers and the general public about EC.    College health centers are encouraged to provide EC.  EC will be marketed to college students in college newspapers and with male pinup posters.  What is this product that is receiving all the attention?  How does it work?  Are there issues of concern for those who believe in the sanctity of human life from conception?  The following discussion will attempt to give some answers to these questions.   What is Emergency Contraception? Emergency Contraception is a general term for estrogen and/or progesterone type (progestin) medications used in high doses within 3 days of unprotected intercourse for the purpose of decreasing the expected pregnancy rate. There are 2 FDA approved products marketed as EC: “Preven,” and “Plan B.” The medications contain the same hormones used in standard birth control pills.  However the single day’s dose is much higher that a single day’s dose of a combination birth control pill.  For instance, Preven contains 10 times the daily dose of estrogen found in a low dose combined oral contraceptive (Levlite), and 10 times the daily dose of progestin as well.  Plan B contains only one hormone, a progestin, in a...

Mechanism of Emergency Contraception

Emergency Contraceptive Pills. [Again,] one must be careful of the terminology. Many now speak of "conception" as that moment when the human blastocyst, the early ball of approximately 100 cells, actually implants in the mother’s uterus (womb). The time from actual fertilization (sperm and egg unite in the Fallopian Tube) until implantation, a period of about 7-10 days, is ignored by this definition, even though no genetic change occurs in the cells during this time period. Many family planning specialists who have supported the terminology change can thus rationalize that the destruction of the human embryo between fertilization and implantation should be labeled "contraception", rather than "early abortion". [American Association of Pro-Life Obstetricians & Gynecologists]   What are hormonal ECPs? The regimen approved by the FDA for post-coital "contraception" identifies 6 brands of ordinary birth control pills (OCs), containing estrogen and progestin, and requires that a high dose of such pills be taken within 72 hours of "unprotected intercourse", followed by a second high dose 12 hours later. How do hormonal ECPs work? According to the FDA, "EC pills…act by delaying or inhibiting ovulation, and/or altering tubal transport of sperm and/or ova (thereby inhibiting fertilization), and/or altering the endometrium (thereby inhibiting implantation)." [emphasis added] [FDA, Federal Register Notice, Vol. 62, No. 37, 25Feb97] These properties of OCs have long been acknowledged, but it is impossible to determine which mode of action is responsible in any given cycle for a woman’s failure to conceive or maintain pregnancy after "unprotected" intercourse. Different modes of action occur depending upon where a woman is in her monthly cycle when intercourse occurs and when...