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As the name suggests, the so-called "morning-after pill" can prevent a pregnancy even after unprotected sex. If the condom broke, or the birth control pills were forgotten, or, worse, a woman was raped, emergency contraception offers a crucial alternative to the prospects of abortion or motherhood. It's a safe, relatively affordable treatment a woman can use at home.
There's only one problem with the morning-after pill: Try getting it the morning after.
In order to get the prescription-only pills, a woman has to reach her doctor, often when offices aren't open. Then she has to find a pharmacy that has the drug available--no mean feat given that many stores don't even stock it, either because they say there's not enough demand, or, sometimes, because they object to it on moral grounds. And she has to do this as soon as possible, ideally within 24 hours.
Here in Minnesota, this obstacle course would change if a handful of women's health advocates had their way. In a year when the state has seen unprecedented changes aimed at eroding reproductive rights and restricting access to health care, a group of doctors, pharmacists, and proponents of family planning are striving to increase access to emergency contraception throughout the state. They plan to do this not through public policy or legislation, but through a homegrown effort to mobilize the pharmacists themselves into a frontline of access to the morning-after pill.
"It can be hard to find. In greater Minnesota, a woman could have to drive a long way. On evenings and weekends, it can take two to three days to get it," says Amy Gilbert, M.D., medical director at St. Paul's Family Tree Clinic, a community clinic that offers family planning. "We have to increase knowledge among clinicians, pharmacists, and among the public, so it just becomes standard."
Access to emergency contraception is so significant because the time element is vital. The "morning-after" moniker is a bit misleading, as experts now say that the pill--which consists of high doses of the hormones found in regular birth control pills--can still be effective if taken within 72 hours of unprotected sex. But the longer you wait, the less effective it is; some estimates indicate that efficacy declines by 50 percent for every 12 hours that you delay the initial treatment.
As many as half of all pregnancies in this country are unplanned. In fact, says Sharon Camp, president and CEO of Washington, D.C.-based Women's Capital Corporation, which makes the emergency contraceptive called Plan B, 48 percent of U.S. women ages 15 to 44 have had at least one unplanned pregnancy. The incidence is even higher among teens and women over 40. And it's worth noting that about half of unexpected pregnancies result in abortions.
Given that emergency contraception can reduce abortions, one might think that abortion opponents would join in the effort to make it more available. And yet efforts to disseminate it are still persistently squelched by anti-abortion-rights groups.
In Minnesota's last legislative session, for instance, abortion rights advocates proposed a measure mandating that all emergency rooms in the state provide emergency contraception to sexual assault victims. (If it seems like offering this option to rape victims is common sense, consider that the abortion rights organization Minnesota NARAL surveyed 137 Minnesota hospitals and found that less than half offered emergency contraception to rape survivors.)
Even as legislators passed a 24-hour-waiting-period abortion bill that threw more obstacles in the path of women seeking abortions, they quickly killed the emergency contraception idea.
"It was a very beginning first step," says Tina Flint Smith, vice president of marketing and public affairs for Planned Parenthood of Minnesota/South Dakota. "We were unable to get that passed, which is really just astounding."
Family Tree's Gilbert says resistance to emergency contraception sometimes stems from confusion about the product, even on the part of physicians and pharmacists. Others contend that it promotes promiscuity--assuming, in other words, that more women would have wanton, unprotected sex if they could fall back on emergency contraception.
"You just don't find that," Gilbert says. Besides, she notes, the product doesn't really lend itself to repeat use. One treatment, for instance, can cost as much as an entire month's supply of birth control pills. It also messes up women's menstrual cycles and can have side effects that include nausea and vomiting.
Nonetheless, when faced with politically empowered opponents who appear to be against not just abortion, but family planning, contraception--and sex in general--it's clear that reproductive rights advocates will have to get the word out another way.
Gilbert's clinic has worked with Twin Cities pharmacists to form collaborative agreements--essentially standing prescriptions--so that if patients find themselves in need of emergency contraception, they can go directly to specific pharmacies to get it.
Last month Family Tree Clinic held a statewide conference about emergency contraception, bringing in experts like Camp and officials from Washington state, where a program to spawn collaborative agreements between physicians and pharmacists has dramatically increased the morning-after pill's availability. The idea behind the conference was to inform pharmacists from across the state about both the need for emergency contraception and ways to make it available, without causing controversy.
Camp estimates that there are at least 37.5 million times each year in the United States when women have unprotected sex, realize they might become pregnant, and don't want to. If emergency contraception were available and used in just 35 percent of those instances, it could reduce the number of unintended pregnancies by 1.5 million.
"We are just scratching the surface of that need," Camp says. "There has to be a grassroots effort both on a global scale and in this country to bring this totally underutilized method of contraception out of the closet, out of the rape crisis center, and into mainstream medicine."
Access would likewise improve if emergency contraception became available over the counter, as it is in other countries. In April, Camp petitioned the Food and Drug Administration to make Plan B available without a prescription. She anticipates a decision sometime next winter.
But until then local women's health advocates will work to educate women, doctors, pharmacists, and legislators. One of the most misunderstood distinctions involves the difference between the morning-after pill and the abortion pill. Too often the drugs are confused, despite the fact that their mechanisms are fundamentally different: Emergency contraception prevents a pregnancy before it occurs, often by inhibiting ovulation; it doesn't terminate a pregnancy.
"One is contraception, one is abortion," declares Flint Smith. "The only thing they have in common is they're both a pill.
"Emergency contraception is essentially a valuable public health tool that has gotten caught up in the politics of reproductive rights," she continues. "It's really hurting Minnesota women and their ability to take control of their own health. Which is really a shame."