The same oral contraceptives used for regular birth control are safe and effective for emergency contraception in cases when a woman has had unprotected sex within 72 hours, according to a UCSF physician-researcher. Too few doctors, however, prescribe emergency contraception, and word of the method has spread too slowly to women, he argues.

"Unintended pregnancies are endemic in the US and the costs are huge. The traditional approach to this problem has been contraception backed up by induced abortion. For decades, emergency contraception has been ignored as a method of primary prevention," said David Grimes, MD, UCSF professor and chief of obstetrics, gynecology and reproductive sciences at San Francisco General Hospital. Grimes' comments are published in an editorial in today’s (Oct. 9) issue of The New England Journal of Medicine.

Although most obstetricians and gynecologists in the US are aware of emergency contraception, they prescribe it infrequently. “Only one percent of women in the US report ever having used emergency contraception. In contrast, two percent to three percent of women of reproductive age have an induced abortion," Grimes writes.

Pharmaceutical firms that manufacture oral contraceptives, he says, have not requested the Food and Drug Administration (FDA) to approve the drugs for emergency contraception and, therefore, they do not promote the drugs for this use. "If women do not know about emergency contraception, they will not request it," he writes. "Thus, emergency contraception has had little use except in student health services, Planned Parenthood clinics, and hospital emergency departments."

Last February a citizens group petitioned the FDA to add emergency contraception as an approved use to the labels of these drugs. While the petition did not lead to a labeling change, it did prompt the FDA to approve the combination of estrogen and progestin as safe and effective for emergency contraception, Grimes writes. However, FDA approval has not led manufacturers to promote their oral contraceptives for this use, he says.

In addition to lack of promotion of the drugs, another barrier has been opponents of abortion who argue that oral contraceptive use in emergencies is the same as abortion. In response, Grimes says, "Pregnancy begins with implantation, not fertilization....(and)....any method of regulation of fertility that acts before implantation is not an abortifacient (does not cause an abortion). Moreover, the estrogen-progestin regimen cannot disrupt an established pregnancy."

Arguing for the expansion of contraception to include "post hoc" or "after the fact" contraception, Grimes writes. "Easy access to emergency contraception could dramatically reduce the number of unintended pregnancies, and thus of induced abortions. It would save money as well. Emergency contraception is not a replacement for but a complement to regular contraception for women who are sexually active. From a public health perspective, one can argue that all women at risk for unintended pregnancy should keep a pack of oral contraceptives handy for emergency use."

Some efforts have been made, according to Grimes, to inform people about emergency contraception. A 24-hour hotline sponsored by the Reproductive Health Technologies Project and Bridging the Gap Foundation has been operating in English and Spanish since February 1996. It offers information and referrals within the caller's geographical area. The number to call is 1-888-NOT-2-LATE (1-888-668-2528).

By Alice Trinkl

1st appeared 10/09/97

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