Independent Perspective News - Morning-After Pill May Go Over the Counter

By KATE ZERNIKE

For years, public health advocates were frustrated that most women did not know about a drug that could prevent pregnancy even if taken several days after sex.

Its potential to reduce the abortion rate was enormous, and opponents of abortion generally did not oppose it. But that potential was unrealized, largely because the two companies distributing the drug in this country were so tiny that they could barely afford advertising. People who did know about it often confused it with RU-486, the abortion pill.

But in the last year, so-called emergency contraception has started to come out of the shadows. Three million doses of one pill have been sold since 1999, and the maker of another says its sales increased 50 percent last year.

On Thursday, New Mexico became the fourth state to allow pharmacists to dispense the drug directly to women, enabling them to avoid trips to a doctor for prescriptions. Legislators or pharmacists in at least 14 states are agitating to do the same.

One company that sells the pills, the Women's Capital Corporation, has applied to the Food and Drug Administration for permission to sell them over the counter. The other, Gynetics, says it, too, expects its product to be sold over the counter by the end of next year.

The president of Women's Capital says she is in discussions with several large drug companies about buying the drug once it is approved for over-the-counter sales, which would put advertising and distribution might behind it.

The American College of Obstetricians and Gynecologists has sent letters to its 43,000 members urging them to give patients advance prescriptions of the emergency contraceptives. Planned Parenthood offers 24-hour online prescriptions in seven states. Fifty-two percent of university health clinics dispense the pills, according to The Journal of American College Health.

Awareness of the pills seems to be growing as well: a Kaiser Family Foundation survey, to be published in Self magazine next month, found that 6 percent of American women had used them, triple the percentage three years ago. In 1997, 1 percent of women reported using the pills. Sixty-eight percent of women know about them, the survey found, an increase from 51 percent in 2000 and 41 percent in 1997.

"It's really a thousand flowers blooming," said James Trussell, director of the Office of Population Research at Princeton University, and one of the earliest advocates of emergency contraception. "What started off as a tiny band of people is now a much larger one, and people are starting to act on their own." Emergency contraception has been an unlikely story from the start. Jane Boggess, director of the Pharmacy Access Plan, which advocates wider distribution of the drug, calls it "the little engine that said it could."

In 1974, a Canadian researcher reported that taking a high-dose regimen of birth control pills within 72 hours of unprotected sex could prevent pregnancy. While RU-486, or mifepristone, is often called the morning-after pill, that description more accurately applies to emergency contraceptives. RU-486 triggers an abortion up to 12 weeks after conception. The emergency contraceptive pill prevents conception.

Researchers say they still do not know how the pill works. It either delays ovulation or prevents a fertilized egg from attaching to the uterus. Depending on which brand is used and how early it is taken after sex, it prevents pregnancy in 75 to 89 percent of cases. New research shows that it can prevent pregnancy even if taken five days after sex. The regimen is two pills taken 12 hours apart, containing a high dose of progestin and, in the case of one drug, Preven, estrogen.

The pills are essentially birth control pills in higher doses. But as their name suggests, they are not intended as regular birth control. They are for what advocates say they hope are rare instances of unprotected sex, or when, say, a condom breaks. As posters in one advertising campaign say, "Accidents happen."

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