'Morning-After' Pill Could Halve Unintended Pregnancies

Health experts say nonprescription Plan B is safe and effective

WEDNESDAY, Dec. 17, 2003 (HealthDayNews) -- The so-called "morning-after" contraceptive that may soon be sold over-the-counter is both effective and safe to use and, if approved, could prevent up to half of unintended pregnancies, experts say.

An advisory committee Tuesday overwhelmingly recommended that the U.S. Food and Drug Administration (FDA) switch the pill to nonprescription status. It is now up to the FDA to make the final decision. Usually, the agency follows the advice of its committees.

According to the package insert, the contraceptive, called Plan B, should be taken within 72 hours of unprotected intercourse, although there is evidence in the medical literature that it can be effective if taken up to 120 hours -- or five days -- after sex. Still, the sooner the better, says Dr. Vanessa Cullins, vice president for medical affairs at Planned Parenthood Federation of America in Washington, D.C.

"Preferably, it should be taken within the first 24 hours because it works best the sooner you take it," Cullins says. A second pill is taken 12 hours after the first.

Plan B delivers a dose of the hormone progestin, which delays ovulation, explains Dr. Sabrina Hussain, assistant professor of obstetrics and gynecology and reproductive sciences at Albany Medical Center in New York.

That's the primary mechanism, but Plan B can also thicken the cervical mucus so the sperm is less likely to penetrate, and can thin out the lining of the uterus so a fertilized egg will not implant.

Plan B is about 89 percent effective, Cullins says. Another "morning-after pill," Preven, uses both estrogen and progestin and is about 75 percent effective. Of the two, Plan B has fewer side effects, experts say.

Plan B is not considered an abortion-inducing drug because, Hussain says, "it doesn't interrupt an implanted pregnancy." The same is true of Preven.

In fact, Cullins adds, "Once implantation has occurred, [Plan B] will not work."

The National Right to Life Committee issued a statement that neither supports nor opposes Plan B.

"The National Right to Life Committee (NRLC) is opposed to abortion, infanticide, euthanasia, and assisted suicide. NRLC takes no position on the prevention of the uniting of sperm and egg. Once fertilization, i.e., the uniting of sperm and egg, has occurred, a new life has begun and NRLC is opposed to the destruction of that new human life," the statement read.

Experts believe the pill, if approved for over-the-counter use, will have a huge impact. "There is a great public health potential to reduce unintended pregnancies and, through reductions in unintended pregnancies, reduce the need for abortion," Cullins says. "There could be up to a 50 percent reduction in unintended pregnancies."

But the issue of availability depends on more factors than just the FDA's approval. Pharmacies need to stock the product and stock it in an easily accessible part of the store, experts say. "The issue is easier access and ready access for the woman who is in this urgent situation," Cullins says.

Another issue will be pricing, which Cullins guesses will be about $20 to $30 for one dose, the same amount as it is when bought with a prescription.

"I think in general it's something that's very underutilized," Hussain says. "In my office, when I discuss contraception, I'll either discuss Plan B or give them a prescription and tell them to go out and get it filled so they'll have it in their medicine cabinet. If it's better publicized, it'll be better utilized."

More information

For more on Plan B, visit its official site. For more on emergency contraception, visit Planned Parenthood.

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