How 'morning-after pill' will affect sex habits

Its sale over the counter could reduce abortion rate, and impact intimate decisions such as the frequency of sex.

If, as expected, the so-called morning-after pill becomes widely available over the counter, it has the potential to revolutionize the debate about abortion and, some contend, sexual mores in the United States.

Advocates believe that having the emergency contraception pills available in pharmacies right next to condoms could reduce by half the 3 million-plus unwanted pregnancies in the US each year. One study already found that in 2000, when it was only available with a prescription, 51,000 abortions were prevented by its use.

But opponents worry that easy availability at the corner pharmacy could lead to more irresponsible sexual behavior, particularly among young people, and the spread of sexually transmitted diseases. Some argue it doesn't prevent abortions at all, but actually causes them by interfering with fertilization.

Yet for all the division over the issue, both sides agree on one thing: The recommended approval of the morning-after pill for over-the-counter use by two key Food and Drug Administration (FDA) panels this week is likely to usher in a new era - deepening the moral debate about some of the most intimate and sensitive decisions individuals can make. "Emergency contraception has always been an intriguing subject, because it's the simplest technology that could revolutionize family planning," says Gloria Feldt, president of Planned Parenthood Federation of America.

Emergency contraception, or EC as the morning-after pill is called, is simply a higher dose of regular birth-control pills taken within 72 hours of unprotected sexual intimacy - whether as a result of rape, contraceptive failure, or failure to use contraception. It operates in one of three ways: by preventing ovulation, interfering with fertilization, or interfering with the implantation of the fertilized egg in the uterine wall, which the medical community defines as pregnancy. It's effective as much as 89 percent of the time, and it has no effect if a woman is already pregnant.

For advocates, Tuesday's 23-to-4 vote by the FDA panel was a "huge win" because it put "science over ideology," according to Princeton University's James Trussell, who was an early advocate of EC use and a member of the panel.

While the FDA does not have to follow the panel's recommendation, it usually does. A final decision is expected by February, at the latest. "Folks were overwhelmingly convinced that going from prescription to over-the-counter would have a big impact on public health in the US by reducing unintended pregnancies," he says. "And that there were no safety concerns about doing so."

That's prompted many antiabortion groups, like the National Right to Life Committee, which declined to discuss the issue, to purposely sit on the sidelines of this debate.

But other antiabortion groups, primarily the Catholic Church and those opposed to all types of contraception, contend that the morning-after pill is indeed a kind of abortive agent because it interferes with conception even though it cannot terminate an existing pregnancy.

Just as those groups fought the original approval of the morning-after pill, they're now urging FDA administrator McClellan to disregard the scientific panel's assessment and prevent over-the-counter access. If that fails, they'll go to the pharmacists themselves and urge them not to stock it.

"We have already encouraged pharmacists to exercise their conscience and simply refuse to provide these pills," says Judie Brown, president of the American Life League, an antiabortion group in Stafford, Va.

Opponents argue that despite the over- whelming number of studies that have found EC safe and effective, and despite its safe and widespread use in Europe, repeated use could still lead to harmful effects for women. "You're talking about taking megadoses of hormones with no physician oversight," says Kathleen Gallagher, director of pro-life activities at the New York State Catholic Conference. "Even the FDA says the effect of repeated use is unknown, so we're going to use women as guinea pigs." But the FDA panel was convinced that science had proved it safe.

Another concern of opponents is that it could increase promiscuity, particularly among the young. That was a key point raised by Ms. Brown, who also testified at the hearing. "The adolescent that can go to the drugstore and acquire these pills without any involvement from her parents," says Brown. "It drives a wedge between unemancipated minor children and their parents."

But proponents note that adolescents already have access to condoms and other over-the-counter contraceptives. The morning-after pill simply provides another method that can be used in an emergency situation. A key issue for them is ensuring that pharmacies across the nation stock it, and that women know it's available.

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