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...rare the United States, and, therefore, the scientific and political debates in the U.S. center only around the use of emergency contraceptive pills, sometimes referred to as the "morning after pill." For the purpose of this article EC will refer solely to these pills.
EC is a high dose of regular birth control pills that can be taken within 120 hours (five days) of unprotected intercourse as a back up method of birth control if a woman did not use a regular method or if her regular method failed (e.g. the condom broke). When taken within 72 hours of unprotected intercourse, EC can reduce a woman's chance of becoming pregnant by 80 to 85%. It is most effective if taken within the first 12 to 24 hours of unprotected sex. (1) EC does not protect against sexually transmitted diseases, including HIV.
EC has been the subject of heated debate in the United States for several decades. Unfortunately, conservative far right organizations have made this debate not about women's health but about abortion, sexual activity, and the restriction of healthcare choices for women. Three issues remain at the center of this debate: 1) whether EC is an abortifacient; 2) whether this back-up method of birth control discourages the use of regular methods of birth control; and 3) whether emergency contraception increases sexual activity. This article is designed to explore these issues and provide some political and historical context to the debate around emergency contraception.
HISTORY OF EMERGENCY CONTRACEPTION
The practice of using oral birth control pills after unprotected sex has been in place since the 1960s. The first such documented case was published in the mid-1960s when physicians in the Netherlands administered postcoital estrogen to prevent pregnancy in the victim of a sexual assault. (2) In 1984, the United Kingdom became the first country to approve a product specifically packaged as EC and today, dedicated products are registered in over 80 countries worldwide. (3)
Beginning in the 1970s, physicians in the United States prescribed a similar method through "off-label" use of oral birth control pills, a common and legal practice. (4) Nonetheless, official approval by the Food and Drug Administration (FDA) was still decades off.
Advocates and physicians wanted the regimen to be formally approved by the FDA so that there would be the possibility of greater access and increased awareness among women. This process began in November 1994 when the Center for Reproductive Rights, formerly known as the Center for Reproductive Law and Policy, attempted to force the FDA's hand, and filed a citizen petition with the FDA on behalf of a coalition of leading medical and public health groups. The petition requested that the FDA require manufacturers of birth control pills to include information about EC in the product packaging of certain brands. (5) Although the FDA declined the petition and, in doing so, declined to require the relabeling of these products as emergency contraception, the agency took an unusual step and unanimously declared, in June 1996, that emergency contraceptive pills are a safe and effective way to prevent pregnancy if taken in the recommended dosages up to 72 hours after unprotected intercourse.
FDA Approval
Shortly thereafter, in February 1997, the FDA officially declared regimens of commonly used oral birth control pills as safe and effective for use as emergency contraception to prevent pregnancy. The FDA published dosage information for six brands of oral contraception in an effort to "encourage manufacturers to make this additional contraceptive option available." The FDA stated that it would accept applications to manufacture and market EC without requiring new drug trials as the safety and efficacy of EC had already been demonstrated. (6) It noted that "... similar regimens have been used extensively in the United...
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