Emergency Contraception

Despite the many highly effective birth control options from which women have to choose, none is 100 percent perfect. Mistakes happen – a condom breaks, a woman misses a pill, or she simply has sex when she did not expect or even want to do so.

Emergency contraception (EC) is a safe, effective back-up birth control method that can prevent pregnancy after unprotected intercourse or contraceptive failure. EC does not terminate a pregnancy and will not work if someone is already pregnant. EC can be used safely multiple times – any time there is a risk of unintended pregnancy. However, EC only works within a certain period of time following intercourse and may not be as effective as routine methods of birth control. It also provides no protection from HIV/AIDS or sexually transmitted infections.

Recent studies have raised concerns about the efficacy of EC pills (particularly levonorgestrel products such as Plan B One-Step® and its generics) when the user is above a certain weight. While the research is still underway as of 2017, what is known is that ulipristal acetate pills (sold in the US as ella®) are effective at higher weights than levonorgestrel pills and the ParaGard® copper intrauterine device (IUD) is the most effective form of EC at any weight. RHTP encouraged more studies on the efficacy of EC at various body weights. In the interim, women over 176 pounds in need of EC should consider using ParaGard® or ella®, which are only available from a provider or with a prescription, respectively.

Since 1992, RHTP has been at the forefront of efforts to bring EC into the mainstream. Early advocates for emergency contraception promoted the repackaging of daily oral contraception pills or advised women on how to put together DIY emergency contraception from their regular daily contraceptive pills. A website and hotline, launched by Princeton University and the Reproductive Health Technologies Project advised women on how and where they could access EC in English or Spanish. The nation-wide advertising campaign that followed used billboards, bus advertisements, television, radio pieces and articles in major women’s and teen magazines. Within a year the hotline received 105,000 calls and the website more than a quarter of a million hits.

RHTP’s History in Emergency Contraception

In 1997, the FDA published a historic notice in the Federal Register that declared EC safe and effective, paving the way for a dedicated product in America. By 1998 the first dedicated product became available – Preven – which required a prescription but was an accomplishment nonetheless. The following year Plan B followed onto the market.

But the existence of EC was still overshadowed by the barriers that many women faced in accessing it. Within 72 hours of unprotected sex a woman had to realize the risk, make a doctor’s appointment, and pick up a prescription. Weekend closures or having to take time off work increase the risk of delay. These obstacles to access took their first major blow in Washington State, where nonprofit PATH used an existing statute enabling pharmacists to provide services that typically required a doctor’s visit to also include dispersion of EC pills without a prescription.

The success of the Washington test led pharmacy-driven prescription access to expand in California and eventually nine states. Advocates celebrated the milestone and used these cases illustrating that women were able to successfully use EC without the supervision of a doctor to push for over-the-counter (OTC) status, starting with a Citizen’s Petition to the FDA submitted in 2001. A Citizen’s Petition is a request to the FDA to take an action such as evaluating a drug’s safety or effectiveness. This petition was followed two years later by an application to approve OTC availability of Plan B submitted by the manufacturer.

The battle that followed between reproductive rights advocates at the FDA was more political than scientific in nature. Opponents claimed that emergency contraception was an abortifacient – a claim scientifically untrue – and advocates struggle with the resulting negative public perception to this day. Eventually scientific evidence was held over political rhetoric and emergency contraception was made available over-the-counter to women 17 and older. The fight continued until 2016, when the FDA eliminated age restrictions. Today anyone of any age can access one-dose levonorgestrel-based EC products on the shelves in pharmacies and through online retailers.

RHTP’s partners over the last 25 years continue to work to make EC products affordable and available to all people without barriers such as age restrictions or religious refusals.