- The Washington Times - Thursday, March 25, 2010

Armed with Rosie the Riveter’s powerful get-‘er-done imagery, the annual campaign to promote emer-

gency contraception (EC) to sexually active women swung into action yesterday.

But the push for EC - an oral-contraceptive product that can prevent pregnancy if used within 72 hours after unprotected sex - has hit a snag.

EC was once touted as a “no-brainer” method to prevent hundreds of thousands of accidental pregnancies, and thus prevent tens of thousands of abortions.

But research has shown that it has not dented either pregnancy or abortion rates.

In light of such sobering results, James Trussell - the renowned expert on contraceptives, especially EC - says it’s time to move beyond EC.

“A constructive response to this disappointment [about EC] requires that we identify new directions and approaches” to reduce rates of unintended pregnancy, Mr. Trussell and two colleagues said in the March issue of Perspectives on Sexual and Reproductive Health, published by the Guttmacher Institute.

A decade ago, EC was portrayed as a superb answer to the nation’s 3 million unintended pregnancies a year, about half of which end in abortion. “EC has the potential to prevent 75 percent to 85 percent of unintended pregnancies and to eliminate approximately 50,000 elective abortions per year,” said a 2007 article in the Journal of the American Academy of Physician Assistants.

EC promotion campaigns were set up by reproductive and sexual health advocates to spread the word, and studies were set up by researchers to capture the exciting results of EC use.

But the findings - as reported by two meta-analyses in 2007 - were stark: Not a single study showed that EC reduced pregnancy or abortion rates.

EC critics - especially those who fought U.S. Food and Drug Administration approval for EC to be sold to 17-year-old girls without a doctor’s prescription - are exasperated: Despite evidence that EC hasn’t lived up to its hype, the campaign still “chugs on,” said Wendy Wright, president of Concerned Women for America.

According to pregnancy resource centers, lots of young women are using EC “multiple times, as a regular form of birth control,” said Ms. Wright.

“We warned that [that] would happen,” she said.

“One young woman told a counselor she had taken it up to 16 times. It’s easier to get than regular birth-control pills. But they’re not getting the medical counseling that goes along with prescription birth-control pills, and Plan B is not as effective as regular birth control - which is why they are ending up at pregnancy resource centers or abortion clinics,” said Ms. Wright.

Plan B One-Step, a single-pill product from Israel-headquartered Teva Pharmaceutical Industries Ltd., is one of two EC products available in the United States. Next Choice, a generic, two-pill product from Corona, Calif.-based Watson Pharmaceuticals Inc., is the other.

In the Guttmacher journal article, Mr. Trussell and his colleagues suggested new areas be explored to decrease unintended-pregnancy rates.

For instance, women should be able to receive IUDs (intrauterine devices) when they ask for them, instead of at a subsequent visit. One study showed that 15 percent of women seeking EC “would have been interested in having a same-day placement of an IUD if the option were available,” they wrote.

Another option is to promote long-lasting-but-reversible contraceptives such as an implant or LNG-IUS (levonorgestrel intrauterine system). Currently available products are Implanon and Mirena, respectively.

In addition, the researchers said, it would be good to know more about certain situations where women can be surprised by a pregnancy. Post-partum mothers, for instance, typically don’t resume their birth control for six weeks - allowing for an unexpected conception - but new research shows that they might not have to wait so long to resume birth control. Also, women who are obese may experience “pill failure,” especially if they are using low-dose birth control; good studies could explain how often that happens.

“We hope that new research focused on these priorities will allow us, 10 years from now, to look back and report greater success in preventing undesired pregnancy than we have seen with the last decade’s investment in emergency contraception,” Mr. Trussell and his colleagues concluded.

Meanwhile, the EC campaign to “back up your birth control” is under way on campuses and in communities nationwide, said Samantha Levine, spokeswoman for the National Institute for Reproductive Health.

More people are aware of EC, she said, but confusion remains about where to get it. “Some women still don’t know that it’s available behind the counter at your pharmacy, for women 17 and older.”

“The thing that’s important about emergency contraception,” she added, “is that it’s there as a backup method. If somebody forgets to take their pill or if a condom breaks or if someone is forced to have sex against their will, there is this method they can use after sex to prevent pregnancy.”

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