Since the June 2022 overturn of Roe v. Wade and the end of constitutional protections for abortion, emergency contraception has become harder to come by and — more than ever — shrouded in misinformation.
Attempts to check inventory have been made by Amazon, Rite Aid and Walmart imposed purchase limits on the emergency contraception known as Plan B since the Supreme Court ruling. Panicked buyers have been trying to stock up on the drug in case it becomes unavailable.
Have different legislatures and bills confused emergency contraception with abortion and try to restrict access to it. The recent court ruling block access to mifepristone — which has been FDA-approved since 2000 — is an ominous sign to many that emergency contraception could be the next target.
Regardless of one’s stance on abortion, it’s important to understand why emergency contraception should be a basic part of women’s reproductive health care and family planning services. As a researcher of women’s sexual and reproductive health and decision makingI have done extensive research on access to emergency contraception.
What is Emergency Contraception?
Emergency contraception is the only way to prevent pregnancy after having had sex. It can be used if contraception has not been used or if it has been used incorrectly, such as forgotten contraceptive pills or broken condoms. Emergency contraception is also used to prevent pregnancy after sexual assault or rape.
Emergency contraception can take the form of pills – also called the morning-after pill – or an IUD or IUD that delays ovulation.
There are two types of emergency contraceptive pills. The most famous is levonorgestrelwhich is sold in the US under the brand name Plan Balong with numerous generic versions.
levonorgestrel was first approved for over-the-counter sale for women aged 18 and over in 2006, and age restrictions were lifted in 2013.
The second type of emergency contraceptive pill is ulipristal acetate, which is sold under the brand name ella. Both plan B and ella work by delaying ovulation. In addition, el also thins the endometrium so that even if an egg were to be fertilized, it would be more difficult to implant in the uterus to start a pregnancy.
Both types of pills are effective in preventing pregnancy. Plan B is most effective when taken within three days of sex, with some diminishing effectiveness on days four and five. Ella is effective if taken within five days of sex and, unlike Plan B, is equally effective all five days.
The most effective forms of emergency contraception are IUDs that are inserted by a healthcare provider. Copper IUDs — also called nonhormonal IUDs — are sold under the brand name Paragard. They release copper ions into the uterus toxic to both eggs and sperm. This allows them to be used as emergency contraception if inserted within five days of sex, and as continuous contraception for up to 10 years.
Levonorgestrel IUDs — called hormonal IUDs — are sold under the brand names Mirena, Liletta, Kyleena, and Skyla. The levonorgestrel released in the uterus thickens the mucus around the cervix so that a sperm cannot enter to fertilize the egg, and it is as effective as the copper IUD when inserted as emergency contraception up to five days after sex. Both Paragard and Mirena IUDs are FDA-approved for use as birth control, but they are not yet specifically approved for use as emergency contraception.
How is emergency contraception different from the abortion pill?
For years, the way emergency contraception works has been misunderstood. There has been confusion over whether emergency contraception is an abortion, that is, a drug that causes an abortion. The main difference is that the abortion pill only works if a woman is pregnant, and emergency contraception only works if she is not.
The so-called abortion pill is used for a medical abortion and actually consists of two separate pills that do different things.
The first of these pills is mifepristone, which blocks the production of the pregnancy hormone progesterone so that the uterine lining thins and the embryo detaches from it. This is the pill that is gaining national attention due to clashing court rulings over access, a battle that is on its way the Supreme Court.
The second pill, misoprostol, stimulates contractions in the uterus to eject the embryo and gestational sac. Emergency contraception prevents a pregnancy before it occurs, while the abortion pill terminates a pregnancy once it has begun.
How do abortion restrictions jeopardize emergency contraception?
With the increase in abortion restrictions, access to a full range of contraceptive options – including emergency contraception – is more important than ever.
There are already numerous barriers to obtaining emergency contraception in a timely manner. The most effective types of emergency contraception, ulipristal acetate and both hormonal and non-hormonal IUDs, should be obtained from a healthcare provider. This means that a woman needs an appointment—usually only available on a weekday during business hours—as well as transportation and the means to pay for the appointment, either through health insurance or paying out of pocket. She may need to take time off from work to attend the appointment, or she may require childcare.
For many women in poor, rural or geographically isolated neighborhoods, these barriers are difficult to overcome. This is especially true given the short time frame in which emergency contraception is effective.
Levonorgestrel emergency contraceptive pills are available over the counter and should be readily available, but people trying to buy them run into numerous obstacles. These include low stocks in pharmacies – especially independent pharmacies – and restrictions on points of sale, such as requirements that buyers must be of a certain age, provide proof of identity or have parental consent. People also come across a lot of misinformation about when to take levonorgestrel for maximum effectiveness and about sales restrictions. Finally, they run into pharmacy workers who object to selling it because they misunderstand how it works.
The surge in demand for emergency contraception since the reversal of Roe v. Wade and the purchasing restrictions imposed by retailers exacerbated these access problems.
What are the benefits of emergency contraception?
Access to emergency contraception promotes women’s health in several ways. Nearly half of pregnancies in the US are unintendedand emergency contraception can prevent approx 95% of unwanted or mistimed pregnancies when used within five days of sex. It can also be used as a backup option when another form of birth control doesn’t work. And it can be given to survivors of sexual assault. Emergency contraception too reduces the need for abortions.
Overall, access to a full range of birth control options — including emergency contraception — gives women more control over their reproductive choices. The ability to control the number and spacing of their pregnancies improves health, social and economic results of women and their families.
