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Biology 103
2003 Third Paper
On Serendip

Should the Morning-After Pill be Available Over-the-Counter?

Natalya Krimgold

Last Tuesday, advisors to the Food and Drug administration voted to make the "morning-after" pill available over-the-counter (1). The FDA has not yet acted on this recommendation (1). The morning-after pill is the vernacular term for emergency contraception, specifically, two pills with the commercial name, "Plan B", which have the ability to inhibit and, depending on one's perspective, possibly to terminate unwanted pregnancies. The FDA approved the first version of the morning-after pill for prescription use in 1998 (1). The issue today is whether it should be available without a prescription.

The morning-after pill is essentially a high dosage of the birth control pill (2). It can contain progesterone, estrogen, or both (2). . It can prevent fertilization in the fallopian tubes by altering sperm and egg transport or by preventing or delaying ovulation, and it can prevent fertilized eggs, or zygotes, from implanting in the uterus by thickening the uterine lining (1). It is not effective if the process of implantation has already begun (5). The morning-after pill is not to be confused with RU-486, the so-called abortion pill, which terminates a zygote implanted in the uterine lining (1).

All three mechanisms of the morning-after pill do not necessarily all take place every time it is used and it is impossible to determine which, if any, of them prevented implantation in any successful case (3). One controversial ethical issue surrounding the morning-after pill is whether it is tantamount to abortion. The debate concerns whether pregnancy and life begin with a fertilized egg or with its implantation.

If conditions in the uterus are ideal, a zygote will begin to implant itself in the uterine lining after about 6 days and take several more days to be complete the process of implantation (3). . One of the reasons why many scientists have chosen to define implantation as the beginning of pregnancy is because half of all zygotes do not survive beyond two weeks even if no action is taken to destroy them and so un-implanted zygotes are not considered necessarily viable (3). According to the Mayo Clinic, the morning-after pill prevents pregnancy from occurring because it does not terminate a developing zygote implanted on the uterine wall (1). According the American Bioethics Advisory Commission, preventing a zygote from implanting in the uterine lining, is technically abortion because life and pregnancy begin with conception (2). The American Heritage dictionary defines conception as the "formation of a viable zygote by the union of the male sperm and the female ovum; fertilization" (10). . Even this definition leaves room for interpretation about whether or not a zygote is viable, but for those who believe that every fertilized human egg is a human life, the debate here is identical to the debate over whether or not surgical abortion should be legal. It is a question of how human life is defined, when it begins, and under which circumstances, if any, it is permissible to end it. In polls, most Americans have demonstrated a preference for earlier abortions over later ones (7). For those who see more shades of gray in such matters, the question becomes, is the morning-after pill a better, more humane, and safer option, than surgical abortion and particularly late-term or partial birth abortion, and if so should it be made readily available?

In many ways, the morning-after pill is a remarkable advance over previously available methods of dealing with the prospect or reality of unwanted pregnancies. In the past women had to wait weeks for the results of pregnancy tests and then weeks more until they were at stage of development when surgery was possible (7). The morning after pill has the ability to prevent women from getting pregnant in the first place and it is not invasive, which makes medical complications far less likely. Still, critics point out that no studies have yet been conducted to reveal the long-term effects of the morning-after pill on the women who use it, especially those who use it more than once (1).

Sharon Camp, president and CEO of Women's Capital Corporation, which makes the morning-after pill, claims that 48% of American Women have had at least one unplanned pregnancy, with higher rates for teenagers and women over 40 (8). . Dr. Carole Ben-Maimon, president of Barr Research, claims that 15% of women who use condoms and 8% of women who take birth control become unintentionally pregnant and over 3 million unintended pregnancies occur each year, half of which terminate in abortions (1). She says it is estimated that half of these unintended pregnancies could be prevented with the morning-after pill (1). The United States abortion rate has dropped 5% between 1996 and 2000 (7). . Researchers at the Guttmacher Institute believe that much of this drop can already be attributed to increased use of emergency contraception (7). The morning after pill is already available over-the-counter in 31 countries and 5 states (1). In the Netherlands, where it is available over-the-counter, the abortion rate for women ages 15 to 19 is about 4 abortions per 1000 women, compared to nearly 30 abortions per 1000 women in the U.S. (9).

The designers of the morning-after pill claim that when it is taken within 72 hours of unprotected sex, it reduces the chance of pregnancy by 89 percent (1). Research shows the treatment to be most effective when taken within 24 hours of intercourse (1). Experts from the World Health Organization say that a woman's chance of becoming pregnant from unprotected sex doubles if she delays taking the morning-after pill for only 12 hours and increases with longer delays (4). Getting to the doctor to get a prescription can be difficult if not impossible on weekends or without a previous appointment. This is one of the main reasons why experts believe the drug should be available over-the-counter instead of by prescription only (1).

Some argue that the morning-after pill will promote promiscuity because it will alleviate the consequences of having sex before marriage (8). To begin with, the side effects of the morning-after pill include nausea, fatigue, headache, abdominal pain or cramps, dizziness, breast tenderness, diarrhea and moodiness, hardly a charming combination (5). More importantly, a teenager interviewed for CBS news in June said "I don't think that [the morning-after pill] causes people to be reckless any more than like airbags cause people to get into accidents. It's just something nice to have just in case something goes wrong, you know" (5). Her analogy is an apt one and illustrates the point that women who use the morning-after pill, in general, are trying to correct a personal mistake not to accommodate a careless lifestyle.

In summary, for those who believe life begins with conception and terminating an unborn human life is always unacceptable, the morning-after pill is just another method of committing an immoral act, but for those remaining, who do not consider all methods of terminating or preventing a pregnancy to have the same moral implications, the morning-after pill is a Godsend. It corrects for the chance ineffectiveness of methods of contraception like condoms and birth control without invasive surgery, and in some cases, or all, depending on one's perspective, without the moral quandary of pregnancy. The pill has the potential to reduce the number of surgical abortions and unwanted pregnancies in the United States dramatically, especially if it is provided over-the-counter. The abortion rate in countries like the Netherlands which already provide it over-the-counter, is marginal. The pill is significantly more effective the sooner one takes it after intercourse and the great advantage of making it available over-the-counter as opposed to by prescription only is that it would give a greater number of women faster and more access to it. This accessibility is crucial for women to be able to make effective use of the pill. Luckily, for the women of America, the Advisory Commission of the FDA has recommended making the morning-after pill available over-the-counter in the United States as it is in other countries. One can only hope that the FDA will follow suit.

WWW Sources

1) Health: Panel backs over-the-counter "morning-after" pill. (

2)The Morning After Pill: What You Need to Know About Emergency Contraception (American Bioethics Advisory Commission 2002)

3) Pro-Life Activities: Life Insight.

4) Health Pregnancy risk of "morning-after" pill (BBC New Online)

5) McKinley Health Center at University of Illinois Urbana-Champaign: Plan B Emergency Contraception (Morning-After Pills)

6) The Early Show: The Morning-After Pill, For Emergencies Only.

7) The Boston Globe: Women having earlier abortions; "morning-after" pill use rises.

8) The Morning-After Pill Gets a Push.

9) There's got to be a morning after.

10) The American Heritage Dictionary of the English Language: Third Edition. New York: Houghton Mifflin Company, 1996.

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