Emergency contraception: Going over the counter?

A quiet movement to make emergency contraceptive pills (ECPs) available over the counter is picking up steam, as advocates say they plan to file a citizen’s petition with the Food and Drug Administration for such action.

The movement got a boost with the December action by the Chicago-based American Medical Association (AMA), which approved a resolution asking the government to consider making ECPs available over the counter (OTC). The organization’s policy-making House of Delegates passed the recommendation without discussion during a convention in Orlando, FL.1

The endorsement of the AMA for making ECPs available without prescription is clearly significant and should help the public and policy-makers understand just how safe ECPs really are, says James Trussell, PhD, professor of economics and public affairs, faculty associate of the Office of Population Research, and associate dean of the Woodrow Wilson School of Public and International Affairs at Princeton (NJ) University. The Office of Population Research and the Washington, DC-based Reproductive Health Technologies Project operate the Emergency Contraception Hotline [(888) NOT-2-LATE), a national toll-free, automated, confidential hotline available 24 hours a day in English, Spanish, and French, as well as an affiliated Web site (www.not-2-late.com).

"It is our hope that this decision will greatly accelerate the groundswell of support within the health care community and that other professional medical associations will join the AMA in their assessment that making EC available OTC is in the public health interest of this country," states Kirsten Moore, project manager at Reproductive Health Technologies Project.

The Reproductive Health Technologies Project hopes to file a citizen’s petition for moving ECPs to OTC status early this year, says Moore.

Having broad agreement in the medical community is essential, and the AMA endorsement creates a big tent everyone can get under, says Sharon Camp, PhD, company president of Women’s Capital Corp. in Bellevue, WA. The company, which markets Plan B, the progestin-only dedicated ECP, is working on an application to take the ECP over the counter, says Camp. The application is expected to be submitted this year.

Britain to expand use

The advent of 2001 brings the sale of ECPs in Britain without prescription through local pharmacists. At press time, the measure would allow sales to women age 16 and above; however, the London-based British Medical Association has asked the government to consider sales to those below the age limit.

"If pharmacists can assess if it is appropriate for someone to have post-coital contraception, they should be able to assess if girls under 16 years are competent and should receive it," states John Chisholm, MD, chairman of the Association’s General Practitioners Committee, in a press release issued by the organization.2 "It is important to reach all those at risk if you are really trying to bring down the number of teen-age pregnancies."

The association also has asked that the government consider making the ECPs available in pharmacies free of charge, since the pills already can be obtained for free with a National Health Service prescription from their family doctor.

Provide ECP info

While women understand the rationale behind making EC available OTC, they also want to know that it is safe to use without a provider’s supervision, says Moore. Based on recent focus group research just completed by the Reproductive Health Technologies Project, women want to feel confident that ECPs sold OTC are safe, and they want to hear that verdict from their health care provider, she notes.

The AMA’s Report of the Council on Medical Service, which served as the basis for the newly passed resolution, calls for physicians and other health professionals to play a more active role in providing education about access to emergency contraception by discussing it as part of routine family planning and contraceptive counseling.3

Because ECPs are more effective the sooner they are taken after unprotected intercourse, having ECPs available OTC could help women to maximize their effectiveness, remarks Trussell. However, OTC status will not necessarily translate into more widespread use, says Trussell, because women still do not know that something can be done after unprotected sex to prevent pregnancy, that such an option is legal and available in the United States, and that they must act quickly because, as he states, "there is no time to lose."

Either clinicians must begin routinely to counsel women about EC in advance, before the need arises, or the drug companies marketing ECPs must wage much larger public education campaigns, asserts Trussell.

"Because the second option seems unlikely, clinicians have a vital role to play in realizing the vast potential for EC to reduce the incidence of unintended pregnancy," he notes.

References

1. Branom M. Better access to morning-after pill urged. Orlando, FL: Associated Press; Dec. 5, 2000.

2. British Medical Association. Morning-after Pill Should Be Free from Pharmacies, Says GP Leader. London; 2000.

3. American Medical Association. Access to emergency contraception. Report of the Council on Medical Service. Presented by Joseph M. Heyman, MD, chair. CMS Report 1-I-00.