Step C: Promote Plan B

An editorial by Anna Glasier published last week in the British Medical Journal noted that the abortion rate in the UK has risen despite the over-the-counter availability of emergency contraception. Glasier, director of family planning at the Lothian Primary Care NHS Trust, writes:

Ten studies in different countries have shown that giving women a supply of emergency contraception to keep at home, so that they have it when they need it, increases use by twofold to threefold. In three studies that measured subsequent pregnancy rates, advance provision of emergency contraception increased its use but had no measurable effect on rates of pregnancy or abortion. When reasons for not using emergency contraception, despite having a supply at home, were documented three out of every four women said they did not realise they had put themselves at risk of pregnancy.

The comments drew quite a bit of attention. Val Buxton, acting chief executive of Brook, a sexual health charity for young people, told BBC News: “Easy access to emergency contraception is an essential part of the picture, and abortion rates might be higher if it weren’t for the fact that emergency contraception is more easily available than in the past.”

At the very least the editorial seems to indicate that FDA approval for EC — approval we know didn’t come easily (PDF) — is only the first step in ensuring that women use the contraception when needed. Access is a crucial component, but it is only part of the solution. Women need basic education about their menstrual cycle and how to know when they are fertile. There also needs to be an even more direct educational push about the importance of using EC each and every time contraception is not used or fails.

In an op-ed published earlier this week in the Boston Globe, Dr. Darshak Sanghavi, an assistant professor of pediatrics at UMass Medical School, makes a convincing argument for a public outreach campaign built around the availability and proper use of Plan B in the United States.

But convincing arguments are rarely enough.

“Unfortunately, the drug’s maker, Barr Laboratories, has no plans for an ad campaign to promote use. A survey in last month’s Southern Medical Journal found that a third of women hadn’t previously heard of post-coital contraception, 80 percent thought it was the same thing as taking the abortion drug RU-486, and only 16 percent had discussed it with a physician,” writes Sanghavi.

“To address this problem, the American College of Obstetricians and Gynecologists in May kicked off the ‘Ask Me’ campaign, encouraging women to learn about emergency contraception, but more efforts are needed. That’s especially important for adolescents, who are largely ignorant of emergency contraception — and still will need prescriptions. (The Society for Adolescent Medicine and the American Academy of Pediatrics object to this restriction.)”

Sanghavi also cites other factors that must be dealt with before Plan B can be considered a realistic and reasonable option. Insurers should pick up the cost, he writes. As it now stands, the projected costs of $25-$40 per dose means many women won’t buy it “just in case.”

Women who need to use it repeatedly should consider more long-term birth control options and “Plan B’s approval should herald more realistic strategies to combat unwanted pregnancy at many levels, especially in schools,” concludes Sanghavi. “In a 1999 study, children getting contraceptive education weren’t more likely to have sex — and were two-thirds less likely to have unprotected sex than those taking abstinence-only classes.”

Over at the The Guardian, Kira Cochrane says enough already with conservatives demonizing the morning-after pill: “[W]hile the widespread, regular demonisation of contraception probably doesn’t have much effect on women once they reach their 20s, for teenagers it must be hugely off-putting. On the one hand, it makes them feel (quite rightly) that there is a strong chance of being harshly judged if they seek out contraception, on the other, they are constantly fed the message that it doesn’t prevent pregnancy anyway. Is it any wonder they’re still fumbling in the dark?”

So while we wait for an ad campaign to promote EC (sigh), do it yourself and start promoting Not-To-Late.com — the indispensable website run by operated by the Office of Population Research at Princeton University and the Association of Reproductive Health Professionals. Here you’ll find all your EC questions answered and you can search for EC providers by city, state or country. Pass it on.

Update: Read about one woman’s attempt to find EC in rural Ohio after the condom broke. Sheesh.