{"id":1668,"date":"2014-03-21T08:18:26","date_gmt":"2014-03-21T08:18:26","guid":{"rendered":"http:\/\/oursilverribbon.org\/?p=1668"},"modified":"2014-03-21T09:35:30","modified_gmt":"2014-03-21T09:35:30","slug":"how-does-contraception-work","status":"publish","type":"post","link":"https:\/\/oursilverribbon.org\/?p=1668","title":{"rendered":"How Does Emergency Contraception Work?"},"content":{"rendered":"

Emergency Contraception: Controversies and Advocacy
\nThe Fight for Fair and Science-based Regulation
\nSarah Michelsen, Lisa Kernan Social Justice Fellow, and Ellen R. Shaffer, Co-Director,
\nTrust Women\/ Silver Ribbon Campaign, a project of The Center for Policy Analysis<\/p>\n

Transcribed from Sarah Michelsen’s Power Point presentation, San Francisco, July, 2013
\nWhat is Emergency Contraception?
\nMyths and Facts
\nWhat is Emergency Contraception?
\n\uf06eA safe and effective birth control method used after unprotected sex to prevent pregnancy
\nIf regular birth control was used incorrectly or fails, or after sex without birth control
\n\uf06e\u201cMorning-after\u201d pill
\n\uf06eRecommended for use after a more reliable method fails, or is not used<\/p>\n

 <\/p>\n

How Does Progestin-Only Emergency Contraception Work?<\/strong>
\n\uf06eProgestin-only EC works by preventing ovulation (the egg cell leaving the ovary).
\n\uf06eIt used to be thought that progestin-only EC could also prevent fertilization (the sperm and egg joining) or the implantation of a fertilized egg (blastocyst) after ovulation, but that has now been debunked.
\n\uf06eThe newest studies show the progestin-only EC is only effective before ovulation-if an egg is already present in the fallopian tube, EC will not be effective.<\/p>\n

 <\/p>\n

\"\"
\nMyths and Facts about Progestin-Only Forms of EC
\n\uf06eMyth: Progestin-only forms of EC, including Plan-B One Step and Next Choice, can cause abortions.
\n\uf06eFact: Progestin-only forms of EC work by preventing ovulation. They have no effect on a fertilized blastocyst before or after implantation.
\n\uf06eMyth: Progestin-only forms of EC will cause birth defects or otherwise harm an embryo if the woman is already pregnant.
\n\uf06eFact: Progestin-only forms of EC have no negative effects on developing embryos, either before or after implantation.<\/p>\n

Other Types of EC
\n\uf06eCombined progestin and estrogen pill \u2013rarely used
\n\uf06eUlipristal acetate pill
\n\uf06eCopper IUD
\nCombined Progestin and Estrogen Pills
\n\uf06eThe same as regular birth control pills, in a larger dose.
\n\uf06eNone currently marketed as EC, although several brands of regular birth control have been approved by the U.S. Food and Drug Administration (FDA) for use as EC.
\n\uf06eWomen in rural areas or situations where they cannot access regular EC may take larger doses of their regular birth control pills to act as EC, but this is not as effective as a progestin-only form of EC.<\/p>\n

Ulipristal Acetate Pills
\n\uf06eMarketed in the US as Ella
\n\uf06eAvailable by prescription only, for women of all ages
\n\uf06eSignificantly more effective than other methods at preventing ovulation, especially between 72 and 120 hours.
\n\uf06eMay have some post-ovulation effect, including possibly preventing implantation after fertilization has occurred.
\n\uf06eNot an abortifacient-does not meet medical definition of an abortion,which is interrupting an established pregnancy, after a fertilized blastocyst is successfully implanted in the uterus.<\/p>\n

Copper IUD
\n\uf06eIntrauterine Device
\n\uf06eMust be prescribed and insderted by a doctor or other trained clinician
\n\uf06eReduces the risk of getting pregnantby more than 99%
\n\uf06eCan be effectively inserted up to 5 days after unprotected sex
\n\uf06eCan keep it in place for up to 10 years.<\/p>\n

Opposition and Barriers to Access<\/p>\n

Who is the Opposition to EC? Misleading Quotes
\n\u201cThe secret best kept from the American public is that these drugs can cause abortions. The time for covering up this unpleasant reality is long past.\u201d
\n\u201cIt can irritate the lining of the uterus so that if the first and second actions fail, and the woman does become pregnant, the tiny baby boy or girl will die before he or she can actually attach to the lining of the uterus.\u201d
\n[NOTE: This is NOT the official AAP \u2013it\u2019s a separate anti-choice rump group.]
\n\u201cDespite self-reports denying it, \u2018ready access\u2019 to EC apparently increases the sexual activity of adolescents which is a risk factor for depression and suicide, poor school performance, more lifetime<\/p>\n

Abortifacient Myth
\n\uf06eAnti-choice leaders choose to define abortion differently from the medical definition.
\n\uf06eThe medical definition: interrupting an established pregnancy, after implantation of the fertilized egg [c. 50% of fertilized eggs do not implant].
\n\uf06eAnti-choice position: Abortion includes even interrupting the release of the egg into the fallopian tube (ovulation)
\n\uf06eAlso: Confusion about the mechanisms of action of different forms of EC, and many believe that OTC forms of EC, progestin only pills, cause abortions.
\n\uf06eBelief that ulipristal acetate forms of EC cause abortions.
\nProtecting\u201d Women and Girls
\n\uf06eOpponents have painted EC as a dangerous drug, and fanned fears that young girls accessing it without parental notification would lead to promiscuity.
\n\uf06eStudies show increased access to EC does not increase promiscuity or reduce use of other contraceptives.
\n\uf06eScare tactics-US Conference of Catholic Bishops spokesperson said expanding access \u201cundermines parents\u2019 ability to protect their daughters \u2026 from the adverse effects of the drug itself.\u201d\u201d<\/p>\n

Why do Barriers to Accessing EC Matter?
\n\uf06eNeed for ID is shaming and stigmatizing.
\n\uf06eNeed to find an open pharmacy, regardless of age.
\n\uf06ePrecludes immigrant women, young women, or others without ID from purchasing, regardless of age.
\n\uf06eCreates a barrier for the trans* community.
\n\uf06eDisproportionately affects low income women and women of color.
\n\uf06eConfusion among the public and pharmacists about who can and can\u2019t purchase leads to older teens and men being denied their right to purchase EC.
\n\uf06eYoung women under the age of 15 seeking EC are the most vulnerable, and yet have the highest barriers to purchase.
\n\uf06eHIGH COST CAN REMAIN A BARRIER \u2013Insurance should cover<\/p>\n

The Long Fight for Fair Access
\nOver a decade of court battles and politically motivated decisions<\/p>\n

The Fight for Fair Access
\n\uf06eEC first approved by the FDA in 1999
\n\uf06e2004: The non-partisan scientific committee assigned by FDA to review the evidence on safety and effectiveness voted 23 to 4 to approve an application to make EC available over the counter without any age restrictions.
\n\uf06eRecommendation supported by 50+ medical\/health organizations
\n\uf06e2005: FDA commissioner overruled decision of the FDA scientific committee
\n\uf06eUnprecedented action
\n\uf06eAug.2005: Dr. Susan Wood resigned as FDA Director of Women\u2019s Health and Assistant Commissioner for Women\u2019s Health in protest political influence over science.<\/p>\n

Science Vs. Politics
\n\uf06eIn 2006 EC was made available OTC for those over 18
\n\uf06eIn 2009 a court ordered the FDA to review that decision, calling it arbitrary and capricious, and to immediately lower the age to 17. FDA lowered age restriction but did not reconsider making it available to all women OTC.
\n\uf06eIn 2011 FDA Commissioner announced they were prepared to grant Teva\u2019s application to remove all age restrictions on OTC sale-but this decision was blocked by HHS Secretary Sebelius.
\n\uf06eUnprecedented for HHS Sec, to overrule her appointed FDA chief .<\/p>\n

The Fight For Fair Access: 2013
\n\uf06eApril 5, 2013-U.S. District Court Judge Edward Korman ordered the FDA to make Plan B and generics of the two-pill medication available for OTC sale to people of all ages.
\n\uf06eApril 30 2013-FDA approves Plan B One-Step emergency contraceptive without a prescription for women 15 years of age and older
\n\uf06eMay 1 2013-Department of Justice files appeal, and moves for a stay pending the appeal.
\n\uf06eMay 10 2013-Judge Korman refuses to grant the stay<\/p>\n

 <\/p>\n

Judge Korman Calls Out the Administration
\n\uf06e\u201cYou made that announcement to sugar-coat this appeal.\u201d
\n\uf06e\u201cThe bottom line is that it\u2019s not possible to provide the data on 11-and 12-year-olds,\u201d Judge Korman said. \u201cYou\u2019re using these 11-and 12-year-olds to place an undue burden on the ability of older women to get this contraceptive.\u201d
\n\uf0a7\u201cThese emergency contraceptives would be among the safest drugs sold over the counter.\u201d
\n\uf0a7\u201cIf this were a voting rights case, you\u2019d be here telling me this was voter suppression,\u201d he said. \u201cYou\u2019re disadvantaging poor people, young people, and African Americans. That\u2019s the policy of the Obama administration?\u201d
\nVictory? And What\u2019s Next?
\n\uf06eJune 11, 2013-Obama administration announces in a letter to Judge Korman that they will accept court defeat, and no longer pursue an appeal.
\n\uf06eJune 12-Judge Korman approves administration\u2019s plan to comply.<\/p>\n

What Did We Win? The Who What and Where of EC SalesOnce this is all implemented\u2026<\/p>\n\n\n\n\n\n\n\n
The Who What and Where of EC SalesOnce this is all implemented\u2026 Product<\/span><\/strong><\/span><\/td>\n<\/strong>Who Can Purchase, OTC or Prescription<\/strong><\/span><\/span><\/td>\n<\/strong>Location<\/strong><\/span><\/span><\/td>\n<\/strong>Point of Sale Restrictions<\/strong><\/span><\/span><\/td>\n<\/tr>\n
Plan-B One Step<\/span><\/span><\/td>\nEveryone<\/span><\/span><\/td>\nRetail Shelf<\/span><\/span><\/td>\nnone<\/span><\/span><\/td>\n<\/tr>\n
Next Choice One Dose (and any other generics)<\/span><\/span><\/td>\nAge 17 and Older: OTCUnder 17: Prescription Only<\/span><\/span><\/td>\nBehind Pharmacy Counter<\/span><\/span><\/td>\nmust ask pharmacist and show ID<\/span><\/span><\/td>\n<\/tr>\n
Next Choice, Levonorgestrel Tablets, and other 2-pill generics<\/span><\/span><\/td>\nAge 17 and Older: OTCUnder 17: Prescription Only<\/span><\/span><\/td>\nBehind Pharmacy Counter<\/span><\/span><\/td>\nmust ask pharmacist and show ID<\/span><\/span><\/td>\n<\/tr>\n
Ella and Ulipristal acetate generics<\/span><\/span><\/td>\nPrescription only for all ages<\/span><\/span><\/td>\nBehind Pharmacy Counter<\/span><\/span><\/td>\nMust ask pharmacist to fill prescription<\/span><\/span><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

 <\/p>\n

 <\/p>\n

What Do Advocates Need to Be Aware Of?
\n\uf06eOnly makes Plan-B One Step available OTC with no age restrictions. Two-pill versions of the drug will still require a prescription if under age 17.
\n\uf06eGives marketing exclusivity to Teva, preventing generic forms from being available OTC for at least 3 years.
\n\uf06eAdministration says that the re-labeling process will happen \u201cwithout delay.\u201d Really?<\/p>\n

What Should Advocates Do?
\n\uf06eHold the Administration accountable for sticking to their compliance plan in a timely manner
\n\uf06eKeep the public informed and pressure the Administration and FDA to continue to make more forms of EC, and other types of birth control, widely available.
\n\uf06ePropose ways to keep the cost of EC down, and prevent future marketing exclusivity that create monopolies
\n\uf06eInform the public about the decision and how their access to EC will change, as well as hold the administration accountable for doing the work to educate the public.<\/p>\n

 <\/p>\n

Works Cited<\/p>\n

\uf06e<\/span><\/span>American College of Pediatricians. “Emergency Contraception Should Not Be Passed out like Candy.” LifeSiteNews<\/span><\/span><\/em>. N.p., 4 Dec. 2012. Web. 19 June 2013. <\/span><\/p>\n

\uf06e<\/span><\/span>Bapat, Sheila. “Justice Doesn\u2019t Just Happen: Feminist Activists Were Essential to EC Ruling.” RH Reality Check<\/span><\/span><\/em>. N.p., 24 Apr. 2013. Web. 19 June 2013. <\/span><\/p>\n

\uf06e<\/span><\/span>Boonstra, Heather. “Emergency Contraception: Steps Being Taken to Improve Access.” Emergency Contraception: Steps Being Taken to Improve Access<\/span><\/span><\/em>. The GuttmacherReport on Public Policy, Dec. 2012. Web. 19 June 2013. <\/span><\/p>\n

\uf06e”Center for Reproductive Rights Reopens Lawsuit Against FDA Restrictions on<\/p>\n

\uf06e<\/span><\/span>Emergency Contraception.” Center for Reproductive Rights<\/span><\/span><\/em>. N.p., 8 Feb. 2012. Web. 19 June 2013. <\/span><\/p>\n

\uf06e<\/span><\/span>“The Fight for Emergency Contraception: Every Second Counts.” Center for Reproductive Rights<\/span><\/span><\/em>. N.p., n.d.Web. 19 June 2013. <\/span><\/p>\n

\uf06e<\/span><\/span>Jacobson, Jodi. “Court Orders FDA to Make Emergency Contraception Available Over-the-Counter for All Ages.” RH Reality Check<\/span><\/span><\/em>. N.p., 5 Apr. 2013. Web. 19 June 2013. <\/span><\/p>\n

\uf06e<\/span><\/span>Jacobson, Jodi. “Judge Approves Administration\u2019s Strategy for EC Over-the-Counter \u2026With Reservations.” RH Reality Check<\/span><\/span><\/em>. N.p., 12 June 2013. Web. 19 June 2013. <\/span><\/p>\n

Works Cited<\/p>\n

\uf06e<\/span><\/span>Jefferson, Erica. “FDA Approves Plan B One-Step Emergency Contraceptive without a Prescription for Women 15 Years of Age and Older.” US Food and Drug Administration<\/span><\/span><\/em>. US Food and Drug Administration Press Release, 30 Apr. 2013. Web. 19 June 2013. <\/span><\/p>\n

\uf06e<\/span><\/span>Keenan, J. A. “Ulipristal Acetate: Contraceptive or Contragestive?” The Annals Of Pharmacotherapy<\/span><\/span><\/em>45.6 (2011): 813-15. Print. <\/span><\/p>\n

\uf06e<\/span><\/span>Kempner, Martha. “Http:\/\/rhrealitycheck.org\/article\/2013\/06\/17\/plan-b-becomes-available-to-women-of-all-ages-but-everyone-should-have-a-plan-a\/.” RH Reality Check<\/span><\/span><\/em>. N.p., 17 June 2013. Web. 19 June 2013. <\/span><\/p>\n

\uf06e<\/span><\/span>Mozzanego, Bruno. “Ulipristal Acetate in Emergency Contraception: Mechanism of Action.” Trends in PharmologicalSciences<\/span><\/span><\/em>34.4 (2013): n. pag. Print.<\/span><\/p>\n

\uf06e<\/span><\/span>No\u00e9, Gabriela, HoracioB. Croxatto, Ana Mar\u00edaSalvatierra, Ver\u00f3nicaReyes, Claudio Villarroel, Carla Mu\u00f1oz, Gabriela Morales, and Anita Retamales. “Contraceptive Efficacy of Emergency Contraception with Levonorgestrelgiven before or after Ovulation.” Contraception<\/span><\/span><\/em>84.5 (2011): 486-92. Print. <\/span><\/p>\n

\uf06e<\/span><\/span>Trussell, James, PhD, and Elizabeth Raymond, MPH, MD. “Emergency Contraception: A Last Chance to Prevent Unintended Pregnancy.” Princeton University, June 2013. Web. 19 Apr. 2013. <\/span><\/p>\n

\uf06e<\/span><\/span>Tumminov. Hamburg. UNITED STATES DISTRICT COURT EASTERN DISTRICT OF NEW YORK. 4 Apr. 2013. US District Court Eastern District of New York<\/span><\/span><\/em>. N.p., 4 Apr. 2013. Web. 19 Apr. 2013. <\/span><\/p>\n

Works Cited<\/p>\n

\uf06e<\/span><\/span>United States Attorney, Eastern District of New York. “Re : Tummino v. Hamburg , No. 12 -CV -0763 (ERK\/VVP).” Letter to Honorable Edward R. Korman. 10 June 2013. N.p., n.d. Web. 19 June 2013. <\/span><\/p>\n

\uf06e<\/span><\/span>Wills, Susan E., Esq. “Emergency Contraception -Boon or Bane?” Emergency Contraception -Boon or Bane?<\/span><\/span><\/em>United States Conference of Catholic Bishops, n.d. Web. 19 June 2013. <\/span><\/p>\n

\uf06e<\/span><\/span>Zaidi, Sidra. “Emergency Contraception and Moral Panic: Dissecting the Newest Misinformation Campaign.” RH Reality<\/span><\/span><\/em><\/span>Check<\/em>. RH Reality Check, 9 Apr. 2013. Web. 19 June 2013. <\/span><\/span><\/span><\/p>\n

 <\/p>\n

For More Information<\/p>\n

\uf06e<\/span><\/span>Princeton University Office of Population Research<\/strong><\/span><\/span><\/p>\n

\uf06e<\/span><\/span>American College of Obstetricians and Gynecologists<\/strong><\/span><\/span><\/p>\n

\uf06e<\/span><\/span>TEDxBayArea Women -Sophia Yen -Cutting Edge Adolescent Medicine<\/strong><\/span><\/span>12\/8\/10<\/span><\/p>\n

\uf06e<\/span><\/span>Department of Health and Human Services, Office of Women\u2019s Health<\/strong><\/span><\/span><\/p>\n

\uf06e<\/span><\/span>Food and Drug Administration Birth Control Guide<\/strong><\/span><\/span><\/p>\n

\uf06e<\/span><\/span>Guttmacher Institute<\/strong><\/span><\/span><\/strong><\/p>\n

 <\/p>\n

Trust Women\/Silver Ribbon CampaignPO Box 29586San Francisco, CA 94129415-922-6204www.oursilverribbon.org<\/p>\n","protected":false},"excerpt":{"rendered":"

Emergency Contraception: Controversies and Advocacy The Fight for Fair and Science-based Regulation Sarah Michelsen, Lisa Kernan Social Justice Fellow, and Ellen R. Shaffer, Co-Director, Trust Women\/ Silver Ribbon Campaign, a project of The Center for Policy Analysis Transcribed from Sarah … Continue reading →<\/span><\/a><\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"ngg_post_thumbnail":0},"categories":[1],"tags":[49,47,51,48,50],"_links":{"self":[{"href":"https:\/\/oursilverribbon.org\/index.php?rest_route=\/wp\/v2\/posts\/1668"}],"collection":[{"href":"https:\/\/oursilverribbon.org\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/oursilverribbon.org\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/oursilverribbon.org\/index.php?rest_route=\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/oursilverribbon.org\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=1668"}],"version-history":[{"count":11,"href":"https:\/\/oursilverribbon.org\/index.php?rest_route=\/wp\/v2\/posts\/1668\/revisions"}],"predecessor-version":[{"id":1670,"href":"https:\/\/oursilverribbon.org\/index.php?rest_route=\/wp\/v2\/posts\/1668\/revisions\/1670"}],"wp:attachment":[{"href":"https:\/\/oursilverribbon.org\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=1668"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/oursilverribbon.org\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=1668"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/oursilverribbon.org\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=1668"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}