Groups, Doctors Seek Wider Use of ‘Morning-After Pill’
Doctors and women’s groups are pushing to widely expand use of the “morning-after pill” to prevent unwanted pregnancies, with prominent Boston physicians offering prescriptions to sexually active women to keep at home just in case, and Planned Parenthood planning to dispense pills through the Internet in Massachusetts beginning in March.
“We’re talking a lot about it with patients, giving them information, and if they want a prescription for pills, we give it to them,” said Dr. Phillip Stubblefield, director of obstetrics and gynecology at Boston Medical Center. “We’re trying to expand access to this and put more of the control into the patients’ hands.”
Planned Parenthood League of Massachusetts also sponsored legislation filed in December to allow certain pharmacists to dispense emergency contraception to patients without a prescription. The bill also would require the state’s hospitals to provide the medicine to rape victims – legislation that the Massachusetts Catholic Conference plans to fight.
Some of the nation’s 600 Catholic hospitals already offer the morning-after pill to some rape victims, as do the hospitals in Caritas Christi, the Archdiocese of Boston’s health-care network and one of the largest hospital systems in Massachusetts. But Catholic hospitals generally do not use the medication as widely as some secular hospitals, because the pill is designed to prevent a fertilized egg from implanting in a woman’s uterus. Many doctors don’t consider a woman pregnant until implantation has occurred. But under Catholic teachings, using the morning-after pill to prevent a fertilized egg from implanting in the uterus is considered abortion.
“They are asking us to do something that is against the beliefs of the Catholic Church, and our hospitals should not be put in that position,” said Maria Parker, associate director of public policy for the Catholic Conference.
Some secular hospitals don’t provide the morning-after pill either, although Massachusetts Hospital Association executives said they’re unlikely to take a position on the proposed law.
Emergency contraception – high-dose birth control pills – generally must be taken within 72 hours after sexual intercourse to prevent pregnancy. Since the pills came on the market four years ago, their use has climbed steadily. The pills were credited in a recent study by the Alan Guttmacher Institute, a nonprofit research institute that conducted the country’s most comprehensive survey on abortion, with helping reduce the US abortion rate by 5 percent from 1996 to 2000. Physicians consider the pills safe, and two years ago the American College of Obstetricians and Gynecologists urged their 40,000 members to offer prescriptions to women during routine checkups to help cut down on unwanted pregnancies.
Dr. Robert Barbieri, chief of obstetrics and gynecology at Brigham and Women’s Hospital, said he now routinely writes prescriptions for morning-after pills for patients who are using condoms or diaphragms for birth control – just in case their method fails or they forget to use it and cannot get to a hospital emergency room or a physician’s office. The women can keep the prescription at home and fill it at a pharmacy if they need it. He said 20 to 30 percent of gynecologists, internists, and nurse practitioners at the hospital are now writing just-in-case prescriptions for patients.
“I am encouraging everyone I meet to do it,” he said. “Our key goal now is to make sure people have easy access to it. A person has 120 hours to take it, so it’s an emergency. It’s also a psychological issue to some degree, because people start to worry if they can’t get to a doctor right away.”
Since Preven, the first brand of emergency contraception, came on the market in 1998, US sales have climbed steadily, to $2.3 million in 2001 – a small figure that indicates the drug has yet to catch on. A newer medication, Plan B, was approved by the Food and Drug Administration in 1999, and doctors wrote more than 200,000 prescriptions for both drugs during the first 10 months of last year.
Unlike older high-dose birth control pills, which can cause strokes and blood clots, Barbieri said, high-dose morning-after pills, which contain the same hormones, appear to have no serious side effects because women take just two pills 12 hours apart. Preven, however, can cause nausea, he said, and doctors who prescribe it usually prescribe an antinausea medication as well.
Morning-after pills reduce the risk that a woman will become pregnant after unprotected sex but don’t entirely eliminate it. If 100 women have sexual intercourse at the midpoint between their monthly periods, eight will become pregnant, Barbieri said. The number of pregnancies is reduced to two out of 100 women when they take the morning-after pill, he said.
Planned Parenthood also is trying to increase use of the pill by allowing women in Massachusetts to request it from the organization’s nurse practitioners over the Internet starting March 12 – something Planned Parenthood already does in Chicago, Indiana, Georgia, and Oregon. Women will pay $45 to $75 for the assessment, pills, and three refills.
At Boston Medical Center, Stubblefield said the hospital’s pharmacy dispenses eight to 10 prescriptions for Plan B a month, many of those to rape victims. “We wish to help people have the babies they want when they want them, and I think the legislation is an excellent idea,” he said. “It’s very unfortunate that some women are deprived of this excellent medical care because they happen to be taken to the wrong hospital.”
Planned Parenthood said this is an issue in secular hospitals as well as religious institutions. In a study last year by Mass NARAL, the state affiliate of the National Abortion and Reproductive Rights Action League, more than half of Massachusetts hospitals refused to provide the prescription to women who called the emergency room and asked for it. A fifth of the hospitals said they couldn’t provide the pill even to women who were raped.
But Planned Parenthood’s proposed legislation in Massachusetts also is worsening the rift between the reproductive rights group and the Catholic Church, which disagree profoundly on contraception and abortion. A telephone survey by Catholics for a Free Choice, a group that supports abortion rights, last year found that just 28 percent of Catholic hospitals would provide morning-after pills to rape victims. The Massachusetts Catholic Conference said the survey was poorly conducted and the percentage is higher.
New York, California, and Massachusetts all have passed laws requiring employers to cover contraception as part of standard company health insurance plans. Some Catholic and Protestant groups in New York filed a lawsuit against the state in December, because the law requires many religious employers, including hospitals and schools, to provide contraceptive coverage – in conflict with church teachings. The Massachusetts Catholic Conference is contemplating its own lawsuit against the state.
In California and Washington state, Planned Parenthood has sponsored laws requiring all hospitals to provide the morning-after pill, although similar legislation has failed in a number of other states. Planned Parenthood executives say given that nearly 10 percent of women who are raped become pregnant, morning-after pills should be widely available.
“If a person is a victim of violence and they happen to be taken to a hospital and they’re not given this option, that’s a sad state of affairs for that woman,” said Dianne Luby, chief executive of Planned Parenthood League of Massachusetts. “Every child should be a wanted child.”
Catholic hospitals, however, want the freedom to try to determine whether fertilization has occurred before prescribing the morning-after pill to women. But there is no foolproof medical test. By measuring hormone levels, doctors often can determine whether a woman has ovulated or whether implantation has occurred, but it is nearly impossible to pinpoint fertilization, the step in between, Brigham’s Barbieri said.
This article originally appeared in the 28 February 2003 edition of the Boston Globe.