Analysis: Plan B could reduce abortions

By PEGGY PECK, United Press International  |  May 7, 2004 at 1:54 PM
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LAKEWOOD, Ohio, May 7 (UPI) -- The Food and Drug Administration's decision to deny women direct access to emergency contraception prevents what many regard as the best opportunity to achieve a real substantive reduction in the number of abortions in the United States.

Plan B, the emergency contraceptive that was the subject of the FDA's ruling Thursday, works in two ways: It inhibits or prevents ovulations and it impairs sperm from fertilizing the egg. It works best when used within three days of unprotected sex, but it can work for up to five days after unprotected sex.

Most important, experts said, it prevents pregnancy either before fertilization or before attachment of the egg to the uterus. It also cannot harm an embryo that has begun to grow in utero, so technically it does not cause an abortion.

Dr. Vivian Dickerson, a professor at the University of California, Irvine, and president of the American College of Obstetricians and Gynecologists, told United Press International her organization estimates half of the 6.3 million pregnancies in the United States each year are unintended.

Although many women decide to carry an unintended fetus to birth, many do not. The Centers for Disease Control and Prevention in Atlanta reported 857,475 legal abortions in 2000. Half of those abortions are performed within the first eight weeks of pregnancy and 88 percent are done in the first 12 weeks.

At eight weeks, there is little information available about potential birth defects, so most of those abortions likely were performed because the pregnancy was unintended. Plan B, supporters contend, could eliminate the need for all those abortions.

Moreover, with Plan B, a woman can make a private decision about pregnancy, explained Dr. Harry Jonas, a member of the board of directors of Physicians for Reproductive Choice and Health and a former president of ACOG.

Jonas called the FDA ruling on Plan B an example of the "continuing decline in support for women's reproductive rights" and an example of "politics overtaking medicine." Jonas currently is special consultant to the dean at the University of Missouri-Kansas City School of Medicine.

The FDA's own expert panel voted 22 to 5, with one abstention, to recommend that Plan B be sold without a prescription and 27 members of the panel said the drug was safe. The FDA said in its ruling the decision was based on a concern about safety for young women. The ruling said there is not enough information about possible adverse effects of Plan B on adolescents and teens 16 and younger.

The research suggests otherwise, however. The main ingredient in Plan B is levonogestrel, the same synthetic progestin found in many birth control pills. There are many studies supporting the safety of birth-control pills in adolescent girls -- there are even studies suggesting birth control pills can be used to treat teenage acne.

Moreover, other studies have confirmed Plan B cannot cause an abortion if a woman is pregnant -- if a fertilized egg is implanted in the uterine wall.

Another argument against Plan B is making it readily available will encourage women to use it rather than standard birth control. Here again, research does not support the claim.

Emergency contraception has been available for years in France without any decrease in the use of birth control pills or barrier contraception. Likewise, in the United States, several states have experimented with limited, over-the-counter dispensing of ECs -- Arkansas, California, Hawaii, Maine, New Mexico and Washington -- and in those states there was no evidence that women "were using EC rather than regular birth control methods," Dickerson said.

There is little doubt women's reproductive rights will be an issue in the fall campaign. For example, Sen. John F. Kerry, D-Mass., the presumptive Democratic Party nominee, has drawn fire from Roman Catholic leaders because he supports abortion rights -- Kerry is a Catholic. Thursday, a Kerry campaign spokeswoman criticized the FDA ruling on Plan B.

President George W. Bush is an outspoken opponent of abortion and conservative groups have lobbied him and congressional Republicans to oppose over-the-counter sale of Plan B.

Dickerson said she and others in medical community want to make emergency contraception and women's reproductive rights a major issue in the fall campaign and she noted leaders of the women's physician community plan to "take back women's reproductive rights at the polls this fall."

Meanwhile, there is some chance the FDA will approve restricted sale of Plan B if an agreement can be worked out with the maker, Barr Laboratories of Woodcliff Lake, N.J., which has indicated it is willing to go along with a plan to limit girls younger than 16 to prescription access only, while older women could buy the drug OTC.

Because most abortions are obtained by women younger than age 25, it is difficult to determine if such a move will have a significant impact on the abortion rate.

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Peggy Peck covers medical research and health policy issues for UPI Science News. E-mail sciencemail@upi.com

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