The Truth about the Morning-After Pill
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During her freshman year at Northeastern University, 19-year-old Jennifer Grant* thought college was just about doing minimal homework, going to parties, and meeting new people. She looked forward to every weekend when she was invited to parties with upperclassmen. Sadly, her world fell apart when she was raped by another student who was an acquaintance. Scared and confused from the experience, she turned to her friends for help.
“They mentioned rumors of this ‘morning-after’ pill that would help you from getting pregnant,” Grant said.
She wanted to go to the Lane Health Center, but it was Sunday and she knew it was closed. She looked on the Internet for information on what she thought was a “magic pill” and discovered she could still take it two days later. On Monday, she walked into the Lane Health Center and after waiting a few minutes, she was assisted by a nurse. After she nervously explained what had happened, she said she was given a survey that contained a series of medical questions. In addition to the emergency contraception pill, a pregnancy test was administered and she was tested for sexually transmitted diseases.
"They did everything they could to help me and make me feel comfortable,” Grant said. “The only thing on my mind was, ‘I can’t get pregnant!’”
The emergency contraception pill (ECP), most commonly known as “the morning-after pill,” is a back-up birth control method that is used after unprotected sex, contraceptive failure, or rape. It prevents pregnancy from occurring, however, it is not a method for abortion nor does it protect against sexually transmitted diseases.
ECPs do not necessarily need to be taken the “morning-after.” They can be taken up to 120 hours after unprotected sex but the sooner it is taken, the more effective it is. According to Pamela Harris, the Health Promotion & Planning Coordinator at Lane Health Center, if it is taken within the first 72 hours after unprotected sex, the risk of pregnancy is reduced to a 15 percent to 25 percent chance.
There are several different kinds of ECPs available. The most commonly used is Plan B. At Lane Health Center, Ovral, Lo-Ovral, and Levlen are other kinds of ECPs that are provided.
ECPs are easy to use and are orally ingested. With Plan B, two doses are taken; one as soon as possible and the other about 12 hours later.
These pills contain one hormone called progestin and includes a total dosage of two pills. Other ECPs pills, such as Ovral and Preven, which combine the progestin and estrogen hormones, can have a dosage of up to eight pills. According to the Emergency Birth Control Organization, it can take up to a week for a woman to get pregnant. ECPs prevent pregnancy by delaying the ovulation, preventing fertilization, and slowing down the implantation process.
Women who take ECPs sometimes experience side effects such as nausea, vomiting, headaches, irregular bleeding, breast tenderness, dizziness, and fatigue. According to Not-2-Late.com, maintained by Dr. James Trussell from Princeton University, about 50 percent of women who take combined ECPs experience nausea and 20 percent experience vomiting. Only 23 percent of women taking the progestin-only ECPs experience nausea and only 6 percent experience vomiting.
Maria Gonzales*, a 21-year-old junior finance major has had to use the pill twice due to contraceptive failure.
“The first time I took it I felt nauseas,” she said. “But he second time I didn’t get sick.”
Grant’s experience was not as easy.
“I felt so tired and out of it,” she said. “My body didn’t react well to the pills. I had to miss my first class the next day because I was so sick and worn out.”
After taking ECPs, menstruation may start earlier or later. According to Dr. Trussell, studies show that after taking ECPs some women experience “irregular bleeding that is not really [a] period.” The menstrual cycle resumes normally within the following month. If it does not, then a pregnancy test is recommended.
At Northeastern, ECPs are available to all students, regardless of what insurance plan they are on. If a student needs the pill after hours or during the weekends, New England Baptist Hospital can be contacted where they refer the student to Beth Israel Deaconess Medical Center for a prescription.
When a student goes to Lane Health Center for ECP, there are certain procedures to follow. First, a questionnaire with about twenty questions must be filled out. The questions ask how long it has been since the student’s last period, if they had any other unprotected intercourse before the exposure, whether they are on birth control, and general health questions such as what medications the student is currently taking, if they are allergic to any medications, etc. Then, based on the student’s answers, the nurse determines if a pregnancy test is necessary. After that, the student is given the ECP along with information about it. In case vomiting, the student also receives a refill of the pill that they can take later if necessary.
A student can also call to get a prescription for the ECP. In that instance, the questions are asked over the phone. If a pregnancy test is not needed, then Lane Health Center can call the prescription to a local pharmacy that is convenient for the student.
While it seems as though the procedure to get the ECP is fairly easy and convenient, some students are apprehensive about it. A senior sociology major, was surprised that Lane Health Center provided the ECP but was still uncomfortable about going there.
“I would rather go to Planned Parenthood or something,” she said. “I don’t want to have them [the nurses] judge me or give me lectures.”
But Harris insists that the Lane Health Center tries not to intimate students.
“We’re here to help the student learn [and] make as good a decision as possible,” she said. “There are lots of different reasons for taking emergency contraception, and sexual assault not the least. We’re certainly not going to be lecturing someone that has survived a sexual assault.”
ECPs have been around since the 1960s, but were mostly used in cases where a woman had been raped. The first method of the ECP was called the Yuzpe Regimen and was approved by the U.S. Food and Drug Administration (FDA) in 1974. The regimen had already been approved in several parts in Europe and was similar to the combined ECPs that contain both the estrogen and progestin.
According to the Planned Parenthood Federation of America, these contraceptive pills were only available as “off-label” drugs and were used by a few hospital emergency rooms, family planning clinics, and university health centers. Health providers in the U.S. were reluctant to advise and educate women about ECPs because of possible legal liabilities associated with an “off-label” drug. A report contained in the FDA Federal Register said that a 1994 petition from the Center for Reproductive Law and Policy for manufacturers to include information about emergency contraceptive use in the packing for certain birth control pills was not supported.
The ECP finally became available to women in 1997, when the FDA declared them to be “safe and effective.” Currently, Plan B and Preven are the two types of oral contraceptives that require a prescription, in the U.S. According to the Henry J. Kaiser Family Foundation (KFF), the FDA is considering a request from the creators of Plan B to sell the drug over-the-counter.
There are several issues with making the ECP over-the-counter. The debate includes whether a physician’s visit is necessary, whether people, especially youths, will “abuse” the service once it is easily accessible, and whether women would be able to use the pills safely without a physician. The KFF argues that a doctor’s visit is unnecessary because there are no known serious side effects from ECPs and not all physicians conduct a pregnancy test before prescribing ECPs. According to the KFF, “the widespread use of emergency contraception in the U.S. could prevent 1.5 million unintended pregnancies and 700,000 abortions each year.”
A junior criminal justice major agreed that ECPs should be over-the-counter.
“If student knows that they can go to the store and just get the pill, it would be dealt with [and] they don’t have to worry about it,” she said.
Harris also believes that ECPs should be provided over-the-counter at pharmacies.
“The easier access, the better,” she said. “It benefits no one to say, ‘No you can’t have this, you’re too young.’ If anything, you don’t want children having children.”
Although there is the ongoing debate of making ECPs over-the-counter, college students in Massachusetts can easily find ECPs in most of their university health centers. A survey conducted in 2001 by the National Abortion and Reproductive Rights Action League in Massachusetts showed that 78 percent four-year colleges and universities in the state provide emergency contraception. The cost in certain family planning clinics and health centers depends on where the ECP is administered and on income.
At Northeastern, the cost for Ovral is $30 and is available 24 hours a day. Lane Health Center normally gives prescriptions for Plan B. If a student is not registered under the school’s insurance plan, then a doctor can call in the prescription to a local pharmacy. In cases where a rape has occurred, the fee is normally waived. Harris said the number of ECPs distributed in a year by Lane Health Center is unknown, but that students come in on a “fairly regular basis.”
There are also other universities in the Boston area that dispense ECPs. Harvard University offers the pill free of charge for students who under the school’s insurance plan and also offers after-hours care. Boston University offers the pill for $35. At Tufts University, the health care service provides the pill at $10 a pack. According to Dr. Margaret Higham, the Medical Director for Tufts University Health Service, 242 packs of Plan B were distributed to students last year.
Some schools cannot dispense emergency contraception due to religious affiliations. For example, Boston College’s website states, “Because of the moral values that Boston College espouses, University Health Services, by policy, does not provide materials for the purpose of preventing conception or counsel that would encourage abortion.”
“We don't provide any contraceptives or we can't because of the view of the Catholic Church,” said Nancy Baker, the Associate Director, Nursing & Administration, Health Services Department at Boston College. “If a student comes in, we refer them to community based facility or private doctor or clinic.”
Baker said that in cases of sexual assault, students are referred to a “network of administration of students” that are available daily and “help guide students through the process of accessing health and psychological care.”
Gonzales believes that all universities should provide ECPs to their students.
“Accessibility means students who may otherwise forget this option, would be more likely to seek the pill,” she said.
In cases where students cannot or chose not to go through their university health care provider, costs for ECP can range from $20 to $240. The doctor’s visit, pregnancy test, and type of ECP provided are all factored into the costs. ECPs can also be obtained in person, by phone, or online, through the Planned Parenthood League of Massachusetts (PPLM). Online, it cost $40 and is available during weekdays from 9 a.m. to 3 p.m. Online prescriptions include three refills and are valid for one year. If the ECP is purchased directly at the Boston, Springfield, or Worcester PPLM center, the cost is $18. A prescription for a local pharmacy can be given as well, with costs ranging from $28 to $35.
Grant is grateful that ECPs were available at the Lane Health Center. She said that getting the pill was one of the more “relieving” parts from the aftermath of being raped.
“Who knows what would have happened if I wasn’t able to get the pill?” she said. “I might’ve had a baby that I was totally not ready for.”