News from
PRINCETON UNIVERSITY
Communications and Publications
Stanhope Hall
Princeton, New Jersey 08544-5264
TEL 609/258-3600 FAX 609/258-1301
Release: March 29, 1995
Contact: Justin Harmon (609/258-5732)
Handbook Describes Options for
Emergency Contraception
PRINCETON, N.J. -- A new handbook by a team of scholars, policy
experts and clinicians aims to educate women about little-known
options for preventing pregnancy after sexual intercourse.
Emergency Contraception: The Nation's Best-Kept Secret, released
March 29, describes safe, legal medical techniques, short of
abortion, which its authors estimate could prevent half of all
unwanted pregnancies and half of all abortions in the United
States each year, if women knew they were available. The book
lists 1,477 providers of emergency contraception across the
country; this list is also published on the Internet.
The book has six authors: Robert A. Hatcher, professor of
gynecology and obstetrics at Emory University School of Medicine;
James Trussell, professor of economics and public affairs at
Princeton University; Felicia Stewart, deputy assistant secretary
for Population Affairs at the U.S. Department of Health and Human
Services; Susan Howells, a consultant in reproductive health in
Bangkok, Thailand; Caroline Russell, an intern at Advocates for
Youth in Washington, D.C.; and Deborah Kowal, a medical writer and
adjunct faculty member at Emory University School of Public
Health. The book is published by Bridging the Gap Communications
of Decatur, Ga.
Emergency contraception is used after sexual intercourse but
before a woman becomes pregnant; it prevents fertilization, or it
prevents implantation of a fertilized ovum. It is the only method
that can reduce the risk of a pregnancy when other contraceptive
methods have failed or when no contraception was used.
The book outlines the treatment regimens and weighs the advantages
and disadvantages of five emergency-contraceptive methods:
-- emergency contraceptive pills, or combined birth-control pills,
which utilize the hormones estrogen and progestin,
-- the intrauterine device (IUD) known as the copper-T and marketed
in the United States as ParaGard,
-- minipills, or birth-control pills containing progestin only,
without estrogen,
-- Danazol, a synthetic hormone used to treat gynecologic problems,
-- Mifepristone, also known as RU 486, which can work as an
emergency contraceptive before pregnancy and as an abortifacient
after pregnancy, though it is currently not available in the
United States.
According to the authors, two factors overwhelmingly limit women's
use of emergency contraception: lack of awareness, and timing.
Women do not know that emergency contraception is available
because, to be marketed for such use, a drug or a device must have
been labeled accordingly in the manufacturer's application to the
federal Food and Drug Administration. In other words, a drug or a
device may have medically appropriate uses within the safety
limits approved by the FDA, but if these are not identified in
initial or supplementary applications, they cannot be advertised
or otherwise promoted by the manufacturer. Clinicians may still
prescribe drug or device for an unlabeled purpose, but a woman may
not know to ask her clinician. (An example of an unlabeled use of
an approved drug about which women apparently have greater
awareness is the prescription of birth-control pills to regulate
the menstrual cycle.)
Manufacturers and distributers are reluctant to apply to the FDA
to relabel existing drugs or devices because they fear backlash
from anti-abortion groups, who object to their use to prevent
implantation, according to the authors. Public awareness of
emergency contraception is poor, and the functional distinction
between emergency contraception and the action of abortifacient
drugs is lost, the authors say.
Timing is also a significant factor, according to the authors. To
be effective, drugs used as emergency contraception must be begun
within 48 to 72 hours after unprotected sex, depending on the
drug. Similarly, an IUD must be inserted within five to seven days
after unprotected sex. Women often lack sufficiently rapid access
to clinical services.
The authors cite as typical the example of the woman who calls her
doctor's office the morning after a contraceptive failure, unsure
what options may be available, but who is told by a receptionist
that there is nothing to do but await her period. By the time the
woman actually sees her clinician, emergency contraception is no
longer an option.
"It seemed to us the best course was to try to educate women about
emergency contraception, so they can demand that it be made
available to them," said Trussell. "The book represents our
attempt to give women the practical information they need to take
control, both of the particular situation in which there is a need
for emergency contraception, and of their reproductive rights more
broadly."
In an article published in the journal _Family Planning
Perspectives_ in 1992, Trussell and Stewart estimated that
postcoital hormonal contraceptives reduce the risk of pregnancy by
75 percent. In a forthcoming article in the journal Fertility
Control Reviews, Trussell and former Princeton graduate student
Charlotte Ellertson estimate that postcoital insertion of a
copper-T IUD reduces the risk of pregnancy by more than 99
percent. (Trussell's estimates of effectiveness rates for
contraceptive methods ranging from periodic abstinence to
barriers, pills and IUDs are used by the FDA, and are mandated by
the agency for use in packaging information on marketed brands.)
In a second article in _Family Planning Perspectives_ in 1992,
Trussell; Stewart; Felicia Guest, deputy director for training at
the Emory AIDS Training Network, and Hatcher estimated that, of
3.5 million unintended pregnancies in the United States each year,
as many as 1.7 million could be prevented through emergency
contraception. Similarly, of 1.6 million induced abortions, 0.8
million could be prevented. In the same article, the authors
recommended that women who do not have medical contraindications
routinely receive kits containing emergency contraceptive pills
when they visit clinics or physicians' offices to obtain
gynecological care, contraceptives or treatment for a sexually
transmitted disease.
The book _Emergency Contraception: The Nation's Best-Kept Secret_
is available from Bridging the Gap by calling 1 (800) 721-6990;
the cost is $9.95, plus shipping and handling. The list of
providers of emergency contraception may be viewed on the
Internet, using the World Wide Web, at
URL:http://opr.princeton.edu/ec/ec.html.
Planning is underway to establish an 800 number staffed round-the-
clock to offer information from the providers list to women in
need of a referral.
Hatcher, Trussell, Stewart and Kowal are among eight authors of
the sixteenth revised edition of Contraceptive Technology (New
York, NY: Irvington Publishers Inc., 1994), a comprehensive
reference book for clinicians.