Background Brief

Emergency contraception (EC)-- also known as the “morning after pill” is a form of contraception that can be used shortly after sexual intercourse to prevent unintended pregnancy. Approved by the Food and Drug Administration (FDA) in 1999 for use with a doctor’s prescription, Plan B, the brand name for EC pills, is designed to be used in cases of unprotected sex or possible birth control failure, such as a condom breaking, and not as a regular form of contraception.  Research suggests that Plan B prevents pregnancy by delaying or inhibiting ovulation or fertilization, or inhibiting a fertilized egg from implanting in the uterus. When taken within 3 to 5 days of intercourse, EC pills are estimated to reduce the risk of pregnancy by up to 89 percent. [1] EC cannot terminate an established pregnancy and is not a form of medical abortion or RU-486.

The availability of EC has raised several contentious policy questions and debates.  Supporters, including major medical and public health organizations and women’s health advocates believe that women should have easier access to EC to help prevent unintended pregnancies in the event of a contraceptive failure or after a sexual assault.  In several states, proponents have spearheaded initiatives that allow women to get EC from pharmacists directly and some states mandate that providers offer EC to women who have been sexually assaulted.  On the national level, supporters have petitioned the FDA to eliminate the need for a doctor’s prescription and approve sale of EC over-the-counter.  However, other groups, including some pharmacists and health care providers, believe that EC is an abortifacient or oppose all forms of birth control, and refuse to dispense EC on moral or religious grounds.  Some opponents also argue that easier access may cause women, especially teens, to engage in riskier sexual practices or go without regular forms of contraception.

These fundamental disagreements have resulted in polarizing debates over some current policy questions, including the pending application to the FDA to allow the drug to be sold without a prescription and the role of pharmacists and other providers in providing the drug when they object to it for moral or religious reasons.

Discussion Questions

• What are the major areas of disagreement about access to EC?
• What state and local policies are currently in place to facilitate women’s access to EC?
• What data would be useful for the FDA to issue a final ruling on the application to make Plan B available over-the-counter?  What issues are they concerned about?
• Why would EC be confused with RU-486?  What approaches could address this confusion?
• What policies are in place at the federal, state, and local levels to help assure that women who have been sexual assaulted have access to EC?  What challenges do providers face?

Acknowledgements: Jane An, Usha Ranji, and Alina Salganicoff of the Kaiser Family Foundation.

Updated: February 2008