In May of this year, the Food & Drug Administration’s center for drug evaluation and research made the decision to continue requiring a prescription for the morning-after-pill (MAP), known as Plan B, amid calls for an investigation and accusations of politics. In January of this year, 49 members of Congress sent a letter to President Bush urging him to reject over the counter status for Plan B, pointing out the vulnerability of adolescents to sexually transmitted diseases.

Dr. Steven Galson said the decision against making the MAP available over-the-counter was made after a 90-day period of public comment and was based on concern that there was still not enough information on the possible effects of the pills on the sexual activity of young girls.

Opponents of the availability of MAP over-the-counter point to a lack of testing for safety of women and that easy access would eliminate counseling and screening for contraindications. Easy access allows someone other than the consumer to buy the MAP and give it to the woman with or without her knowledge, increasing the likelihood of sexual abuse. For instance, in Thailand, the major purchasers were men.

The reported safety of the MAP is based on the safety of the birth control pill, but the MAP is a much higher dose, actually quadrupling the dose of the birth control pill and a prescription is required for the birth control pill.

Easy access to the MAP would increase sexual activity. In the United Kingdom, where it is available without prescription, there has been an increase of 3,000 cases of chlamydia and a 50% increase in cases of gonorrhea. The highest increases were among 16-19 year olds. Four out of 12 women said their choice to have unprotected sexual intercourse was influenced by the knowledge that they could obtain the pill from a pharmacy. Many women used it repeatedly during the same year.

Adolescents are unlikely to recognize contraindications or follow directions on the label. After secretly taking the MAP, they were less likely to seek help if they suffer complications. One-third of the women users did not understand that the MAP is not a regular form of birth control.

Proponents of easier access to the drug claim it would reduce the number of abortions by as many as hundreds of thousands a year. In fact, the MAP is an abortion! Plan B promoters claim that MAP inhibits implantation, but does not end a pregnancy. The beginning of pregnancy is fertilization, not implantation (despite redefinition by the American College of Obstetricians & Gynecologists in the late 1960’s). If the MAP prevents implantation, it ends the life of the baby.

When the MAP was first approved, Planned Parenthood suggested that every woman should have it in her medicine cabinet “just in case.” The American College of Obstetricians & Gynecologists is now urging doctors to give patients an advance prescription for emergency contraception long before they need it. The goal is to give women the pills or an undated prescription so she has access to the pills if and when she needs them. Will school-based clinics be the next opportunity for distribution?

Although the decision to require a prescription for Plan B (MAP) was a victory for women, the FDA left the door open to allowing over-the-counter availability. Suggesting that Plan B would get another chance if the company could submit information proving that it could be used safely by girls younger than 16 or limiting its over-the-counter availability to 16 or older. We must stay vigilant to be sure that doesn’t happen.

Mary Anne Hackett