Should "Morning After" pregnancy preventative be available without prescription?

when I googled, granted I didn't research as extensively as I would if it were a medication I were actually thinking of taking, all I found was the progestin-only kind, oddly enough, containing higher dose of the exact progestin I used to be taking (which is no longer available maybe because of this "morning after" controversy? or maybe because they are making more money off it in this other form, who knows.). If it does contain estrogen, yes, I most certainly do believe it should be prescription only. Maggie, can you change my vote? That stuff is way too dangerous to ever be made otc. Any form of hormone treatment containing estrogen is dangerous, there are just too many risks, and in my humble opinion should not be on the market at all, much less over the counter, except for very severe cases and in very small doses and should probably be a vaginal suppository instead of an oral medication to control the amount that makes it into the woman's blood more accurately. How many women who take bcp actually read the package insert and patient info sheet? I never did, and I never had a doctor tell me any of the possible side effects the eight years I was taking it, they just did the pap, "thank you ma'am, here's your prescription. Next patient, please." And it was even worse when I had no insurance and was getting my pills from the free clinic.


Brighid, you are sadly mistaken if you think the risks of hormonal bcp are "small indeed" and are even comparable to the risks of pregnancy. There are risks in pregnancy, most of them risks created by things doctors do to pregnant and laboring women, and some of them possibly fatal. But our bodies are designed to get pregnant and birth babies, and if left to our own devices, we would do that just fine without the "help" of the medical profession. BCP does not produce a natural state in a woman's body, it can actually damage the hormone-controls in a woman's body to the point where she is permanently infertile (a small but very real side effect for those women who have experienced it). BCP containing estrogen can cause cancer, heart attack, stroke. Even though commonly prescribed as a temporarly treatment for women with abdominal cramps and pain, it usually makes any endometriosis or other disorders associated with estrogen dominance much worse in the long run. How many doctors actually do blood work to test a woman's hormone levels before prescribing bcp? No, what they do is adjust the dose if the first one is causing problems or isn't working right, like the woman is some sort of a guinea pig....

 

I'm sorry, but that isn't possible.

As for pregnancy being more or less dangerous. In our society, with ready access to health care ect. the risks of pregnancy may be small, but in the recent past, and in developing countries, pregnancy is and was one of the main causes of death for childbearing womyn. The risk of blood clots is higher while you are pregnant, than when you are on the Morning After Pill or oral contraceptives. So is the risk of other health conditions.

In our society, womyn have access to good health care, and I am not saying "pregnancy is dangerous" for everyone, but, if the stats are looked at, being pregnant, as beautiful as many of us think it is, is still a bigger health risk than a few days of a combo Plan B.

Mamaboogie, Plan B (which contains estrogen) is only taken for a few days. The risks to your health are small indeed. In a country where many womyn may have to travel 100 miles or more to find a clinic which will even prescribe Morning After BC, the risk of these womyn being pregnant far outweighs three days on estrogen.

And, yep, regular BC pills CAN and ARE used as Morning After BC. Doctors do this every day. They did not take any progestin only pills off the market, PLan B as well as the progestin only Morning After pilll are still TOTALLY LEGAL, they just require a prescription.

In an emergency, QUICK access to this medicine is essensial. Considering most BC accidents happen on weekends (this is when more people tend to have sex) and many doctors are not available on weekends, and the longer you wait to take Plan B the less effective it is, having it available OTC is still a good choice, in the minds of many.

Every medication available by prescription contains an insert. I remember getting the insert in my BC pills in the 1970s! No one should accept a presctiption from a doctor without asking questions. He may assume you already know the risks, as they are not only well know, but readily available. And most, if not all pharmacies now also have their own, printed readout-side effect sheet given with every presctiption.

As womyn, we NEED to take responsibility for our own health. Doctors are busy, they often assume we know more than we do (and it IS our responsibility to KNOW this stuff) and often womyn just take prescriptions without asking questions of either the doctor OR the pharmacist. I never take a drug I have never taken before without FIRST discussing it with my doctor and or my pharmacist. I also look up the drug before taking it (before the internet, there were (and still are) plenty of good books about drugs and their side effects.) Just be careful of books which have agendea (like, the "all prescription drugs are evil" cadre, whose message does more harm than good.) You are better off, for side effects, looking at something like Medline or WebMD or The USPDI for fact based info on medications. For breastfeeding and pregnancy facts (as the Physicians Desk Reference is NOT the best place to look for these situations) Medications and Mother's MIlk, by Dr. T. Hale or Drugs in Pregnancy and Lactation by Briggs et all are the most accurate place for fact based knowlege, without an agenda.

 

I didn't want to take this so totally off topic, so I didn't elaborate or explain myself. I was taking Ovrette, which contains norgestrel, the same progestin that is in most combo bcp and in the morning after pill that I found with my very quick google. It is no longer being made, and I was switched to a different progestin-only pill, containing norethindrone instead, which is not as effective for me and has caused some icky side effects that I did not experience while taking the Ovrette. I was only speculating on why Ovrette is no longer available, seeing as how the same active ingredient is in other progestin-containing medications.


The high risk of death during childbirth in our country's past was caused by doctors who did not wash their hands, it was much lower before doctors took over "delivering" babies from the women-folk. Even with our advanced medical technology in the US, there are at least 20 other countries with lower maternal and neonatal fatality rates. And, at the WHO website, I found a study that showed something like 80% of the complications during pregnancy and childbirth were actually caused by things doctors did to the women. (I used to have links to the stats handy, before my computer crashed. sure I can find them again)

 

No, sorry, I'm not mistaken at all, you're simply not looking at the bigger picture. Both pregnancy and BC have risks, and the risks escalate with the same lifestyle choices and socio-economic factors.......smoking, substance abuse, poor diet and nutrition, etc, will increase the risk of poor outcomes in both situations. Long term use of hormonal contraceptives may have negative effects on the body, as does multiple pregnancies. Pregnancy, while a natural state, is not a typical state for a woman's body to be in.

The middle to upper class, educated, healthy white American woman will have less risks associated with her pregnancies. But for many women the risk of BC is less than the risk of unwanted or multiple pregnancies. Women who don't have the resources to eat whole foods and maintain a healthy lifestyle, pregnancy can be dangerous.

I'm a midwife, and very low-intervention, but I just love it when people think that if left alone, everyone will have healthy, happy pregnancies with healthy happy babies. The natural birth community tends to romanticize "primitive" birth, thinking that it was all perfectly wonderful. Take a look at the maternal and infant mortality rates in the third world where very few women have access to health care, family planning, trained birth attendants, good food and clean water, all the things we take for granted. Yes, if not messed with, birth works wonderfully well......IF the woman is eating a wholesome, nutritious diet, IF she is in good health, IF she hasn't had 10 kids in 10 years. African American, Native American, and Hispanic women have some of the poorest birth outcomes in North America, they are also the least likely to get prenatal care, have enough money to feed themselves properly, and at higher risk for substance abuse and other social factors. You cannot possibly believe that a woman from a lower socio-economic bracket is at less risk with multiple, unassisted pregnancies than she is on birth control? We can't forget when advocating holistic care for women to look at each and every individual woman in a holistic light.....not just her physical, but her emotional social, economic, spiritual and mental health as well.

 

Statistics on death and morbidity rates per 100,000 womyn, for both pregancy and birth control pills. These stats are from the Centers for Disease Control, Planned Parenthood and other sources.



the incidences of pregnancy-related stroke were 46.2 (95% CI 30.7-69.5) per 100,000 pregnancies.



67% developed stroke in the 3rd trimester and puerperium, and 73% of CVT occurred in the puerperium period



From the CDC:

Maternal and infant mortality are basic health indicators that reflect a nation's health status. In the United States, infant mortality has declined steadily; however, this is not true for maternal mortality. This report presents data from death certificates compiled by CDC's National Center for Health Statistics, which indicate that in the United States, the annual maternal mortality ratio * remained approximately 7.5 maternal deaths per 100,000 live births during 1982-1996.

Annual maternal mortality ratios were calculated using information contained on death certificates filed in state vital statistics offices and compiled by CDC (1,2). Maternal deaths were defined as those deaths that occurred during a pregnancy or within 42 days of the end of a pregnancy and for which the cause of death was listed as a complication of pregnancy, childbirth, or the puerperium (International Classification of Diseases, Ninth Revision, codes 630-676). Maternal mortality ratios were calculated as the number of maternal deaths per 100,000 live births (1,2).

In 1930, the national maternal mortality ratio was 670 maternal deaths per 100,000 live births (3). The ratio declined substantially during the 1940s and 1950s, and continued to decline until 1982. During 1982-1996, the annual maternal mortality ratio fluctuated between approximately 7 and 8 maternal deaths per 100,000 live births (Figure_1). During that time, trends by race were similar to the overall ratio, and no reductions were observed for either black or white women. Maternal mortality ratios remained higher for black women than for white women. Ratios for black women generally fluctuated between 18 and 22 per 100,000 births and for white women between 5 and 6 per 100,000 live births.

Reported by: Div of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion; Div of Vital Statistics, National Center for Health Statistics, CDC.





For nonsmokers, the risk of cardiovascular death from OC use is less than the risk of death from pregnancy. However, for smokers over age 35, the risk of cardiovascular death from OC use is greater than the risk of death from pregnancy for women over age 35.1



From Planned Parenthood:

Results of the study found 0.06 and 3.0 deaths per 100,000 nonsmokers 15 to 34 years of age and 35 to 44 years of age, respectively from Birth Control Pills

Pregnancy deaths have certainly decreased since the 670 dead womyn per 100,000 pregnancies in 1930, but our current rate of about 7 to 8 deaths due to pregnancy per 100,000 womyn due to pregnancy is still higher than the 0.06 to 3 per 100,000 deaths due to hormonal contraceptives. (That number, 3, contains womyn who should not have been taking the Pill, such as womyn over 35, who smoke tobacoo, as well. The 0.06 per 100,000 is normal BC usage in an otherwise healthy womyn.)

 

Mamaboogie, Orvette was taken off of the market as more "advanced" types and lower dosages of BC pills were developed. It had nothing to do with people using it as Morning After Pills. ANY BC pill can be used for this purpose.

Brigid, thank you for explaining the differences between different birth styles. Yes, womyn with "high intervention" births often have a higher death rate. One explaination of this is that the interventions themselves cause higher death rates, this may be true in some cases, however, womyn who would have never carried a baby to term (like ME) benefit from "high intervention" pregnancies, as we get children out of them. Yes, womyn with other health risks get higher rates of interventions, and they also have higher death rates, but they are still lower than death rates just 70 years ago, and still HIGHER than the death rates for birth control pill users. Womyn who GET higher intervention pregnancies are often the womyn who certainly would have died in pregnancy or childbirth just 70 or less years ago. I know I would have.

Now, I am no great lover of hormonal BC. It makes me physically ill. But, many many womyn benefit from it. And, looking at the death rates for pregnancies, especially in black womyn, where rates are as high as 33 womym per every 100,000, The Morning After Pill can only save the lives of womyn who either do not want to be pregnant, or for whom pregnancy would be a death sentence.

Exactly what I was saying. I think we are on the same track here.

 

I really am not wanting to argue with you all. I actually agree with what your are saying for the most part. It's just that certain things, such as estrogen-containing hormonal medications, are subjects which I feel very strongly and passionately about. And it really has nothing to do with the topic of this thread, except and unless the "morning after" pill contains estrogen-like chemicals, which are very dangerous. If we are talking about giving women free access to such medications, I cannot be more against it. If we are talking about a progestin-only medication, I stand by my original vote that it should defniitely be available otc. I am all for women having control of their own reproductive health. But certain medications being freely available I feel will only cause more problems than it solves. This is only my opinion. I respect anyone who has the wherewithal to look up the risks and make up their minds for themselves after educating themselves thoroughly on the subject. It is those people who do not educate themselves first that worry me the most.


The big problem with BCP and such is that they are not like pregnancy in one huge way, they only contain chemicals similar to *two* hormones. Pregnancy causes changes in literally hundreds of different hormones that work in conjunction with each other, and science has yet to find or understand even half of them. Taking a medication that contains estrogen is particularly harmful because estrogen is stored in our fat cells, building up over time, increasing our chances of many different health problems and diseases, many of which are only now being recognized as risks of having taken estrogen in a person's past. And, there is also the problem with our drinking water becoming contaminated with estrogen from the urine of women taking such medications, building up in everyone's fat cells, causing major long term health problems of epidemic proportions. That's not to mention how such medications are manufactured, or how pharma companies test them on women in third world nations before knowing how dangerous they are or what would be a proper dose....


there has got to be a better solution out there, waiting to be found.

 

It's not an argument, it is a discussion, where people are putting forth facts and ideas about a subject. I make my decisions based on facts. And I posted the ones I found to be true.


I agree that I don't like to take estrogen drugs either. I am in perimenopause, and I would much rather suffer the hot flashes, mood swings ect than take that stuff. Maybe there might be "something better" in the future, but for the girl whose boyfriend's condom broke last night, or the womyn who got raped this morning, it is all we have.

IMO, and in the opinion of most HCPs, the risks of 3 days of Plan B are much less than those of an unwanted pregnancy (actually the risks are less, in terms of your life than a wanted pregnancy) as long as womyn KNOW those risks, they should be free to use the medication, without having to schedule a doctor appointment, get herself to the doctor, perhaps fight with the pharmacist about getting the drug, and then having to take it also.

Personal decsion. But the risks are not that huge, not compared to pregnancy. And if a girl had a birth control accident yesterday, and being pregnant would NOT be in her best interest, it is this 3 day regimene of Plan B or a full scale abortion. I think the Plan B is preferable to most womyn. JMO.

 

In Maine, the law is a pharmacy must give you a consultation and then you are given the pill - no questions asked and I believe no matter how old you are

I think its a great law

 

I think we need to trust women to make smart decisions regarding their own care. If a woman is opposed to taking ANYTHING with estrogen then she need not take the morning after pill. That doesn't mean because she doesn't like the risks or side-effects that it shouldn't be available to other women. It isn't like we are asking it to be sold with no instructions, warnings, or side-effects listed. I am perfectly capable of understanding and making an informed decision about taking or not taking a pill.

If a woman has to wait to get into the doctor or find out if she is for sure pregnant before she can get the pill then the whole thing is useless. And we shouldn't bother ourselves with wether women are using it as birth control or not, just because some would be irresponsible with it doesn't mean we should treat it like everyone will be. I know people that pop 5-6 OTC sleeping pills at a time, which is not how that stuff should be used, so should we take that stuff away from everyone?

 

Very true, Sera.

We cannot punish the whole of a group because some people are abusing their own bodies by not educating themselves and abusing the drugs they are given.

These people are only damaging themselves. If anything, the law should specify that if the party involved abuses the OTC emergency contraception and it causes any harmful affects, they should not be allowed to sue the pharmacy, doctors, or pharmaceutical companies.

But for the most part, women are going to be responsible with their bodies. They're not going to abuse drugs if they are aware of the consequences. By making this drug only available through prescription means that it will be harder to get it within the time alloted (72 hours), and that, in effect, will render the drug useless in some cases.

As a society, we need to learn to trust citizens to make responsible, informed decisions about their lives and health. By taking away the need to be informed and responsible, we're making the problem of drug abuse worse.

 

http://www.cbc.ca/story/science/national/2005/04/20/pill-emergency050420.html
In Canada, Plan B is behind a pharmaceutical counter and you still need to talk to a pharmacist about it, before they give it to you. If you go to a doctor to get a prescription, you don't have to pay for it in Canada.

 

For the most part, people are responsible. However, you're not allowed near anything harder than aspirin without a doctor being involved cause of that one percent.

"Hi, I like, had sex, like, with my boyfriend and we could have reached over and got the condoms out of the dresser drawer but we didn't want to spoil the mood and now I think I'm pregnant. Since I am responsible with my own body having proven it up to this point with my aforementioned actions involving said body, please give me megadoses of hormones to poison my uterus"

The only reason I agree is: this woman should not have children.

 

Plan B is also used in cases of rape (the majority of which are not reported, especially if it is someone the victim knew) in cases of incest, in cases of broken rubbers and slipped off rubbers, and when a dude says he will pull out (I promise I promise I promise) and doesn't.

Who said the condoms were in the dresser drawer and if they were, why didn't the man lean over and get them, in your scenerio?

 

Mags: I agree wholeheartedly.

I'm not opposed to access to these drugs.

I'm just saying I know of at least two women who used abortion as birth control, but eve that isn't my issue. Hormones are perscription drugs for a reason.

 

I think Plan B is much preferable to abortion. It is cheaper, less invasive and not as difficult emotionally on the womyn and her man. In the countries where this drug is available OTC, there have been no problems with abuse or overuse. The side effects, which are unpleasant see to that.

 

There have been 2 times when the condom broke and I was so thankful for planned parenthood and the morning after pill. It could keep stupid people from reproducing, mistakes from turning into life long consequences, and the amount of people choosing to get abortions could go down significantly. I wish they would just go ahead and make this readily available. Even if people choose to use it as birth conrtol at least they aren't getting knocked up, and hell if a child won't teach them maybe an STD from unprotected sex will.

Just my 2 cents

 

Plan B is available over the counter here, and i used it...I ABOSLUTELY CONDEMN THE ACCESSABILITY OF PLAN B OTC. I DO understand that YES sometimes birth control and Morning after pills DO fail, but the Pharmacist i visited did NOT explain to me that the likeliness of it working is JUST as low as the likeliness of it NOT working. Lo and behold a month later, who finds out they're pregnant??? Not only was i ON birth control, but plan B failed me as well. Morning After pills are not available over the counter because they're dangerous meds, and people would ABUSE them to extreme measures unaware of their unreliability. If people rely on PLan B for contraceptive precaution OTC HOW MANY MORE YOUNG GIRLS AND WOMEN ARE GOING TO HAVE TO HAVE ABORTIONS BECAUSE PLAN B FAILED THEM simply because a pharmacist wanted to make $60????? When i visted my family dr after finding a positive result, i told her what i did, and she said Plan B is the worst possible route to take if you want results. The pharmacist should have immediately sent me to another facility...be it a gyno, the ER, a teen health centre...anywhere but to Plan B. Thanks to that fucking pharmasist (who ARE NOT DOCTORS i might add) who could have directed me otherwise , i had the scariest most unexpected, unplanned for, traumatic 3 months of my life.

And yeah, go on and say it, that if i'm going to "thank anyone" i should thank myself..... i'll say it again, i took the precautionary measures and was alerady on BC for YEARS and went for the m/a pill. This wasn't a drunken 'oops, teehee let's cross our fingers and hope nothing happens' mistake.

 

You sould like it was planB that got you pregnant...

 

i'm not 11, i know how i got pregnant, you don't have to be hurtful like i'm directly insulting you with my post i just want people to know WHY it's so much better NOT to go for an over the counter m/a pill. Pharmacists are NOT doctors, they don't take the time to explain anything to you when they should. All she had to do was say "it's not proven to be very effective, see someone else immediately". My family dr, my gyno and the dr my mom works for all said the same thing. Accidents happen, and i think when 2 contraceptives and a pull out fail on me, it's pretty clear it was an major ACCIDENT. I should have been given alternate options and not given false hope that these pills would work. In the mean time i've heard of several women who still got pregnant after the plan b was taken.