AMA Seeks to Improve Access to Morning After Pill
WebMD News Archive
"This is an access issue," said Annis. "The more we
looked at this, the more we talked about how most unintended pregnancies occur
among uninsured and low income women for whom access is a problem. And once we
started to talk about access, we had to think about how to make this more
Most of the recommendations in the report call for physicians
to educate their patients about the availability of emergency contraception.
But clearly, over-the-counter status was the most controversial aspect of
debates about the issue. During hearings on the subject, Richard W. Whitten,
MD, a delegate from Olympia, Washington, informed physicians about a pilot
project in his state in which physicians formed collaborative arrangements with
pharmacies to dispense emergency contraception over-the-counter.
As of March 2000, 146 pharmacies were participating in the
project, with a total of 11,969 emergency contraception prescriptions filled.
Forty-two percent of women receiving emergency contraception under the system
did so after regular business hours, and 70% received emergency contraception
services within one day of unprotected intercourse, Whitten reported.
When asked if AMA would support similar state pilot projects,
Hill said the association would be supportive if the projects "were under
the supervision of a physician."
Emergency contraception provide a short, high dose of combined
estrogen and progestin thought to suppress ovulation, and have been shown to be
approximately 75% effective in preventing pregnancy when taken within 72 hours
after unprotected intercourse, with greater success the earlier the pills are
used, according to the AMA report.
But some physicians at the meeting said the mechanism of action
is uncertain depending on when it is taken, and that the "morning
after" pill may, in some instances, be acting not as a form of
contraception but as a form of abortion.
John Littel, MD, of Kissimmee, Fla., and a board member of the
National Catholic Medical Association, said that in some instances the pill
will not be preventing ovulation, but will be preventing the implantation of an
already fertilized egg. "Most physicians and patients believe human life
begins at fertilization and that to take the morning after pill violates their
basic morality," Littel said.
Joseph M. Heyman, MD, chair of the Council on Medical Services
and a delegate from West Newbury, Mass., underscored the importance of making
the pill readily accessible, if it is going to be used at all. "The sooner
the pill is taken [following intercourse] the more definitely the mechanism of
action is delaying or preventing ovulation," Heyman tells WebMD. "If it
is taken later, it may be preventing implantation."