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AMA Seeks to Improve Access to Morning After Pill

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"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 accessible."

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."

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