Doctors Not Telling Women About Plan B

Emergency Contraception: If Women Don't Ask, Doctors Don't Tell

Medically Reviewed by Louise Chang, MD on June 19, 2008

June 19, 2008 -- Despite widespread misinformation about emergency contraception -- the so-called morning-after pill -- only 3% of women's doctors discuss Plan B with them.

The finding comes from data collected during face-to-face interviews with 7,643 women aged 15 to 44. The interviews were conducted in 2002, when emergency contraception was available only by prescription. Yet only 3% of women said their doctors discussed the issue with them.

Even when women saw a gynecologist for a Pap test or pelvic exam, only 4% received emergency-contraception counseling, find University of Pittsburgh researchers Megan L. Kavanaugh, DrPH, and Eleanor Bimla Schwarz, MD.

"A lot of women, and the American public in general, are very misinformed about what emergency contraception is, how to use it, and how to access it," Kavanaugh tells WebMD. "Yet counseling about emergency contraception really is missing from the clinical encounter, especially for young women, low-income women, and minority women."

There was also good news from the survey. The researchers found that 73% of women who had used emergency contraception had used it only once. The finding shows that women are truly using the "morning-after pill" for emergencies, and not -- as some had feared -- for routine birth control.

Women were more likely to have used emergency contraception if their doctors had told them about it. But the small number of doctors who have such conversations with their patients rankles David M. Plourd, MD, assistant professor of obstetrics and gynecology at San Diego's Naval Medical Center and clinical instructor at the University of California San Diego. Plourd was not involved in the Kavanaugh study.

"This is abysmal. It is embarrassing [that] the numbers are so low on women getting this crucial information from their gynecologists," Plourd tells WebMD. "I just don't know the downside of emergency contraception. The upside is preventing terminations and unintended pregnancies."

Plan B 'Special' on Birth Control Menu

Nearly all of the FDA's outside advisors, including a 2003 expert advisory panel, urged the agency to make the emergency contraceptive Plan B available over the counter. But the agency delayed making a decision until 2006 -- and then it ruled that Plan B could be sold without a prescription only to women aged 18 and older. Prescriptions are still needed by women aged 17 and younger.

On the menu of contraceptive options doctors offer to women, Plourd says Plan B is like an off-the-menu special.

"A woman has a menu of contraception options," Plourd says. "It is my job, as the 'waiter,' to help her understand what is on that menu -- and to tell her that emergency contraception is one of the best things we have, but it is not on the menu. It is my job not to tell her what to order, but to tell her about what we have to offer."

Plourd says he tells his patients about emergency contraception during their annual checkups. He wants all his sexually active patients who do not want to get pregnant to keep Plan B on hand, just in case.

"Emergency contraception is like a fire extinguisher. If your house catches fire, this is not the time to go out and buy one," he says. "And if you have a contraceptive failure or, God forbid, you are involved in a nonconsensual sexual act, there is Plan B."

Many women, Kavanaugh says, confuse Plan B with the abortion pill RU-486 (Mifeprex). Plan B does not cause abortions. When it does not work, a woman has a normal pregnancy. When it does work -- which, according to Plourd, is 75% of the time -- it either prevents sperm from fertilizing an egg or prevents the fertilized egg from implanting into the womb and becoming a fetus.

Although Plan B is a brand name, it really is plan B. It's less effective than other forms of contraception used before intercourse.

Plan B is more likely to work the sooner after intercourse it is taken. That's why Plourd wants every woman who isn't ready to be pregnant to have it on hand. Kavanaugh says this is particularly important for sexually active women under age 18.

"For those under 18 who still need a prescription, it is very much in their interest to get it in advance so they don't waste time going through the prescription process when they need emergency contraception," she says.

Plan B isn't the only form of emergency contraception. Women may also opt for the Copper T IUD, an intrauterine device that can prevent pregnancy even when implanted five days after intercourse.

Kavanaugh and Bimla Schwarz report their findings in the June issue of Perspectives on Sexual and Reproductive Health.