Morning-After Pills (Also Known as “Plan B” or “Emergency Contraception”)

Overview

Morning-after pills (MAPs) are given within 72 hours of sexual intercourse. These differ from the “abortion pills” or RU-486 in that MAPs must be taken within 72 hours of intercourse to be effective. RU-486 is an abortion-inducing drug which has been approved for use by the FDA through the first 49 days of pregnancy.

Morning-after pills are being marketed as “emergency contraceptives,” when their action is known to be abortifacient (abortion causing). Although it can sometimes act to prevent conception, making it a true contraceptive, medical evidence indicates that it may also act to prevent implantation of the newly formed individual in the mother’s womb, causing the pregnancy to be aborted.

Issue Analysis

MAPs have four potential mechanisms of action:

  1. Prevention of ovulation
  2. Interference with fertilization
  3. Interference with transport of the fertilized egg to the uterus
  4. Prevention of implantation in the uterine wall.[1]

It is the last two possible actions that most concern those who share a pro-life view.

In August 2006, the FDA expanded the use of MAPs by approving the distribution of “Plan B,” a brand name morning-after pill, for over-the-counter sale at pharmacies. The FDA order originally stated that the drug may only be sold to those 18-years-old or older without a prescription. In 2009, a federal court ordered that the pill must also be made available to 17-year-old girls without a prescription. Under the Bush administration, the FDA had resisted the lawsuit, but with the 2008 election of Barack Obama, the FDA accepted the judge’s order and quickly revised its rules to allow over-the-counter access for 17-year-olds. However, in a surprising move in late 2011, the Obama administration blocked efforts by the FDA to allow over-the-counter access for all minors (16 and under). In February 2012, the Center for Reproductive Rights re-opened their lawsuit against the FDA for its restriction, and in April 2013 the court ruled in their favor. Weeks later, the FDA announced that Plan B would be available for girls ages 15 and older. The Obama administration announced in May that it would appeal the judge’s order to lift all age limits, but in June the Second Circuit Court of Appeals in Manhattan ruled to allow girls of all ages to purchase morning-after drugs without obtaining a prescription or any form of parental notification or permission. [2]

As of September 2013, this drug has been made available without any age or prescription restrictions[3] and can even be found on the shelf at some pharmacies.

There are currently three brands of approved morning-after pills in the United States. The first two, PlanB/Plan B One-Step and Next Choice, contain a synthetic progesterone (levonorgestrel). Both drugs are to be taken within 72 hours of intercourse.[4] Plan B requires taking two pills 12 hours apart, whereas Plan B One-Step, as the name implies, is one double-dose pill. The two-pill version has essentially been phased out by the manufacturer. Next Choice is a generic version of Plan B.[5]

In 2010, the FDA approved a new “morning-after pill” called “ella,” which is a 30 mg tablet of ulipristal acetate, designed to prevent pregnancy up to five days after intercourse.[6] Currently, ella is only available by prescription. The timeline for this drug and its chemical operation make it more like the RU-486 abortion pills than the other morning-after pills. When used up to five days after intercourse, ella is more likely to cause an abortion by interference in transportation or implantation of the fertilized egg, rather than “preventing” pregnancy.[7]

A previous brand of morning-after pill, Preven, has been discontinued.[8]

Medical Issues

Side effects of the morning-after pill may include:[9]

  • Nausea or vomiting
  • Dizziness
  • Fatigue
  • Bleeding between periods or heavier menstrual bleeding
  • Breast tenderness
  • Headaches
  • Lower abdominal pain or cramps
  • Diarrhea

Plan B One-Step contains 10-15 times the amount of the levonorgestrel hormone found in a regular birth control pill.[10] Given the known, serious safety risks of ordinary birth control pills, including blood clots, stroke, heart attack, gallbladder disease, vision problems, and liver tumors,[11] there is concern that such extreme hormone levels in morning-after pills could have a significant impact on the health and safety of women.[12]

Further, ella has a chemical make-up more closely related to RU-486, which has been known to cause severe hemorrhaging, complications from ectopic pregnancies, and even death.[13]

Other Safety Issues

Over-the-counter status is not appropriate for a medication that contains a high dose of hormones since women, and particularly minors, will not have the opportunity to consult with a healthcare professional who can review her medical history or any contraindications for the drug.

Moreover, the recent decision by the Second Circuit Court of Appeals and agreement by the Obama administration to allow emergency contraception over the counter without any age restriction is a slap in the face to parental rights and any notion of common sense. Parental consent is required for a school to give a student Tylenol, yet there is no requirement for a medication that administers a high dose of hormones to a minor girl and has the potential to end a preborn life.

Denying parents the right to make a serious medical decision for their children not only presents medical risks to the life of the child, but also limits a parent’s ability to protect their children from sexual abuse. Predators see the accessibility of MAPs as a way to cover up their sexual assaults on minors.

Talking Points

  • “Morning-after pills” can cause an abortion. Although it can sometimes act to prevent conception, making it a true contraceptive, medical evidence indicates that it may also act to prevent implantation of the newly formed individual in the mother’s womb, causing the pregnancy to be aborted.
  • “Morning after pills” are not the same as RU-486, also known as the abortion pill. The main differences are that the “morning-after pill” can only be taken up to 72 hours after intercourse, is available over the counter, and doesn’t always act as an abortifacient.
  • Parents have an undeniable right to be involved in the health decisions of their minor daughters. The recent decision to remove all age and prescription restrictions for obtaining the morning-after pill flies in the face of parental rights and shows just how far proponents of “reproductive rights” are willing to go.

Conclusion

While the varieties of morning after-pills do not always abort a preborn child, they still have the capability to, and present a number of serious health and safety risks to women. These risks are further magnified when the drug is available without any oversight from a medical professional or without regard to the patient’s age.

 

© January 2014 Center for Arizona Policy, Inc. All rights reserved.
This publication includes summaries of many complex areas of law and is not specific legal advice to any person. Consult an attorney if you have questions about your specific situation or believe your legal rights have been infringed. This publication is educational in nature and should not be construed as an effort to aid or hinder any legislation.


[1] Mayo Clinic Staff, Morning-after pill, June 28, 2013, www.mayoclinic.com/health/morning-after-pill/MY01190 (last visited Sept. 24, 2013).

[2] Tummino v. Hamburg, No. 13-1690 (6th Cir. 2013).

[3] Alexandra Sifferlin, Timeline: The Battle for Plan B, Time, June 11, 2013, available at www.healthland.time.com/2013/06/11/timeline-the-battle-for-plan-b/.

[4] Morning-after pill, supra note 1.

[5] Types of Emergency Contraception, The Emergency Contraception Website, Aug. 26, 2013, www.ec.princeton.edu/questions/dose.html (last visited Sept. 24, 2013).

[6] Highlights of Prescribing Information, Food and Drug Administration (2010), www.img.medscape.com/pi/alert/watson/Ella%204%20page%20final%20PI.pdf (last visited Sept. 24, 2013).

[7] Letter from Pro-Life Leaders to FDA Commissioner, July 28, 2010, www.ellacausesabortions.com/ellapetition/Media_Center_files/Ella%20Group%20Letter.pdf (last visited Sept. 24, 2013).

[8] Drug Details: Preven Emergency Contraceptive Kit, Food and Drug Administration, www.accessdata.fda.gov/scripts/cder/drugsatfda/index.cfm?fuseaction=Search.DrugDetails (last visited Sept. 24, 2013) (search by name).

[9] Side Effects, The Emergency Contraception Website, July 31, 2013, www.ec.princeton.edu/questions/ecsideeffects.html (last visited Sept. 24, 2013).

[10] Plan B One-Step contains 1.5 mg levonorgestrel. Typical birth control pills with levonorgestrel as the active ingredient contain 0.10 or 0.15 mg levonorgestrel. See, e.g., Drug Details: Lessina-28 (generic drug), www.accessdata.fda.gov/scripts/cder/drugsatfda/index.cfm?fuseaction=Search.Search_Drug_Name (search by name) (contains 0.10 mg of levonorgestrel); Drug Details: Altavera, www.accessdata.fda.gov/scripts/cder/drugsatfda/index.cfm?fuseaction=Search.Search_Drug_Name (search by name) (contains 0.15mg of levonorgestrel).

[11] Omnia M. Samra, et al., Birth Control Medications (Contraceptives), www.emedicinehealth.com/understanding_birth_control_medications_contrace/article_em.htm (last visited Sept. 24, 2013); see also MedicineNet.com, Oral Contraceptives, www.medicinenet.com/oral_contraceptives/article.htm (last visited Sept. 24, 2013).

[12] See Mailee Smith, Tracking the FDA’s Approval of Plan B: 10 Years of Endangering Women’s Health, Culture of Life Foundation, Apr. 23, 2010, www.culture-of-life.org//content/view/576/1 (last visited Sept. 24, 2013).

[13] Mifepristone U.S. Postmarketing Adverse Events Summary through 04/30/2011, Food and Drug Administration, available at www.fda.gov/downloads/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/UCM263353.pdf.