My Personal Experience with Emergency Contraception

Posted by on April 18, 2013 in Body, Policy | 10 comments

During our newlywed years, contraception was a trial for us. We intended to start a family sometime within a few years of our marriage, so permanent or long-term options were out. However, we were determined not to accidentally start a family a moment too soon. Like many other couples, we wanted to build a strong foundation for our marriage before we added the important but stressful component of child-rearing. Unlike many other couples, we also needed to make some difficult choices before we began our family. My husband has genetic diseases that could be passed on to our children. How would we handle that? Risk it? Adopt? Medically intervene? At that point, we were still considering our options.

I took hormonal birth control while my husband used a condom. According to the textbook, this should have been an ideal solution for our situation. Both methods are temporary and quite effective; combining the two methods made the system even more effective.

But my body rebelled. During my second or third month on any birth control pill or shot, uncontrollable vaginal bleeding would begin. Sure, the hormones were still preventing pregnancy, but mostly by making me feel too gross to even consider having sex.

The only way to stop the bleeding was to stop taking birth control, wait for the side effects to go away, and then go back to the doctor for a different kind of prescription—all of which yielded the same results.  During the interim, our two-part pregnancy prevention system would be reduced to one part—the condom.

And one night, that condom broke.

At that time, emergency contraception required a doctor prescription—quite the stumbling block for an intervention that becomes ineffective within a few days after intercourse.  Luckily, I was able to get an appointment.  My insurance did not cover emergency contraception, but since emergency contraception is actually just a higher dose of hormonal birth control, she prescribed me birth control pills and instructed me to take several right away.plan b

My husband and I were both relieved that we averted an unintended pregnancy, but my husband asked me a few days later, “We didn’t just have an abortion, did we?” His concern was based on reading this statement by the Food and Drug Administration (FDA):

Plan B [emergency contraception] works like other birth control pills to prevent pregnancy.  Plan B acts primarily by stopping the release of an egg from the ovary (ovulation). It may prevent the union of sperm and egg (fertilization). If fertilization does occur, Plan B may prevent a fertilized egg from attaching to the womb (implantation). If a fertilized egg is implanted prior to taking Plan B, Plan B will not work. Reference A 

Some people have argued that emergency contraception is a type of abortion because they believe that the beginning of life is fertilization and because the FDA states that emergency contraception may prevent a fertilized egg from implanting in the womb.  As Mormons, our faith does not doctrinally define the beginning of life, leaving us to wonder whether a potentially fertilized egg should be considered a person. Reference B  Personally, I felt quite confident that a potentially fertilized but unimplanted egg was not yet a person; my husband was less confident.

Just last year, a New York Times investigation revealed that my husband’s uneasiness and guilt over our use of emergency contraception could have been prevented.  There never was evidence to support the claim that emergency contraceptive pills affect fertilized eggs and research since the time the FDA wording was put in place has demonstrated that the claim is false.  However, that anxiety- and guilt-inducing falsehood is still required to be printed on emergency contraception packaging.  Reference C  Another barrier to emergency contraception is that although it no longer requires a prescription,  women are required to ask a pharmacist for it instead of buying it off the shelf.  A recent court ruling may finally make it available over-the-counter in the next few weeks. Reference D

Forgive my hubris, but I consider our case to be the perfect example of responsible use of emergency contraception.  We were a married couple that had tried to utilize other contraception methods, only resorting to emergency contraception when those other methods failed. Preventing an accidental pregnancy was vital; there would have been serious medical consequences for a child born because of an accident, since he/she would most likely have inherited genetic diseases.

But let’s talk about another case.  This event was related to me, without identifying information, by a health care worker.  He was annoyed to see the same obnoxious teenager in his office, rudely demanding emergency contraception for the second or third time.  He had already given it to her before—along with lots of advice about more responsible ways of preventing pregnancy and contraceptive resources to that end.  She was irresponsible and unrepentant and it would serve her right if she got pregnant, he thought.

Then he reminded himself that if this girl got pregnant, the result would be either an abortion or the birth of an innocent child.  It wouldn’t be the child’s fault that his/her mother was so young, obnoxious, and irresponsible. What kind of a life would this child lead, if raised by this person who was so obviously unprepared for motherhood?

He gave her the emergency contraception.

A Brief History of Emergency Contraceptive Pills in the U.S.A.

1966: Researchers at Yale University demonstrate that it is possible to prevent pregnancy with oral contraception taken within 6 days after intercourse. Reference E 

1971: Information published in medical literature leads to increasing off-label use of oral contraceptives as emergency contraception after intercourse. Reference F Reference G 

1999: The U.S. Food and Drug Administration (FDA) approves Plan B, an oral contraceptive designed to be taken after intercourse to prevent pregnancy.  The medication is available by prescription only. The FDA requires wording to be included on Plan B packaging stating that the medication may block implantation of a fertilized egg, against manufacturer objections and in spite of lack of evidence to back this claim. Reference H  Reference C

2006: The FDA approves use of Plan B without a prescription for women 18 and older.  Women are required to request the medication from a pharmacist, rather than picking it up off the shelf like other non-prescription medications. Reference H

2009: A court ruling expands use of Plan B without a prescription to women and girls 17 and older. Reference H

2011: The FDA approves sales of Plan B over-the-counter.  For the first time in known history, the U.S. Secretary of Health and Human Services overrules an FDA decision, maintaining the requirement that girls 16 and younger get a prescription and that girls and women 17 and older request the medication from a pharmacist. Reference I 

2012: A New York Times investigation publicizes that there never was scientific evidence to support the statement required by the FDA that emergency contraception may block implantation of a fertilized egg.  The article also asserts that  research since 1999 has demonstrated that this statement is false.   Reference C

2013: On April 5, a federal court rules that Plan B must be sold over-the-counter without age restrictions, beginning no later than May 5, 2013. Reference D

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10 Comments

  1. I’m very impressed with the courage it took to post this. I agree, Plan B is a worthy alternative to having a baby when you aren’t ready, but unfortunately most of the church feels differently. I think most women haven’t put a lot of thought into the fact that their usual BCP could possibly cause many of the things Plan B does- which, depending on your definitions, could count as abortion. The definition of “the beginning of life” is grey enough that I say each couple can decide for themselves if Plan B is acceptable.

    • I thought that too– that regular birth control pills also can prevent a fertilized egg from attaching.

  2. The thing with the health care worker annoys me. He does not know her life or situation. She might have been raped for all he knows. Ya know? She might have been using contraception and it failed like yours did. It’s ridiculous that he thinks, well a baby would serve her right, like a baby should be a punishment.

    • Yes. that line of thinking is all wrong and the health care worker who related the story knows it and agrees. He told this story as an example of how he overcame this problematic line of reasoning and he advocates that health care workers do not interfere with anyone’s access to birth control.

      • I am a student NP. One of my clinical sites is a college health center where the policy limits Plan B to twice per student. After that they have to go get it at a pharmacy, we give it away for free and it is fairly expensive. We assess every patient requesting Plan B for rape and I would never deny Plan B to someone who was raped. I don’t think it is unreasonable to ask someone who habitually uses Plan B to find a more reliable form of birth control (which we are happy to provide) or pay for it themselves.

  3. This may be a dumb question, but if a condom fails and you happen to be *right* in the process of ovulating, will Plan B prevent pregnancy? I thought it would, but the info in this post makes me think that must not be right.

    • After the egg is released, contraception may still prevent the egg and the sperm from fertilizing, if you take it before the two unite. If the egg and sperm have already met and so the egg has already been fertilized, Plan B will not prevent the pregnancy, according to current research on the topic. (And of course you thought it would, that is what the packaging incorrectly says.)

  4. I went to my local drugstore for PlanB after a condom-breaking incident very much like yours (married, coulnd’t use hormone-based BC). When I made my request to the pharmacist I was told that they were all out of it. I repeated my plea, perhaps even crying a bit. She “found” some for me somewhere behind the counter. Since then I’ve wondered if she said that same thing to every woman requesting PlanB or if she saw my wedding ring and decided that it was okay to give me some.

    • Such a poignant example of the need to get third parties out of the equation! I hope nothing prevents Plan B from going on the shelf this May, as the court has ordered.

  5. April, I love your research and telling your experience. I have also used Plan-B, once, after a condom broke (I was avoiding hormone-based bc as I was breastfeeding an infant). It was unlikely I would get pregnant at that point in the month, but I didn’t want to risk it.

    It has bothered me to hear politicians describing this super birth control pill as an “abortion pill,” as it points to a lack of awareness about the reproductive cycle, fertilization, and implantation. There is a huge difference between preventing a pregnancy and terminating a pregnancy. Plan B will only prevent a pregnancy, but it won’t make a pregnant woman abort her pregnancy.

    A fertilized egg isn’t a baby, and not allowing it to implant and cause a woman to become pregnant is not an abortion. Neither is discarding (or even not correctly placing for implantation) embryos from IVF. If we think along these lines, the many couples who have relied on in-vitro fertilization, and the many more who will come that need that technology, may be left without this joy-giving option.

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