The Food and Drug Administration says emergency contraception is very safe, having been used by 2.4 million American women and millions abroad with few side effects.
Tuesday, the FDA asked its scientific advisers whether women will understand how and when to take emergency contraception without professional advice, key to the agency's ultimate decision.
Using the drug within three days of unprotected sex can cut by up to 89 percent the chance of getting pregnant, said Barr Laboratories, maker of the Plan B brand of postcoital contraception. The sooner it's used, the more effective it is, but it's hard to find a doctor to write a prescription in time, especially on weekends and holidays - and then many pharmacies can take 24 hours just to get some in stock, Barr said. "There is a public health imperative to increase access to emergency contraception," said Dr. Vivian Dickerson, president-elect of the American College of Obstetricians and Gynecologists, marking a rare occasion for the 45,000-member doctors' group to push for FDA action. "If we are truly dedicated to lowering the number of unintended pregnancies and abortion in this country, then let's prove it by making emergency contraception available over the counter."
If FDA ultimately lifts the prescription requirement, the question would become whether morning-after pills would sit next to the aspirin, or would pharmacists have to hand them over upon request. That option would make advice available if desired.
Already, five states allow women to buy emergency contraception directly from certain pharmacists without prescriptions, so-called behind-the-counter sales. The programs are in Washington, California, Alaska, Hawaii and New Mexico. Barr prefers no restrictions on sales, and some of FDA's advisers said Tuesday that behind-the-counter sales would be a barrier to women's access.
Morning-after pills are higher doses of the hormones in regular birth control pills. They work mainly by preventing ovulation or fertilization of an egg. If fertilization already has occurred, they also may prevent the egg from implanting into the uterus, the medical definition of pregnancy. If a woman already is pregnant, emergency contraception has no effect. So it hasn't proved nearly as contentious as RU-486, the abortion pill.
Emergency contraception does have opponents, however, groups such as the anti-abortion Concerned Women for America that oppose any interference with a fertilized egg. Critics contend if regular birth control pills are too risky for nonprescription use, then they are for emergency use as well. They also worry that broader access to emergency contraception could increase sexually transmitted diseases. Proponents argue there's no evidence that access to emergency contraception makes women more careless about regular birth control.
Studies of nonprescription emergency contraception found that 68 percent of women used the pills correctly, and the step that tripped up some - knowing to take the second dose 12 hours after the first - could be clarified better in the label, FDA reviewers concluded.