Ovral

With her busy career as an attorney in Dallas and no steady relationship, Nicole feltshe couldn't entertain the notion of getting pregnant. But one night, an unexpected slipup left her with heavy consequences to handle. "I thought we were being responsible," she recalls, "but when we literally burned rubber and broke the condom. I did get a little panicked."

Nicole vaguely remembered hearing about some pills that could keep you from getting pregnant after sexual intercourse, so the next morning she called her gynecologist. After speaking with her doctor, she chose to take the morning-after pill, an emergency contraceptive that many women aren t aware of, to decrease her risk of pregnancy. Luckily, all she had to do was pick up a prescription at her pharmacy and make a follow-up appointment with her doctor in three weeks.

Nicole took the pills that night and went to bed. "The next morning I felt so nauseated I had to call in to work sick," she remembers. "I think I spent the whole morning next to the toilet and in bed." Despite the discomfort, Nicole believes she did the right thing. "Given my other option, I would do it again. But after this experience, I don't think I'd put myself in that position again."

What millions of sisters don't know is that this so-called morning-after pill (MAP), which can prevent pregnancy after unprotected sex, has been available through doctors and family-planning clinics for years. Routinely administered to rape victims, MAPs are really just birth-control pills, usually Ovral, taken in a higher dosage.

Regardless of the hesitancy some physicians and clinical professionals may have about MAPs. many agree that the pills need to be made available Considering that there are more than 3.6 million unintended pregnancies every year, using emergency contraception could reduce this number dramatically. MAPs are also considerably less costly, safer and more convenient than abortions, which number more than 1.6 million annually.

Although only for emergencies, the MAP is an option we need to know more about.

HOW THE MAP WORKS

If a woman has had unprotected sexual intercourse and strongly feels that she might be pregnant, with proper instructions from her doctor she can take the specialized dosage of Ovral. Two of these pills, containing estrogen and progestin hormones, are taken within 72 hours of unprotected sex, along with another two pills 12 hours later. In this concentrated form, Ovral can either prevent the fertilization of a woman s egg or prevent a fertilized egg from implanting itself on the wall of the uterus and developing into an embryo.

Linda Swan Jackson. a nurse practitioner at a Planned Parenthood clinic in Chicago, counsels patients about the MAP. After gathering a thorough medical history, Jackson gives a pelvic exam and a pregnancy test to ensure that the woman tests negative. If a woman has conceived within 72 hours of a pregnancy test, it will still report negative results. A woman will never know whether she was actually pregnant or not if she takes the MAP successfully.

Administering the pills, a physician gives the woman clear instructions on how to take them, along with warnings about risks and side effects. Though perhaps more intense, common side effects are similar to those associated with taking the Pill: nausea, vomiting, breast tenderness, bleeding and headaches. "No serious complications have ever been reported," according to Dr. Robert Hatcher, professor of gynecology at the Emory School of Medicine in Atlanta. In contrast, risks linked to long-term use of birth-control pills include blood clots, heart attack, stroke, liver damage, gall-bladder disease and high blood pressure. With the MAP, Hatcher says, "Women are only taking a small dosage in comparison." Women with a history of these medical problems aren't good candidates for MAPs, and neither are women over 35 who smoke.

THE CONTROVERSY

Considering the ease of this method and the relatively low risk, many women are left wondering why they have never heard of the MAP and why it's not more widely used. To begin with, the Food and Drug Administration (FDA) has only approved Ovral for use as a contraceptive method to be taken once a day, just like other birth-control pills. Because of this restriction, Ovral's manufacturer, Wyeth-Ayerst Laboratories, cannot market or label the drug as an emergency contraceptive.

Although it is not illegal to prescribe or take the Pill as emergency contraception, some doctors question the ethical issues surrounding nonapproved uses of Ovral. Hatcher sees no ethical dilemma. "Twelve percent of all women taking oral contraceptives use them not for contraception but for cysts, acne, menstrual pain and many other nonlabeled indications," he states. "Between 45 and 50 percent of the time, drugs approved by the FDA for one indication are used for other applications, which is perfectly ethical and legal." Because of the extremely high cost and length of time involved in testing, many manufacturers do not pursue FDA approval for all possible uses of their drugs.

Another obstacle to doctors prescribing Ovral for emergency situations is that surprisingly many physicians do not even know it can be used under such circumstances. Hatcher routinely asks first-year medical students if they know that an emergency-contraceptive pill exists. "Out of a class of 100, only 15 had ever even heard of it, and those students went to colleges that made it available to students," says Hatcher. Doctors uninformed of such an option, of course, can't even discuss it with their patients, let alone prescribe it.

The most likely places to learn about MAPs are local clinics. Sonja Avery, clinic coordinator at the Feminist Women's Health Center in Atlanta, notes that most women find out about MAPs through friends or clinic visits. The Feminist Women's Health Center holds community-outreach workshops in which young women are informed of various birth-control options, including emergency contraception. Yet the most prevalent means of finding out about MAPs is by word of mouth.

Even among doctors who are well aware of emergency contraception, there are still those who do not dispense MAPs because of the possible liability they face in case the pills do not work. Some medical experts debate whether the MAP would affect a developing fetus. "There is no evidence that a woman might have a problem pregnancy if the MAP doesn't work," claims Susan Wysocki, president of the National Association of Nurse Practitioners in Reproductive Health.

Many doctors do not administer MAPs because they have reservations about abortion and would rather not participate in what they consider an abortive procedure. Doctors and clinicians continue to dispute the "gray area of conception": the question of whether a child is conceived when the egg is fertilized or when the fertilized egg attaches itself to the uterine wall. Some doctors will prescribe MAPs. Melody McCloud, M.D., an obstetrician-gynecologist in Atlanta, states, "While I don't perform abortions, I have at times prescribed MAPs because I don't see that as abortion." Nonetheless, McCloud strongly advises, "Although the MAP is available, it's still better to deal with your contraceptive needs before sex, not afterward."

Some professionals are uneasy about the potential abuse of the MAP as a birth-control method. Yet given the uncomfortable side effects of nausea and vomiting, such as Nicole experienced, many women are deterred from using the MAP on a regular basis.

Jackson and Avery say they have never had a patient ask for the MAP twice. "When we counsel patients," says Jackson, "we tell them that [the MAP] is an emergency option only, not birth control. And if we did have clients come in consecutive months asking for the MAP, we wouldn't administer it. But it's never happened." As part of prescribing the pills, all inform their patients that emphasis should be on being responsible in the first place, not after the fact, and the practitioners offer more practical methods for birth control.

Another solution may be on the horizon that would make MAPs as easy to obtain as aspirin. According to Dr. Kenneth Edelin, chair of the American College of Obstetrics and Gynecology's Committee for Underserved Women in Washington, in five years oral contraceptives could be made available without a prescription. "They are among the safest medicines to take," he says. "They're actually even safer than other over-the-counter medicines." When we stop to consider the enormous responsibility we have for not getting pregnant, most of us want as many options as possible available. Wysocki states, "When you think about a woman's reproductive span from age 12 to 55, it takes a lot to keep from messing up. We re not perfect." Indeed, having MAPs at our disposal could help us have peace of mind when we are not.

HOW TO FIND OUT MORE

If you'd like to learn more about emergency contraception, contact the following organizations: . American College of Obstetricians and Gynecologists Resource Center, 409 12th St. S.W., Washington DG 20024-2188. Send a self-addressed, business-size envelope with "Birth Control Pills (AP021)" written on the front, lower left corner to receive a pamphlet on the Pill. Federation of Feminist Women's Health Centers, 633 E. 11th Ave., Eugene OR 97401; (800) 995-2286 or (503)344-0966. Call this organization for clinic locations in your area. Planned Parenthood Federation of America, 810 Seventh Ave., New York NY 10019; (800) 230-PLAN. Write or call for a clinic near you or for literature on reproductive health.

RELATED ARTICLE: HOW TO GET THE MAP

The morning-after Pill (MAP) can prevent pregnancy after unprotected intercourse. Legally available to women, it is not widely known. Dr. Robert Hatcher, professor of gynecology at Emory School of Medicine in Atlanta, coauthored Emergeny Contraception: The Nation's Best Kept Secret (Bridging the Gap Communications, Inc., (800) 721-6990 or (404) 373-0530, paperback, $9.95). Due this spring, the book will list methods of emergency contraception, including birth-control pills. Hatcher States, "Women are either totally unaware that emergency contraception exists or they have to call numerous doctors just to find it."

RELATED ARTICLE: OVER-THE-COUNTER PILL?

What if we could walk to the corner drugstore and buy a package of condoms and a supply of birth-control pills? It would mean convenience for millions of women who rely on monthly precription refills from their doctors or clinics. But experts believe that putting birth control into the hands of women would have more resounding effects.

"Making birth-control pills available over the counter would give greater access to more women," claims Susan Wysocki, president of the National Association of Nurse Practitioners in Reproductive Health. "It's one of the safest drugs on the market and has had extensive testing." Robert Hatcher, M.D., gynecology professor at Emory School of Medicine in Atlanta, cites a 1988 study in which more than 200 people died from taking anti-inflammatory and over-the-counter pain medicines while none died from estrogen-based drugs.

However, not everyone agrees that making birth-control pills available without medical supervision is good. Linda Swan Jackson, R.N., a nurse-practitioner at a Planned Parenthood clinic in Chicago, believes the monthly refills keep women in touch with the health-care system who might not otherwise come in. "Lots of women need an exam," she states," and if they can just buy pills without getting a checkup or education--especially teens who think they can take pills the night before they have sex--is that really helping?" Wysocki agrees that all women, regardless of what type of contraception they use, need to go in for routine pelvic exams.

Jackson raises the issues of misuse if women aren't counseled. She gives the example of making yeast-infection cream available over the counter, saying that many women mistakenly use these products for serious infections like gonorrhea and could jeopardize their fertility. "The directions are very confusing for birth control," she adds, "and if they're sold over the counter, nobody will be there to instruct about proper usage and side effect." Wysocki takes the opposite view on the issue, asserting that with general avialability, instructions could be made more consumer-friendly.

Nonetheless, until a manufacturer applies to the Food and Drug Administration for over-the-counter status, all these issues will continue to be contemplated. Wysocki estimates that the application and acceptance process will take between five and ten years. When it is complete, the question of cost will arise. Experts like Wysocki and Jackson are concerned that the pills may be put out of the financial reach of many women. This problem may be resolved by making pills available both over the counter and by prescription.

COPYRIGHT 1995 Essence Communications, Inc.
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