State tries Plan B for unwanted pregnancies

By GINA KOLATA

The New York Times

Each month, at least one woman comes into Katterman’s Sand Point Pharmacy in Seattle to ask for a prescription drug. None of the women has seen or spoken to a doctor but each says she needs the drug immediately.

The routine for a pharmacist there, Beverly Schaefer, never varies. First she ushers the woman into a private cubicle. Then she counsels her and gives her the prescription pill.

The pill is an emergency contraceptive, modeled after the old “morning-after pill,” that can prevent pregnancy if it is taken within 72 hours after intercourse, and it is part of what public health officials say is a revolution that is just as important – if quieter – than the one initiated by the recent approval of the abortion-inducing pill, mifepristone, or RU-486. While mifepristone offers a way to end pregnancies, the emergency contraceptive pill can prevent them.

The contraceptive pill’s name is Plan B (as in, If Plan A – the usual means of preventing pregnancy – fails, try Plan B). And Katterman’s Pharmacy is one of 155 pharmacies, about 13 percent of those in the state of Washington, that have volunteered to participate in a program to provide the pills to women without requiring them to speak to a doctor first. Women who want to find a pharmacy near them need only call 888-NOT-2-LATE or visit the Web site www.not-2-late.com. The Web site from the maker of Plan B has a similarly catchy address: www.gotoplanb.com.

Alaska is testing a pilot program to make emergency contraceptives available to women without requiring them to see a doctor, and California and Oregon will soon put into place their own pilot programs. Earlier this month, Norway became the first country to make a similar drug, called NorLevo, available over the counter, on shelves and out in the open along with headache remedies and cold medicines. And on Thursday, the French Parliament changed its law on contraceptives to allow nurses to give NorLevo to teen-age girls in schools, said Dr. Andre Ulmann, whose company, HRA-Pharma, makes NorLevo.

Public health advocates have also gotten the new emergency contraceptive pills approved in Canada and some African, Asian, and South American countries, including some, like Mexico, Brazil and Venezuela, where abortion is illegal.

The new pill has the same ultimate effect as the old morning-after pill: It uses high doses of hormones to prevent pregnancy. But the morning-after pill was never an actual product. Doctors would mix it up themselves, ripping open packets of birth control pills and telling women to take a handful of them, the exact dose depended on the brand of pills. The regimen, while effective, often caused nausea and vomiting.

The new pill, in contrast, is packaged, marketed and designed specifically to prevent pregnancy. It also has fewer side effects.

The emergency contraception pills are not universally accepted, however. While most public health experts and doctors say that they are contraceptives, not abortion-inducing drugs, because they work before a fertilized egg has implanted itself in the uterus, some abortion opponents disagree. The National Right to Life Committee, for example, asked to comment on the pills, sent a fax saying that as far as it is concerned, once an egg is fertilized, a pregnancy has begun. And most pharmacies in Washington, including Schaefer’s, have no signs in their stores advertising that they give out emergency contraception. “There could be some controversy,” Schaefer explained.

But, said Elise Wells, a public health advocate who helped start the Washington project and is now starting the one in Alaska, there has been little outcry in Washington from opponents. “There had been concern that there would be protests and pickets, but that has not happened,” Wells said.

Public health advocates say the pill could provide enormous benefits.

“Our belief is that if emergency contraception pills really were widely used, to their maximum potential, then the number of unintended pregnancies could be cut in half,” said Dr. James Trussell, associate dean at Princeton University’s Woodrow Wilson School of Public and International Affairs. “It has a huge potential. But I can guarantee you that the emphasis in that sentence is on potential,” he added.

Plan B was born out of the passion of people like Trussell. It was the deliberate conception of a consortium of public health advocates who decided that there was a crying need for the drug, located a Hungarian company to make it and formed a company to market it in the United States. On July 28, 1999, the pill was approved for sale by the Food and Drug Administration, and on Aug. 23 of that year, the marketing company, called Women’s Capital Corp., filled its first order, for Planned Parenthood of Pasadena, Calif.

At first, Plan B was sold only to groups like public health clinics and Planned Parenthood. But about two months ago the company put the pills into commercial distribution.

For 25 years, doctors have known that women can prevent most pregnancies simply by taking high doses of birth control pills within 72 hours after having unprotected intercourse. The exact number of pills needed varied depending on the brand. Ordinarily, eight out of every 100 women who have unprotected sexual intercourse during the second or third week of their menstrual cycle will become pregnant. But if they take high doses of birth control pills, just two will become pregnant.

Medical experts say that a fetus is not harmed if a women takes emergency contraceptives and remains pregnant, and for that reason the American College of Obstetricians and Gynecologists determined that women do not need pregnancy tests before taking the pill. The exact reason why the pill works is not established, Trussell said, although one thought is that they alter the uterine lining, making it inhospitable to a fertilized egg.

But there were two problems with simply using birth control pills for emergency contraception. One is that half the women who take them feel nauseated and nearly one in five vomits, raising questions of whether women should take anti-nausea medication first and whether they should take more pills if they vomit. The other problem was simply the way the pills were provided. Doctors waited for women to ask for them. And even when women did ask, the pills hardly looked like routine medicine.