Policies needed to increase awareness of emergency contraception.In September 1998, the Food and Drug Administration (FDA FDA
Food and Drug Administration
n.pr See Food and Drug Administration.
n.pr the abbreviation for the Food and Drug Administration. ) approved for the first time a dedicated emergency contraception Emergency Contraception Definition
Emergency contraception or emergency birth control uses either emergency contraceptive pills (ECPs) or a Copper-T intrauterine device (IUD) to help prevent pregnancy following unprotected vaginal intercourse. (BC) drug product for use by women to prevent pregnancy if taken within 72 hours of unprotected intercourse. (1)
Despite experts' predictions that wide scale use of BC could dramatically lower the unintended pregnancy and abortion rate, knowledge of its availability and use has proved disappointingly low within the United States United States, officially United States of America, republic (2005 est. pop. 295,734,000), 3,539,227 sq mi (9,166,598 sq km), North America. The United States is the world's third largest country in population and the fourth largest country in area. .
While both the U.S. House of Representatives and the U.S. Senate have introduced legislation relating to relating to relate prep → concernant
relating to relate prep → bezüglich +gen, mit Bezug auf +acc its accessibility and use, they have taken virtually no action. This is not true across the country. State legislatures have succeeded in introducing and passing laws that would make EC more accessible, thus increasing use and decreasing unintended pregnancies.
WHAT IS EC?
EC is a high dose of birth control pills birth control pill
See oral contraceptive.
birth control pill Oral contraceptive, see there that can reduce a woman's chance of becoming pregnant by 75 to 89 percent if taken within 72 hours of unprotected intercourse. It does not protect against sexually transmitted diseases Sexually transmitted diseases
Infections that are acquired and transmitted by sexual contact. Although virtually any infection may be transmitted during intimate contact, the term sexually transmitted disease is restricted to conditions that are largely (STDs), including HIV HIV (Human Immunodeficiency Virus), either of two closely related retroviruses that invade T-helper lymphocytes and are responsible for AIDS. There are two types of HIV: HIV-1 and HIV-2. HIV-1 is responsible for the vast majority of AIDS in the United States. .
EC is not, as often believed, the "abortion pill abortion pill See Contragestive, Oral contraceptive, RU-486. " (or mifepristone Mifepristone Definition
Mifepristone is a pill that can be taken as an alternative to a surgical abortion.
This medication most often is used for ending early pregnancies. , also known as RU-486). While mifepristone induces expulsion of an already-implanted egg, BC inhibits ovulation ovulation /ovu·la·tion/ (ov?u-la´shun) the discharge of a secondary oocyte from a graafian follicle.ov´ulatory
The discharge of an ovum from the ovary. , fertilization, or implantation. BC cannot cause abortion. If an egg is already implanted in a woman's uterus, BC will not terminate the pregnancy, nor will it cause any harm to the developing fetus.
In fact, BC is so safe that a growing number of major medical and public health organizations have publicly supported efforts to make BC available over-the-counter, including the American Medical Association American Medical Association (AMA), professional physicians' organization (founded 1847). Its goals are to protect the interests of American physicians, advance public health, and support the growth of medical science. , the American College of Obstetricians and Gynecologists The American College of Obstetricians and Gynecologists (ACOG) is a professional association of medical doctors specializing in obstetrics and gynecology in the United States. It has a membership of over 49,000 and represents 90 percent of U.S. , the American Academy of Pediatrics The American Academy of Pediatrics ("AAP") is an organization of pediatricians, physicians trained to deal with the medical care of infants, children, and adolescents. Its motto is: "Dedicated to the Health of All Children. , and the American Public Health Association The American Public Health Association (APHA) is Washington, D.C.-based professional organization for public health professionals in the United States. Founded in 1872 by Dr. Stephen Smith, APHA has more than 30,000 members worldwide. .
BC meets the FDA'S criteria for over-the-counter status: it is safe, effective, and easy to use; it does not have serious or harmful side effects Side effects
Effects of a proposed project on other parts of the firm. ; it is not dangerous for individuals with particular medical conditions See carpal tunnel syndrome, computer vision syndrome, dry eyes and deep vein thrombosis. ; and women can self-diagnose their need for it.
A July 2002 survey indicates that more than 60 percent of American voters do not know what BC is. (2) It is also estimated that only two percent of American women have ever used EC. (3) This significant lack of knowledge and use is attributed to a dearth of awareness about the product, a lack of access to it, and misconceptions about what it is and how it works.
Any policy efforts to increase knowledge and use of BC must tackle the significant barriers that women face. Consider the following:
* Only 20 percent of obstetricians and gynecologists routinely talk about BC with their patients (4)
* Almost half of university-based health clinics in the United States do not offer EC (5)
* Finding a pharmacy that stocks BC is a challenge, as evidenced by the fact that nearly half of the pharmacies in New York City New York City: see New York, city.
New York City
City (pop., 2000: 8,008,278), southeastern New York, at the mouth of the Hudson River. The largest city in the U.S. carry neither Preven nor Plan B, the two BC products approved by the FDA (6)
* Surveys in six states demonstrate that fewer than 40 percent of hospitals provide BC to rape victims (7)
* A recent survey of Catholic hospitals in California List of hospitals in California (U.S. state), grouped by county and sorted by hospital name. Alameda County
It is estimated that BC has the potential to reduce unintended pregnancies and abortions by 50 percent. Proponents must work to implement policies that will help eliminate barriers. (9) In other words Adv. 1. in other words - otherwise stated; "in other words, we are broke"
put differently , they must work to put policies in place that educate the public and make EC easily available.
POSITIVE STATE EFFORTS
During the past 12 months, 22 bills were introduced in 14 states that would increase access to and availability of EC. (10) Seven resolutions promoting access to BC were also introduced in three states. (11) These bills focus on public education and awareness, pharmacists' ability to dispense BC without a prescription, over-the-counter (OTC OTC
See over-the-counter market (OTC). ) status for EC, and the immediate availability of BC for victims of sexual assault.
State laws in Alaska, California, and Washington currently allow pharmacists to dispense BC without a doctor's prescription. Legislation was also introduced in 2002 in three states--Hawaii, New York New York, state, United States
New York, Middle Atlantic state of the United States. It is bordered by Vermont, Massachusetts, Connecticut, and the Atlantic Ocean (E), New Jersey and Pennsylvania (S), Lakes Erie and Ontario and the Canadian province of , and Virginia--that would allow physicians or nurse practitioners to delegate their authority to prescribe certain medications to pharmacists through "collaborative agreements."
New Mexico New Mexico, state in the SW United States. At its northwestern corner are the so-called Four Corners, where Colorado, New Mexico, Arizona, and Utah meet at right angles; New Mexico is also bordered by Oklahoma (NE), Texas (E, S), and Mexico (S). pharmacists will also soon be able to dispense EC by authority granted to them by the state's Board of Pharmacy. The New Mexico Board of Pharmacy has issued a "written protocol" which allows pharmacists who have completed a training course to dispense EC. The New Mexico Medical Board must adopt the resolution before it can go into effect.
Given that women should take EC within 72 hours of unprotected sexual intercourse--and it is more effective the sooner it is taken--these agreements help alleviate problems women often face in finding a doctor on short notice or over a weekend.
EC also holds tremendous promise for victims of sexual assault. California, Illinois, and Washington have enacted laws requiring hospitals to provide BC to such victims. Eight states--Arizona, California, Delaware, Florida, Hawaii, New Jersey, Washington, and Wisconsin--introduced legislation in 2002 that would require hospitals to provide BC to rape victims upon request or refer them to a facility that would provide it.
Weaker bills in Maryland and South Dakota South Dakota (dəkō`tə), state in the N central United States. It is bordered by North Dakota (N), Minnesota and Iowa (E), Nebraska (S), and Wyoming and Montana (W). would require hospitals to provide information about BC but would not require them to dispense it or make referrals to a facility that would.
NEGATIVE STATE EFFORTS
Even though "collaborative agreements" and New Mexico's "written protocol" policies have improved EC accessibility, state refusal clauses still have the potential to significantly harm the effectiveness of any pro-active measures.
Twelve states currently have refusal clauses allowing health care professionals and/or facilities to refuse to provide contraception-related services. (12) Some states have tried introducing laws that would give pharmacists the right to refuse to provide BC, among other drugs.
There have also been attempts by some states to pass contraceptive coverage laws with refusal clauses. This means that employers and insurers could refuse to cover BC and other reproductive health Within the framework of WHO's definition of health as a state of complete physical, mental and social well-being, and not merely the absence of disease or infirmity, reproductive health, or sexual health/hygiene drugs. While these tactics have proved largely unsuccessful, BC opponents will likely continue to attempt to expand such clauses.
Although not as successful as state efforts, the U.S. Congress has introduced several bills that would increase education about BC as well as availability of BC to victims of sexual assault. No hearings were held on these bills during the 107th Congress, so legislators will have to re-introduce them when the 108th Congress convenes in January 2003.
The Emergency Contraception Education Act (S. 1990 and H.R. 3887) would educate the public about BC by directing the U.S. Centers for Disease Control and Prevention Centers for Disease Control and Prevention (CDC), agency of the U.S. Public Health Service since 1973, with headquarters in Atlanta; it was established in 1946 as the Communicable Disease Center. (CDC See Control Data, century date change and Back Orifice.
CDC - Control Data Corporation ) and the Health Resources and Services Administration The Health Resources and Services Administration (HRSA) is an agency within the United States Department of Health and Human Services whose goal is to improve access to health care for those without insurance. (HRSA HRSA Health Resources & Services Administration (US)
HRSA Historical Radio Society of Australia
HRSA Hamilton Rating Scale for Anxiety
HRSA Hotel and Restaurant Suppliers Association (Canada) ) to develop and distribute information about BC to both the public and health care providers.
The information would include a description and explanation of BC as well as recommendations for its use. At the end of the 107th Congress, the Senate bill had nine cosponsors and the House bill had 90 cosponsors.
The Compassionate Care for Female Sexual Assault Survivors Act (H.R. 4113) would require all federally-funded hospitals to offer BC to sexual assault victims. At the end of the 107th Congress, this bill had 65 cosponsors.
U.S. Rep. Melissa Hart (R-PA), an outspoken opponent of BC, also introduced an BC bill in this session of Congress. The Schoolchildren's Health Protection Act (H.R. 3805) would deny federal education funding to any elementary or secondary school that provided access to BC.
This bill would impose a disproportionate penalty on those districts where local decision--makers have opted to improve access to BC. Rep. Hart attempted to include this provision in the Labor, Health and Human Services Noun 1. Health and Human Services - the United States federal department that administers all federal programs dealing with health and welfare; created in 1979
Department of Health and Human Services, HHS appropriations bill last year but was forced to withdraw it.
She will likely revive her efforts during the appropriations process in the next Congress.
PUBLIC SUPPORT FOR EC
While policymakers continue to treat EC as a controversial issue, the public soundly supports it.
A recent poll found that once voters are informed about BC, almost three in four (72 percent) favor legislation aimed at expanding public health information about it. (13)
In addition, more than three in four voters (77 percent) support teens having access to information about EC, demonstrating the public's recognition that it has potential as a logical and safe way to prevent pregnancy and as a better option for young women than abortion. (14)
Support for BC crosses partisan lines. Eighty-one percent of Democrats, 76 percent of Independents, and 60 percent of Republicans favor legislation that would expand public health information about BC and its availability. (15) Even among voters opposed to abortion, 45 percent support this type of BC legislation. (16)
Voters also overwhelmingly support legislation that would require hospitals to inform victims of sexual assault about the availability of BC. (17) In addition, more than three in four Catholic voters support such legislation. (18)
While progress has certainly been made since the FDA'S approval of the first EC drug in 1998, the drug's full promise is still far from recognized.
The fact that much of the public and many policymakers still erroneously associate BC with mifepristone demonstrates that public education is still needed. This is an issue on which abortion opponents and pro-choice advocates should be able to find common ground.
EC is a way to prevent unintended pregnancies and, therefore, abortions. In addition, parents see EC as part of a package of prevention. When coupled with comprehensive sexuality education and an emphasis on abstinence, EC offers young people the information and tools they need to make healthy decisions about sex and pregnancy.
Given the political climate in Washington, DC, it is unlikely that federal EC legislation will succeed in the upcoming Congress. For the immediate future, state legislatures will likely serve as the primary venue to help increase knowledge, use, and availability of this contraceptive option.
EMERGENCY CONTRACEPTION BILLS IN 2001-2002 PERMIT PHARMACISTS REQUIRE ACCESS TO TO DISPENSE EC EC FOR SEXUAL ASSAULT Bill Number Any Action Taken Bill Number AZ SB 1334 CA SB 1169 (2001) Enacted AB 1860 DE HB 564 FL SB 2-E (1) SB 2246 HB 125 HI HB 2124 HB 1802 HB 2806 Passed House SB 727 (2001) SR 35 SCR 73 HB 46 (2001) HR 137 Adopted by House HCR 194 Passed House IL SB 114 (2001) HB 430 (2001) KS HB 2311 (2001) MD HB 930 (3) MI MN (4) SF 1775 (2001) SF 1461 HF 2068 (2001) HF 1860 (2001) MO NH HB 1276 (2001) Failed to Pass House NJ SB 956 AB 297 NY (5) SB 6323 SB 1743 (2001) AB 9653 SB 2347 (2001) AB 2214 (2001) SD HB 1157 (6) VA SB 623 Passed Senate HB 1263 WA SB 6537 HB 2690 WI SB 391 AB 724 Federal HR 4113 REQUIRE ACCESS TO EDUCATE PUBLIC EC FOR SEXUAL ASSAULT ABOUT EC Any Action Taken Bill Number Any Action Taken AZ CA Enacted DE FL HI Passed House IL Enacted (2) Passed House KS MD MI HB 6235 MN (4) MO HCR 35 NH NJ NY (5) SB 4884 (2001) AB 3577 (2001) Passed Assembly SD VA WA Enacted WI Passed Senate Failed to Pass House Federal HR 3887 S 1990 Source for state legislative data: NARAL's State-by-State Guide to Legislative Bills. Available on-line at: http://mail.naral.org/longdoc.nsf? Open Database (1.) Florida's bill would have appropriated funds and given priority in payment to health facilities that inform victims of rape about EC and provide access to EC for victims of rape. (2.) Illinois' law requires only that hospitals inform victims of rape about EC. Hospitals are not required to provide EC. (3.) The Maryland bill requires information only (no access to EC is mandated by the bill). (4.) In 2002, Minnesota introduced two resolutions, SF 3447 and HF 3704, urging the FDA to make EC available over the counter. Both of the resolutions died without action. (5.) In 2002, the New York City Council also introduced three resolutions. There resolutions would: (1) require pharmacies to post a notice if they do not dispense EC (INT 278); (2) require the City to provide funding only to hospitals that inform rape victims about the availability of EC (INT 281); and (3) require the Department of Health to make EC available at health facilities (INT 285). All resolutions are in committee. (6.) The South Dakota bill requires information only (no access to EC is mandated by the bill).
For more information about EC and how to find a health care provider, visit www.backupyourbirthcontrol.org or call 1 (888) NOT-2-LATE.
(1.) The FDA approved Preven in 1998 and Plan B in 1999.
(2.) Data from public opinion survey conducted by Peter D. Hart Peter D. Hart is the chairman of Peter D. Hart Research Associates since 1971, and is a Senior Counselor to the McGinn Group. Together with Robert Teeter, Mr. Hart and his company have provided NBC News and The Wall Street Journal with polls since 1989. More than 40 U.S. Research Associates on behalf of the Reproductive Health Technologies Project (RHTP RHTP Reproductive Health Technologies Project ), July 11 to 14, 2002. It included interviews with 503 likely voters, The margin of error was plus or minus 4.5 percent.
(3.) Kaiser Family Foundation The Henry J. Kaiser Family Foundation (KFF), or just Kaiser Family Foundation, is a U.S.-based non-profit, private operating foundation headquartered in Menlo Park, California. and Lifetime Television, Vital Signs Index No. 2: Emergency Contraception (Selected Findings) (2000).
(4.) Kaiser Family Foundation, "Women's Health Women's Health Definition
Women's health is the effect of gender on disease and health that encompasses a broad range of biological and psychosocial issues. Care Providers' Experiences with Emergency Contraception," Survey Snapshot, November 2000.
(5.) S. K. McCarthy, "Availability of Emergency Contraceptive Pills at University and College Student Health Centers," Journal of American College Health, vol. 51, no. 1, July 2002, p. 15.
(6.) The Council of the City of New York, Emergency Contraception--Available at a Pharmacy Near You? (Staff Report to the Committee on Oversight and Investigations and the Committee on Health, October 2002.) Available at www.council.nyc.ny.us/pdf_file/reports/ecp.pdf.
(7.) Minnesota NARAL NARAL National Abortion and Reproductive Rights Action League Foundation, Access in Crisis: The Continuing Decline of Hospital-Based Emergency Contraceptive Services in the State of Minnesota (2000), p. 7; The Missouri NARAL Foundation, The Access Project: An Assessment of Reproductive Health Services in Missouri (2001), p.22; NARAL/NY Foundation, Preventing Pregnancy After Rape: Does Your Hospital Provide Emergency Contraception to Rape Survivors? (1999), p. 9; Rebecca Simons, Emergency Contraception for Sexual Assault Survivors: A Survey of Hospital Emergency Rooms in Pennsylvania, Clara Bell Duvall Education Fund (May 2000); TARAL, where Can a Woman Go? A Guide to Reproductive Services (August 2001), p. 2; Wyoming NARAL, Abortion Access Project, Preliminary Results, May 27, 2000.
(8.) Data from research conducted by Ibis ibis (ī`bĭs), common name for wading birds with long, slender, decurved bills, found in the warmer regions of both hemispheres. The body is usually about 2 ft (61 cm) long. Most ibises nest in colonies. Reproductive Care, Inc., on behalf of Catholics for a Free Choice Catholics for a Free Choice (CFFC) is a pro-choice political organization whose founders hold the belief that "the Catholic tradition supports a woman's moral and legal right to follow her conscience in matters of sexuality and reproductive health. , November 2002.
(9.) News Release, American College of Obstetricians and Gynecologists (ACOG ACOG American College of Obstetricians and Gynecologists.
ACOG American College of Obstetricians & Gynecologists ), "ACOG Supports Safety and Availability of Over-the-Counter Emergency Contraception," Feb. 28, 2001.
(10.) These states are Arizona, California, Delaware, Florida, Hawaii, Maryland, Michigan, New Jersey, New York, South Dakota, Virginia, Washington, and Wisconsin.
(11.) These states are Hawaii, Minnesota, and Missouri.
(12.) The Alan Guttmacher Institute, State Policies in Brief: Exemptions from Providing Health Services health services Managed care The benefits covered under a health contract , November 2002. Available at www.agi-usa.org/pubs/spib_EPHS EPHS Eden Prairie High School (Eden Prairie, Minnesota)
EPHS Electrically Powered Hydraulic Steering
EPHS East Providence High School (East Providence, Rhode Island) .pdf.
(13.) RHTP public opinion survey.
(14.) RHTP public opinion survey.
(15.) RHTP public opinion survey.
(16.) RHTP public opinion survey.
(17.) RHTP public opinion survey.
(18.) RHTP public opinion survey.
RELATED ARTICLE: CALL FOR SUBMISSIONS -
The SIECUS SIECUS Sexuality Information and Education Council of the United States Report welcomes articles, reviews, or critical analyses from interested individuals. Upcoming issues of the SIECUS Report will have the following themes:
Young People Talk about Sex
April/May 2003 issue
Deadline for article submission: February 14, 2003
The Debate about Sexual Addiction sexual addiction Sex compulsion Sexology Compulsive and ritualized sexuoerotic hyperactivity, generally under specific sexuoerotic conditions and stimuli. See Sexaholics Anonymous. and Compulsion
June/July 2003 issue
Deadline for article submission: April 18, 2003
Monitoring Sexuality Education in the United States/Tenth Anniversary
August/September 2003 issue
Deadline for article submission: June 1, 2003