Efficacy of 'morning after' pill questioned

Increased availability of emergency contraception has not lowered abortion or pregnancy rates in the UK, according to a family planning expert.

Abortion rates have in fact climbed from 11 per 1000 women (136,388 abortions) in 1984, to 18 per 1000 women (185,400 abortions) in 2004, despite wider access to the so-called �morning-after pill�.

Anna Glasier, a family planning expert at the Lothian Primary Care NHS Trust in Edinburgh, UK, says that while the morning after pill is �better than nothing� for women who have had unprotected sex and do not want to get pregnant, it is not a useful public health measure for reducing abortion rates.

In an editorial in the British Medical Journal today, Glasier writes: �If you are looking for an intervention that will reduce abortion rates, emergency contraception may not be the solution, and perhaps you should concentrate most on encouraging people to use contraception before or during sex.�

Perceived risk

Ten studies in different countries � including one carried out by Glasier herself � showed that even preparing women by supplying them with packets of morning-after pills to use if need-be, did not affect the proportions of women having abortions or unplanned babies.

Three-quarters of the women who had unplanned pregnancies in the studies, said that they had not used the pill since they had not realised they had put themselves at risk of pregnancy, Glasier says.

In the UK, the morning-after pill has been available over-the-counter in pharmacies since 2000, although it is expensive. But the prospect of this level of availability in the US, where abortion is a politically charged issue, sparked intense debate.

Plan B

In late-August 2006 the US Food and Drug Administration approved over-the-counter sale of this medication, which is made by Barr Pharmaceuticals Inc. and sold as �Plan B�.

Advocates of emergency contraception pills � which work by manipulating hormone levels � argue that it helps to lower the risk of unwanted pregnancy and, subsequently, abortion rates.

But Glasier believes the efficacy of the pill is over-estimated. In the editorial, entitled �Emergency contraception: Is it worth all the fuss?� she writes that while 1% of UK women requesting abortions in 1984 said they had taken emergency contraception, that percentage has climbed to 12% in 2002. Meanwhile the abortion rate has risen.

Unknown numbers

�It is worth all of the fuss,� says Rachel Jones at the Guttmacher Institute in New York, US, a non-profit reproductive health advocacy group. �Women need to have access to this.�

�If a condom is a principle means of contraception and it breaks or there has been slippage then it is absolutely right that a woman should have access to emergency contraception,� agrees Tony Kerridge at Marie Stopes International in London, UK, a provider of reproductive health information and services.

But Kerridge says that it is not possible to know the number of women for which emergency contraception did in fact work.

Glasier points out that it is difficult to assess the efficacy of the pill because it is not possible to conduct certain types of experiments: �No woman in her right mind would take part in a placebo-control study of contraception so we don�t know.�

The increased rate of abortion in the UK may be due to a relaxing of attitudes towards abortion combined with women having sex earlier and wanting to delay their first childbirth to their late 20s or early 30s, experts say.

Journal reference: British Medical Journal (vol 333, p 560)

Source NewScientist.com