When the emergency contraception—or the morning-after pill—became available to adult women without prescription in the U.S. in 2006, it predictably whipped up a public health controversy. Some commentators said it would encourage unprotected sex and raise the rates of sexually transmitted infections (STIs). The Food and Drug Administration’s Deputy Operations Commissioner Janet Woodcock even expressed concern that it would lead to the formation of “sex-based cults.” Others predicted that making the drugs available would lower rates of unwanted pregnancies and so lower abortion rates.
But it turns out that providing emergency contraception to women in advance of need may do none of these things. In a review of 11 trials involving a total of 7,695 women from the U.S., China, India and Sweden, researchers for the Cochrane Collaboration—a group of volunteer scientists who periodically review evidence on the effectiveness of treatments—found that women given emergency contraception in advance were no more likely to have unprotected sex, to contract STIs or to change their use of other contraceptive methods, compared with women who did not get the pills. Access to emergency contraception also did not lower the rate of unwanted pregnancies. “The review proved everyone wrong,” says lead researcher Chelsea Polis of the Johns Hopkins Bloomberg School of Public Health, who undertook the review for Cochrane. “We did find that early provision increased the use of emergency contraception and it did lead women to take the [pills] sooner after intercourse. But that’s about it.”
But if more women took morning-after pills, and took them early, why was there was no difference in the unwanted pregnancy rate? That, Polis says, “is the million dollar question.” She said it’s possible that the women who were more likely to take the morning-after pill were already at low risk of pregnancy. “On the other hand, it’s possible that women at high risk of unwanted pregnancy because of biological or behavioral reasons did not take it,” she says.
Another confounding factor is the lack of reliable data on the effectiveness of the morning-after pill. “The original trials did not compare it against a placebo. We know for sure that it works but we don’t know to what extent,” says Polis.
Polis said that because no increase in STIs was found across the various studies, the review did not support a change to the U.S.’s existing policy on the morning-after pill. “Early provision didn’t make women less careful. It didn’t make women more promiscuous. And it didn’t change their behavior in terms of other contraceptives. So women still need easy access and information about emergency contraception. But it won’t be a silver bullet in terms of reducing unwanted pregnancies. We need to do a better job of educating women about both emergency contraception and more effective and reliable methods of contraception,” says Polis. —By Eben Harrell