Oral contraceptives (the Pill) are of two types: combination products, consisting of an estrogen and a progestin (progesterone-like drug), and the “mini-pill,” containing only progestin. These products are taken once daily for twenty-one consecutive days, after which time menstruation begins. In the mid-1970s, studies showed that if high doses of either pill type were taken, breakthrough bleeding would occur. This led to the “morning-after pill.”
The morning-after pills, emergency contraceptives (EC), are taken after sexual intercourse and are intended to prevent pregnancy resulting from a contraceptive failure, such as a broken condom, missed pills, the absence of any contraceptive, or sexual assault. The most widely used ECs are progestin-only (levonorgestrel) products, which are marketed in different parts of the world as Plan B, Levonelle, or NorLevo.
Plan B approval in the United States has been the subject of ethical concerns and political influences. Its effectiveness and safety are unquestioned: When taken within seventy-two hours of sexual intercourse, Plan B is 89 percent effective in preventing pregnancy. Nausea is the most common side effect. Most scientists believe that it works by preventing ovulation and fertilization of the ovum, rather than by preventing the fertilized ovum from attaching to the uterus. Unlike mifepristone (RU-486), it has no effect on established pregnancies; neither does it cause abortion.
In 1999, the Food and Drug Administration (FDA) approved Plan B as a prescription EC, intended only for occasional use. In 2003, an expert FDA advisory committee and FDA’s own staff overwhelmingly recommended that it be made available without a prescription—a recommendation the FDA uncharacteristically rejected. Likely succumbing to political pressure from pro-life groups, the FDA argued that adolescents without medical supervision could not use Plan B safely, and that its use would lead to indiscriminate unprotected sex by teenagers. In 2009, a U.S. District Court called the FDA decision “arbitrary and capricious” and not based on good-faith reasoning. It ruled that Plan B be made available, without a prescription, to individuals older than seventeen. In 2010, the FDA approved—without political overtones—Ella. A drug only available by prescription, Ella is effective in preventing pregnancy up to five days after sexual intercourse.
SEE ALSO Food and Drug Administration (1906), Estrone and Estrogen (1929), Progesterone and Progestin (1933), Enovid (1960), Mifepristone (1988).
Conception may occur within hours of having sex, but the sperm-and-egg rendezvous is more common days later. It is generally believed that “morning-after pills” work by preventing or delaying ovulation, preventing fertilization, or by interrupting the fertilized egg from being implanted in the uterus.