The Latest Word on Emergency Contraception: How Effective is It?
The Most recent Aricles in the Green Journal: What Else Can We Say??
ArticleImpact of Increased Access to EC; Raymond, Et al, Ob & Gyn, Vol. 108, No. 5, Nov. 2006
Objective: To assess how strategy to maximize access to EC pills would affect rates of pregnancy and STI’s.
Methods: Sexually active 14 to 24 y.o. women, randomly assigned, one group had FREE ADVANCED provision, unlimited supply; the other group had OTC access, but had to pay for and procure as needed. Participants followed for 1 year.
Conclusion: This intensive strategy to enhance access to EC pills (remember, FREE ADVANCE ACCESS) substantially increased the use of the method, and had no adverse impact on STI risk. However, it did not show benefit in decreasing pregnancy rates.
(AAPLOG note: You will notice that this is the same result as the Scotland and the San Francisco studies. You will also note that while STI risk may be the same in both groups, the OTC women, because they do not have to see a physician, will almost certainly have a much lower or much delayed rate of diagnosis and treatment. The authors make no mention of that. And the ACOG has never seriously addressed this problem, as far as we are aware.)
ArticlePopulation Effect of Increased Access to Emergency Contraceptive Pills: Raymond, Trussell, Polis, Ob & Gyn, Vol. 109, No. 1., Jan. 2007
Objective: We systematically reviewed data on effects of increased access to EC pills on pregnancy rates and use of the pills.
Tabulation, integration, and results: The authors selected for review 23 of 717 articles that met their criteria. In all but one study, increased access to EC pills was associated with greater use. However, no study found an effect on pregnancy or abortion rates. (Most of us thought that is the reason this medicine is being pushed so hard-to prevent 89% of expected pregnancies.)
Conclusion: Increased access to emergency contraceptive pills enhances use buthas not been shown to reduce unintended pregnancy rates. (AAPLOG’s question: What possible good comes from “greater use” associated with no decrease in pregnancy rates?) The article concludes with: “Further research is needed to explain this finding and to define the best ways to use EC to produce public health benefit.” (AAPLOG note: what can be “better” than FREE unlimited advance access and personalized counseling?)
All this has been common knowledge for a couple years now. This knowledge, however, did not blunt the ACOG’s enthusiasm in urging practitioners to dispense the medication. Nor was the FDA able to discern that “no effect on pregnancy rates” actually meant that EC was not effective as advertised—at least these recent findings are not reflected in the the product labeling.
Everyone should know that EMERGENCY Contraception is 100% “effective” for 25 days of each month (pregnancy is not possible 25 days a month, since there are just 5 potentially fertile days per month-the day of ovulation, and the 4 days prior to ovulation). The overall effectiveness can be quoted as 89% because the effectiveness studies were carried out on women who were “estimating” when they might ovulate. Many of these women had no chance to conceive during the cycle in question, and these “non-conceptions” are credited as EC “successes”, driving the “success” rate up to 89%. This is a kind of deception in advertising that shouldn’t happen, but has. And women, including teenagers, will not benefit from this “success rate” misinformation.
Absolutely Remarkable Turnabout
The preceding 2 articles by Trussell and Raymond represent a remarkable about-face in opinion. This turnabout comes, conveniently for OTC EC advocates, AFTER EC has been granted OTC status. Earlier, the same two authors offered radically different advice to the FDA and American women. In 1998, James Trussell, a widely respected Population Council expert, was quoted in a CNN special: “We decided about six years ago that making emergency contraception widely available was the most important step we could take in the United States to reduce the incidence of unintended pregnancies.”, said Dr. James Trussell of Princeton University. (From the CNN program: Specials, 1998 Year in Review/Health – Emergency kit wins FCA approval).
Dr. Elizabeth Raymond, writing with Dr. David Grimes in 2002, proclaimed: Easier access to and wider use of emergency contraception could dramatically lower the high rates of unintended pregnancy and induced abortion in the United States. Family Health International, David A. Grimes, MD, and Elizabeth G. Raymond, MD, MPH, 6 August 2002. {Volume 137 Issue 3} Pages 180-189. This article was cited in 5 major journals, including Neurology, Academic Emergency Medicine, Pediatrics, Annals of Int. Med, and the NEJM. (AAPLOG wonders how many journals will cite the author’s new opinion that, “it did not show benefit in decreasing pregnancy rates.” Our guess: NONE will. We hope we are wrong.)
Still on the record is the remarkably inaccurate testimony by ACOG Pres.-Elect Dr. Vivian Dickerson to the 2003 FDA hearings considering OTC approval. Dr. Dickerson proclaimed: “Overall it is estimated that widespread use of EC pills has the potential to decrease by at least 50% the current incidence of unintended pregnancies and subsequent abortions.” (AAPLOG note: that would be 700,000 less abortions per year!)
Drs. Trussell and Raymond, much to their credit, have gone on record recognizing the error of their previous opinion. This was brave of them, as they will undoubtedly pay a professional price for their recent article.