Emergency Contraceptive

What has been referred to as the "morning after" pill was first used in Europe for rape victims. The Yuzpe method, as it is called, involves four estrogen/progestin pills: two tablets at 12-hour intervals within 72 hours of unprotected intercourse. This preparation is currently available OTC in England. Although not available in America yet, RU-486 (a similar formula) is being studied by one pharmaceutical company.

In the current study, researchers conducted a random survey of 2,002 men and women aged 18 or older and 307 obstetrician-gynecologists to assess their knowledge of these "morning-after" pills.

Among respondents from the general public, 36% reported that they were not aware that "anything could be done" to prevent pregnancy within a few days after intercourse. Fifty-five percent had "heard of" emergency contraceptive pills, but only 1% had ever used them. The likelihood of having heard of emergency contraception increased with age, education, income, and having discussed birth control with a health professional.

Among the obstetricians, 99% reported being familiar with emergency contraception, however, 80% told only 10% or fewer of their patients about them. And, although 70% reported prescribing emergency contraceptive pills within the last year, 77% of those did so five or fewer times.

The authors concluded that physicians should make emergency contraceptive pills readily available and inform more patients about them. While they are no substitute for planned birth control, these pills are a reasonable option in emergency situations.

(Harper D. Emergency contraceptive pills. Journal Watch 1997; 17:108)

COMMENT: Although no proprietary product is currently available in the U.S., high doses of oral contraceptives have been used selectively by obstetricians for more than 20 years to prevent pregnancy after unprotected intercourse. The faculty at Northwestern Medical School (Chicago) estimates that the method could reduce the number of unintended pregnancies by 1.76 million and the number of abortions by 0.8 million.

My obstetrical colleagues tell me this is widely available from OB-GYN physicians throughout the country. The American College of Obstetricians and Gynecologists (ACOG) is currently undertaking a promotional campaign among other physician groups (particularly emergency room physicians and family practitioners) to encourage wider use—beyond rape victims. (See JAMA July 9, 1997, pp. 101-102.) Since the Yuzpe method renders the fertilized egg non-viable, it is considered an abortificient. The method is about 90% effective. - R. A.