Health Leader, Misconception over Contraception

STORY BY

Sonora Hudson

'Morning-After' Pill vs 'Abortion' Pill
Know the Difference

If you rely on the media for information about reproductive issues, you may be confused about the differences between emergency contraception (EC) and the "abortion pill."

Errors in the press (and use of misleading terms such as morning-after pill for EC) blur the distinctions and keep many women from fully realizing their options, according to one recent study in Houston.

EC: Emergency Contraception Pill

EC refers to the use of hormones such as those in birth-control pills to prevent pregnancy within a few days after unprotected intercourse or failure of conventional birth-control methods. It inhibits or delays ovulation and/or interferes with implantation of a fertilized egg.

EC is available in 100 countries, 33 of which do not require a doctor's prescription. Five US states already allow pharmacists to dispense EC over the counter.

"Abortion" Pill

The "abortion pill" refers to mifepristone, which is given within 49 days after conception for non-surgical abortion. Mifepristone blocks progesterone receptors in the lining of the uterus, cutting off support to the embryo. It is followed by a dose of a second drug, misoprostol, a prostaglandin, which causes uterine contractions that expel the embryo from the uterus.

RU-486 is perhaps the better known name of mifepristone. It was named after the French pharmaceutical company, Roussel-Uclaf, which created it.

The method has been used successfully by more than 200,000 American women since it became commercially available in this country. It is approved for use in most of Europe and has been used for at least 10 years in France , Great Britain and Sweden .

Misinformation

That EC and medical abortion are often confused in the media was borne out by a study by Sandi Pruitt, BA, MPH, a graduate student at The University of Texas School of Public Health at Houston.

When she analyzed 1,077 articles that appeared in 113 US newspapers during 1992-2002, she found that almost half contained explicit comparisons of the methods of EC and abortion, with most containing only incorrect statements. Forty-five per cent had at least one type of inaccuracy regarding the EC/medical abortion distinction. Only five articles were corrected in later editions.

"People should question the information they see in the media and write letters to the editor to correct errors," Pruitt urges. "It's been very disturbing to me to see so much erroneous information."

Both EC and the "abortion pill" have recently received considerable public attention. The commissioner of the US Food and Drug Administration (FDA) is currently considering granting over-the-counter status to a progestin-only EC product, Plan B or Preven, after joint recommendations of two FDA advisory committees in mid-December.

The American College of Obstetricians and Gynecologists and the American Medical Association have also recommended that the FDA approve this product for over-the-counter status.

Women who should not use it are those who

are already pregnant (for whom it is ineffective)
are hypersensitive to any component of the product
have undiagnosed abnormal genital bleeding

It reduces the risk of pregnancy by 89 percent (from about eight percent to one percent) for one-time use and has been shown to cause fewer side effects than a combination estrogen/progestin product used for the past 25 years.

No serious complications have been associated with EC. Common side effects can include nausea, abdominal pain, fatigue, headache and menstrual changes. It is considered safe for almost every woman.

"I would like more people to know about it," says Michele Curtis, MD, MPH, associate professor in the Department of Obstetrics and Gynecology at the University of Texas Medical School at Houston. "Until it is available over the counter, backup prescriptions would be a good idea. I think all women who can get pregnant should always have a backup prescription."

The mifepristone/misoprostol abortion method caused a renewed stir last fall when a young California woman died from septic shock. Six deaths have been associated with its use worldwide. It has been used successfully by hundreds of thousands of women. It is also used to treat Cushing's disease and is being investigated to determine its effectiveness in relieving pain associated with endometriosis, in shrinking fibroids and in treating some types of cancer.

Estimates indicate that about half of the pregnancies every year in the United States are unintended with more than half of these unintended pregnancies ending in abortion. According to the Planned Parenthood Federation of America, use of EC could prevent 1.7 million unintended pregnancies and 800,000 abortions annually in this country.

Studies of EC in other countries suggest it has not caused increased sexual activity in teens and has resulted in increased interest in all methods of contraception.

Washington, California, Alaska, New Mexico and Hawaii already allow pharmacists to distribute EC without an advance prescription. Five states require hospitals receiving government funding to provide information about EC or EC, itself, to rape victims.

Studies indicate that women are becoming more aware of EC, but that many physicians do not automatically mention it to patients unless patients initiate discussion.

"If you've read about it and want more information, ask your doctor," Curtis says. "Don't wait for her or him to bring it up. Or you might want to bring it up if your son or daughter is sexually active."

For more information visit http://ec.princeton.edu/.

Last Updated: 2-19-2004

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About Dr. Curtis:

Dr. Michele Curtis is an associate professor in the Department of Obstetrics and Gynecology at the UT Medical School.

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Health Tip:

Packing Bag Lunches Safely

If you pack lunches for your child to take to school, be careful that you do not accidentally expose them to foodborne illness.

Bagged lunches, especially those containing perishable foods, need to be packed and handled properly in order to keep the food safe. In general, perishable foods should not be left at room temperature for more than two hours. If left out too long, the temperature of the food can enter the danger zone where bacteria grow most rapidly, which is between 40 and 140 degrees Fahrenheit.

Below are some tips to help families pack bagged lunches safely:

Pack foods that are nonperishable and won't require refrigeration.
If you do pack perishable foods such as luncheon meats or prepackaged cheese and crackers, include a frozen gel pack or a frozen juice carton with the food in an insulated lunch bag or box.
Pack only the amount of perishable food that your child can eat at lunch.
Preparing lunches the night before and storing them in the refrigerator until you pack your child's lunchbox in the morning can help keep food cold longer the next day.
Don't reuse packaging materials such as paper or plastic bags, aluminum foil, etc. as they can contaminate other foods and cause foodborne illness. Have your child discard all used food packaging and paper bags after lunch.

Before eating lunch or snacks at school, make sure your child washes his or her hands with soap and warm water for at least 20 seconds. If your child's school does not have a handwashing program in place, encourage them to adopt a such a program, as handwashing is one of the best ways kids and parents can protect health and stop the spread of germs.