In spite of widespread availability of effective birth control, half of all pregnancies are still unintended. And although “morning after pills” (or “emergency contraception”) have been available over the counter since 2006, this rate has not fallen. Which leads OB/GYNs like myself to sit up and take notice whenever people get all atwitter about new ways to prevent unwanted pregnancy.
So here’s the skinny: a federal advisory board that usually whispers into the ear of the FDA voted unanimously on Thursday to approve a new type of emergency contraception, called Ella. This medication, which blocks progesterone, a hormone that is a necessary part of both ovulation and maintaining a healthy pregnancy, is a close cousin of the abortion pill RU-486 (mifepristone). As you can imagine, this has caused ripples in the red-and-blue tinged waters of our politically charged American population.
Why We Might Get Excited About Ella
Currently available emergency contraception options like Plan B, Plan B One Step, or Next Choice, which are all available over the counter without a prescription for those 17 and over (and by prescription for younger women), must be taken within 72 hours of unprotected sex and are most effective when taken in the first 24 hours.
But what happens if you’re an 18-year-old college kid who doesn’t even know Plan B exists? You lament to your roommate about the date rape you just experienced, and she eventually gets you to go to the university clinic where they offer you emergency contraception — but by then it’s too late. That was five days ago.
Enter Ella. Studies show that Ella is effective up to five days after unprotected sex, and seems to be equally effective whether you take it on day one or day five.
The mechanism of action behind what fuels Ella is still a bit iffy. We know that it blocks progesterone, which is a necessary hormone in pregnancy. What’s unclear is whether the drug acts to block ovulation (as manufacturers suggest), or to prevent a new pregnancy from implanting (as anti-abortion advocates insist).
What trips people up is that some say five days would be too long after intercourse to prevent ovulation. And if you’re actually preventing implantation, are you aborting a fetus (even though you don’t even know you’re pregnant yet, and may not know for weeks)?
Does Ella Cause Abortions?
Unlike RU-486, which aborts pregnancies in animals, animal studies show that Ella does not appear to abort already existing pregnancies — at least not the ones that are far enough along to diagnose. But there’s the rub. Does it abort a new pregnancy that is too early to be diagnosed? Maybe. No one seems to know for sure. And if you’re one of the women who took it — and it worked — you’d never know the difference.
Does Emergency Contraception Work?
Yes, it does. An episode of unprotected intercourse leads to a 1/20 chance of conceiving. Plan B, Next Choice, and Plan B One Step reduce this chance to 1/40, while Ella appears to reduce it to 1/50.
So if emergency contraception exists, why do we still have so many unplanned pregnancies? Ah — there’s the big question. The bummer is that too many women still don’t know emergency contraception even exists. So ladies, do me a favor. Tell your daughters. Tell your girlfriends. Tell your sisters. This way, we can all make our own choices about what is right for our individual bodies, minds, and spirits. Let’s not let ignorance rule our reproductive lives. Spread the word.
Next: Choosing an Emergency Contraceptive: A Shopper’s Guide