Abortion Emergency Contraceptives Explainer
Pharmacist Simon Gorelikov holds a generic emergency contraceptive at the Health First Pharmacy in Boston. Photo: AP file
health

'Morning after pill' not always option after rape

6 Comments
By AMY FORLITI

Some leaders in states with strict abortion bans say exceptions for rape or incest victims aren’t needed because emergency contraceptives can be used instead. But medical professionals and advocates for rape survivors say that while emergency contraception is a helpful tool, it’s not always foolproof, and getting access to these emergency measures in the short time frame in which they would be effective may not be realistic for someone who has just been assaulted.

Here’s a look at emergency contraceptives and what some people are saying.

WHAT ARE EMERGENCY CONTRACEPTIVES?

Emergency contraceptives are used to prevent pregnancy after unprotected sex or if a method of birth control fails.

Two types of medications, sometimes referred to as “morning after pills," are available: levonorgestrel, known by the popular brand name Plan B; and ulipristal acetate, known under the brand ella. They should be taken as soon as possible after unprotected sex.

The pills prevent ovulation, which is when an egg is released from an ovary, said Dr. Jonah Fleisher, director of the Center for Reproductive Health at the University of Illinois in Chicago. If an egg is not released, it cannot be fertilized.

ARE THEY THE SAME AS ABORTION PILLS?

No. Emergency contraceptives prevent a pregnancy. The abortion pill, mifepristone, ends a pregnancy after a fertilized egg has implanted in the lining of a woman’s uterus. It's commonly administered with the drug misoprostol and can be taken up to 11 weeks after the first day of a woman’s last period.

DOES EMERGENCY CONTRACEPTION WORK?

Not 100% of the time. The pills' effectiveness improves the sooner they are taken after unprotected sex, doctors said. The drugs won't prevent pregnancies if they are taken before sex, Fleisher said.

The Food and Drug Administration has approved Plan B for use up to 72 hours, or three days, after unprotected sex. Ella is approved for up to 120 hours, or five days.

Timing is important because sperm can live inside a woman’s body for up to five days, so a woman can still get pregnant if ovulation occurs after intercourse, said Dr. Dana Stone, an OB-GYN in Oklahoma City. If a woman has ovulated prior to intercourse, the pills are unlikely to help.

“So that’s where the failure comes in. It’s based on the timing,” Stone said.

A woman's weight also may play a role, though there is conflicting information on that. Guidance from the American College of Obstetrics and Gynecology says levonorgestrel may be less effective in women with a body mass index that's over 25. The organization says some research suggests ulipristal acetate also has lower effectiveness among women with a BMI that's 30 or higher.

However, the FDA found conflicting data and reached no conclusion in a 2016 review of the effectiveness of levonorgestrel in women who weigh more than 165 pounds or have a BMI above 25. The agency said additional research should be a priority.

Another form of emergency contraception, a copper intrauterine device, is seen as the most effective method, if inserted into a woman's uterus within five days of unprotected sex. Its effectiveness is not dependent on weight, Fleisher said.

A doctor or nurse must insert a copper IUD, which can remain in place for many years as a regular form of birth control.

Plan B can be purchased over the counter by anyone 17 or older, but younger people need a prescription. Ella requires a prescription.

WHAT DID THEY SAY?

Officials in some states, such as Texas Gov. Greg Abbott and South Carolina state Rep. Doug Gilliam, point to emergency contraceptives as a reason abortion bans don't need exceptions for rape or incest.

During an Aug. 31 House debate, Gilliam said, in a hypothetical case of a 12-year-old raped by her father, the child would have “choices” and wouldn’t be “forced” to carry a pregnancy. Among them, he said, she could go to the hospital and get an emergency contraceptive, or go to the store and get one without a prescription.

Pressed by a fellow lawmaker on who would take the girl to the store to get the pill, he initially replied “The ambulance,” then corrected himself and said, “The hospital when she’s there."

In a follow-up interview with The Associated Press, the Republican lawmaker said he did not mean to suggest that an ambulance would take a girl to a store, but that if she were to go to the hospital, she would likely be offered emergency contraception.

“I don’t want anybody to think that I told you a 12-year-old that just been raped … is going to call an ambulance to go to a store,” he said. “I just let them know the options were out there, and one of them was emergency medical contraceptives.”

WHAT ABOUT RAPE VICTIMS?

Most rape victims don't report the crime to law enforcement, according to Jude Foster, advocacy medical forensic and prevention programs director for the Minnesota Coalition Against Sexual Assault. Many also may not go in for immediate medical care. Not everyone knows that emergency contraceptives are an option and part of a routine rape exam, or that such an exam is free.

“Why is sexual assault used as a political football when you are talking about access to reproductive care?” Foster said. “Please don’t. It just really frustrates me.”

Stone said the belief that a woman can just take Plan B if she is raped is misguided.

“We need all kinds of options for women because nothing is a one size fits all,” Stone said. “People have transportation problems, they have financial problems. There are always barriers to some percentage of women that will keep them from accessing this in the short time frame that they have.”

STATE LAWS

Several states have explicitly allowed for emergency contraception in their abortion laws.

Arkansas, Kentucky and Oklahoma all have laws that ban abortion at all stages of pregnancy, and make no exceptions for cases of rape or incest. Arkansas’ and Kentucky’s laws explicitly say they don’t prohibit contraceptive measures if they are used before a pregnancy can be determined. Oklahoma’s abortion ban also does not apply to emergency contraception.

Abortion bans aside, the National Conference of State Legislatures says 21 states and the District of Columbia have statutes related to accessing emergency contraception, and 16 of them and the District of Columbia require hospitals or health care facilities to provide information about or administer emergency contraception to women who have been sexually assaulted.

Fleisher said emergency contraception does not replace the need for abortion care, and these issues should be between a doctor and patient.

"The people writing the laws don’t understand the choices that real people are making," he said.

© Copyright 2022 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed without permission.

©2022 GPlusMedia Inc.

6 Comments
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"The people writing the laws don’t understand the choices that real people are making," he said.

This is the main problem, that the opinion of the experts that understand the needs of the patients and the reality of the situation is not being taken into account. Which ends up with laws that cause more problems than what they solve.

There is no value in pointing out solutions that are not available for many people and say these options make the rest unnecessary, to replace one measure it is first required for the replacement to be as accessible and effective as what is being replaced.

3 ( +7 / -4 )

Once again, the idiots who think they are the 'leaders' of the land are opening their big mouths and showing their ignorance and total lack of knowledge or concern about what rape or incest even is, let alone solutions for the problems. Once again, they are flapping their yaps showing their single digit IQs and more often than not, what they say is 100% DUMB.

One example - a Republican congressman actually claimed that when a woman gets raped, she has a 'natural' (internal) abortion inside herself. Well, this cretin has no medical degree or any clue about gynecology and that fall he was elected OUT of office. Never mind all the outrageous lies about how abortion is performed, nobody ever asked the women on that.

The sexual 'education' in American HSs is a disgraceful joke. Of course, some people are going to be irresponsible and there will be rapists. But rape/assault education is even worse, there were some things about that subject I didn't even get to learn until I was in college. With American attitudes being so victim-blaming/shaming as well, all these factors make things even WORSE for the victims.

And not having these 'morning after' pills available is only going to lead to more 'coathanger' jobs like it was in Communist Romania where abortion and contraception were banned. I don't like abortion, but I don't want this in MY America either.

Thanks for nothing, Supreme Court and state governors.

5 ( +9 / -4 )

Once again, the idiots who think they are the 'leaders' of the land are opening their big mouths and showing their ignorance and total lack of knowledge or concern about what rape or incest even is,

Not true, most Pro-lifers want either no abortion or limited depending on the circumstances. Nothing ignorant about wanting to preserve life.

let alone solutions for the problems.

They do, but the abortion supporters don't want to listen or even have a discussion with a Pro-lifer, so if you can't even get from point A to B then why engage with someone or anyone that is irrational, take the emotion out of the argument. Because intelligent people should be able to do that.

One example - a Republican congressman actually claimed that when a woman gets raped, she has a 'natural' (internal) abortion inside herself. Well, this cretin has no medical degree or any clue about gynecology and that fall he was elected OUT of office. Never mind all the outrageous lies about how abortion is performed, nobody ever asked the women on that. 

I can't speak for the former congressman, but there are many people that don't have medical degrees and chime in on this sensitive issue and act as if they know everything, that is not a left/right thing either. I think contraception is a great thing.

The sexual 'education' in American HSs is a disgraceful joke.

Thank the Democrat party and the Teachers Union for that, but I definitely agree.

And not having these 'morning after' pills available is only going to lead to more 'coathanger' jobs like it was in Communist Romania where abortion and contraception were banned.

Not just Romania, many, many countries used that method.

I don't like abortion, but I don't want this in MY America either. 

Neither do I, this is why I think the decision to overturn Wade was the best, most legal, and constitutionally right thing to do.

Thanks for nothing, Supreme Court and state governors.

I vehemently disagree.

-7 ( +2 / -9 )

60% of Americans support the right to abortions.

The choice should be between a female and her doctor, not with her lawyer or priest.

Many state abortion bans do not have exemptions for rape and incest.

Less than 1-in-10 rapes are reported. Probably even less for incest.

What about ectopic pregnancy?

5 ( +6 / -1 )

bass4funk

I can't speak for the former congressman, but there are many people that don't have medical degrees and chime in on this sensitive issue and act as if they know everything, that is not a left/right thing either. I think contraception is a great thing.

no, it is not a left/right thing either. Many issues are not so simple but simple minds on both sides have this 'us and them'/black-or-white + no gray attitude. That makes things hard for everyone. In the 5th grade we were told about compromise and meeting each other half the way. A lot of Americans need to go back to the 5th grade and learn that stuff again.

The sexual 'education' in American HSs is a disgraceful joke.

Thank the Democrat party and the Teachers Union for that, but I definitely agree.

You have be responsible with it and know the odds. As the slogan goes, 'No glove, no love'. Unless you're ready to become a parent.

And not having these 'morning after' pills available is only going to lead to more 'coathanger' jobs like it was in Communist Romania where abortion and contraception were banned.

Not just Romania, many, many countries used that method.

Yes they did, and do. And it leads to some dead moms in the alleys as well. It's not desirable. We need better sex education in America, it's a disgraceful joke.

4 ( +5 / -1 )

no, it is not a left/right thing either. Many issues are not so simple but simple minds on both sides have this 'us and them'/black-or-white + no gray attitude. That makes things hard for everyone.

Yes, this is true, but the left constantly demonizing the right and calling them Nazis or traitors if you support Trump is more than insulting, you can't pigeonhole and lump all Trump supporters as one monolithic group, it doesn't help the anger and the vitriol growing against the left and it sure doesn't help unity when Biden uses our Marines in the backdrop with red illuminating lights giving a sour and grim outlook towards anyone that is a conservative.

In the 5th grade we were told about compromise and meeting each other half the way. A lot of Americans need to go back to the 5th grade and learn that stuff again. 

Yes, but sadly, as long as the Democrats are entrenched in the school system, don't bet on it.

You have be responsible with it and know the odds. As the slogan goes, 'No glove, no love'. Unless you're ready to become a parent. 

So then why don't the schools teach the kids this? Apparently, not enough.

Yes they did, and do. And it leads to some dead moms in the alleys as well. It's not desirable. We need better sex education in America, it's a disgraceful joke.

Not the way the Democrats are pushing the issue, they are turning out more perverse predators than educating them. Don't believe me, read a few chapters of "Gender Queer"

-4 ( +0 / -4 )

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