The morning-after pill, also known as emergency contraception or emergency birth control, is a pill regimen that a woman can take up to three days after she has had sexual intercourse to prevent the implantation of a fertilized egg in her uterus. Its availability is limited by its controversial status; its use as a contraceptive is held to be immoral by some groups including the Catholic Church. Others who oppose its use classify its potential to prevent implantation of a fertilized egg as an abortion.

The morning-after pill, however, operates in a manner distinct from that of abortifacient pills like RU-486.

Types of morning after pills

Morning-after pills consist of two high-dose birth control pillss taken 12 hours apart, reducing the risk of pregnancy by 75% to 89%. The high dose of hormones can cause the user to feel ill.

The most popular of these drugs in the United States is available under the brand name Plan B. An earlier product called Preven is lately falling out of use as it is less effective and has more severe side effects. Plan B contains only the hormone progesterone, while Preven, like many birth control pills, contains progesterone and estrogen.

The most popular of these drugs in France are Tetragynon®, Stéridil®, and NorLevo®. The first two contain estrogen and progesterone. They requires medical prescription due to their side effects (phlebitis and coagulation troubles) and are covered by medical insurance.

The newer one, NorLevo, contains only progesterone (lévonorgestrel), is considered more efficient (99% of success if taking within 24 hours against 77% for Tetragynon, source IPFP). It is available without medical prescription.

Use as a birth control method

The morning-after pill cannot be recommended as the main means of birth control because of its strong side effects and relatively low reliability. It also does not protect against sexually transmitted diseases. However, it is used by some as a back-up when other means of contraception have failed—for example, if one has forgotten to take the Pill or when a condom is torn during sex.

An alternative to the morning-after pill is the intrauterine device which can be used up to 7 days after unprotected intercourse.

Morning-after pills and abortion

For those who hold that pregnancy begins at implantation, the morning-after pill prevents pregnancy. Those who hold that pregnancy begins at conception classify this prevention of implantion as an abortion in cases where fertilization has already occurred. Medically, the morning-after pill is not classified as an abortifacient, since medically that term relates only to an established pregnancy where implantation has already occurred.

The morning-after pill prevents implantation by preventing ovulation, by preventing the released egg from being fertilized, or by preventing the implantation of the fertilized egg in the uterus, or by both methods. The predominant mechanism probably varies according to the stage of the menstrual cycle.

The morning-after pill is somewhat controversial: opponents, often social or religious conservatives, object to it since it may prevent the implantation of an already fertilized egg, which they consider to be an abortion. Others hold that it is emergency contraception which reduces the number of unwanted pregnancies and surgical abortions, and is therefore beneficial. They have no moral objection to preventing the implantation of a fertilized egg.

The morning-after pill is not to be confused with RU-486, an actual abortifacient which ends a pregnancy by inducing a chemical abortion of an implanted embryo.

International availability

In January 2000, France decided to dispense morning-after pills in junior and high schools by school nurses without prescription, because of high rates of undesired pregnancies among teenaged girls; after strong opposition from the Catholic Church, and much debate around the fact the teenager could later suffer from the doubt of not knowing whether fertilization had occurred or not, the decision was overruled by a court in July 2000. The French parliament changed the relevant law in October 2000 and now school nurses are again able to dispense the drugs. The pill NorLevo is now available in France without prescription, without parent authorization and for free for teenagers under the age of 18 since the 9th of January 2002 to insure urgency contraception.

As of early 2001, women of age 16 and higher may obtain the morning-after pill in the United Kingdom without prescription. This was challenged by an anti-abortion group, but the High Court let the rule stand in April 2002.

In the United States, the American Medical Association issued a non-binding recommendation in 2000 that morning-after pills be available over the counter without prescription in the U.S. On December 16, 2003, an advisory committee to the Food and Drug Administration recommended that the pill be made available over the counter. [1]

The American retailer Wal-Mart announced in May 1999 that it would not sell morning-after pills in its 2,400 pharmacies; it fills prescriptions for regular birth control pills to be used as emergency contraceptives but does not stock Preven nor Plan B. Many smaller pharmacies in the United States have also followed suit.

Emergency contraception is available without prescription in Albania, Belgium, Denmark, Finland, Israel, Morocco, Norway, Portugal, South Africa, and Sweden.

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