Get the Facts Right on Contraception

By SAM URETSKY

Science is wrong – sometimes. Science, after all, is just a word meaning “as far as we know” or in some cases “best guess.” One of the better examples is “parallel lines never meet” except that of course they do as anybody who lives in any sort of proximity to a railroad track knows, look down the track and you can see ==== turn into >. The fact is that parallel lines do meet at infinity, which would be more useful if anyone with the possible exception of Buzz Lightyear, could even conceive of infinity. George Kantor, a great mathematician, conceived that there are levels of infinity, some greater than others.

What we call science is simply a method of testing a hypothesis until we’re satisfied that even if it’s not an absolute truth, it’s true enough to be used to solve problems. This brings us to the Food and Drug Administration and its turn around on the labeling of levonorgestrel, probably best known by the brand name Plan B. In July 28, 1999, FDA approved a new drug application (NDA) for the original product, Plan B, for prescription use. The drug was sold by prescription only and was classified as emergency contraception, a form of birth control that could be used to prevent pregnancy after unprotected sex, or at least in theory, if the use of protection failed. They are also appropriate after rape. or condom breakage, slippage, or incorrect use. Copper containing intrauterine devices are probably the most effective method of emergency contraception but the most difficult to obtain since they must be inserted by a qualified physician.

The World Heath Organization (WHO) recommends that a copper-bearing IUD, when used as an emergency contraceptive method, be inserted within 5 days of unprotected intercourse. This method is particularly appropriate for women who would like to start using a highly effective, long-acting, and reversible contraceptive method. The WHO also warns that a copper-bearing IUD should not be inserted for emergency contraception following sexual assault as the woman may be at high risk of a sexually transmitted infection such as chlamydia and gonorrhoea.

On August 24, 2006, FDA approved a supplemental new drug application (NDA) permitting nonprescription availability of Plan B for women 18 years and older and by prescription for women 17 years and younger. On July 10. 2009, the FDA approved a reformulation of Plan B, which was remaned Plan B One Step. The original Plan B used a two-dose regimen with 0.75 mg of levonorgestrel in each tablet to be taken 12 hours apart, while PBOS is a single dose tablet that contains 1.5 mg of levonorgestrel. Finally, on June 20, 2013, FDA approved PBOS for nonprescription use without age restrictions. While levonorgestrel is highly effective it’s not perfect. When taken within 24 hours, levonorgestrel EC is 95% effective. If taken 48–72 hours after unprotected sex, the effective rate is 61 about. The effectiveness of hormonal emergency contraception declines with the time interval. On the other hand, because levonorgestere is easily obtained, it’s feasible to keep a supply on hand alongside other OTC drugs.

But – there’s always a “but” – there’s a problem. According to the New York Times, “Up to now, packages of the brand-name pill, Plan B One-Step, as well as generic versions of it, have said that the pill might work by preventing a fertilized egg from implanting in the womb — language that scientific evidence did not support. That wording led some abortion opponents and politicians who equate a fertilized egg with a person to say that taking the morning-after pill could be the equivalent of having an abortion or even committing murder.” The “right to life” supporters are almost certain to claim that the labeling change was politically, an attempt to get around the Supreme Court’s decision on Dobbs v. Jackson which overturned the right to abortion. There is a confusion already on how some antipregnancy drugs do work. There are true “abortion pills,” notably misoprostol, a synthetic prostaglandin E1 analogue, used in treatment of ulcers, that is used off-label for a variety of indications in the practice of obstetrics and gynecology, including medication abortion. These should not be confused with levonorgestrel, which acts by delaying ovulation so there is no relation to abortion. It’s important to correct this confusion as quickly and forcefully as possible. In some studies, up to 41% of women do not understand how these drugs work, and it’s safe to say that neither does Justice Alito. Emergency contraception is a valuable resource now that the Supreme Court no longer recognizes rights that weren’t mentioned in the 18th century. Science, like the Supreme Court, is sometimes wrong. We have to get the facts out ASAP.

Sam Uretsky is a writer and pharmacist living in Louisville, Ky. Email sdu01@outlook.com.

From The Progressive Populist, February 1, 2023

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