Emergency Contraception-A Short History

[Guest guest]

Emergency Contraception

Emergency contraception has been available for more than 25 years and could

prevent 1.7 million unintended pregnancies and 800,000 abortions each year in

the U.S. It is a safe and effective method of contraception, and women who have

used it report high levels of satisfaction.

Despite its enormous potential, anti-choice groups oppose the use of emergency

contraception. In order to hinder women's access to this important method of

contraception, they falsely claim that emergency contraception (EC) is an

abortifacient, and they disseminate other misinformation about its safety and

efficacy.

Fortunately, public awareness and availability of emergency contraception has

increased, and hopefully more women will benefit from this important backup

birth control method in the future.

Widespread Use and Availability of Emergency Contraception Could Prevent More

than Half of All Unintended Pregnancies and Abortions in the U.S.

Forty-three million, or seven in 10 women of reproductive age, are sexually

active and do not want to become pregnant (AGI, 2005a). Nearly half of America's

six million annual pregnancies are accidental; half of them are terminated by an

abortion (AGI, 2004).

Seventy-four to 95 percent of teen pregnancies are unintended, and in 2000, an

estimated 840,000 U.S. teenage women aged 15-19 became pregnant; more than half

became mothers (Advocates for Youth, 2004; Henshaw, 2004; Ventura, et al.,

2004).

Widespread use of emergency contraception could potentially prevent an estimated

1.7 million unintended pregnancies and 800,000 abortions each year in the United

States (Glasier & Baird, 1998; Trussell, et al., 1992). In 2000, an estimated

51,000 abortions were prevented through the use of emergency contraception;

moreover, EC was responsible for approximately 43 percent of the decrease in

total abortions between 1994 and 2000 (Boonstra, 2003).

Emergency Contraception Is Not Just a " Morning-After Pill " . Multiple Emergency

Contraception Options Are Available.

Emergency contraception, also called postcoital contraception, can reduce the

risk of pregnancy after unprotected intercourse. Emergency contraception is

provided in two ways: using hormonal contraceptive pills — either progestin-only

birth control pills or combined oral contraceptives — or inserting a

copper-releasing IUD (intrauterine device).

The Yuzpe Regimen

This method of emergency contraception is named for Canadian Professor A. Albert

Yuzpe who published the first studies demonstrating the method's safety and

efficacy in 1974. This regimen uses two doses of oral contraceptive pills that

combine estrogen and certain progestin hormones (FDA, 1997). It can reduce the

risk of pregnancy if taken within 120 hours (five days) of unprotected

intercourse. The treatment is more effective the sooner it begins (Ellertson, et

al., 2003; " FDA Approves... " , 1999; Rodrigues, et al., 2001; , et al.,

2004). (Because emergency contraception has a five-day window of effectiveness,

the popular term " morning-after pill " is misleading.) The doses are taken 12

hours apart. Various prescription products contain the appropriate hormone

combination and can be used as EC:

Many common oral contraceptive pills can be used as EC, although their

manufacturers do not label the pills for this use. " Off-label " use of approved

medications is legal and commonplace in American medicine. Further, in February

1997, the U.S. Food and Drug Administration (FDA) declared emergency use of

birth control pills, following the Yuzpe regimen, to be safe and effective. At

that time, six suitable pill brands were available on the U.S. market (FDA,

1997). Currently, the following brands can be used as EC in the U.S.:

Pill BrandManufacturerPills per Dose

Alesse®Wyeth-Ayerst5 pink pills

Aviane®Barr5 orange pills

Cryselle®Barr4 white pills

Enpress®Barr4 orange pills

Lessina®Barr5 pink pills

Levlen®Berlex4 light-orange pills

Levlite®Berlex5 pink pills

Levora®4 white pills

Lo/Ovral®Wyeth-Ayerst4 white pills

Low-Ogestrel®4 white pills

LuteraTM®5 white pills

Nordette®Wyeth-Ayerst4 light-orange pills

Ogestrel®2 white pills

Ovral®Wyeth-Ayerst2 white pills

Portia®Barr4 pink pills

Seasonale®Barr4 pink pills

SeasoniqueTMBarr4 light-blue-green pills

Tri-Levlen®Berlex4 yellow pills

Triphasil®Wyeth-Ayerst4 yellow pills

Trivora®4 pink pills

(OPR, 2006).

Progestin-Only EC

On July 28, 1999 the FDA approved the first progestin-only EC available in the

U.S. Produced by Barr Pharmaceuticals, Inc. and known as Plan B®, it consists of

two pills, taken 12 hours apart, and contains only the hormone levonorgestrel, a

progestin. While this treatment is also more effective the sooner it begins,

Plan B can be started up to 120 hours after unprotected intercourse (von

Hertzen, et al., 2002). Plan B contains no estrogen ( " FDA Approves..., " 1999).

Off-label administration of progestin-only oral contraceptives is also

effective, but it requires taking 20 Ovrette® oral contraceptive pills, and then

taking another dose of 20 pills 12 hours later (, et al., 2004).

A recent study has shown that a single administration of the two full doses of

progestin-only EC is also effective (ACOG, 2005; von Hertzen, et al., 2002).

The IUD

A copper-releasing IUD (ParaGard®) can be inserted within five days of

unprotected intercourse as a method of emergency contraception (WHO, 2004). It

can be left in place for up to 12 years for very effective contraception. Or the

IUD can be removed after the next menstrual period, when it is certain that

pregnancy has not occurred (Hatcher, et al., 2005).

EC Reduces the Risk of Pregnancy by up to 95 Percent, and Emergency

Contraception IUD Insertion Reduces the Risk by 99.9 Percent.

Two time factors influence the efficacy of EC: the amount of time elapsed after

unprotected intercourse, and the point in a woman's cycle at which she had sex.

The earlier EC is taken after unprotected intercourse, the more effective it is

(TFPMFR, 1998). The closer a woman is to ovulation at the time of unprotected

intercourse, the less likely the method will succeed (, et al., 2004). EC

is not as effective as correct and consistent use of precoital, reversible

contraceptive methods such as the pill, IUD, or contraceptive implants,

injections, patches, or rings, and they do not protect against sexually

transmitted infections (Knowles & Ringel, 1998; Roumen, et al., 2001; Zieman, et

al., 2002).

The Yuzpe regimen of combined estrogen and progestin EC reduces the risk of

pregnancy by roughly 75 percent if started within 72 hours of unprotected

intercourse. Not every woman at risk of pregnancy actually becomes pregnant. On

average, only eight out of 100 women will become pregnant after having

unprotected sex during the second or third week of their menstrual cycles. But

if they take EC, only two out of those 100 women will become pregnant. Combined

hormonal EC thus reduces the risk of pregnancy by roughly 75 percent, preventing

six of eight likely pregnancies (Knowles & Ringel, 1998; OPR, 2005; Rodrigues,

et al., 2001; , et al., 2004).

When used within 72 hours of unprotected intercourse, progestin-only EC was

found to reduce the risk of pregnancy by 89 percent in a World Health

Organization-supported study involving nearly 2,000 women in 21 clinics around

the world. When taken within 24 hours of unprotected intercourse, it was found

to reduce the risk of pregnancy by 95 percent ( " FDA Approves..., " 1999; TFPMFR,

1998).

More than 9,400 copper-bearing IUDs have been inserted postcoitally since 1976,

with only ten pregnancies occurring: a rate of fewer than one in 1,000, reducing

the risk of pregnancy by more than 99 percent (OPR, 2005; , et al.,

2004).

Emergency Contraception is a Safe Backup Method of Birth Control.

Millions of women around the world have used EC safely and effectively (Glasier,

1997; Guillebaud, 1998). EC is less effective than the most popular precoital

methods of contraception, and in general practice, women only turn to EC in

emergencies — as a backup to their usual birth control method.

Almost every woman who needs emergency contraception can safely use EC — even

women with contraindications to the ongoing use of oral contraceptives may use

them (Guillebaud, 1998; Hatcher, et al., 2005). EC can also be used safely by

adolescents. One study designed to evaluate the safety of EC use in teenagers

enrolled 52 teens between the ages of 13 and 16. EC was found to be safe and

well tolerated by the teens. They took the medicine properly, and they returned

to their normal menstrual cycles at the same rate as adult women taking EC

(Harper, et al., 2004).

EC should not be used by women who are already pregnant, not because the pills

are thought to be harmful, but because they are ineffective at terminating

established pregnancies (, et al., 2004).

Emergency Contraception Is Not Abortion.

Emergency contraception cannot end a pregnancy.

According to the FDA, " Emergency [contraception is] not effective if the woman

is pregnant ... " (FDA, 1997). A recent study found that most often, EC reduces

the risk of pregnancy by inhibiting ovulation (ns, et al., 2002). More

recent studies demonstrate that progestin-only EC only works by preventing

ovulation or fertilization, and has no effect on implantation (Croxatto, et al,

2003; Ortiz, et al., 2004). Scientific authorities agree that emergency

contraception reduces the risk of pregnancy and helps prevent the need for

abortion; it itself is not a form of abortion (Grimes, 1997; Guillebaud, 1998;

, 1972; , et al., 2004).

The copper IUD, used as a regular method of contraception, prevents

fertilization by releasing copper that stimulates the body to alter the fluid

within the uterus and the fallopian tubes to act as a spermicide (Grimes, 2004;

Hatcher, et al., 2005). In theory, the copper IUD may prevent implantation by

thinning the endometrial lining of the uterus, but there is no scientific

evidence that this actually happens (Alvarez, et al., 1988; FHI, 2005).

Postcoital emergency contraceptive insertion of a copper IUD may involve the

same mechanism in some cases, but it is more likely to interfere with

implantation (, et al., 2004).

Progestin-Only EC Greatly Reduces Side Effects.

Combination hormone EC induces nausea in 30-50 percent of women, and vomiting in

15-25 percent of women. Anti-nausea or anti-emetic medications taken one hour

before ingesting EC may reduce these side effects. Breast tenderness, fatigue,

irregular bleeding, abdominal pain, headaches, and dizziness may also occur.

These side effects usually taper off one or two days after ingesting EC (Knowles

& Ringel, 1998; ,et al., 2000; , et al., 2004).

Nausea and vomiting are far less common using progestin-only EC than using the

Yuzpe regimen (, et al., 2004). In a World Health Organization-supported

study using levonorgestrel, nausea occurred in 23.1 percent of cases, and

vomiting in 5.6 percent. Other side effects were also less common (TFPMFR,

1998).

In about 10-15 percent of women treated, EC changes the amount, duration, and

timing of the next menstrual period. This effect is usually minor, and

menstruation occurs a few days earlier or later than expected (Hatcher, et al.,

2005). If EC is used frequently, periods may become irregular and unpredictable

(Knowles & Ringel, 1998).

Side effects of IUD insertion may include abdominal discomfort, vaginal bleeding

or spotting, and infection. Possible side effects of IUD use include heavy

menstrual flow, cramping, infection, infertility, and uterine puncture (Grimes,

2004; , et al., 2004).

Neither EC nor IUDs prevent the spread of sexually transmitted infections,

including HIV. Many women who need emergency contraception are at risk of these

infections. At heightened risk are those who have had unprotected sex with

infected partners, those who use IV drugs or have a partner who does, and

victims of sexual assault. For those at risk of sexually transmitted infections,

EC is likely to be a safer choice than IUD insertion (Knowles & Ringel, 1998).

During IUD insertion, bacteria from a preexisting infection can be introduced

into the sterile uterine cavity — untreated, such infections can lead to pelvic

inflammatory disease. HIV infection can also increase the risk of pelvic

inflammatory disease associated with an IUD (Grimes, 2004).

Women should discuss with their clinicians any sign of pregnancy after using

emergency contraception. The signs include a missed menstrual period, nausea,

inexplicable fatigue, sore or enlarged breasts, headaches, and frequent

urination (Cunningham et al., 1997; , et al., 2004).

Emergency contraception, like other contraceptives, decreases the risk of

ectopic pregnancy — a pregnancy that develops outside the uterus — by reducing

the risk of pregnancy (ACOG, 2005). However, in the event of pregnancy following

the use of emergency contraception, a clinician should test for ectopic

pregnancy. Ectopic pregnancies, left untreated, will cause complications that

can cause death. Women should seek medical attention if they have signs of

ectopic pregnancy, which include severe pain on one or both sides of the lower

abdomen, abdominal pain and spotting, especially after a very light or missed

menstrual period, and faintness or dizziness (Knowles & Ringel, 1998; ,

et al., 2004).

Users of EC Report High Levels of Satisfaction.

A study of 235 women who had used EC found that the overwhelming majority — 91

percent — were satisfied with the method, and 97 percent would recommend it to

friends and family. These women also reported that they did not intend to

substitute EC for regular contraceptive use (Harvey et al., 1999).

Of 119 women who obtained EC at Planned Parenthood of New York City clinics, 92

percent stated that they would use the method again if necessary, but reported

that they believed EC should be reserved for emergencies. Three-fourths of the

sample indicated that since using EC, they were more likely to use precoital

methods of contraception (Breitbart et al., 1998).

Anti-Choice Organizations, Pharmacists, Religious Hospitals, and Hotline

Difficulties Threaten Women's Access to Emergency Contraception.

Major anti-choice organizations such as the American Life League, Human Life

International, and Stop Planned Parenthood International oppose emergency

contraception and have launched national and international misinformation

campaigns claiming that it is an abortifacient (ALL, 1997; Gallagher, 1998;

STOPP International, 2000). In addition, they falsely assert that testing has

not been done to confirm the safety of EC (ALL, 1997); they underreport

statistics on the efficacy of emergency contraception (STOPP International,

2000), and they dismiss evidence of decreased side effects of progestin-only EC

(e, 2000).

Individual pharmacists have refused to fill prescriptions for EC, presumably

based on the false assumption that EC is an abortifacient (Cohen, 1999). This

problem received widespread attention in May 1999, when Wal-Mart® announced that

it would not sell Preven® — a combined hormone EC that is no longer on the

market — in its approximately 2,400 pharmacies (Canedy, 1999). In February 2004,

a Denton, Texas pharmacist refused to fill a rape survivor's prescription for

EC, citing " religious convictions " (Austin, 2004). A survey of 195 pharmacies in

New York City revealed that 25 percent did not carry EC, and of those, none had

posted signs required by law, saying they do not carry the pills (tta,

2004).

Although the Ethical and Religious Directives for Catholic Health Care Services

states that " A female who has been raped should be able to defend herself

against a potential conception from the sexual assault " (USCCB, 2001), many

Catholic hospitals do not provide emergency contraception, even to rape victims.

A study of the nation's nearly 600 Catholic hospital emergency rooms found that

only 28 percent offered EC to women who had been raped (CFFC, 2002). Sometimes a

Catholic hospital is a community's only provider — leaving sexual assault

survivors with very little chance of being taken to a hospital that will provide

her with EC.

An evaluation of the Emergency Contraception Hotline found that while at least

76 percent of callers were able to obtain a telephone prescription or an

appointment with a hotline provider within 72-hours of unprotected intercourse,

11 percent failed (Trussell, et al., 2000). Although the hotline provides an

important resource for women seeking emergency contraception, lack of available

appointments and limited practice hours necessitate additional venues to

facilitate access.

Efforts to Improve Access to Emergency Contraception

In 1999, France became the first country in the world to distribute its brand of

EC — NorLevo® — in pharmacies without prescription or parental consent. NorLevo

is also distributed free-of-charge along with other methods of contraception at

family planning centers (Ollivier, 1999).

In January 2000, France's Deputy Education Minister, Segolene Royal, took the

unprecedented step of granting its school nurses the right to dispense EC in

both junior and high schools (Daley, 2000; McNeil, 2000). The initiative was

accompanied by a nationwide sex education campaign that included information on

emergency contraception. Provision of EC in schools received widespread support

from students, health practitioners, and the union of school nurses (Ollivier,

1999; McNeil, 2000).

However, in July 2000 the Council of State, France's highest administrative

court, overruled this decision citing a 1967 law that says hormonal

contraception may only be distributed under prescription by pharmacies. The

ruling followed a strong show of opposition by the Catholic Church and was

lauded by the National Confederation of Catholic Family Associations, which also

expressed regret that the court did not take additional steps to reaffirm

parental authority in such matters (McNeil, 2000). In October 2000, the French

Parliament amended the law to once again allow school nurses to dispense

emergency contraception (Kolata, 2000).

Restrictions on the dispensing of emergency contraception are easing in other

countries as well. Women in 42 countries, including Albania, Belgium, Canada,

Denmark, Finland, India, Israel, Morocco, Norway, Portugal, South Africa,

Sweden, and the United Kingdom, can obtain emergency contraception without a

prescription (Trussell & Wynn, 2006).

Steps have also being taken to make EC available over-the-counter or via

collaborative practice agreement in the United States. In July 1997, an

emergency contraception collaborative drug therapy agreement pilot project was

launched in Washington. Collaborative drug therapy agreements between

pharmacists and prescribers, such as physicians or nurse practitioners grant the

pharmacist the authority to write prescriptions under a set of prescribing

protocols. In the first 13 months of the project in the state of Washington,

9,333 EC prescriptions were provided, preventing between 504 and 2,100

pregnancies, about half of which would have ended in abortion. ( " Pharmacists,

Providers..., " 1999). Similar programs have been established in Alaska,

California, Hawaii, Maine, Massachusetts, New Hampshire, and New Mexico, and

more states are considering legislation that would allow pharmacists to dispense

emergency contraception without a prescription (Greenberger, 2005; Haddix, 2004;

Neergaard

, 2005).

At public hearings held in June 2000, advocates including the National Women's

Health Network, the Reproductive Technologies Project, and the National Abortion

and Reproductive Rights Action League testified at the FDA in support of

reclassifying EC as over-the-counter drugs ( " Advocates Testify..., " 2000).

Prominent groups such as the American Academy of Pediatrics, the American

College of Obstetricians and Gynecologists, the American Medical Association,

the American Medical Women's Association (AMWA), the American Public Health

Association, and Planned Parenthood Federation of America have since voiced

support of making EC available OTC through a pharmacist (ACOG, 2001; AGI, 2005b;

AMWA, 1996; Foubister, 2001).

Improving women's access to emergency contraception does not increase women's

reliance on it as a primary method of birth control. A study found that women

who were given EC to take home used other birth control methods at the same rate

as women who did not have the pills in their medicine cabinets. Women who had

the pills at home were more likely to use emergency contraception once. But they

were not more likely to use it repeatedly. Women who had home access to EC used

the method correctly 98 percent of the time and had fewer unintended pregnancies

than those who did not have EC at home (Glasier & Baird, 1998).

On February 14, 2001, the Center for Reproductive Rights filed a petition with

the FDA on behalf of more than 70 medical, public health, and other

organizations, to grant over-the-counter status to EC (CRR, 2003). No decision

was ever issued for this petition. The makers of Plan B filed a second petition

in 2003. In December 2003, two FDA advisory panels found that Plan B meets the

criteria for availability without a prescription, and recommended granting

over-the-counter status. Five months later, despite these recommendations, the

FDA chose to deny the petition, citing concerns about adolescent use and

potential increases in promiscuity. A dozen members of Congress called for the

resignation of key FDA officials for denying the over-the-counter petition based

on political and ideological — not scientific — reasons. Forty-one members of

Congress asked that the FDA reconsider its decision (Kaufman, 2004).

The distributor of Plan B, Barr Pharmaceuticals, Inc., vowed to continue to work

with health organizations and advocated to get the FDA to reverse its decision

(, 2004). Numerous studies have since been published that refute the FDA's

claim that use of EC would lead to increased promiscuity. These studies

demonstrate that while advanced access to EC does increase the chances of using

EC, it does not alter sexual behavior or the risk for contracting STIs (Belzer,

et al., 2003; " Easy EC access... " , 2005; Marston, et al., 2005; " Plan B " , 2005;

Raine, et al., 2005).

A study of adolescent mothers examined the impact of giving teenagers EC before

they need them. One group of teen mothers received education about EC and were

given an advance supply of the pills. Another comparison group received only

education about EC. At the six-month follow-up, 83 percent of the group that

received the pills used EC, as compared to only 11 percent of the education-only

group. The group that received EC was not more likely to report having

unprotected sex within the follow-up period (Belzer, et al., 2005).

Another study about advance provision of EC to adolescents had similar findings

— the teenagers were more likely to use EC they received, and their use of

condoms did not decrease (Harper, et al., 2005).

A 2004 study substantiated the findings of previous studies on advance

provision. Adolescent women, aged 15 to 20, were randomized into two groups —

one group received EC and education about emergency contraception and the

comparison group received education alone. In the first month of the study, the

teens in the group that received the pills were twice as likely to use EC as the

comparison group. They also took the pills an average of 10 hours sooner than

the teens in the education-only group — an important finding because EC's

efficacy is time-limited. The two groups did not differ in their rates of

hormonal contraceptive use at the six month follow-up. Notably, the group that

received the pills was more likely to report condom use at six months than the

education-only group (Gold, et al., 2004).

The FDA announced that it would, by January 21, 2005, issue its ruling on a

subsequent application by Barr Pharmaceuticals, requesting over-the-counter sale

of EC to women who are 16 and older. The FDA did not meet its deadline (Baer,

2005). On August 26, 2005, while acknowledging that Plan B could be safely sold

to women over the age of 17, the FDA announced yet another delay on deciding

whether or not to make Plan B available over-the-counter. Citing concerns

associated with the difficulty in enforcing over-the-counter age restrictions,

the FDA opened a 60-day public comment period to address EC over-the-counter

implementation strategies (, 2005). This comment period ended November 1,

2005; the FDA is currently reviewing as many as 10,000 comments it received

(Kaufman, 2005).

On November 14, 2005, the Government Accountability Office (GAO) released its

report on Plan B calling the handling of the application by the FDA " unusual " .

It found that the high-level involvement of top FDA officials was atypical, that

the decision not to approve the application may have been made before the review

was even completed, that Plan B was the only application in the last 10 years

that did not receive approval according to the FDA's advisory committees

recommendations, that no other FDA approved contraceptive has age-related

marketing restrictions, and that the rationale for not approving the application

was novel (GAO, 2006). Congressmen and women continued to fight to bring EC over

the counter.

In March of 2006, Senators Hillary Clinton (D-NY) and Patty Murray (D-WA) kept

the fight to bring EC over the counter in the forefront of the Senate when they

vowed to place a hold on FDA Commissioner nominee von Eschenbach's

confirmation hearing until EC was approved for OTC sale. On July 31, Barr

Pharmaceuticals received a letter from Dr. von Eschenbach requesting that the

company amend its application for the sale of Plan B. The acting commissioner of

the FDA requested that the age restriction for the sale of Plan B be raised to

18 years, and that Barr Pharmeceuticals consider revising the packaging for EC

and the location of sale - e.g. at a pharmacy where the age of the consumer

could be closely monitored (Tanne, 2006).

On August 24, 2006, the FDA announced its approval of the sale of EC

over-the-counter to women 18 and older (Barr Pharmaceuticals, 2006). It is

expected to become available for OTC sale by the end of 2006. While Planned

Parenthood is pleased that the FDA has finally taken action on this issue, we

are troubled by the scientifically baseless restriction imposed on teenagers.

Research shows that over-the-counter access to emergency contraception does not

increase or encourage sexual activity among teens, and better access to proven

prevention methods like accurate sex education and emergency birth control are

the best ways to reduce the alarming rate of teen pregnancy in this country.

Planned Parenthood will continue to do all it can to educate women of all ages

about EC and help them access emergency contraception.

EC-OTC: Surveys Show High Levels of Support for Collaborative Practice

Agreements between Physicians and Pharmacists.

A survey conducted on behalf of the Reproductive Health Technologies Project

found widespread support for emergency contraception among voters and licensed

pharmacists in New Jersey and Oregon. Among its findings

Approximately 60-70 percent of voters and pharmacists, including Catholics,

support the idea of emergency contraception being widely available.

The majority of pharmacists — 56 percent in New Jersey and 67 percent in Oregon

— support adding EC to the protocol of drugs that they can prescribe directly

for patients through collaborative drug therapy agreements.

Eight in 10 New Jersey voters and seven in 10 Oregon voters oppose refusal

clause legislation, which would allow pharmacists to refuse to fill

prescriptions because of religious or moral objections (RHTP, 2000).

A more recent nationwide survey of 824 physicians conducted by HCD Research,

found that 65 percent believe that pharmacists should have the authority to

dispense EC. Seventy-eight percent oppose state refusal clauses for legally

prescribed medication ( " Survey finds... " , 2005).

Emergency Contraception Is Available OTC and at Planned Parenthood Health

Centers.

Over-the-counter sale of Plan B is expected to become available by the end of

2006. Plan B and other forms of EC are also available by prescription for all

women (Barr Pharmaceuticals, 2006).

Planned Parenthood is the leading provider of emergency contraception in the

U.S. The number of women receiving EC from Planned Parenthood has grown from

roughly 17,000 in 1995 to 984,000 in 2004 (PPFA, 1996; PPFA, 2005). Some Planned

Parenthood health centers offer " just-in-case " emergency contraception kits to

keep at home, also called EC-to-Go. Planned Parenthood offers all safe,

available emergency contraceptive choices, but not every method is available at

every Planned Parenthood health center.

If you need a prescription for EC, contact your nearest Planned Parenthood

health center at 1-800-230-PLAN for information.

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Lead Author — Deborah Weiss

Revised By — Deborah Friedman, MPH

Published by the Katharine Dexter McCormick Library

Current as of August 2006

© 2006 Planned Parenthood® Federation of America, Inc. All rights reserved.

Planned Parenthood®, PPFA®, and the logo of " nested Ps " are registered service

marks of PPFA.

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champagne in one hand, strawberries in the other, body thoroughly used up,

totally worn out and screaming " WOO HOO - what a ride! "