Behind the headlines: Can emergency pill stem abortion?

What is the story?

The ‘morning-after pill’ has always been a popular topic for newspapers, so the latest claim  that emergency contraception has had no impact on abortion rates is no exception. 

The story comes from a BMJ editorial in which Professor Anna Glasier, from the Univer-sity of Edinburgh and director of family planning at the Lothian Primary Care NHS Trust, highlights the fact that, despite improved access to emergency contraception, the abortion rate in the UK has not gone down. 

Indeed, while the use of emergency contraception has increa-sed, abortion rates in the UK have also risen. 

The professor also questions the efficacy of emergency contraception. In the BMJ article she explains that while studies have shown that home access to emergency contraception is linked to its increased use, this had no measurable effect on rates of pregnancy or abortion.    

The professor also stresses the need for the focus to shift to encourage people to take precautions before or during sex rather than after the event. 

What does the editorial say? 

Glasier notes that, by extrapolating from US data, some authors have claimed that emergency contraception prevented more than 66,500 abortions in England and Wales in 2004. 

But Glasier says that far from falling, abortion rates have risen: from 11 per 1,000 women aged 15–44 in 1984 (136,388 abortions) to 17.8 per 1,000 in 2004 (185,400 abortions). 

The editorial also questions whether it is possible to measure the efficacy of emergency contraception properly. 

It states that while 10 studies revealed that giving women a supply of emergency contraception to keep at home increased its use up to threefold, three studies that measured subsequent pregnancy rates showed that it had no measurable effect on rates of pregnancy or abortion. 

Glasier concludes that emergency contraception still has a place for women who have had unprotected sex. 

But she adds: ‘If you are looking for an intervention that will reduce abortion rates, emergency contraception may not be the solution. Perhaps you should concentrate most on encouraging people to use contraception before or during sex, not after it.’ 

What does the researcher say? 

Professor Glasier explained that her editorial emphasised that in calling for greater availability to emergency contraception, some campaigners had overstated the effectiveness of the drug. 

She said some lobbyists used ‘non-robust data to make extravagant claims’. 

She also questioned the effectiveness of emergency contraception and the extent of its use. 

‘Three out of four women, including those who have a supply of emergency contraception in their bathroom cabinet, do not use it. Either they didn’t realise that they had put themselves at risk of pregnancy or they didn’t acknowledge it.’ 

However, Professor Glasier said that GPs were not incentivised under the GMS contract to encourage patients to use other contraceptive methods. 

‘Sexual health has not been identified as a priority. There has been a big reduction in IUDs since the new contract.’ 

She urged policy makers to rethink the contract. 

Professor Glasier said it was important that her message was not misconstrued. She is not advocating a reduction in the use of emergency contraception.     

‘The message to women remains unchanged. Emergency contraception is useful as a back-up if you have unprotected sex or if your method of contraception lets you down. It is more effective the quicker you use it so it is more likely to stop a pregnancy if it is readily available.’ 

What do other experts say? 

Dr Catti Moss, honorary senior lecturer at Warwick University Medical School and an author of the Family Planning Associa-tion’s (FPA’s) The Handbook of Sexual Health in Primary Care, said: ‘I’m not sure why everyone seems to be so surprised at this editorial, which is saying some fairly sensible and practical things. 

‘No one expected the availability of emergency contraception to change the abortion rate on its own. 

‘In view of the widespread reduction in family planning clinics across the country, we might have expected a rise. These are complex issues and there are no easy simple rules,’ she said.      

‘The variability of unwanted pregnancy rates and accessibility of abortion is more important than the effect of emergency contraception.’ 

Toni Belfield, of the FPA, said: ‘Emergency contraception is no substitute for correct, regular use of contraception. It is not, and was never intended to be, a panacea for abortion.’ 

A DoH spokeswoman said emergency contraception had never been heralded as the answer to rising abortion rates. 

‘Our policy has always been that safe sex, using reliable contraception on a regular basis, is the best way for women to protect against unwanted pregnancy,’ she said.

Informing patients 

Emergency contraception has not reduced abortion rates, but will prevent pregnancy in most women who have had unprotected sex.  

A telephone call to a primary care service, either in or out-of-hours, should enable a patient to pick emergency contraception up within a few hours.  

Pharmacies can supply those over 16 years old, although the medicine has to be paid for.  

A family planning facility will also supply emergency contraception, as well as many youth ‘drop in’ services and similar organisations. 

Emergency contraception is a useful back-up but should not replace the use of contraceptives before or during intercourse.

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