Emergency contraception is no more contraception than abortion. Now don’t get me wrong: I am very pro-choice. But the emergency contraceptive pill implies to misguided people that they don’t have to take responsibility for sexual activity until after the fact.
Many women change birth-control methods frequently, and some are choosing emergency contraception (EC) as their main form of birth control. They might say they don’t have enough sex to get pregnant, or they don’t like the pill, or have some other reason to use only condoms—but then the partner doesn’t like condoms, or condoms ruin the mood, or there isn’t a condom available.
If condoms really are being used, why are chlamydia rates still sky-high?
I think we are starting to get the message across that condoms, while not perfect, help prevent sexually acquired infections. But we may have gone too far: Now, women using such perfectly reliable birth-control methods as Implanon, which has the lowest failure rate after abstinence or intrauterine devices, come in asking for emergency contraception. They think if they have failed to use a condom for disease-prevention purposes, they need EC.
According to a recent review and Cochrane study, women who were given advance EC to use if their regular method of birth control failed had the same rate of unintended pregnancy as women who didn’t have EC. Again, this may be attributable at least in part to poor patient education. We need to find a better way of managing the situation. “Get as much free EC as possible, through prescriptions or free handouts from clinics,” is our current mantra. If the patient doesn’t use it, maybe she has a relative or friend who will. Our hearts are in the right place, but what does this tell our patients? We are using reverse contraceptive psychology: Don’t take advance responsibility for your actions; you can play and then maybe not pay later. That is, unless you are the angry woman sitting across from me who did use EC and got pregnant anyway.
We know EC works best in the first few hours after intercourse, then within 12 hours, and finally up to 120 hours. But quiz women on the streets, and most have little or erroneous information. In addition, many confuse the purpose of the EC pill with that of the abortion pill. What is really needed is more national education and attention focused on responsible pregnancy prevention. Those of us who are pro-woman need to make our voices heard, loud and clear. We need to convey accurate information any way we can.
I liken EC to the fire department: You are glad you can call the fire department if your house is burning down, but it’s much better to have a smoke alarm, fire extinguisher, and a fire-prevention plan. House fires are uncommon, and birth-control failures and subsequent use of EC should be as well.
We need to push the message that pregnancy prevention is a proactive measure. We need to get into the trenches and reach out to our patients and prove to them that accurate information and access are the best prevention tactics they have. The widespread availability of EC is a blessing, not to be abused or taken for granted. Our family-planning tax dollars are under attack, and resources will only get tighter. We need to urge our legislators to remember these women when deciding their budgets. There is so much to lose! n