Emergency contraception (EC)

Making EC easier to buy in Canada

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Overview:

There are many factors preventing widespread use of emergency contraception (EC). An article in the Canadian Medical Association Journal (CMAJ) lists some barriers which are true across North America: "...lack of knowledge, reluctance of young women to request medication from their physicians, denial of pregnancy risk, and lack of timely access to physicians or family planning clinics."

Not included in this list is a rejection of EC by some women for religious reasons. Most pro-life agencies and many -- primarily conservative -- faith groups:

• Define pregnancy as starting at conception; physicians and pro-choicers generally define it as starting when the blastocyst -- a pre-embryo -- becomes embedded in the uterus.
• Refuse to accept recent evidence that EC will not prevent the implantation of a blastocyst  in the uterus.

These groups generally teach that EC can act as an abortifacient. Some groups state flatly that EC is an abortifacient. Most of these faith groups also teach that human personhood starts when the pre-embryo is fertilized. Thus, many regard any method of interrupting the development process after conception to be murder of a human being.

Pro-choice agencies, physicians, religious liberals and others generally follow the traditional definition of the start of pregnancy -- it happens when the blastocyst implants itself in the wall of the uterus. Since EC has no effect during or after implantation, these groups do not consider it to be an abortifacient.

The CMAJ concludes that: "As the effectiveness of emergency contraception is time-dependent, convenient prescription and dispensing mechanisms are crucial to enabling its use."

EC is generally available as an over the counter medication in the U.S. to women 17 year-of-age or older, and by a doctor's prescription for younger women.

"Plan B,"^™ a popular EC, was approved for purchase without a prescription in Canada on 2005-APR-20. ₁₀ A public opinion survey by Leger & Leger during 2004-MAY found that 81% of adults in Quebec and 70% of adults in all of Canada agreed that EC should be available without a prescription.

The Society of Obstetricians and Gynaecologists of Canada, the Canadian Medical Association, Planned Parenthood Federation of Canada, the Canadian Pharmacists Association, the College of Physicians and Surgeons, the Federation of Medical Women of Canada, the Canadian Women's Health Network, and the Canadian Nurses Association all approved of the move. Canadian Physicians for Life is opposed, as are numerous pro-life and conservative religious groups.

Plan B is generally available in Canada and stocked in most pharmacies.

British Columbia study

In 2000-DEC, this province was the first jurisdiction in Canada to allow specially trained pharmacists to provide EC without a prescription. Dr. Judith Soon and team at the University of British Columbia studied women's use of ED in the province between 1996 and 2002. The study was reported in the CMAJ. The team found that the number of ECs dispensed rose from an average annual rate of 8,805 during the interval of 1996 to 2000 to 16,038 in 2001 and 17,794 in 2002. This is an increase of 102% overall, or about 20% per year. Very little of this increase can be attributed to the change in British Columbia's population, which averages only about 1% per year. CMAJ concludes that: "The policy change that granted pharmacists authority to provide ECs to women without a physician’s prescription did not simply expand EC availability but was associated with an overall increase in EC use in the province." ₁

Additional information from the study:

	56.2% of the women reported that they used EC because a method of birth control had been used but failed; this was almost always a condom failure.
	According to the Canadian Broadcasting Corporation, Dr. Soon "...estimates the drug prevented 390 unwanted pregnancies over...two years." She said: 'Perhaps about half of those [women] would have had an abortion. That did not occur because of the emergency contraceptives."
	86.6% of the women received only one dose of EC in a given year; 10.4% received two; 3.0% received more than two. Since 97% of women used EC either once or twice in a year, it is obvious that very few were using EC as their regular contraception method, as some critics have suggested.
	Women in British Columbia terminate 23% of all pregnancies through abortion; for teenagers aged 15 to 19 years, the number rises to 58%. 5

A Health Canada proposal to make EC available without prescription:

Access to medication in Canada is controlled by both the federal and provincial/territorial governments:

	Health Canada, a department of the federal government, determines whether a medication can be made available in Canada and whether it requires a doctor's prescription.
	The provincial and territorial governments decide under what conditions medications are sold in pharmacies. They might require the pharmacist to interview the woman carefully. They might require the pharmacist to simply ask a few questions before dispensing the medication. They might permit the medication to be sold over the counter.

On 2003-JUN-16, Health Canada distributed a letter asking for comments on their proposal to reclassify EC to non-prescription status. They received comments on their proposal from 64 "stakeholders:"

27 associations or organizations and 7 individuals responded with support for the proposal. They raised a number of issues: A counseling system must be in place before changes are made; EC should be an insured benefit by drug benefit plans; Women should be cautioned to not use EC repeatedly; Registered nurses be allowed to dispense EC, etc.

4 associations or organizations and 24 individuals responded with opposition to the proposal. They raised a number of issues: Most believe that women should not be able to obtain EC under any circumstances or that access to EC should be restricted by continuing to require a doctor's prescription. Some believe that EC induces an abortion. Some object to EC being labeled "emergency contraceptive," since they believe that it does not prevent conception. Actually, they are wrong. If an ovum has not been released, EC inhibits its release, thus preventing conception. If an ovum has been released and not fertilized, then EC prevents conception. Otherwise, EC has no effect. Health Canada replied: "The term emergency contraceptive (EC) has been used internationally for many years to refer to all methods of contraception that are used after intercourse and before implantation. It is the term used by the World Health Organization for levonorgestrel at this dosage strength." Most were concerned about ECs side effects, long-term health risks, and problems arising from repeat usage. Health Canada quoted various studies which show that EC does not present a health risk. One quoted a study which showed no decrease in abortion rates in Scotland following the availability of EC. Health Canada responded that abortion rates had dropped in countries other than Scotland. Also, abortion rates are influenced by many factors in addition to the availability of EC. One mentioned a report that abortion rates among teens in Britain had not dropped since the introduction of EC. Health Canada was unable to find such a report. They did find a 2002 study which indicated that teen birthrates had dropped more than 20% since 1990 in the U.S. Three were concerned that minors might obtain EC. Health Canada commented that condoms and many other forms of birth control are already generally available to minors. Six were concerned about an increase in STDs with EC use. The medication will contain a label mentioning that EC does not protect against STDs. Four were concerned that EC would facilitate irresponsible sexual activity. Three were concerned that pharmacists would not have access to the woman's medical history. Three were concerned that pharmacists might not provide adequate counseling. One was concerned that the woman might not have adequate privacy when being counseled. Four wanted pharmacists to be free to refuse to dispense ECs on moral grounds. One was concerned about the lack of a follow-up visit and whether each woman's repeat usage of ECs will be tracked. One asked that pharmacist's counseling include a referral of women to a local pro-life organization.

On 2004-MAY-18, Federal Health Minister Pierre Pettigrew released a statement announcing that Health Canada would be making EC available without a prescription at an unspecified date in the future. He said:

"Women facing an emergency need timely access to this type of therapy. Making the drug available in pharmacies without a prescription will help women to prevent unwanted pregnancies." ₆

	Abby Lippman, co-chair of the Canadian Women's Health Network would prefer that EC be available over-the-counter like cold remedies. She responded: "There are still barriers to a woman having access to the drug if she has to go through a pharmacist to have it." 6
	Dr. Delores Doherty of Canadian Physicians for Life said: "It further encourages risk-taking behavior and sexually transmitted diseases are going through the roof." 6

On 2004-MAY-25, Health Canada published their proposal to reclassify Plan B to non-prescription status. They stated:

"The term emergency contraceptive has been used internationally for many years to describe contraceptive methods that can be used by women within a few days after unprotected intercourse or contraceptive failure to prevent an unwanted pregnancy. Some forms of EC have been available for almost thirty years.....Levonorgestrel as a component of oral contraceptive products has been widely used as a prescription drug in women for several decades. There is therefore a large amount of post-market data available regarding the long-term effects of daily use of levonorgestrel by women. There is also a long history of safe and effective use of levonorgestrel as an EC. The first clinical trials using levonorgestrel as an EC were conducted in the 1970's. Post-marketing surveillance by pharmacovigilance agencies indicates no safety problems. There have been no adverse drug reaction reports in Canada for levonorgestrel as an EC during the three years that it has been available as a prescription drug....Levonorgestrel for emergency contraception is available without a doctor's prescription in 28 countries including the United Kingdom, France, Denmark and Norway."

Once a medication is given non-prescription status, it is up to the provincial and territorial pharmacy regulatory authorities to determine exactly how the drug is sold. The National Drug Scheduling Advisory Committee (NDSAC) of the National Association of Pharmacy Regulatory Authorities (NAPRA) recommends that EC be obtained only "behind the counter" after discussing the medication with a pharmacist. Health Canada writes that "The Canadian Pharmacists Association (CPhA) has developed guidelines and extensive training for pharmacists who would be dispensing levonorgestrel 0.75 mg to ensure that women are appropriately screened and counseled before receiving it." ₃ The media reports imply that provincial and territorial pharmacy regulatory authorities are accepting these recommendations.

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Canadian Medical Association Journal editorial:

In their 2005-MAR issue, Canadian Medical Association Journal (CMAJ) published an editorial suggesting that both the prescription and the "behind the counter" classifications for EC is not justifiable. The latter requires pharmacists to play a counseling role. "Few pharmacies offer the privacy necessary for such a conversation. This mundane fact, together with the professional fees attached to the consultation, represents a needless barrier to access." The CMAJ recommends that EC be as freely available "over the counter" as are cold remedies and aspirin. They write: "There are no serious adverse effects to the woman or, if she happens already to be pregnant, to the fetus....Why, then, must competent women who have experienced contraceptive failure, a lapse in caution, or sexual coercion or assault be regarded as fair game for unwanted questioning and unsought advice — at their own expense?" ₄

EC becomes available in Canada without a prescription:

On 2005-APR-20, Health Canada confirmed that Plan B, an emergency contraceptive, has been approved for use without a prescription. Canada News Wire claims that 70% of Canadians, and every leading medical organization in the country approve. Plan B is distributed in Canada by Paladin Labs Inc. It is 95% effective in preventing unintended pregnancy if taken within 24 hours of unprotected sexual intercourse, and 85% if taken within 72 hours. ₇

	Jonathan Ross Goodman, President and CEO of Paladin Labs Inc. said: "This is a landmark day for Canadian women who now have immediate access to Plan B, a safe and effective morning after pill that has been used by millions of women in more than 100 countries around the world to prevent unintended pregnancy." 7
	Linda Capperauld of Planned Parenthood Federation of Canada, said: "Timely access to an emergency contraceptive is important to ensure effectiveness. Being able to obtain Plan B from pharmacists will increase access for many women who do not have timely access to a doctor." She stressed that education and awareness are also crucial to reduce the numbers of unintended pregnancies. 7
	Dr. Andre Lalonde, Executive Vice-President of the Society of Obstetricians and Gynaecologists of Canada said: "Today's decision equalizes access to emergency contraceptives to women across Canada. Due to the nature of emergency contraception, it needs to be taken as soon as possible, within a maximum of 72 hours after unprotected intercourse. Better access and greater knowledge and use of emergency contraception could significantly reduce the incidence of unintended pregnancy in Canada." 7
	Jim Hughes, National President of Campaign Life Coalition (CLC) -- a pro-life group -- said: "This drug is a double dose birth control pill which is a hazard to women's health, yet Health Canada seems not to care. Even the regular birth control pill causes blood clots and strokes. The morning after pill also prevents a newly conceived child from implanting in the uterus, resulting in the death of the child. Promoters are trying to deceive the public into believing that this is not an abortifacient and that it is safe for women." 8 (Campaign Life continues to believe that EC can operate as an aborifacient inspite of medical evidence to the contrary.
	Mary Ellen Douglas, National Organizer of CLC said: "The government is telling our young people to act irresponsibly sexually and then run to the pharmacist who will provide them with a magic pill to solve their problems. Some pharmacists do not want to dispense a drug which they know is harmful to the woman and deadly for the child. Will their freedom of choice be respected?" 8
	The CLC asked Health Canada to return Plan B to prescription status before women and their newly conceived children die. Their news release said: "The Liberal government is determined to drag our country down a morally corrupt path." 8

References used:

1. Judith A. Soon, et al., "Effects of making emergency contraception available without a physician's prescription: a population-based study," Canadian Medical Association Journal, 2005-MAR-29. It is online at: http://www.cmaj.ca/
2. "Population, provinces and territories," Statistics Canada, 2003 estimates. See: http://www.statcan.ca/
3. "Food and Drugs Regulations - Amendment - Levonorgestrel - 1272," Health Canada, 2004-MAY-22, at: http://www.hc-sc.gc.ca/
4. "Emergency contraception moves behind the counter," Editorial, Canadian Medical Association Journal, 2005-MAR, http://www.cmaj.ca/
5. "Morning-after pill use doubles in B.C.study," CBC News, 2005-MAR-29, at: http://www.cbc.ca/
6. 'Morning-after pill will be available without prescription across Canada," CBC News, 2004-MAY-19, at: http://www.cbc.ca/
7. "Health Canada Gives Canadian Women a Plan B-Plan B 'Morning After Pill' Now Available Without a Prescription," Canada Newswire, 2005-APR-20, at: http://www.newswire.ca/
8. "Abortion-Causing Morning-After Pill Approved Across Canada Without Prescription," LifeSiteNews.com, 2005-APR-20, at: http://www.lifesite.net/
9. "Paladin Labs Inc.: Health Canada Gives Canadian Women a Plan B," Paladin Labs, 2005-APR-20, at: http://press.arrivenet.com/
10. Plan B is a registered trademark of Duramed Pharmaceuticals, Inc.

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Copyright © 2005 to 2010 by Ontario Consultants on Religious Tolerance
Originally published on 2005-APR-24
Latest update: 2010-JUN-20
Author: B.A. Robinson

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