The Morning After Pill

1. The Morning After Pill and RU486 What are the differences and similarities in their action and application ? Linda Daguerre

2. HistoryUnfolds… • 2000- the FDA approves RU486, the Abortion Pill aka • Early Option Pill, for early medical abortions (non- • surgical) in the United States. • 1999- FDA approved morning after pill, Plan B • 1998- FDA approved morning after pill, PREVEN • 1997 FDA declares emergency contraception safe • and effective in the U.S. • 1997- Much controversy surrounds RU486 by Right to • Life and religious groups. Drug’s introduction is delayed • in U.S. indefinitely. • 1996- The Population Council submits drug application to • FDA recommending RU486 as a safe and effective abortion • method. • 1988-RU486 approved in France. • 1980- Researchers at Roussel-Uclaf, a French pharmaceutical company • develop Mifepristone (RU486). • 1974- Albert Yuzpe, a Canadian Gynecologist publishes first studies on women’s • post-coital contraception by administering combination hormones. • 1960(s)- Clinicians in France legally prescribe oral contraceptives “off label” • to protect from pregnancy AFTER intercourse.

3. Words to Know • Fertilization:When sexual intercourse allows • the male’s sperm (gamete) to reach the • woman’s mature egg (ovum) at which • the combination forms a cell ( zygote). • Coitus or Coital- Sexual Intercourse • Contraceptives (tion)- Any artificial method of birth control • ( birth control pills, condoms, IUD, • hormone injections, etc.) • Abortion: Medical, surgical or chemical means of • terminating a pregnancy. • Abortifacient: A medication that induces or causes • an abortion ( not an EC) • Emergency Contraception (EC)- a method • implemented within 5 days of unprotected • sexual intercourse (72 hours recommended) • to stop fertilization from occurring, • preventing pregnancy.

4. Conflicting answers from biologists, physicians, researchers, right to life groups and clergy leave us with different answers, however, a few facts are certain: When does life actually begin? Both sperm and ova ( the woman’s eggs) are living organisms, so when fertilization begins, it is a relevant time to begin charting a new life. When a fetus reaches day 21, the tiny heart begins to beat. A 25 week old preemie 18 Weeks 7 weeks

5. What is the Morning After Pill? The Morning After Pill also referred to as emergency contraception (EC), is a high dose of hormones taken within a specified number of days or hours following unprotected sexual intercourse to interrupt the fertilization process, therefore preventing pregnancy. Not effective if subject is already pregnant.

6. How does the Morning After Pill Prevent Pregnancy? • It stops ovulation, so the egg cannot be fertilized. High doses of hormones make it impossible for fertilization to occur. No fertilization, Egg is never released Therefore , no IMPLANTATION

7. Are there RISKS orSide Effects with theMorning After Pill ? Aa . As with most medications, the Morning After Pill has some incidence of mild to moderate side effects in some women. Single hormone drugs, as in Plan B: Irregular menstrual periods headaches breast pain upset stomach dizziness acne These are severe side effects and need to be reported to your physician. Bleeding for extended time, lack of menstrual periods or severe stomach pain Note Combination hormones, as in Preven and the Yuzpe method, may increase risk of breast cancer, endometrial cancer and liver tumors.

8. COSTAND AVAILABILITY The Morning After • Emergency Contraceptives are very affordable and • easy to obtain: • Any licensed physician may prescribe ( Urgent Care, • Family Physicians, Family Planning Clinics), • although many may not be willing due to • controversial nature. • 2. Many college campus health centers may dispense, • although at this time, COS does not. • Abortion Clinics and Free Clinics • Prices range from $20-$25, plus office visit • ( these prices are approximate and may be • higher depending on the physician’s fees)

9. What is RU486 • RU486 also referred to as the “abortion pill”, is a two part therapy/regime known as an abortifacient, which terminates an early pregnancy (within 9th week ) by robbing the uterine lining of progesterone, a hormone vital to sustaining pregnancy. AND

10. How the abortion pill actually works Of the 2 Medications taken: • Mifepristone, keeps the progesterone( a hormone vital to sustaining pregnancy) from nourishing the uterine lining. (endometrium) • Misoprostol, causes the uterus to contract, expelling the pregnancy tissue.

11. Availability of RU486 Where can I get the abortion pill ? • Only medical doctors that are licensed to perform • surgical abortions are able to prescribe RU486. • Family Planning Clinics and Abortion Clinics have • these available upon examination and confirmation • of early pregnancy. • College health centers cannot prescribe this regimen, • however, can provide information, referrals and • counseling in most cases. • Depending on the physician’s stand on • abortion, even if able to prescribe, many would • not be willing due to personal judgements. FYI

12. Cost of RU486 • Costs vary depending on geographical location: • $300-$600, depending on income • Some insurance companies will • cover this expense, Medi-Cal • included. • Fees usually include ultrasound, • lab work and 3 office visits. • ** Additional fees may apply if a surgical abortion • is still needed after patient has undergone • pharmaceutical therapy without complete • results.

13. Side Effects of RU486 67% nausea 34% vomiting 32% headaches 23% diarrhea 97% 97% abdominalcramping * Percentages overlap due to incidence in more than one side effect per person

14. Potential to RU486? Risks Safety and health are the primary concern when taking this therapy of combined medications. • Severe abdominal cramping • Hemorrhaging ( heavy bleeding) • Pulmonary Embolism ( blood clot in lung) • Incomplete Abortion-surgical abortion may still be necessary. • Maternal Death ( death of mother) There are many lesser side effects that are possible with this medication that may include headaches, nausea, fever and diarrhea. Be Aware

15. Effectiveness of RU486 Yes/No % &Morning After Pill • The Food and Drug Administration has found that • RU486 if taken as prescribed , the effectiveness is • from 95%-98% , with little side effects. Misoprostol, which • is the second part of this regimen is a large part of its • success, usually giving complete results within 24 hours of • taking second pill. • The Morning After Pill, also if taken as prescribed has a • success rate of 89% in prevention of pregnancy after • unprotected intercourse, with few side effects.

16. Global Approval Not Greenland AK Russia Canada Europe US NotIndia Not Africa Taiwan Malaysia Limitedin So. America Not Australia or New Zealand some some ** Within Europe, Italy, Ireland, Portugal and Luxemborg not approved. These are countries that have gained approval for RU486. EC’s are usually approved in these Countries prior to abortion pill, unless otherwise noted.

17. Where are we headed with this ??? • AS OF TODAY: • The United States is fighting against a potential • abortion pill due to many recent deaths. Cause • is still being investigated. • Morning After Pill- Controversy is surrounding the • question on whether to make EC’s over the counter. • Decision may include age restriction on medications • to include parental consent for minors. • Australia continues to rally for approval on RU486, • but government doesn’t indicate any possibilities • that approval is imminent. • Since it is not approved in many developing countries, • black market pills are being sought and purchased. • This remains one of the most controversial topic across • nation and throughout the world in politics, religion, • medical and pro-choice/pro-life groups everywhere. • 1 out of 5 pregnancies in the world end in abortion.

18. Very controversial Carries higher risks if not taken properly. Is not available every-where. Costly Many countries are trying to get approved for use. Limited to persons without chronic medical Conditions. 95%-98% effective Only to be taken if pregnant Does NOT protect against Sexually Transmitted Diseases The FDA now recommending that any symptoms of vomiting, fever or diarrhea be treated immediately antibiotics. Controversial in many areas. Available in many areas with examination. Side effects in high doses of hormones increased. Affordable 89% Effective- higher if taken within first 24 hours following sexual intercourse. Does NOT protect against Sexually Transmitted Diseases Not to be taken if pregnant. WE NOW KNOW THIS… RU486 Morning After Pill

19. Resources Cited • Critchlow, Donald T., The Politics of Abortion • and Birth Control in Historical Perspective, • pp.75-79, University Park, PA, The Pennsylvania • State University Press, 1996 • Laden, Lawrence A Private Matter, Amherst, NY, • pp.115-118,142-143, 215-218, Prometheus Books, 1995 • The Encyclopedia of Birth Control, pp. 106-108, • Santa Barbara, CA 2001 • 4. The Reproductive System, Westport, CT, Greenwood • Press, 2004 • Web Resources • Health and Reproductive Rights: Emergency Contra- • ception, National Women’s Law Center, November 2005 • www.nwlc.org

20. Web Resources-continued • FDA Issues warning on abortion pill deaths, July 20, 2005 • Http://www.countrywatch.com • 2. What you need to know about RU486, Feb/Mar 2001, • SIRS Researcher, links to abortion, then mifepristone • 3. FDA needs to act on Morning After Pill, Sept.9, 2005, • SIRS Researcher, search emergency contraceptives and • scroll to article. • The Morning After Pill: Dosages, Applications, Risks and • Frequently Asked Questions, March 2006, • Http://ec.princeton.edu also under • Http://www.not-2-late.com • Health: Planning on Plan B, Newsweek, Inc., • February 20, 2006, p16 • 6. RU486 in the News, Where to get RU486, Side Effects, • http://RU486Facts.org