Emergency Contraception: What it does and does not do

By Jennie Bristow, Editor of Abortion Review.

An advertisement promoting emergency contraception prescribed for free by BPAS over the Christmas period provoked international media coverage and divided opinions. The advert, pictured on the back page of the Winter 2008/9 edition of Abortion Review, shows a woman locked in a steamy embrace with a man dressed as Father Christmas, under the slogan: ‘Santa only comes once a year…but that’s all it takes!’

Noting that ‘the closure of high street pharmacies, family planning clinics and GP surgeries over the Christmas holidays can pose serious problems for women after contraceptive failure, putting them at risk of unintended pregnancy’, BPAS announced that it would be prescribing emergency hormonal contraception (the ‘morning after pill’ ) for women to keep at home in advance of need, free of charge, from 10 clinics across the UK. EC costs around £26 to buy from a high street pharmacy.

Reacting angrily to the advert, Fiona MacRae in the Daily Mail asked: ‘Is this crude ad really the best way to tackle unwanted pregnancies at Christmas?’ ‘Critics claim the service’s scheme to hand out emergency contraception “gift kits” will fuel promiscuity and the spread of sexually-transmitted infections’, wrote MacRae. ‘They also question whether it will do anything to cut abortion rates, which have topped 200,000 a year for the first time.’

But reactions from readers of the Daily Mail were rather more mixed. The100-plus comments on the Mail website were split between those who condemned the advert for promoting irresponsible sex and destroying childish innocence about Santa Claus, and those who commented: ‘hilarious’, ‘brilliant’, ‘British sense of humour at its best’.

The success of this advertising campaign indicates the gulf that exists between the anti-abortion lobby’s attitudes to emergency contraception, and those held by the public at large. Opponents of Emergency Contraception (EC) are motivated by a belief that the methods used to prevent pregnancy after sexual intercourse, rather than before, in some way act as an abortifacient. BPAS’ Medical Director Patricia Lohr explains here how EC actually works. But the idea that EC is ‘like’ an abortion has had a significant impact on the general perception of EC, resulting in high-profile cases in Britain and the United States in which pharmacists exercise a conscientious objection to prescribing the Emergency Contraceptive Pill (ECP), and leading to a public confusion about the difference between ECPs (which contain the drug levonorgestrel) and the ‘abortion pill’ (which contains the drug mifepristone, and is used to end a confirmed pregnancy of up to 63 days’ gestation).

Despite the misinformation generated by opponents of EC, many men and women in the UK are aware that it exists, and are open to making use of it. Many of the respondents to the Daily Mail article argued that using EC was a sensible response to having unprotected sex, and that the BPAS ad was an amusing and effective way to get this point across. Among the public at large, the issues surround EC seem to have little to do with worrying about whether the drug is a method of contraception or abortion: the issues are more to do with remembering to take the drug within 72 hours after sex, and ideally ‘the morning after’; and getting affordable access to ECPs.

The reason BPAS has consistently promoted advance provision of ECPs is to improve this situation. As Ann Furedi, Chief Executive of BPAS, said of the Christmas ad:

‘Sex isn’t always planned or prepared for. It’s easy to get carried away, which is why we advise women to back up their birth control by keeping the morning after pill at home. You don’t wait until you get a headache to buy your pain relief, why wait until you’ve risked pregnancy to get the morning after pill?’

Raising the profile of EC, and improving access issues, are extremely important for giving women the ability to prevent unintended pregnancy after their contraception has failed, or after they have failed to use contraception. But it is also important for family planning professionals to keep a sense of perspective about the extent to which EC can prevent unintended pregnancy. In a presentation to the BPAS conference in June 2008, Kate Guthrie, Clinical Director of Hull and East Riding Sexual Healthcare Partnership, opened a frank discussion about the fact that EC use is now known not to have an impact on abortion rates, and the reasons why that might be. Guthrie’s paper can be read in full in the Abortion Review Special Edition, ‘Abortion and Women’s Lives’.

The fact that EC has no proven impact on abortion rate is an important point both for family planning professionals, and for the anti-abortion lobby. A favourite argument put forward by the anti-abortion lobby is that increased availability of EC will encourage promiscuity – presumably as a result of women choosing to have sex and access EC, rather than abstaining from sex altogether. Commenting on the BPAS ad, Anthony Ozimic, political secretary of the anti-abortion campaign SPUC, said:

‘It is....a despicable ploy which threatens unborn children, promotes promiscuity, undermines public health and insults the child-centred meaning of Christmas. The offensive sexual innuendo linked to Santa Claus is evidence of BPAS’ morally bankrupt status.’

Rather than promoting what some may view as irresponsible behaviour, EC should be viewed as a responsible intervention when a woman has had unprotected sex. However, despite improved access, many women do not routinely use EC following unprotected sex, even if they have been prescribed the morning-after pill in advance. Indeed, as Guthrie notes, one of the reasons for the lack of impact on the abortion rate from EC is ‘insufficient use’. This means that the family planning movement does need to take care not to overstate the public health benefits of Emergency Contraception.

However, on an individual level, EC provides women with a vitally important back-up. In that respect, all measures that improve access, helping those women who want to use it to use it in time, are a positive and progressive development. For all those in the Daily Mail and anti-abortion lobby who objected to BPAS’ ‘offensive sexual innuendo linked to Santa Claus’, there will have been many more women who have benefited from the ability to prevent an unintended pregnancy, and welcomed the opportunity to laugh in recognition of a simple fact of modern life: that sometimes, contraception is an after-thought, and it is not just the thought that counts.

This article appears in Issue 27 (Winter 2008/9) of the print edition of Abortion Review. The print edition can be downloaded in full here.