A 85 Paulin S 892 L Krueger

MEMORANDUM IN SUPPORT

Reported referred to Assembly Ways and Means 01/19/2011
Referred to Senate Higher Education Committee 01/05/2011

AN ACT to amend the education law, the insurance law  and  the  public health  law, in relation to providing for dispensing emergency contraception under certain conditions.

The American Congress of Obstetricians and Gynecologists, District II (ACOG) strongly supports this bill, also known as the Unintended Pregnancy Prevention Act, as a method to increase access to emergency contraception (EC). 

This legislation would increase women’s access to EC in several ways:

• Authorize nurses and pharmacists to dispense EC pursuant to a non-patient specific prescription written by a licensed physician, certified nurse practitioner or a licensed midwife.
• Require insurance policies that cover prescription contraception to cover EC when it is provided by a non-patient specific prescription or over-the-counter (OTC).
• Direct the New York State Department of Health to include information on EC, including its safety, efficacy in its wellness education and outreach program. 

On August 24, 2006, the Food and Drug Administration (FDA) approved OTC sale of Plan B® emergency contraception for women 18 years and older. This decision also stipulates that a woman must provide government issued identification as proof of age. There is no scientific or medical reason to impose an age restriction on over-the-counter sale of EC. EC is safe for over-the-counter use by all women of reproductive age.

The restriction of EC’s availability as an OTC product creates undue barriers to accessing EC for women who are not able to obtain the required government issued identification, or for women under 18 who still require a prescription. Unfortunately, obtaining a prescription from a licensed prescriber is not always practical or possible, particularly during the evenings or over a weekend when traditional medical offices are closed. EC’s efficacy decreases as time passes and therefore, timely access to EC is essential for all women of reproductive age.

The FDA has missed an unparalleled opportunity to prevent unplanned pregnancies and reduce the number of abortions. This legislation will increase access to EC to women who have difficulty obtaining the required documentation and to women under 18 years of age. Passage of this legislation is critical to ensure that all women of New York have timely access to this important, safe and effective back-up method of birth control.

What is EC?

EC is simply a higher dose of the same hormones contained in common oral contraceptive pills. It is taken by mouth within 72 hours of unprotected sexual intercourse to prevent pregnancy.  EC prevents pregnancy because it disrupts the normal hormone patterns in the menstrual cycle.

How does EC work?

The pills work primarily by inhibiting or preventing ovulation and secondarily by impairing the migration and function of sperm. EC will not interrupt an established pregnancy.  Medical organizations and the U.S. government concur that implantation marks the beginning of pregnancy.[1] Moreover, if a woman takes EC without knowing she is already pregnant, it will not harm the woman or the established pregnancy. 

EC is safe.

There are no known serious side effects associated with the use of EC.  Even inappropriate use of EC does not cause serious harm.  An intentional overdose could result in nausea, vomiting or menstrual irregularity but not serious complications.  In contrast, several hundred persons die each year in the U.S. from overdoses of aspirin.[2]

Moreover, repeated use of EC would not cause any serious harm.  If a woman abandoned traditional contraception and used EC repeatedly, the only adverse effect would be irregular menstrual cycles. 

However, it is unlikely that women would choose to supplant regular and consistent use of birth control with EC because in addition to causing discomfort from irregular cycles, it would be cost prohibitive for most women and less effective in preventing pregnancy. The cost of EC is typically $30-$50 per use versus the same or lesser amount for a month’s supply of birth control pills. EC can be up to 89% effective at preventing pregnancy if taken within 72 hours of unprotected sex while consistent use of birth control pills are 99% effective.  Studies on four continents show that provision of EC does not sabotage traditional contraception.[3]

Emergency contraception has no documented medical contraindications, except pregnancy.  This is reflective of the lack of benefit rather than any risk to the women or an established pregnancy.[4] Contraindications for contraceptive pills listed on the package insert are for routine and continuous use.  An extrapolation of these contraindications to the emergency use of contraceptive pills is not scientifically justified.[5]  

EC is effective in preventing unplanned pregnancy and abortions.

When used within 72 hours of unprotected intercourse, EC can reduce the chance of becoming pregnant by as much as 89%.  Increased access to EC will further prevent unplanned pregnancies and reduce the number of abortions.  Use of EC could prevent as many as 1.7 million of the approximately 3 million unintended pregnancies that occur each year in the United States, including as many as 800,000 pregnancies that now result in abortion.[6] In fact, EC prevented 51,000 abortions in 2000, and the increased use of EC could be responsible for up to 43% of the 11% decline in abortion rates between 1994 and 2000.[7] 

Again, EC refers to birth control pills taken at a different dose for immediate risk of pregnancy.  Birth control pills have been used for long term, non-emergency contraception by millions of women throughout the world for decades and are among the most extensively studied drugs in the history of pharmaceuticals.[8] 

For these reasons, ACOG strongly supports A.85/S.892 and urges its passage.

January 19, 2011

The American Congress of Obstetricians and Gynecologists, District II (ACOG) represents the board certified obstetrician-gynecologists in the state who deliver health care to New York’s women.  Our Albany office offers the New York State Legislature its resources as a scientific and educational organization dedicated to quality health care for women.  If you have questions on this or any other state legislative proposal, please contact our office at 518-436-3461.