The Use of Emergency Contraception - Research Paper Example

? Position Paper on Emergency Contraception Position Paper on Emergency Contraception The use of emergency contraception is controversial because of debates on its health, religious and ethical aspects. However, emergency contraception methods are approved by the US Food and Drug Administration and they have been authorized as legal and safe by the FDA. Emergency contraception is a method that prevents pregnancy in a woman after unprotected sexual intercourse. In United States, various emergency contraception methods are available which include contraceptive pills, minipills and copper-T intrauterine device. Emergency contraceptive pills should be taken immediately after unprotected sexual intercourse or within a time period of 72 hours. These pills contain both estrogen and progestin. The minipills are birth control pills that only constitute of progestin (Trussell et al 1997). “When started within 72 hours after unprotected intercourse, a combination of ethinyl estradiol and levonorgestrel is at least 75% effective against pregnancy.” (Glasier 1997 p.1058). Emergency contraception methods should be made available to women of all ages as it is an effective method of preventing unintended pregnancy. Especially availability of emergency contraception to young women of child-bearing ages is important in controlling pregnancy after unprotected sex. The consequences of unintended pregnancy are quite serious and are a cause of over-bearing burdens on the women and their surrounding families. This necessitates the importance and significance of emergency contraception in prevention of unwanted pregnancy. However, it is also crucial that enough information regarding its adverse effects, mode of action, uses and primary purposes should be provided to the general public. Between 1996 and 2002 the percentage of women who had awareness about emergency contraception and the percentage of women who had ever used emergency contraception increased. This reflected that the attitude towards emergency contraception had become more positive over the years. The side effects and the adverse effects on fertility caused by the emergency contraception were observed as major factors affecting the reduced usage of this method in birth control. However, in the year 2002, cost became a major barrier (Aiken, Gold & Parker 2005). It has been observed that awareness about the emergency contraception is very inadequate amongst the women and such short-comings should be overcome by the health providing centers and professionals. Not only should emergency contraception remain available to women of all childbearing ages, information should be made available to the public to educate all women about the use, purpose, potential side effects and the availability of emergency contraception. View 1: Pro Emergency Contraception Young women should be educated on all of their options when it comes to contraception. They should be aware of emergency contraception methods and complete knowledge about these methods should be made available to them. In certain situations such as rape or birth control failure, knowledge about emergency contraception becomes particularly important in preventing unwanted or unplanned pregnancies. It has been observed through national surveys and health care surveys that public knowledge about emergency contraception is quite limited. A random survey of 1000 American women and 1002 men who were 18 years and above was conducted in 1994. It was estimated that Americans were not well informed about the emergency contraception methods. Only 1% had actually used the emergency contraceptive pills and 55% had heard of the pills. It was concluded that the aspects of availability and uses of emergency contraceptive pills should be made clear to the public and enhanced knowledge should be provided. Health care providers could play an important role as the general public relies on them for health information and awareness (Delbanco, Mauldon & Smith 1997). Unintended pregnancies can occur due to several causes and in these situations knowledge and availability of emergency contraception to the women is important. Birth control methods failure can lead to unintended pregnancies. These include the condom breaking or the inability to stop coitus and withdrawal at the right time if the method of birth control that is being used is coitus interruptus or if the female does not take the oral contraceptive pills regularly (Weisberg and Fraser 2009).Condom rupture has been found to be frequently occurring in 13.3% of cases in African countries and 3.9% cases in USA (Faundes, Brache & Alvarez 2003). In certain circumstances like rape, unprotected sexual intercourse may become the cause of unplanned pregnancy in women. In these situations, the knowledge about emergency contraception becomes crucial as it provides a safe and effective method of preventing pregnancy. Unplanned or unintended pregnancy may become a cause of emotional, financial and social discomfort and instabilities and hence it is the right of every woman to have complete information about emergency contraception (Weisberg and Fraser 2009). Education on emergency contraception is important so that women are aware that this is not a form of regular birth control and it should only be used in emergency situations. It is the right of the women to know that emergency contraception is not a regular method of birth control and is only intended in emergency situations such as forced intercourse, unexpected intercourse without contraceptive protection or contraceptive failure. The high dose levonorgestrel emergency contraceptive pill should be taken as soon as possible after intercourse or in the form of two tablets-one initially and the other in the next 12 hours. The alternative Yuzpe method can be used within 72 hours after unprotected intercourse. The copper intrauterine contraceptive device can be used up to 5 days after unprotected intercourse. Anti-progesterones like mifepristone are also effective emergency contraceptive pills but they can cause termination of pregnancy in high doses and hence are controversial (Weisberg and Fraser 2009). In UK, emergency contraceptive pills were made available without prescriptions for women over the age of 16 and it was estimated through a national study that easy accessibility of the pills has improved the services of women and they could easily use them (Killick & Irving 2004). Education also needs to be provided on side effects, cost of emergency pills, and that emergency pills cannot terminate an existing pregnancy or prevent against sexually transmitted diseases (STDs). Birth control methods such as birth control pills and condoms should be taken to prevent pregnancy and STDs. It was observed that in spite of increased awareness of emergency contraception, there was a lack of education regarding emergency contraception. According to a study carried out in Princeton University, it was observed that students remarked on the low levels of discussions about emergency contraception and provision of education about its uses and purposes. In Great Britain also, education of emergency contraception methods were lacking. 40% of the women were unaware of emergency contraception and 30% of women seeking abortion at Oxford hospitals had no knowledge about emergency contraceptive methods (Gold et al 1997). The World Health Organization Medical Eligibility Criteria for Contraceptive Use has advised that no medical contra-indications are associated with the usage of emergency contraceptive pills. However, copper IUDs should be used with medical care as they are contra-indicated in existing pelvic infections, chlamydial or gonoccocal infections and distorted uterine cavity. Women have the right to information about the mode of action, the functional efficiency and the appropriate usage of emergency contraception so that they can make an informed choice according to their religious, personal and moral beliefs. Women should be educated about the associated adverse effects and the outcomes if the emergency contraceptive pills are used repeatedly after unprotected sexual intercourse (Faundes, Brache & Alvarez 2003). Rather than a woman having to become pregnant with a child she is not ready for, either emotionally or financially, the women can prevent the pregnancy from ever happening by using emergency contraception in certain situations. Emergency contraception is a cost-effective method of preventing pregnancy and this has been estimated through research studies. Emergency contraceptive pills were found as the most cost-effective method as compared to minipills and copper IUD. Moreover, emergency contraception could also reduce the medical and social costs that can be caused by an unintended pregnancy (Trussell et al 1997). Women can be faced by an unplanned pregnancy which can serve as a burden on their family financially or emotionally if they are not ready for another baby. In certain circumstances such as rape, unintended pregnancy can be a source of social and emotional distress. Emergency contraception serves as an effectual way of reducing social, emotional and financial burdens associated with an unplanned pregnancy. Position 2: Against Emergency Contraception Emergency contraception as a method of possibly terminating a pregnancy should not be available to women especially under age of 17, for religious and/or ethical reasons. In some religions it is viewed that emergency contraception is a form of abortion and the only approved way of preventing pregnancy is abstinence. Many anti-abortion organizations and communities strongly oppose the emergency contraception as they consider it as an anti-child step taken by a couple. Although research clearly states that emergency contraception does not cause abortion, the Catholic believers think otherwise and as stated by the United States Conference of Catholic Bishops, it prevents the development of an embryo thus resulting in the termination of life or and the death of a potential being. According to the American College of Obstetricians and Gynecologists, pregnancy initiates not at fertilization but at implantation in the uterine wall. The mechanism of action of the emergency pills most commonly is stopping ovulation or preventing sperm to fertilize the egg. But in some cases it may prevent the fertilized egg form implanting in the uterine wall. Those religious believers who consider that life or pregnancy begins at fertilization will consider emergency pills as abortifacient (Shorto 2006). Many health care professionals may also conscientiously refuse to provide emergency contraception to their patients as they consider contraceptive pills equivalent to abortion or they consider this practice itself as immoral or unethical (Card 2007). The availability of emergency contraception may encourage unprotected sex with the knowledge that emergency contraception is available. However emergency contraception is not a replacement for regular birth control and it should not be abused. Many people strongly oppose the availability of emergency contraceptive pills as over-the-counter pills as this can stimulate the women especially young girls towards sexual promiscuity and abuse of sexual freedom. However, “to place barriers to its use is a transgression of the ethical principles of respect to the autonomy of each person”(Faundes, Brache & Alvarez 2003 p. 303). However, no quantitative evidence has been reported that supports such fears and no rise in estimates of sexual promiscuity or unprotected sex has been seen (Shorto 2006). Personal View While I am able to understand both sides of this argument, my religious background and upbringing make it difficult for me to understand the termination of life. Emergency contraception serves as a method to prevent pregnancy, thus acting as a barrier in the production of new life. If pregnancy has to be avoided, my religious beliefs and understanding suggests that unprotected sexual intercourse should be avoided as much as possible. However, I understand that every woman does not belong to the same religious background and each individual has his/her own set of beliefs and religious limitations. Furthermore, it is the right of every woman to have complete knowledge of the emergency contraception methods available for her and she should have thorough information and awareness regarding them. The right to avail emergency contraception in cases of emergency usage should be given to every woman so that she can reach to a wise, healthy and insightful decision for herself. Although several objections are raised when it comes to the usage and access of emergency contraception, it should remain available and efforts should be made by the government to have more education available to young women on the use and risks associated with taking emergency contraception pills. The national surveys and researches have brought forward that the public lacks information and awareness about the emergency contraception. They have vague concepts about its use, availability, access, side effects, purposes and effects on fertility. Efforts should also be made to make emergency contraception more available in a cost effective manner. Emergency contraception provides a very effectual and safe method of preventing unintended or unplanned pregnancy which would otherwise have serious consequences. Unintended pregnancies result in financial instabilities, emotional disturbances in the family and the women herself as well as social barriers. Emergency usage could prevent all the serious consequences associated with an unplanned pregnancy. Hence, efforts in terms of easy and cost-effective access to the emergency contraception methods should be made. References Aiken, A. M., Gold, M. A., & Parker, A. M. (January 01, 2005). Changes in young women's awareness, attitudes, and perceived barriers to using emergency contraception. Journal of Pediatric and Adolescent Gynecology, 18, 1, 25-32. Card, R. F. (January 01, 2007). Conscientious objection and emergency contraception. The American Journal of Bioethics : Ajob, 7, 6, 8-14. Delbanco, S. F., Mauldon, J., & Smith, M. D. (January 01, 1997). Little knowledge and limited practice: emergency contraceptive pills, the public, and the obstetrician-gynecologist. Obstetrics and Gynecology, 89, 6, 1006-11. Fau?ndes, A., Brache, V., & Alvarez, F. (January 01, 2003). Emergency contraception--clinical and ethical aspects. International Journal of Gynaecology and Obstetrics: the Official Organ of the International Federation of Gynaecology and Obstetrics, 82, 3, 297-305. Glasier, A. (January 01, 1997). Emergency postcoital contraception. The New England Journal of Medicine, 337,15, 1058-64. Gold, M. A., Schein, A., & Coupey, S. M. (January 01, 1997). Emergency contraception: a national survey of adolescent health experts. Family Planning Perspectives,29, 1.15-19. Killick, S. R., & Irving, G. (January 01, 2004). A national study examining the effect of making emergency hormonal contraception available without prescription. Human Reproduction, 19, 3, 553-557. Shorto, R. (May 27, 2006). Contra-contraception. The New York Times. Retrieved from http://www.thenationalcampaign.org/media/PDF/2006/NYT_05_07_06.pdf Trussell, J., Koenig, J., Ellertson, C., & Stewart, F. (January 01, 1997). Preventing unintended pregnancy: the cost-effectiveness of three methods of emergency contraception. American Journal of Public Health, 87,6, 932-7. Weisberg, E., Fraser, I. S., & World Report on Women's Health 2009 Reproductive and Sexual Health Rights: 15 years after the International Conference on Population and Development. (August 01, 2009). Rights to emergency contraception. International Journal of Gynecology and Obstetrics, 106, 2, 160-163. Read More