Roanoke Times
Copyright (c) 1995, Landmark Communications, Inc.
DATE: SUNDAY, July 23, 1995 TAG: 9507250001
SECTION: HORIZON PAGE: G-1 EDITION: METRO
SOURCE: SHEBA WHEELER/STAFF WRITER
DATELINE: LENGTH: Long
As she walked down a hallway to the examination rooms, the woman passed several posted signs about birth control methods and protection against sexually transmitted diseases.
On an earlier occasion, a particular poster had caught her attention. It was about emergency contraception, commonly known as "morning-after pills," and the message read: "Did your condom break? Ask your clinician about emergency contraception."
The young woman did not appear distraught to nurse practitioner Mary Nottingham when she candidly recounted her story and asked for a prescription for the so-called morning-after pills. She and her boyfriend had been making love when his condom broke - and she was afraid she may have become pregnant.
She had heard that morning-after pills could prevent a pregnancy after unprotected sex by stopping a fertilized egg from implanting in her womb. And she knew from the poster that the pills were available at the clinic.
What the woman knew may have quieted most of her anxieties and brought her into the clinic for counseling and a prescription, Nottingham said.
But for several reasons, she may be one of the few women in Roanoke who would seek morning-after pills to prevent a crisis pregnancy.
Even the most sincere efforts to prevent an unintended pregnancy by using traditional contraceptives can fail. Condoms break. Birth control pills are forgotten. People are raped.
Researchers say morning-after pills, could safely and effectively cut in half the number of unintended pregnancies and abortions.
But not all the clinicians who could prescribe the drugs know much about them, and in many cases the women who might use them don't even know they exist.
While those doctors who do know about them say that the contraceptive methods are effective in preventing pregnancies, anti-abortion supporters say the pills are not a contraceptive at all - but a form of abortion.
The treatment combines two high doses of normal birth control pills to stop the embryo from implanting in the uterine lining.
Timing is crucial when using this procedure. The patient has up to seven days to use certain methods to prevent pregnancy. However, if the woman has already become pregnant, then the methods will not work.
Morning-after pills are not the same as mifepristone, the drug commonly known as RU 486, or the "French Abortion Pill." When used after a woman has become pregnant, mifepristone causes an abortion, clinicians say. But clinicians claim that morning-after pills act before pregnancy.
Opponents of the treatment say that pregnancy occurs when a sperm and egg unite during a sexual encounter. When a woman takes the pills after the embryo was created, the pills actually kill the embryo by refusing to let it implant and develop in the mother's womb.
According to the book, "Emergency Contraception: The Nation's Best-Kept Secret," more than half of all unintended pregnancies occur because women did not use their contraceptive method consistently or correctly.
Each year more than 3 million pregnancies in the United States are unintended - and more than half of those pregnancies end in abortion. Among teen-agers, four of five pregnancies are unintended. And in Roanoke, one in 10 teen-age girls becomes pregnant every year - more than twice the state average.
Morning-after pills, as well as other forms of contraception, are available at Planned Parenthood and the Roanoke Medical Center for Women in Roanoke. They are also available at various clinics and women and family centers across the state. Usage of the pills is widespread on college campuses, and they are often given to sexual assault victims.
Jane Horton, director of student health services at Washington and Lee University, said she prescribes the pills 50 to 60 times within a nine-month school year.
In contrast, Megan McKewan, director of clinical services at Planned Parenthood of Roanoke, said she prescribes them much less often - about two times a month.
Horton said college campuses more readily provide information concerning sexuality and health issues. The student population is in a higher risk group for pregnancy and exposure to sexually transmitted diseases because students "are at an age where they begin to experiment with sex and attempt to develop relationships with other people," Horton said.
McKewan said it is clinicians' professional duty to offer the morning-after pills among family-planning options - despite religious or anti-abortion activists' objections.
But Nottingham said she is annoyed that doctors aren't making a conscientious effort to alert the public to the pills' availability. A recent Kaiser Family Foundation survey indicated that doctors familiar with emergency contraception find the methods safe and effective. However, only a few have prescribed the methods within the past year. And then, only to a handful of patients.
"Health care providers have not done a good job about getting the word out,'' said Nottingham. "People need to know that [emergency contraception] is available. When others teach about health care issues and family planning, they often emphasize using birth control, but this option also needs to be incorporated."
Researchers contend that the public isn't aware the method exists mainly because pharmaceutical companies have not sought Food and Drug Administration approval to distribute high doses of birth-control pills for use after intercourse.
If no company gains formal FDA approval for the products, manufacturers cannot market or advertise them. And without commercial promotion, doctors and potential patients remain in the dark about the contraceptives.
Over the years, clinicians have slowly begun to distribute more information about the methods and their availability. Emergency contraceptions include the morning-after pills, minipills and the copper-T intrauterine device. Each requires a prescription.
Nausea occurs in about half of those treated, and a smaller percentage may experience vomiting. Other women experience breast tenderness, abdominal pain and headaches. These side effects disappear in a few days after treatment is completed.
When clinicians prescribe the methods, Nottingham said, they also counsel women about more reliable family planning methods and the potential of sexually transmitted diseases.
Women are generally first-time patients - and one-time users - of emergency contraceptions.
"Many people think that this is just another means for allowing women to be promiscuous because they can have sex one night, then jump up and go to the clinic the next day to prevent a pregnancy, but we don't see it that way," Nottingham said. "Just one of these frightening experiences is all they need to make them want to use a more reliable method."
Not all family planning counselors agree that the methods are an appropriate option for women facing a crisis pregnancy. Unlike clinicians, anti-abortion supporters say emergency contraceptions are abortions because they kill the developing fetus.
"There are two different outlooks on when life begins here," said Andrea Sexton, chairperson of the Roanoke Valley Chapter of the Virginia Society for Human Life. "Doctors look at the embryo as a clump of cells and not a human being. Tumors are a clump of cells. But when that egg and sperm unite, you have the beginnings of a unique human being."
The methods can create additional dilemmas if the process does not work, said Ruth Fielder, director of the Crisis Pregnancy Center of Roanoke Valley. The center offers women resources and support to carry their pregnancies to term. Fielder said she has counseled women who used morning-after pills, but later discovered they were still pregnant.
"The woman becomes aggrieved because she must now make the decision to carry the child to term or go through with medical surgery to remove the pregnancy," Fielder said. "If she decides to carry the child, she is afraid that the child could be deformed [because of hormones in the uterus]. It just becomes a traumatic experience."
But Father Ken Stofft of Roanoke's Our Lady of Nazareth Church disagrees with those who believe emergency contraception usage is the same as an abortion. If the method inhibits implantation and pregnancy, then the Catholic Church does not see it as an abortion, he said.
However, individuals must have a "moral" reason for why they would choose to use any form of contraception, Stofft added.
"In the context of a marriage, if the couple decides to use contraception to sustain the emotional stability of the marriage, coordinate family planning, or adjust economics then this is moral," Stofft said. "But if they are using contraception for convenience, out of pride or selfishness then this is immoral. It just doesn't wash."
by CNB