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Understanding Plan B

There has been a great deal of conversation as of late about the "morning after pill,"  AKA Plan B, and access to the pill for young women. One aspect of the public discourse that is quite obvious? Many folks are just plain confused about Plan B—generically named levonorgeterol—how it works and how it is to be used.

From “I heard the generic form isn't effective,” to “I take it weekly to better decrease my chances of getting pregnant,” to “If I don’t support abortion, why would I support this pill," this doctor has heard enough to feel that education about emergency contraception is sorely lacking. 

So how does Plan B work?  By definition, contraception refers to the use of methods to prevent pregnancy by interfering with the normal process of either ovulation (the release of a female egg from her ovary), fertilization (an egg meets sperm from a male), and/or implantation (a fertilized egg by sperm rests on the lining of the female uterus to support growth of a fetus).  Research supports that Plan B works primarily by preventing or delaying ovulation and interfering with fertilization, making it difficult for the egg to meet the sperm. 

Plan B will not work if the woman is already pregnant.  If a fertilized egg actually makes it and implants into the lining of the uterus, Plan B cannot stop the development of a fetus nor end a pregnancy. Therefore, it is not an abortion pill and does not function in the same capacity as an abortion procedure.

How is it taken? There are one-dose and two-dose regimens.  Plan B One-Step and Next Choice One Dose, another brand, work best when taken as soon after having unprotected sex and up to 72 hours later, whether the lack of protection was intentional or not—i.e a broken condom or nonconsensual sex.   If the pill is taken with 72 hours, it can reduce the chance of pregnancy by up to 89%, and if taken within 24 hours, that reduction increases to 95%.  The original Plan B, NextChoice, and the generic brand still come in a two-dose option. The first pill you also take as soon as possible after unprotected sex and within 72 hours.  The second pill is taken 12 hours after the first.  Both pills must be taken to work effectively.

Most medical experts agree that Plan B and other forms of approved emergency contraception are safe and effective methods of preventing pregnancy.  About 49% of pregnancies were not planned according to a 2011 CDC study. The highest proportion was among teens younger than 15 years of age.  Unmarried women, Black women, and women with less education and a lower income are also more likely to have unintended pregnancies, according to the National Health Statistics Reports.

Currently, the FDA allows those 15 and older to buy the morning after pill without a prescription and with a valid ID. Despite FDA approval, different states do have different policies in place that either expand or restrict access to emergency contraceptives. 

The rationale for the age requirement is based on evidence that those 15 and older understand how emergency contraception works, how to use it, and how to prevent spreading sexually transmitted infections.  However, it is not clear how many 15 year olds have access government issued IDs required to buy it. Recently, a Federal District Court Judge ruled to allow all women regardless of age have access to emergency contraception. The Obama Administration does not agree with this ruling and is appealing.  The debate continues on.

In the meantime, if you are thinking about emergency contraception, remember: it will NOT prevent or treat a sexually transmitted infection or HIV.  If one is having unprotected sex or the condom failed, it is strongly recommended that you go for testing and follow up with a health professional.

Lastly, this pill is not indicated to be taken on a weekly basis in order to prevent pregnancy and should not be used as a regular form of birth control; hence the ‘emergency’ part of emergency contraception and the language ‘Plan B’ in which it is to be used only as a back-up when ‘plan a’ didn’t work. 

Dr. Aletha Maybank is a Board Certified physician in both Pediatrics and Preventive Medicine/Public Health. You can follow her on Twitter at @DrAlethaMaybank.