Plan B

Unintended pregnancy is a public health problem with major significance worldwide. Plan B, a progestin-only type of emergency contraception, is an effective yet underutilized method of pregnancy prevention. Plan B is 75 to 89 percent effective in preventing pregnancies when taken within 120 hours (five days) after sexual intercourse; however, the medication is more effective the earlier it is used. Although Plan B has been controversial and wrapped up in the abortion debate, it is not effective if a woman is already pregnant and therefore does not disrupt an established pregnancy. It has been estimated that wider access and acceptability of Plan B could reduce the number of unintended pregnancies and could prevent 1 million abortions annually. This form of contraception is important in that, unlike most forms of contraception, it is effective after sexual intercourse but before pregnancy.

Plan B is orally administered and consists of two white pills—one pill is taken within 120 hours of unprotected intercourse and the second pill is taken 12 hours later. In 2009, Plan B-One Step was developed, which consists of one pill that is taken within 72 hours of unprotected intercourse. Overall, Plan B is a safe form of contraception with very few side effects and contraindications. The mechanism of action of Plan B is the same as oral contraceptives. Plan B can work to inhibit:

• Ovulation: can suppress hormone needed for ovulation
• Fertilization: can inhibit movement of egg/sperm
• Transport: can inhibit path of the fertilized egg to uterus
• Implantation: can change the endometrium so the blastocyst cannot implant

Although emergency contraception has become more available in both developed and developing countries, three main barriers to access to Plan B seem to perpetuate a lack of awareness and utilization of this birth-control method. First, the public, including providers and women themselves, either do not know about it or have certain misunderstandings about Plan B. Second, some healthcare providers and professionals do not prescribe or dispense it. For example, there have been numerous accounts of doctors refusing to write prescriptions and pharmacists refusing to dispense it. Third, inadequate education is provided to women about it.

In an effort to remove barriers to accessing Plan B, there has been a push for over-the-counter (OTC) access; however, in some countries this proposal has been met with great trepidation. In the United States, over-the-counter approval is for women 18 years and older, with prescriptions required for those 17 years and younger. Plan B advocates globally continue to work toward the removal of barriers to access of this important form of contraception.