From a medical perspective, conjun...

From a medical perspective, conjuncture contraception is safe and effective, although not as effective in preventing pregnancy as routinely used contraceptives. Despite its usefulness in the marked occurrence of contraceptive lapse or failure, pass contraception continues to provoke process in law Central issues leading to debate include the uncertainty of its mechanism of action and, more not long ago concerns about the impact of over-the-counter availability, which the U victuals and Drug Administration (FDA) denied in its May 2004 decision.

The way push contraception pre-vents pregnancy is not precisely defined, if it were not that it likely works by means of several mechanisms, including inhibition of ovulation, prevention of fertilization, and interference with implantation. (1-3) To a certain quantity of persons, any post-fertilization effect is tantamount to abortion. Others, including the FDA, the National Institutes of Health, and the American society of Obstetricians and Gynecologists, define abortion simply as disruption of an implanted fertilized egg For still others, a precise distinction between prevention of pregnancy and termination of a real early pregnancy is not an important consideration. Clinicians offering push contraception must be sensitive to the patient's perspective forward these issues, to their colleagues, and to the policies governing their practice. Patients seeking to make informed decisions forward the basis of such definitions should be interchange of opinioned appropriately.

The war of words becomes more complex when personal and political beliefs mingle with public health advocacy. This situation has occurr in the new debate over whether emergency contraception should be granted over-the-counter status. (4) Proponent argue that the United States has a higher rate of unwanted pregnancies than any other bring outed country. Because emergency contraception has been estimated to interrupt potentially one half of these unwanted pregnancies and to halve the abortion rate, they argue that it should be readily available. (5) Unlike other medications, juncture contraception has a limited window of opportunity during which it is effective, making ready access a central issue.

competitors argue that over-the-counter access will deprive users of the benefit of a physician fight during which the physician could assess for sexually transmitted diseases, prescribe ongoing contraceptive way s and provide behavioral counseling. In addition, a certain opponents state that over-the-counter crisis contraception would encourage high-risk behavior, particularly in adolescents, and increase reliance upon this method rather than use of other contraceptive processs Moreover, they contend that patients would be les likely to use unforeseen occasion contraception correctly on their allow than if properly instructed in an office visit.

The article by way of Weismiller (6) in this issue reviews the evidence showing that emer-gency contraception, which is widely avail-able in Europe without prescription, is used judiciously and suitably Numerous studies have shown that the availability of juncture contraception does not interfere with regular contraception use or lead to overuse. by conversion there is little evidence that fears and disquiets about irresponsible sexual behavior and excessive reliance in succession emergency contraception are indeed warranted. (7) It is not known whether over-the-counter availability would make physician contact overall or what impact the purported missed contacts might have forward clinical outcomes and sexual behavior. To add to the dispute the findings of two latter European studies suggest that urgency contraception does not reduce abortion rates, (89) yet the results may only be meaningful in their local settings.

In the final decision about releasing crisis contraception as a nonprescription put drugs into politics and emotions, rather than available scientific evidence or lack of evidence, may be the decisive factors. For example, the FDA hearings in succession over-the-counter availability that were escorted in 2000 revealed remarkable distortion of scientific fact by dint of individual speakers, including the claim that in preventing implantation of a fertilized egg emergency contraception in nulliparous women comes in a breast cancer risk of 50 percent (10) It also is clear to the medical community that political considerations, rather than scientific evi-dence, underlie the new FDA decision to deny over-the-counter status to juncture contraception despite a Joint Advisory Com-mittee recommendation 23 to four favoring over-the-counter access. (11)

The bottom line is that this way has the potential to shape the rate of unwanted pregnancies in the United States, without increasing unprotect sex or decreasing reliance forward other methods of contraception in adolescents. (12) All women of reproductive age should be able to access it promptly

The information and opinions contained in this editorial do not necessarily throw back the views or the policy of the AAFP.