For emergency contraception, political gaps are not scientific gaps.

Abstract

Emergency contraception (EC) is the only opportunity for women to prevent an unwanted pregnancy after unprotected intercourse. Simple compassion for women who are in this situation combined with solid scientific data to support the safety of oral EC should be enough to promote strategies to expand access to these medications as well as the most effective method of EC, the copper IUD. A wide array of women's healthcare organisations promote increasing EC access to improve clinical care, a position clearly supported by the four foundations of biomedical ethics: autonomy, nonmaleficence, beneficence, and justice. Ironically, in the political sphere, conservative morals are the foundation for limiting access, despite the conflict with scientific evidence. In this issue, Drs. Cameron, Li, and Gemzell-Danielson present an opportunity for clinicians to review the data behind public and scientific oral EC controversies. These controversies can easily be divided into two groups. The first group contains issues that despite scientifically sound evidence remain controversial because of religious and political opposition. In essence, these issues are not scientifically controversial. Contention exists only because EC provides greater reproductive autonomy and thus clashes with conservative sexual values, which aim to shame women having sex for pleasure and not for procreation. Limiting effective methods of post coital contraception supports this position and limits women's sexual freedom. This scientifically uncontroversial group includes the oral EC mechanism of action, excellent safety, lack of population effect, and inability to serve as an abortifacient. The second group contains topics where scientific evidence is lacking or imperfect. This group includes the potential decrease in progestin containing contraception efficacy when initiated with ulipristal, methods to manage the potential negative effect of obesity on EC efficacy, and whether the oral EC mechanism of action is important to users. Ironically, despite sound evidence, it is this first group which forms the foundation for opposition to implementing EC best practices. As scientists and clinical researchers have done their work here, this realm is now the work of policy experts, advocates, and politicians. There are many examples of politics influencing good clinical care, which for oral EC means improving access and affordability. Inexpensive over the counter (OTC) availability of oral EC is the target for advocates and politicians on both sides. Whereas oral levonorgestrel and ulipristal EC products are available OTC in Europe, a long political battle has been waged on this issue in the USA, where OTC ulipristal is not even on the horizon. However, promoting regulatory approval is not enough. Politics can also support pharmacists who refuse women access to EC or prevent this behaviour. Sexual assault victims are a critical group in need of EC and several entities have passed legislation mandating offering EC when these women present for medical care. Finally, EC coverage can be mandated or restricted through private and government-sponsored medical coverage. In the USA, a Supreme Court decision enables private companies to forego EC insurance coverage for employees based on moral beliefs even though the court has acknowledged these are not scientifically valid. In areas of medical controversy, scientific evidence and biomedical ethics can lead both clinicians and policy makers in the right direction. In this case the road clearly leads to increasing EC access and affordability. Dr Turok reports grants and personal fees from Teva pharmaceuticals, outside the submitted work. Teva distributes the Paragard copper IUD, a method of emergency contraception. The ICMJE disclosure form is available as online supporting information. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.