The Interim

The U.S. Food and Drug Administration’s advisory committee for reproductive health drugs on June 28 unanimously approved the “safety and effectiveness” of emergency contraceptives, also known as morning- after pills (MAPs), but questions are being raised as to just how safe and effective they really are.

Until the approval, the drugs used as MAPs had not been specifically authorized for post –coital contraceptive purposes in the U.S. They have not been approved for that use in Canada. However, the lack of assent hasn’t prevented many medical practitioners in both countries from prescribing them to patients for “off-label” use for several years.

A Calgary Health Services information sheet last year, for example, said despite the lack of official sanction, there was clear evidence that “provision of oral contraceptives for emergency contraception is an accepted medical practice in Calgary.” Three student health service units and over 50 family physicians were said to be providing MAPs.

The procedure involves taking a double dose of oral contraceptives (estrogen and progestin) 72 hours after intercourse, followed by another double dose 12 hours later. It is said to work because there is a six-day delay between fertilization and implantation of an ovum. The drugs disrupt the woman’s ovarian hormonal process and change the uterine lining to make it unsuitable for implantation.

The procedure was developed in 1982 by Dr. A. Albert Yuzpe of the University of Western Ontario.

According to Dr. Eugene F. Diamond, chief executive officer of St. Margaret Mercy Healthcare Centres in Hammond, Indiana, the prevention of implantation has an abortifacient effect, even though the official definition of pregnancy has been changed in recent years so that it is said to begin with implantation.

“The American College of Obstetrics and Gynecology defines pregnancy as beginning with implantation, but this manipulation of language is not related to modern scientific understanding so much as the need to fulfill a political agenda,” says Diamond. “Drugs which interfere with (early) stages of human development are abortifacients, not contraceptives.”

He says that if MAPs are administered after ovulation, the effect is to loose an implanting embryo.

Mike Izzotti, a co-coordinator for Pharmacists for Life International in Canada, concurs. “It is well known that the use of MAPs has a high potential to act as an abortifacient. You can check this out by asking your pharmacist.”

The most common administration of MAPs is with Ovral brand oral contraceptives, produced by Wyeth-Ayerst Canada Inc. According to Mary D. Mackenzie, the company’s assistant director of medical affairs, Wyeth-Ayerst does not sanction, encourage, promote or recommend the use of Ovral as a MAP.