The Morning After: A History of Emergency Contraception in the United States by Heather Munro Prescott (review)

The twenty-first-century global health agenda considers family planning as a “human right,” yet for all the technological and scientific expertise in the United States, this recognition for American women has been complicated and slow in coming. In The Morning After: A History of Emergency Contraception, Heather Munro Prescott demonstrates how this right of women in the United States has been recognized (or not) as a component of reproductive health by tracing the history of emergency contraception. Munro Prescott’s analysis of how emergency contraception fits into the American healthcare matrix is insightful and incisive, providing a new perspective on the social, philosophical, and medical history of contraceptives in American society. The story that she brings to readers—beginning with the social activism of the 1960s and brought nearly to the present—has all the elements of a spy novel: secrets, conspiracy, shifting political and economic alliances, undercover scientific research, and “behind the counter” drugs. As she reveals the history of emergency contraception through these decades of social and scientific change, Munro Prescott demonstrates how access to and the perception of medical information and products depend on the social and political climate in which they are presented.

In 1966, when the morning after pill was heralded as the start of the second revolution in birth control, the implications of the first revolution had not been fully revealed. According to Munro Prescott, contraception was generally understood as a medical cure for the disease of unwanted pregnancy. New contraceptive methods emerged along with a broader interest in consumer protection and public health, while the idea that unwanted pregnancy was a disease to be cured by science continued to be reinforced by prescription-only dispensing of the pill and postcoital contraception. Munro Prescott describes, however, how the public discussion surrounding contraception eventually changed from a medical conversation to a conversation about women’s empowerment. By the 1980s, postcoital contraception was not just understood as a tool of crisis management, it was seen as an entrée into better healthcare for women. As the discussion of emergency contraception broadened to include advocating for women’s health and empowerment, the availability of accurate information about the drugs themselves continued to be a difficult issue.

One focus in this primarily American story is the question of who has access to information about emergency contraception. In the medical disease model, the physician holds the power to decide how much information is given to patients. At the same time, the FDA controlled information available on drug packaging, which effectively controlled the access of manufacturers to producing postcoital contraception as well as the off-label use of birth control pills as emergency contraception. Eventually, the FDA responded to criticism from consumer activists who asked for women’s complaints to be recognized.

Munro Prescott looks at developments in regulation and the pressure from consumer groups and medical advocates from the vantage point of twenty-first-century access to health information. However, she does not allow this more recent perspective to obscure the difficulty of obtaining accurate information about the safety and efficacy of emergency contraception in an earlier period. In particular, the author’s research into the impact of student health on developments in emergency contraception is critical to understanding how the pressure for change and implementation emerged first in university health centers. Experimental studies, many in college health centers, supplied new models for emergency contraception, but this research relied on “courageous” volunteers. The small number of subjects and the selectivity of the group was a problem that had no easy solution—it was difficult to get volunteers to test the efficacy of emergency contraceptives. Without social changes that allowed information about emergency contraception to be publicly available, researchers had to look to colleges and health centers, and much of the impetus for change came...