The Morning After: A History of Emergency Contraception in the United States

Chapter 4. Balancing Safety and Choice

In a 1971 article in Family Planning Perspectives, Dr. Philip Corfman, director of the Center for Population Research at the National Institute of Child Health and Human Development (NICHHD), announced the center’s five-year plan to fund research to develop new contraceptive methods. The center had been established in August 1968 as part of President Lyndon B. Johnson’s administration’s efforts to alleviate poverty by providing federal support for contraceptive research and development. Funding for the center continued during the presidency of Richard Nixon, who charged the center to work with other agencies, nonprofit organizations, and the contraceptive industry to develop new birth control methods as rapidly as possible. Corfman observed that the currently available technologies were inadequate to meet the myriad of issues regarding population growth. Many people who used contraceptives —especially teenagers and young adults—failed to use them properly. Others found current methods unacceptable. In particular, recent experience with the contraceptive pill and intrauterine device showed alarmingly high discontinuation rates due to fears about serious health risks and complications. Corfman observed that greater oversight of women using these methods was needed to ensure safe and effective use while scientists continued to develop new contraceptives. Corfman argued that a drug that could be taken only after intercourse had advantages over other methods requiring constant or daily use. In fact, for women who had sex infrequently, a postcoital contraceptive would be ideal because continual medication and its possible side effects would be avoided and the need to remember to take the medication on a regular basis would be unnecessary.1 Balancing Safety and Choice 55 Chapter 4 56 The Morning After Corfman’s description of postcoital contraception as an ideal method for certain users was not new: the first reports on this birth control method framed it as a way to make up for contraceptive “non-compliance,” especially among girls and young adults. By the early 1970s, policy makers and population experts were interested in stemming what many considered to be an emerging “epidemic” of unwed teenaged pregnancy in the United States. Like epidemics of other diseases, professionals in public health and reproductive science saw technological innovation as the best way to prevent pregnancy in unmarried teenagers.2 The search for a new postcoital contraceptive was also prompted by the outcry from feminist health activists and consumer groups about the safety of DES. In reaction to those protests, the center became interested in finding new drugs that could be substituted for DES. In 1972, the Center for Population Research issued a request for proposals (RFP) for clinical studies of other estrogens as postcoital contraceptive agents.3 Contraceptive researchers were not the only ones who were interested in finding a new postcoital contraceptive. Some young women also were eager to use this birth control method. Women read articles about the morning-after pill in the popular press and saw reports about it on major network news broadcasts. While these stories emphasized the safety issues raised by the congressional hearings on DES, they also helped to raise awareness about this contraceptive technology.4 Workers at rape crisis centers observed that while the use of DES was controversial, some patients asked for it even after they had been warned of possible side effects.5 Physicians in emergency medicine at the University of New Mexico also found that almost all rape victims they saw “voiced a strong desire to rid themselves of the physical and emotional vestiges of sexual assault.”6 College health professionals reported that they still wrote hundreds of prescriptions for postcoital DES per year. A survey of forty-two health institutions, including the student health services of fourteen large universities and outpatient gynecology services of fourteen major hospitals , conducted by the Cancer Control Bureau of the New York State Health Department indicated that twelve prescribed DES to women directly and eleven others referred them to a physician who would prescribe it. The study estimated that 450 women were treated or referred in New York State alone during 1973, with the heaviest use at college and university health centers.7 Healthcare professionals at independent abortion clinics also continued to distribute DES to clients who requested it after having unprotected sex.8 It was this ongoing demand from young women desperate to avoid unwanted 57 Balancing Safety and Choice pregnancies that played a key role in efforts to find new drugs for postcoital contraception. Feminist health activists...