They were splashy headlines this week: The emergency contraceptive pill “Plan B” does not work well in heavier women, and appears not to work at all in women over 176 pounds.
The FDA is considering whether the pills’ labels should be changed to warn heavier women not to count on their contraceptive powers, NPR reported; the French maker of a similar pill is already planning such a warning.
But the controversial morning-after pill has a bigger problem than that. Family planning advocates have fought hard to make Plan B easier to get in order to bring down the high American rates of unintended pregnancy. But so far, on that score, it’s looking like a dud.
Plan B hasn’t made a dent in the stunning statistic that a full one-half of U.S. pregnancies are unintended. This despite its FDA approval way back in 1999 and the growing access to emergency contraception over the last couple of decades — and despite major recent victories for family planning advocates: Plan B is now available over the counter to all ages.
“While there’s a lot of data to show it can prevent pregnancy in individual women, we’ve all been disappointed that on the population level, it just hasn’t had the effect we hoped,” said Dr. Deborah Nucatola, senior director of medical services at the Planned Parenthood Federation of America. “The unintended pregnancy rate hasn’t changed at all.”
Why might that be? There are two main theories, Dr. Nucatola said: Maybe the women who most need Plan B aren’t using it when they are actually at highest risk for pregnancy. Or maybe they’re just not using methods that are effective enough, and women should shift to more effective types of emergency contraceptives.
Enter what we might call Plan C. Around the country, Planned Parenthood affiliates are launching a new campaign called EC4U to educate women and clinical staffs about two more effective methods of morning-after help: Paragard, the copper IUD, and “ella,” a relatively new pill that uses the hormone ulipristal acetate, rather than the levonorgestrel in Plan B and a similar pill, Next Choice.
Accumulating data suggest that Plan B has two main weak points. One is weight; it was highlighted in this week’s reports, but contraceptive specialists had known for many months that the pill’s effectiveness drops in overweight women and approaches nil in women with a Body Mass Index above 35. Continue reading