Today, you can walk into many drugstores, pharmacies, or major retailers and pluck the morning-after pill right off the shelf. You can even order it online. It does not require a prescription and there are no age restrictions. While there are still some areas, such as small towns or religious regions of the country, where it might be more difficult to purchase emergency contraception locally, the morning-after pill is more widely available than ever before.
However, this hasn’t always been the case — simple, readily available emergency contraception is a pretty recent development. The formulation of and access to this important medication has changed dramatically over the course of the last century, which is why it’s worth taking a closer look at the history of emergency contraception to see just how far we’ve come.
1920s: First Animal Experiments
The roots of modern emergency contraception actually stretch all the way back in the 1920s. At that time, Edgar Allen and Edward A. Doisy used animal experiments to learn more about hormones related to the menstrual cycle. More specifically, these researchers wanted to understand the role of ovarian hormones (later named estrogen) in pregnancy in mammals.
In some studies, Allen and Doisy found that the estrogen they extracted could interfere with animal pregnancies. This information would later be used in the development of emergency contraception for women.
1960s: Women First Receive Emergency Contraception
It took around 40 years for those first veterinary experiments to lead to emergency contraception use in human trials. In the mid-1960s, the first documented cases of postcoital estrogens in women were published in the US.
In these studies, women were given high-dose estrogens over several days. For example, a common dosage was known as the 5×5 regimen: 5 mg of ethinyl estradiol per day for five days. Although it did have a number of side effects, it appeared to be relatively effective.
Early 1970s: The Yuzpe Method
In 1972, Canadian doctor Albert Yuzpe conducted studies on a new type of emergency contraception which combined estrogen and progestin, as opposed to the high-dose estrogen method used up to that point. His research involved a single dose of estrogen (100 mcg) and progestin dl-norgestrel (1 mg), which came to be known as the “Yuzpe method.”
This new method had fewer side effects for women compared to a high dose of estrogen. In addition, the estrogen and progestin formula was similar to the combination birth control pill (like Camrese or Mononessa), leading doctors to recommend taking multiple birth control pills in order to prevent pregnancy after unprotected sex.
Around that same time, doctors began developing progestin-only emergency contraception. Research published in 1973 looked at the effects of five different dosage levels of progestin levonorgestrel (150 mcg, 250 mcg, 300 mcg, 350 mcg, and 400 mcg). This was a landmark study that would eventually lead to the progestin-only morning-after pills that are widely used today.
The progestin hormone helps reduce the risk of becoming pregnant by stopping or delaying ovulation. Progestin-only pills are considered superior to estrogen-only and combination pills because they are more effective and cause fewer side effects.
Late 1970s: The Copper IUD
In the late 1970s, another important advance in emergency contraception occurred. The copper-releasing intrauterine device (IUD) was developed as long-term birth control, but it was soon discovered to be an incredibly effective form of emergency contraception as well.
When this type of IUD is inserted within five days of unprotected sex, it greatly reduces the risk of becoming pregnant. As an added bonus, it can remain inserted for years to offer ongoing nonhormonal contraception.
Late 1990s: FDA Approval
The prescription Preven Emergency Contraception Kit was developed in the late 1990s. It was modeled after the Yuzpe method and included four combination pills, along with instructions and a urine pregnancy test. This kit was approved by the FDA in September 1998, but had been available in Europe for years before that.
The first progestin-only morning-after pill, known as Plan B, was approved by the FDA for emergency contraception in July 1999. It was made available by prescription only.
2000s: Fight for Nonprescription Availability
The prescription requirement for emergency contraception became a hot-button issue in the 2000s. Many reproductive rights activists fought for Plan B to become available over the counter in order to improve access. The need for a prescription was especially challenging for women since Plan B must be taken within 72 hours of unprotected sex. It is most effective when taken as soon as possible.
In August 2006, the FDA approved Plan B for over-the-counter sale, but only for those age 18 and older. It wasn’t until June 2013 that the FDA approved Plan B for over-the-counter sale with no age restrictions.
2010: A New Emergency Contraceptive Pill
In August 2010, a new emergency contraceptive pill called Ella was approved by the FDA. This pill uses the medication ulipristal acetate to prevent or delay ovulation. It can be taken up to five days after unprotected sex and is more effective than progestin-only pills when taken as directed. However, it is still available by prescription only.
Emergency Contraception in Pop Culture
The morning-after pill has been featured in some TV shows and movies, including:
- Black Mirror: In a season four episode, a mother learns her teenager is pregnant through an implanted chip tracker and gives her emergency contraception without the girl’s knowledge, causing her to have a miscarriage. Unfortunately, this episode gets it wrong, as emergency contraception is not an abortion pill.
- Shrill: This Hulu series shows the main character finding out that the progestin-only morning-after pill is less effective for women weighing over 175 pounds. (The episode doesn’t mention it, but Ella is effective for women up to 195 pounds).
- Master of None: In one episode of this Netflix series, two characters go to a pharmacy in the middle of the night to get Plan B after a condom breaks during sex.
- The Pill: This movie features a story about a woman who takes the morning-after pill after a one-night stand.
It’s been a long road, but today there are several forms of emergency contraception available with or without a prescription, the morning-after pill is referenced in pop culture, and safe and effective emergency contraception appears to be here to stay.
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