Demand for the morning-after pill in the US is rising as abortion restrictions spread

Use of Plan B emergency contraception, also known as the “morning-after pill,” has surged in the U.S. over the past five years, while demand for other forms of birth control, such as birth control pills and condoms, has declined, according to an analysis of market research data.

Nearly 15 million units of Plan B drugs were sold last year, according to an analysis by the Financial Times, an increase of about 59 percent compared to 2018. During the same period, oral contraceptive new prescriptions fell nearly 15 percent, while the Condom sales fell about 18 percent, according to Symphony Health, a data provider.

Health experts said the data — which are estimates based on commercial insurance claims, retail sales and other data — highlights big changes in Americans’ access to reproductive health services as abortion services declined after the Supreme Court’s Roe vs. Wade decision last year Year was lifted, are becoming increasingly restricted.

At the same time, increasing over-the-counter access to Plan B emergency contraception in pharmacies has coincided with changing attitudes towards contraception and a decline in in-person visits.

Line chart of annual changes in U.S. contraception rates since 2018, showing emergency contraceptive use increasing

Plan B is a single-dose medication that uses a hormone called levonorgestrel to delay ovulation. It works best when taken within three days of unprotected sex and can reduce the chances of pregnancy by 75 to 89 percent. It’s less effective than traditional birth control pills, which are 99 percent effective when used perfectly, according to Planned Parenthood, a healthcare provider.

The US Food and Drug Administration advises that Plan B is not suitable for routine birth control, but has failed to advise that there are greater health risks associated with taking the drug than with using standard birth control pills.

Many health professionals argue that increasing reliance on emergency contraception versus standard methods, particularly among some young people, should be counteracted by more education, outreach, and removing barriers to entry for all forms of birth control. They say Plan B is less effective than other forms of birth control and point to rising rates of sexually transmitted diseases in the US.

But calls by some conservative groups to limit access to Plan B should be countered at a time when abortion services are growing, they argue.

“The answer is not to limit plan B, but to open the doors to other types of birth control and make it easier for people to access information,” said Dr. Kate White, gynecologist and associate professor at Boston University’s Chobanian & Avedisian School of Medicine.

White said changing societal attitudes mean young people are less willing to routinely accept doctor recommendations, especially if friends or family have had bad experiences with side effects from birth control pills or pain from intrauterine devices.

“There’s a lot of mistrust of highly effective contraceptive methods, especially those involving hormones,” White said. “People still want to have a plan B on hand, but there’s a growing distrust of these regularly ongoing methods.”

Access to standard birth control pills, or IUDs — tiny devices inserted into a woman’s uterus to prevent pregnancy — is only available in the US by prescription, usually after consulting a doctor. In contrast, Plan B can be purchased over-the-counter, typically at prices around $40-$50.

The growing reliance on Plan B also comes as fewer women attend annual pelvic exams. The number of employment-insured women who saw a gynecologist for an annual check-up last year fell to 3.7 million in the 11 months ended November, compared with 5.9 million for all of 2018, according to data from Symphony Health . Covid-19 and a change in guidelines for cervical cancer screening, which raised the recommended age to start Pap smear testing from 21 to 25, have had an impact.

Cynthia Harper, a professor of reproductive sciences at the University of California, San Francisco, called the decline in doctor visits a “disturbing trend” with numerous consequences, including the neglect of contraception.

She said increasing use of Plan B is a “promising answer” to preventing unwanted pregnancies. About 45 percent of US pregnancies, about 3 million a year, are unwanted, according to research by the Guttmacher Institute, which defines this as a pregnancy that is either unwanted or wanted in the future, but not at this time.

Following last year’s Supreme Court ruling that led to a stampede by Republican-led states restricting access to abortion, public awareness of Plan B, approved for over-the-counter access in 2013, has exploded. Some retailers have introduced temporary restrictions on purchases over the past year.

Some universities are also expanding access to Plan B on campus. “If you need Plan B, there’s a small window where you can take it so it’s effective. We’ve removed the two biggest barriers to entry for students — time and money,” said Charlotte Beatty, one of a group of students who successfully campaigned for the installation of a Plan B vending machine on the Boston University campus last year.

The machine sells Plan B for $7.25 via a credit or debit card payment, with all bank transaction purchases listed as “snacks” to ensure confidentiality. The American Society for Emergency Contraception, an advocacy group, said it has worked with 83 schools in 32 states and is aware of at least 33 vending machines on college campuses.

The expansion of emergency contraception has sparked resistance from some anti-abortion groups, including Students for Life Action, who have tried to falsely link the drug to terminating a pregnancy.

“Plan B is sold as a quick fix,” said Kristan Hawkins, President of Student for Life Action. “This lack of talk about the effects of taking powerful hormones that can terminate pregnancy does not prepare women for the harsh realities they may face later.”

The surge in sales will boost profits for two private equity groups, Kelso and Juggernaut, which bought the branded version of the drug from drugmaker Teva in 2017 for $675 million. Syzygy Healthcare Solutions and other manufacturers of generic versions of Plan B like Take Action and AfterPill will also benefit.

Bayer, one of the largest suppliers of conventional contraceptives in the US market, said a drop in birth control pill and long-acting IUD prescriptions has led to a decline in the overall market.

“The real problem and concern is that for more and more women, plan B is becoming plan A and it’s ultimately not a drug that was designed to be plan A,” said Sebastian Guth, Bayer’s president of Pharmaceuticals for the Americas. Demand for the morning-after pill in the US is rising as abortion restrictions spread

Adam Bradshaw

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