Better Safe Than Sorry

My friend recently wrote one about sex education in his widely-read blog, based on personal experiences and state of present day schooling in his home state. We were all gently poking fun at his ignorance and immaturity about those things during his growing years, when all of a sudden, I was drawn into delivering an impromptu lecture on related matters, not at the level kids at seventh grade get it, but at a more contemporary level, a more practical discussion of the arcane topic. I was the only erudite doctor amongst these talented scientists and engineers and felt a natural responsibility to take the lead in what could be called my expertise. Soon, I was drawing charts of the female hormonal cycles and talking about 'safe' days and the 'rhythm method', options of abortions and emergency contraception pills (ECP). Talking to them, I felt that someone our age cannot afford to be insouciant about the biology and its practical ramifications for any eventuality that may arise.

Earlier today, I was looking to update myself with the state of ECP in the US, since everything associated with abortion and life-issues is huddled with so much controversy. ECP are nothing but high doses of the regular contraceptive pills (combination of the hormones estrogen and progesterone) that should be taken after unprotected sex or a failed form of contraception like the tearing of a condom or in case of a sexual assault, to prevent pregnancy. In recent years, the popularity of the progesterone-only pill (known as plan B in the US) has grown mainly owing to its fewer side effects. These have to be taken within 72 hours of intercourse and they work by preventing or delaying the implantation of the egg in the uterus, whether or not it is fertilized by the sperm. To some, it might seem like a form of abortion since the ovum may already have been fertilized, but in reality, there is no growing fetus until it is implanted successfully. In fact, the majority of natural abortions (or miscarriages as they are known) are due to chromosomal abnormalities or improper implantation of the embryo. These will occur irrespective of any intervention. ECP, however, should not be confused with Mifepristone, a drug that is given in high dose to abort a first-trimester fetus, well after implantation. Whereas pro-life groups consider hormonal contraceptives immoral and abortion-like (that it prevents pregnancy), the pro-choice factions fear that soon, breast-feeding could be considered an abortion method (that it renders the woman temporarily sterile) and immoral!

Of the 300,000 sexual assaults occurring in the US annually, 25,000 result in pregnancy and 90% of these are preventable had there been better awareness about and easier access to ECP. Also, nearly one half of America's 6.4 million annual pregnancies are accidental! It was only on August 26 this year that the FDA approved the universal sale of the 'morning-after pill' over-the-counter at pharmacies to girls aged 18 and above, whereas those underage still need a doctor's prescription. Some controversial questions, however, remain. Like does encouraging the use of emergency contraception lead to increase in unprotected sex and hence, to increased incidence of STI (sexually transmitted infections) in the community as a whole?