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The Morning After NO LATER THAN 72 HOURS AFTER UNPRO-tected intercourse, take either: first dose. Repeat 12 hours later. Or: in the first dose. Repeat 12 hours later. Read before beginning treatment: Do not take this treatment if you have a history of blood clots; inflammation of veins; liver disease; unexplained vaginal bleeding; cancer of the uterus, cervix, vagina or breasts. Do not take this treatment if you have a positive pregnancy test; if you have had other unprotected intercourse following your last period; or if your last period seemed different from those you usually experience Do not take this treatment unless you are willing to have an abortion if it doesn’t work. Though this treatment is considered very safe, discontinue it and see a doctor immediately if you experience chest or arm pain; shortness of breath; unusual pain or swelling in the legs; severe headaches; vision disturbances; abdominal pain; yellowing of the skin or eyes; severe depression. Nausea and vomiting are normal, but can be lessened or avoided by taking the pills on a full stomach. It is a good idea to have an extra dose of the pills to take in case you lose one from vomiting. Bleeding should begin within 21 to 30 days. If it doesn’t, see a doctor The morning after treatment is not to be used often. If you need a birth control method, see your reproductive health care provider. \(You might want to start with an IUD inserted within five days of unprotected interD.N. This publication is available in microform from UMI. UMI 800-521-0600 toll-free 313-761-4700 collect from Alaska and Michigan 800-343-5299 toll-free from Canada Fairmont Clinic doesn’t. El Paso’s Planned Parenthood just started a program in September and nationwide, morning-after treatment is offered in about two-thirds of Planned Parenthood’s 169 affiliates. That leaves several where it’s not, including the Planned Parenthood clinic in Manhattan. Not even in Manhattan? What’s the problem? The most obvious one is that, though Ovral has the Food and Drug Administration’s OK for use as a daily contraceptive, it is not approved as a morning-after pill. Doctors may legally prescribe FDA-approved drugs for any purpose whatsoever. But many worry about being sued if anything goes wrong. There is a “real litigious sort of climate,” says Patti Pagels, former director of Reproductive Services in El Paso and currently a family planning consultant in the Dallas metroplex. “Clients who choose [the morning-after treatment] tend to be educated. They ask a lot of questions, and that makes doctors nervous. You have do counseling before you give the pills. You have to say to the woman, ‘If this doesn’t work would you be willing to have an abortion?’ You have to spend time with her, then follow her up. For many doctors, that’s too much trouble. And what if the treatment doesn’t work and the women goes on with the pregnancy? If she ended up with a deformed baby you might have a suit.” Pagels’ mention of deformed babies reflects concern created by the hormone diethylstilbesanomalies in daughters whose pregnant mothers took it in the 1950s to prevent miscarriages. That finding has led to suspicion about similar estrogen hormones like those in Ovral. So far, though, the closest study done on babies inadvertently exposed in utero to birth-control pills has shown no increased incidence of birth defects. No one has checked into the risk posed by a day or so of morning-after treatment. But Dr. Michael Policar, Planned Parenthood Federation of America’s Vice President for Medical Affairs, thinks that none would be found if the research were done. Who will do it? Apparently not Wyeth-Ayerst Laboratories, which makes Ovral. The company has long declined to do safety and effectiveness studies needed to get FDA approval to use the product as a morning-after treatment. Audrey Ashby, Wyeth-Ayerst’s public relations manager, acknowledged that the company is aware Ovral is widely used as a morning-after treatment. But she would not comment on the situation. “Ovral has been around for a long time and it’s only indicated as an oral contraceptive. It’s very difficult to go through the testing that’s required” to approve it as a morning-after treatment, Ashby said. Pagels thinks Wyeth-Ayerst feels that spending millions of dollars on FDA research would not be cost effective: “Women who use Ovral for birth control buy a package of 21 pills, month in and month out,” she says. “But the morning-after treatment is a one-shot purchase, and you only use four pills.” Still, hospital emergency rooms nationwide routinely give those four pills to rape victims to prevent pregnancy. Pagels says the assumption is that these women are in such dire straits and so grateful for the pills that they would never think of suing later. But as popular as this emergencyroom practice is, it is kept rather hush-hush; probably because of the argument about whether postcoital treatment constitutes abortion. Policar says it doesn’t. “It’s not like RU486, which aborts a pregnancy by causing the embryo to detach from the uterine wall after implantation,” he says. “With a morning-after dose of Ovral, the egg never has a chance to implant, so pregnancy doesn’t occur.” This distinction is irrelevant to many anti-abortionists who believe life begins at conception rather than implantation. That is another reason why pharmaceutical companies and doctors don’t want to touch postcoital treatments. “From the point of view of the political flak they could get, it’s just not worth it,” Policar says. So how does a woman in need get the pills? Pagels and Policar say that if you can’t find a willing medical provider, it is safe to dose yourself. In a pinch, one way to do this is to seek out a friend with a birth control prescription for Ovral and ask her to “lend” you a few. In the longer run, Texas women should think communally and think Mexico. Next time you or your friends go across the border, everyone should stock up on Ovral. You can get them without prescription there at any large pharmacy; a package with enough pills for four morning-after treatments costs only about $2 \(compared to $28 in this country but that’s another medicines for “personal use,” meaning you can bring back scores of birth-control pills with no questions asked. Back home, keep Ovral in your medicine cabinet. Note the expiration date and replace old ones with a fresh supply. Keep them for your friends and neighbors, just as you would a cup of flour or a set of jumper cables. Of course, this is only one tiny, regional, self-help answer to a huge crisis the backlash against contraception R&D, against women’s ability to control their reproductive lives, against the essence of gender equality. But at least it’s something; and it’s something all women should know about. Not to mention their doctors. If yours doesn’t offer the morning-after treatment, “Ask him why not? Ask him why he’d rather subject you to an invasive procedure like an abortion?” Pagels urges. While you’re waiting for answers, read and clip the attached box. Pull out your SpanishEnglish dictionary. Get some Ovral. Then do politics, in whatever language, around the bigger problem. Note: The Observer does not endorse the use of Ovral or any other prescription drug without proper precautions and understanding of the potential risk entailed in the use of the substance. After this article was submitted, an article appeared in the New England Journal of Medicine describing a study that determined that the French RU-486 pill also functioned as a “morning-after” pill, prohibiting the implantation in the womb of a fertilized egg. THE TEXAS OBSERVER 19