Planned Parenthood of Hawaii's Ursula Penrose, holding "morning after" pills, said they can be up to 92 percent effective.

Women remain in the dark
about the morning-after pill

Some advocates push to make
emergency contraception
available over the counter here

By Helen Altonn

A 45-year-old woman who thought she no longer had to worry about pregnancy suddenly had a contraceptive method failure.

"She was stuck. She had four children and absolutely didn't want any more," said Ursula Penrose, Planned Parenthood of Hawaii patient services director.

The woman's eldest daughter provided a solution, telling her about emergency contraception, said Penrose, citing the case to emphasize the need for increased access to "morning after" pills.

These are birth control pills in stronger doses. They do not protect against sexually transmitted diseases, but temporarily stop eggs from being released when used within 72 hours after unprotected sex, Penrose said.

They can be up to 92 percent effective, she said, adding that they do not interfere with an established pregnancy or harm the baby.

The dilemma is that it is "the best-kept secret," state family planner Kit Uyeda wrote in a paper on emergency contraception. Many people are unaware of it or have no access to it, she said.

A Healthy Mothers Healthy Babies Coalition of Hawaii survey of 81 family planning providers, emergency rooms, pregnancy, counseling and sex abuse treatment facilities shows "significant barriers" to obtaining emergency contraceptive pills.

The coalition and other Hawaii organizations want to remedy the situation with a system similar to those in Washington and California where women can obtain the pills from pharmacies without prescriptions.

Washington's program began in 1998 under collaborative agreements between pharmacists, physicians and nurse practitioners.

It has contributed to a 30 percent drop in the state's abortions, said pharmacist Don Downing, clinical associate professor in the University of Washington School of Pharmacy, who was on the project's advisory board.

Organizers thought 350 to 500 women might participate in the effort when it began, and the count was almost 12,000 at the end of 16 months, he said in a telephone interview. "We were absolutely shocked."

Downing, former Washington pharmaceutical care services director, will discuss his state's experience during meetings here next week. He will speak at an informational session from 10:30 a.m. to 12:30 p.m. Aug. 9 at the Kapiolani Medical Center Auditorium.

He said he has trained thousands of pharmacists in Washington, California, Alaska and British Columbia as they adopted collaborative programs. Patient education is stressed, and the pharmacists make many referrals to community clinics and doctors' offices, he said.

The Washington Medical Association initially opposed the program, but passed a resolution supporting it three months after it began, Downing said.

Women rave about it for "allowing them to take control of their lives," he said.

"If it had been available when I was a teenager, I would have had a different kind of life," a woman in her 70s told him, explaining she was forced into a marriage after becoming pregnant.

Many countries are putting emergency contraceptive (EC) pills on shelves like aspirin, said Karen Mak, supervisor of the state Health Department's Family Planning Services Section, which mounted an information campaign about family planning methods in 1998.

According to state figures, 52 percent of Hawaii's pregnancies are unintended for all ages, and 75 percent for women under 20 years old. About half of unintended pregnancies are aborted, Mak said.

Since the information campaign, however, abortions statewide dropped to 3,941 in 2000 from 4,404 in 1999.

The state's 50 clinics provided federally subsidized emergency contraception services to 1,203 uninsured clients in 2001, Mak said.

Planned Parenthood of Hawaii clinics had nearly 2,000 visits for emergency contraception in the fiscal year ending June 30, said Barry Raff, executive director.

Yet the Healthy Mothers Healthy Babies survey "shows we're terrible in the state in access to EC," he said, particularly on Saturdays and holiday weekends, and "especially outrageous was access in emergency rooms."

State Rep. Marilyn Lee (D, Waipio-Crestview-Mililani) introduced a bill in the last session to establish a collaborative emergency contraception program similar to Washington's. It passed the House, but no hearings were held in the Senate.

The Hawaii Medical Association supported the measure based on the American Medical Association's position favoring collaborative agreements for over-the-counter emergency contraceptive pills.

Lee believes they would prevent many high-risk pregnancies and could bring pro-life and pro-choice interests together.

Downing said there was no formal opposition to the program in Washington. Some national pro-life people wrote letters saying, "Although we may in some way oppose what you're doing, your end point is the same as ours, and that is lowering the abortion rate," he said.

However, Dan Kennedy, chief executive officer of Human Life in Redmond, Wash., a Right to Life affiliate, and John Long, Hawaii Right to Life executive director, say they oppose emergency contraceptive pills.

"If the pill is truly contraceptive in nature, then there's no problem," Long said. "But many times ... it doesn't stop the egg from being impregnated but just stops it from being attached to the uterine wall. That becomes an abortification, which we are opposed to."

Les Krenk, Maui Clinic Pharmacy owner and Hawaii Pharmacists Association president, said some pharmacists probably would not provide "morning after" pills without prescriptions, even if it was legal, because of liability and religious concerns.

However, the association has joined other organizations in sponsoring meetings with Downing so pharmacists can be informed, Krenk said.

For more information about emergency contraceptive pills or where to obtain them, call the toll-free national Emergency Contraception Hotline, 888-NOT-2-LATE (888-668-2-5283), or see the Web site

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