Analysis Contraception

Clearing Up Confusion: Emergency Contraception and Weight

Martha Kempner

Rewire takes a look at the recent media storm around emergency contraception and weight and explains what readers need to know about the research.

Recently, there has been a lot of discussion in the news about emergency contraception pills and whether they are effective for women over a certain weight. Below is Rewire‘s explanation of why this story came to light, and what women who may need emergency contraception now or the future should know. 

Why is everyone talking about weight and emergency contraception right now?

A few weeks ago, a European manufacturer of emergency contraceptive pills identical to some of those on the market in the United States announced it was changing its labeling to add a caution that the product is less effective in women with a higher body mass index (BMI). This decision was based, at least in part, on the company’s own research, but there is other published research that has found the same thing. The media picked up the story and questioned whether the Food and Drug Administration (FDA) was going to ask or require U.S. manufacturers to make the same labeling change.

Remind me: What is emergency contraception?

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Emergency contraception is birth control that is used to prevent pregnancy after a couple has unprotected vaginal intercourse. In order to be effective, emergency contraception has to be used within 120 hours of unprotected sex.

Emergency contraceptive pills (ECPs) are taken orally and work by preventing ovulation and therefore pregnancy. There are two types of ECPs on the market in the United States. The first type is referred to as LNG pills because they rely on a synthetic version of the hormone progesterone called Levonorgestrel. LNG pills are sold under the brand name Plan-B One Step as well as the generic versions Next Choice One Dose and My Way. This is the type of ECP that is available over-the-counter to women of all ages in the United States. This is also the type for which the label was changed in Europe. The other type of ECP relies on a chemical called Ulipristal acetate (UPA) and is sold under the brand name Ella. This is not available over-the-counter.

It is also possible for a woman to have a copper intrauterine device (IUD) inserted into her uterus after unprotected sex, which can prevent pregnancy and also continue to act as a birth control method for up to ten years. Copper IUDs are more than 99 percent effective at preventing a pregnancy when inserted on an emergency basis. IUDs, however, can be very expensive and must be inserted by a health-care provider, which makes it difficult, if not impossible, for many women to access this method, especially within the 120-hour window.

What is the research on ECPs and weight?

In 2011, researchers analyzed two randomized controlled trials on the efficacy of LNG and UPA pills to try to understand why emergency contraception does not always work. They found timing to be the most important predictor of whether ECPs would work—how close a woman was to ovulation when she took the pills. However, they also found that ECPs were significantly less effective in women who were overweight or obese. Specifically, they found that women with a BMI of 30 or greater who used either kind of ECP became pregnant more than three times more often than women who were not obese.

The analysis found differences between the two types of pills. UPA pills were effective in women with a BMI of up to 35 but LNG pills lost efficacy at a much a lower BMI. In fact, pregnancy rates among women with a BMI of 26 or higher who took LNG pills were no different than would have been expected had they not used EC at all.

Body mass index is a way to determine obesity based on an individual’s height and weight. A BMI of under 25 is considered healthy, between 25 and 29 overweight, and 30 and over obese. As an example, a woman who is 5′ 6″ and 160 pounds would typically have a BMI around 26, whereas a woman who is 5′ 2″ and 160 pounds would have a BMI of over 30. The average weight for U.S. women is 166 pounds, and 35 percent of people in the United States are obese. Though BMI remains the most common tool used to measure obesity, there is an ongoing debate as to whether it is a reliable measure or a good indicator of overall health.

To put the research in terms of weight, which can be easier to understand, LNG pills seem to lose efficacy beginning at 165 pounds and become ineffective in women above 176 pounds.

Can’t women over a certain weight just take a higher dose?

As of now, there is no research to suggest that taking a higher dose of ECP pills would increase their efficacy, and it is not recommended that women do so.

Should women who are over a certain weight not use emergency contraception at all?

No. Health-care providers are still figuring out what the research really means and whether it should change what women do. Many think there isn’t enough research to recommend such a change yet. That said, it’s important that women know the research and discuss it with their provider, ideally before they need emergency contraception.

Women over 165 pounds who need emergency contraception may want to consider using UPA pills like Ella or getting a copper IUD inserted instead. As mentioned above, however, access to these methods, especially within the 120-hour window, can be difficult because they require a health-care provider either to write the prescription or to insert the IUD. They may also be cost prohibitive.

Women who cannot access these other methods quickly may want to considered using the LNG pills, as they may work and the side effects are minimal.

Will the FDA require label changes in the United States as well?

That remains to be seen. After the news of the label change in Europe, many people questioned whether the FDA would require a similar label change for Plan-B One Step and its generic equivalents. The FDA has told media outlets that it is reviewing the information and research and will make that determination in the near future.

Does this research apply to birth control pills as well?

Though some monthly oral contraceptives do rely on LNG, there is no research to suggest that birth control pills are ineffective in women over a certain weight or BMI. However, there is some research to suggest that the contraceptive patch may be ineffective in women over a certain weight; women using or considering the patch may want to talk to their health-care provider about that.

Analysis Politics

The 2016 Republican Platform Is Riddled With Conservative Abortion Myths

Ally Boguhn

Anti-choice activists and leaders have embraced the Republican platform, which relies on a series of falsehoods about reproductive health care.

Republicans voted to ratify their 2016 platform this week, codifying what many deem one of the most extreme platforms ever accepted by the party.

“Platforms are traditionally written by and for the party faithful and largely ignored by everyone else,” wrote the New York Times‘ editorial board Monday. “But this year, the Republicans are putting out an agenda that demands notice.”

“It is as though, rather than trying to reconcile Mr. Trump’s heretical views with conservative orthodoxy, the writers of the platform simply opted to go with the most extreme version of every position,” it continued. “Tailored to Mr. Trump’s impulsive bluster, this document lays bare just how much the G.O.P. is driven by a regressive, extremist inner core.”

Tucked away in the 66-page document accepted by Republicans as their official guide to “the Party’s principles and policies” are countless resolutions that seem to back up the Times‘ assertion that the platform is “the most extreme” ever put forth by the party, including: rolling back marriage equalitydeclaring pornography a “public health crisis”; and codifying the Hyde Amendment to permanently block federal funding for abortion.

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Anti-choice activists and leaders have embraced the platform, which the Susan B. Anthony List deemed the “Most Pro-life Platform Ever” in a press release upon the GOP’s Monday vote at the convention. “The Republican platform has always been strong when it comes to protecting unborn children, their mothers, and the conscience rights of pro-life Americans,” said the organization’s president, Marjorie Dannenfelser, in a statement. “The platform ratified today takes that stand from good to great.”  

Operation Rescue, an organization known for its radical tactics and links to violence, similarly declared the platform a “victory,” noting its inclusion of so-called personhood language, which could ban abortion and many forms of contraception. “We are celebrating today on the streets of Cleveland. We got everything we have asked for in the party platform,” said Troy Newman, president of Operation Rescue, in a statement posted to the group’s website.

But what stands out most in the Republicans’ document is the series of falsehoods and myths relied upon to push their conservative agenda. Here are just a few of the most egregious pieces of misinformation about abortion to be found within the pages of the 2016 platform:

Myth #1: Planned Parenthood Profits From Fetal Tissue Donations

Featured in multiple sections of the Republican platform is the tired and repeatedly debunked claim that Planned Parenthood profits from fetal tissue donations. In the subsection on “protecting human life,” the platform says:

We oppose the use of public funds to perform or promote abortion or to fund organizations, like Planned Parenthood, so long as they provide or refer for elective abortions or sell fetal body parts rather than provide healthcare. We urge all states and Congress to make it a crime to acquire, transfer, or sell fetal tissues from elective abortions for research, and we call on Congress to enact a ban on any sale of fetal body parts. In the meantime, we call on Congress to ban the practice of misleading women on so-called fetal harvesting consent forms, a fact revealed by a 2015 investigation. We will not fund or subsidize healthcare that includes abortion coverage.

Later in the document, under a section titled “Preserving Medicare and Medicaid,” the platform again asserts that abortion providers are selling “the body parts of aborted children”—presumably again referring to the controversy surrounding Planned Parenthood:

We respect the states’ authority and flexibility to exclude abortion providers from federal programs such as Medicaid and other healthcare and family planning programs so long as they continue to perform or refer for elective abortions or sell the body parts of aborted children.

The platform appears to reference the widely discredited videos produced by anti-choice organization Center for Medical Progress (CMP) as part of its smear campaign against Planned Parenthood. The videos were deceptively edited, as Rewire has extensively reported. CMP’s leader David Daleiden is currently under federal indictment for tampering with government documents in connection with obtaining the footage. Republicans have nonetheless steadfastly clung to the group’s claims in an effort to block access to reproductive health care.

Since CMP began releasing its videos last year, 13 state and three congressional inquiries into allegations based on the videos have turned up no evidence of wrongdoing on behalf of Planned Parenthood.

Dawn Laguens, executive vice president of Planned Parenthood Action Fund—which has endorsed Hillary Clinton—called the Republicans’ inclusion of CMP’s allegation in their platform “despicable” in a statement to the Huffington Post. “This isn’t just an attack on Planned Parenthood health centers,” said Laguens. “It’s an attack on the millions of patients who rely on Planned Parenthood each year for basic health care. It’s an attack on the brave doctors and nurses who have been facing down violent rhetoric and threats just to provide people with cancer screenings, birth control, and well-woman exams.”

Myth #2: The Supreme Court Struck Down “Commonsense” Laws About “Basic Health and Safety” in Whole Woman’s Health v. Hellerstedt

In the section focusing on the party’s opposition to abortion, the GOP’s platform also reaffirms their commitment to targeted regulation of abortion providers (TRAP) laws. According to the platform:

We salute the many states that now protect women and girls through laws requiring informed consent, parental consent, waiting periods, and clinic regulation. We condemn the Supreme Court’s activist decision in Whole Woman’s Health v. Hellerstedt striking down commonsense Texas laws providing for basic health and safety standards in abortion clinics.

The idea that TRAP laws, such as those struck down by the recent Supreme Court decision in Whole Woman’s Health, are solely for protecting women and keeping them safe is just as common among conservatives as it is false. However, as Rewire explained when Paul Ryan agreed with a nearly identical claim last week about Texas’ clinic regulations, “the provisions of the law in question were not about keeping anybody safe”:

As Justice Stephen Breyer noted in the opinion declaring them unconstitutional, “When directly asked at oral argument whether Texas knew of a single instance in which the new requirement would have helped even one woman obtain better treatment, Texas admitted that there was no evidence in the record of such a case.”

All the provisions actually did, according to Breyer on behalf of the Court majority, was put “a substantial obstacle in the path of women seeking a previability abortion,” and “constitute an undue burden on abortion access.”

Myth #3: 20-Week Abortion Bans Are Justified By “Current Medical Research” Suggesting That Is When a Fetus Can Feel Pain

The platform went on to point to Republicans’ Pain-Capable Unborn Child Protection Act, a piece of anti-choice legislation already passed in several states that, if approved in Congress, would create a federal ban on abortion after 20 weeks based on junk science claiming fetuses can feel pain at that point in pregnancy:

Over a dozen states have passed Pain-Capable Unborn Child Protection Acts prohibiting abortion after twenty weeks, the point at which current medical research shows that unborn babies can feel excruciating pain during abortions, and we call on Congress to enact the federal version.

Major medical groups and experts, however, agree that a fetus has not developed to the point where it can feel pain until the third trimester. According to a 2013 letter from the American Congress of Obstetricians and Gynecologists, “A rigorous 2005 scientific review of evidence published in the Journal of the American Medical Association (JAMA) concluded that fetal perception of pain is unlikely before the third trimester,” which begins around the 28th week of pregnancy. A 2010 review of the scientific evidence on the issue conducted by the British Royal College of Obstetricians and Gynaecologists similarly found “that the fetus cannot experience pain in any sense prior” to 24 weeks’ gestation.

Doctors who testify otherwise often have a history of anti-choice activism. For example, a letter read aloud during a debate over West Virginia’s ultimately failed 20-week abortion ban was drafted by Dr. Byron Calhoun, who was caught lying about the number of abortion-related complications he saw in Charleston.

Myth #4: Abortion “Endangers the Health and Well-being of Women”

In an apparent effort to criticize the Affordable Care Act for promoting “the notion of abortion as healthcare,” the platform baselessly claimed that abortion “endangers the health and well-being” of those who receive care:

Through Obamacare, the current Administration has promoted the notion of abortion as healthcare. We, however, affirm the dignity of women by protecting the sanctity of human life. Numerous studies have shown that abortion endangers the health and well-being of women, and we stand firmly against it.

Scientific evidence overwhelmingly supports the conclusion that abortion is safe. Research shows that a first-trimester abortion carries less than 0.05 percent risk of major complications, according to the Guttmacher Institute, and “pose[s] virtually no long-term risk of problems such as infertility, ectopic pregnancy, spontaneous abortion (miscarriage) or birth defect, and little or no risk of preterm or low-birth-weight deliveries.”

There is similarly no evidence to back up the GOP’s claim that abortion endangers the well-being of women. A 2008 study from the American Psychological Association’s Task Force on Mental Health and Abortion, an expansive analysis on current research regarding the issue, found that while those who have an abortion may experience a variety of feelings, “no evidence sufficient to support the claim that an observed association between abortion history and mental health was caused by the abortion per se, as opposed to other factors.”

As is the case for many of the anti-abortion myths perpetuated within the platform, many of the so-called experts who claim there is a link between abortion and mental illness are discredited anti-choice activists.

Myth #5: Mifepristone, a Drug Used for Medical Abortions, Is “Dangerous”

Both anti-choice activists and conservative Republicans have been vocal opponents of the Food and Drug Administration (FDA’s) March update to the regulations for mifepristone, a drug also known as Mifeprex and RU-486 that is used in medication abortions. However, in this year’s platform, the GOP goes a step further to claim that both the drug and its general approval by the FDA are “dangerous”:

We believe the FDA’s approval of Mifeprex, a dangerous abortifacient formerly known as RU-486, threatens women’s health, as does the agency’s endorsement of over-the-counter sales of powerful contraceptives without a physician’s recommendation. We support cutting federal and state funding for entities that endanger women’s health by performing abortions in a manner inconsistent with federal or state law.

Studies, however, have overwhelmingly found mifepristone to be safe. In fact, the Association of Reproductive Health Professionals says mifepristone “is safer than acetaminophen,” aspirin, and Viagra. When the FDA conducted a 2011 post-market study of those who have used the drug since it was approved by the agency, they found that more than 1.5 million women in the U.S. had used it to end a pregnancy, only 2,200 of whom had experienced an “adverse event” after.

The platform also appears to reference the FDA’s approval of making emergency contraception such as Plan B available over the counter, claiming that it too is a threat to women’s health. However, studies show that emergency contraception is safe and effective at preventing pregnancy. According to the World Health Organization, side effects are “uncommon and generally mild.”

News Politics

Trump Adviser and Possible Vice President Pick: ‘Women Have To Be Able to Choose’

Ally Boguhn

During an interview Sunday, Retired Army Lt. Gen. Michael Flynn said when asked about his stance on abortion that women "are the ones that have to make the decision because they’re the ones that are going to decide to bring up that child or not.”

Retired Army Lt. Gen. Michael Flynn, an adviser to Donald Trump who is also rumored to be a contender to join the presumptive Republican nominee’s ticket as vice president, said that women should “be able to choose” abortion during an interview on Sunday before backpedaling the next day.

“I think women have to be able to choose,” Flynn—a registered Democrat who is being vetted as a vice presidential contender, according to NBC News—said during an interview on ABC’s This Week when asked about his stance on abortion by Martha Raddatz. “They are the ones that have to make the decision because they’re the ones that are going to decide to bring up that child or not.”

In the same interview, Flynn also suggested that marriage equality was something “people [do] in their private lives.”

“These are not big issues that our country is dealing with that will cause our country to collapse,” Flynn went on, adding that he is “more concerned that our country could collapse because we are not dealing with education issues, immigration issues.”

Marjorie Dannenfelser, president of the national anti-abortion group Susan B. Anthony List, swiftly condemned the retired general, claiming Flynn’s comments had “disqualified himself from consideration as Vice President” in a Sunday statement, according to USA Today. “His pro-abortion position is unacceptable and would undermine the pro-life policy commitments that Mr. Trump has made throughout the campaign.”

The next day, Flynn walked back his seeming support for abortion rights, telling Fox News that he is in fact a “pro-life Democrat.”

“This pro-choice issue is a legal issue that should be decided by the courts. I believe in law. If people want to change the law, they should vote so that we can appoint pro-life judges. I believe the law should be changed,” Flynn told the network on Monday, referring to Roe v. Wade.

Flynn’s comments on ABC had given the retired general sizable distance from the Republican Party’s stance on abortion. The party’s platform in 2012 was stringently anti-choice, calling for a “human life amendment to the Constitution,” or a so-called personhood amendment, which could criminalize abortion and ban many forms of contraception. Though Trump has previously claimed he would change the party’s platform to include exceptions on abortion bans, CNN’s Tal Kopan reported Monday that the 2016 platform draft shared with the outlet “does not include language about such exceptions” and “does not diverge strongly … from the 2012 position on abortion, saying that unborn children are protected by the Constitution and decrying abortion.”

Trump is expected to announce his pick for vice president ahead of next week’s Republican National Convention in Cleveland, Ohio.