Use of Plan B emergency contraception, also known as the “morning-after” pill, has soared over the past five years in the US while demand for other forms of contraception such as birth control pills and condoms has fallen, according to an analysis of market research data.
Almost 15mn units of Plan B medication were sold last year, according to Financial Times analysis, a jump of about 59 per cent compared with 2018. Over the same timeframe new prescriptions of oral contraceptive pills dropped by almost 15 per cent, while condom sales fell about 18 per cent, 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 shifts in how Americans access reproductive health services as abortion services become increasingly restricted following the Supreme Court’s decision overturning Roe vs Wade last year.
At the same time, increased over-the-counter access to Plan B emergency contraception at pharmacies has coincided with changing attitudes towards contraception and a decline in in-person doctor visits.
Plan B is a single-dose medication that works by delaying ovulation with a hormone called levonorgestrel. It works best when taken within three days of unprotected sex and can lower a person’s chance of getting pregnant by between 75-89 per cent. It is less effective than standard birth control pills, which when used perfectly are up to 99 per cent effective, according to Planned Parenthood, a healthcare provider.
The US Food and Drug Administration advises that Plan B is not for routine contraception but has not indicated that there are any greater health risks associated with taking the medication than using standard birth control pills.
Many health experts argue a growing reliance on emergency contraception as opposed to more standard methods, particularly among some young people, should be countered via increased education, outreach and removal of barriers to access for all forms of birth control. They say Plan B is less effective than other forms of contraception and point to increasing rates of sexually transmitted disease in the US.
But calls by some conservative groups to restrict access to Plan B should be resisted at a time when abortion services are growing, they argue.
“The answer is not to restrict Plan B but to open up the doors to other types of contraception and make it easier for people to access information,” said Dr Kate White, a gynecologist and associate professor at Boston University Chobanian & Avedisian School of Medicine.
White said changing societal attitudes mean young people are no longer prepared to routinely accept recommendations by doctors, particularly when friends or family have had bad experiences with side-effects from contraceptive pills or pain from intrauterine devices.
“There is a lot of distrust about highly effective methods of contraception, especially those with hormones in them,” White said. “People still want Plan B at their fingertips, but in terms of those regular ongoing methods — distrust is rising.”
Access to standard birth control pills or IUDs — tiny devices inserted into a woman’s uterus to prevent pregnancy — are only available on prescription in the US typically following consultation with a doctor. In contrast, Plan B can be bought over-the-counter typically for prices of about $40-$50.
The growing reliance on Plan B also comes as fewer women are getting annual gynaecological check-ups. The number of women with commercial insurance who went to see a gynecologist for a preventive annual visit last year fell to 3.7mn in the 11 months to the end of November, compared to 5.9mn over the whole of 2018, according to Symphony Health data. Covid-19 and a change to guidelines for cervical cancer screening, which raised the recommended age for starting Pap smear tests from 21 to 25 years, have had an effect.
Cynthia Harper, professor of reproductive sciences at University of California, San Francisco, called the decline in doctor visits a “troubling trend” with numerous consequences, including contraception being neglected.
She said the increase in use of Plan B was a “promising response” to prevent unwanted pregnancies. About 45 per cent of pregnancies in the US, roughly 3mn every year, are unintended, 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 that point in time.
After the Supreme Court ruling last year, which led to a rush of Republican-led states curbing abortion access, public awareness of Plan B, which was authorised for over-the-counter access in 2013, has exploded. Some retailers introduced temporary limits on purchases last year.
Some universities are also expanding access to Plan B on campus. “When you need Plan B there is a small window when you can take it for it to be effective. We eliminated the two biggest barriers to access for students — time and money,” said Charlotte Beatty, one of a group of students who successfully campaigned to have a Plan B vending machine installed on campus at Boston University last year.
The machine sells Plan B for $7.25 via a credit or debit card payment, with all purchases listed on bank transactions as “snacks” to ensure confidentiality. The American Society for Emergency Contraception, an advocacy group, said it had worked with 83 schools in 32 states and was aware of at least 33 vending machines on college campuses.
The expansion of emergency contraception has prompted pushback from some anti-abortion groups, including Students for Life Action, which has sought to erroneously link the medication to terminating a pregnancy.
“Plan B is being sold as a quick fix,” said Kristan Hawkins, president, Student for Life Action. “That lack of conversation about the implications of taking powerful hormones that can end pregnancy doesn’t prepare women for the hard realities they may face later.”
The surge in sales will boost profits for the two private equity groups, Kelso and Juggernaut, who bought the branded version of the drug from pharmaceutical group Teva in 2017 for $675mn. Syzygy Healthcare Solutions and other manufacturers of generic versions of Plan B, such as Take Action and AfterPill, will also benefit.
Bayer, one of the largest suppliers of conventional contraceptives in the US market, has said that a fall in new prescriptions of birth control pills and long-acting IUDs has caused a decline in the overall market.
“The real issue and the concern is that Plan B for an increasing number of women is turning into plan A and ultimately it’s not a medicine that is designed to be plan A,” said Sebastian Guth, Bayer’s president of pharmaceuticals for the Americas.