When emergency contraception was first introduced to the United States in the late 90s, it was known among reproductive health advocates as the country’s “best-kept secret.” In 2000, a year after the Food and Drug Administration approved the brand-name emergency contraceptive pill Plan B, just over half of women of reproductive age were aware of it, and many of them didn’t know that—at the time—getting it required a prescription from a doctor.
In other words, about half of women capable of getting pregnant didn’t know that there a backup method of preventing pregnancy if other methods of contraception failed them, or if they hadn’t used any in the first place.
A lot has changed since then. Plan B became available over-the-counter in 2006, and overall awareness of emergency contraception has grown to 95 percent: Between 2013 and 2015, 22 percent of women reported having used emergency contraceptive pills in their lifetime, a big jump from the 4 percent who said the same in 2002.
Yet confusion persists: Though the vast majority of women have heard of emergency contraceptive pills—and are aware that they are not the same as abortion pills—recent polling from the Kaiser Family Foundation found that 62 percent of people wrongly believe that pills like Plan B can be used to end an early pregnancy.
Just 44 percent of women of reproductive age know that this is not the case.
What's the difference between Plan B and abortion pills?
Emergency contraceptive pills delay ovulation in order to prevent a pregnancy from happening; they’re completely ineffective if a pregnancy has already begun. Emergency contraception is sometimes called the morning-after pill. Plan B, one brand of emergency contraception, has also become a common shorthand to refer to it, but there are multiple generic versions too. (The FDA approved another brand-name pill called Ella in 2015, which can be taken up to five days after unprotected sex, though it's still prescription only.)
Mifepristone is one of two drugs doctors administer for first-trimester abortions with pills, a method also known as medication abortion. The drug stops a pregnancy from progressing and, when followed by a second medication, misoprostol, a miscarriage is induced. Unlike emergency contraception, a decades-old FDA policy requires providers to dispense mifepristone in person, at a hospital or clinic, making it illegal to sell the drug over-the-counter. Health care providers can’t write a prescription to the drug for patients to pick up at a pharmacy, as they would for nearly all other medications people take at home.
So while emergency contraception like Plan B is highly visible, the restrictions on medication abortion leave abortion pills clouded in relative obscurity for the general public, potentially leading to confusion that conflates the two, explained Usha Ranji, the associate director of women’s health policy at the Kaiser Family Foundation.
These barriers to access help explain why so few people are aware of mifepristone and medication abortion—just 36 percent of women between the ages of 18 and 49 had heard of it, according to the recent polling. And it also provides clues as to why so many people still aren’t sure what exactly abortion pills do that emergency contraception doesn’t.
Nathalie Duroseau, a New York-based pediatrician and fellow with Physicians for Reproductive Health, said part of her job involves dispelling these misconceptions on a regular basis. “Many patients understand that emergency contraception has no effect on an already [established] pregnancy, and others still remain confused, or not quite clear,” Duroseau said. “I make a point to go over with them how the emergency contraception pill works and that it is not, in any way, an abortifacient.”
So why do people confuse Plan B with abortion pills?
The researchers behind the recent Kaiser Family Foundation survey didn’t conduct any follow-up polling to find out exactly where this misunderstanding stems from, but experts have some ideas.
Duroseau suspects that the conflation of emergency contraception and abortion pills has something to do with a lack of comprehensive sex education. Currently, 26 states require that sex education heavily emphasizes abstinence, while just 24 states require any sex education at all. Duroseau said that leaves millions of young people without any information about different birth control methods, and with significant gaps in knowledge about how pregnancy occurs.
But experts say there’s likely another insidious factor to consider—the extent to which anti-abortion activists and politicians emphasize that life begins “at conception,” or when a sperm fertilizes an egg. The slogan forms the ideological core of the anti-abortion movement, and is often deployed as an argument against certain methods of birth control, including emergency contraception, which some abortion opponents mistakenly believe can terminate a pregnancy.
“When you have 99 percent of sexually active heterosexual women using birth control at some point in their lifetime, the anti-abortion lobby knows they don’t have the constituency to be [explicitly] anti-birth control,” said Mary Alice Carter, a senior advisor at Equity Forward, a reproductive health coalition. (Though in her experience most anti-abortion activists are also anti-birth control, she added.) “So they tend to follow the adage, ‘If you can’t convince them, confuse them.’”
Susan Wood, a professor of health policy at George Washington University, experienced this disinformation campaign against Plan B firsthand. She used to serve as the FDA's assistant commissioner for women’s health and as director of the office of women’s health until she resigned in protest in 2005, decrying the agency’s delay in approving emergency contraception for over-the counter use.
“There was huge confusion about the difference between it and the abortion pill, mifepristone [among the public], and that was definitely promulgated by the small group of people opposed to emergency contraception,” Wood recalled.
Efforts to lump these two medications together are harmful.
The conflation of emergency contraception and abortion pills can have serious consequences for people who want to end a pregnancy but aren’t sure which pill regimen best applies to their situation.
“The real danger is someone thinking, ‘Oh, this Plan B pill could help me have an abortion—it’s the same thing,’” Carter said. “That person would take Plan B and remain pregnant, and it could be many more weeks before they realize they’re still pregnant. They could find themselves in a situation where they’re going to then have a harder time accessing the abortion they were led to believe they could get with a morning-after pill.”
Carter and others feel hopeful though. As medication abortion becomes more common and less stigmatized, she said she believes a younger generation will become more aware of the options available to them and the purpose each option serves.
“I’m optimistic,” Wood said, pointing to the statistics that show women of reproductive age are at least aware that there is a difference between the two drugs. “Hopefully over time that knowledge will increase.”
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Read more about medication abortion:
Almost 40 Percent of Abortions Are Now Done With Pills
The FDA Is Restricting Access to the Easiest, Safest Form of Abortion
Buying Abortion Pills Online Is Overwhelmingly Safe, But Maybe Illegal
This article originally appeared on VICE US.