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Political opposition is the main hurdle to developing birth control methods that could be more suitable than current options for many women, health experts said today (Sept. 23) in an editorial. The authors called on researchers to embrace and study birth control methods that act after sex, and can be taken only occasionally.
Current contraception methods are designed to work primarily by keeping sperm and eggs apart, but it is also possible to prevent pregnancy after an egg is fertilized.
Such post-fertilization birth control methods offer several advantages over existing contraceptives, among which is that they can be taken occasionally, for example, once a month, offering an alternative to women who experience difficulties with their current options.
"Although such methods would displease abortion opponents, they would likely be welcomed by many women," wrote the authors, a team of reproductive medicine and public health experts, in an editorial published today (Sept. 23) in the Journal of Family Planning and Reproductive Health Care.
As with any scientific endeavor there will likely be technical challenges to overcome in the making of a new birth control method, the researchers said. [7 Surprising Facts about the Pill]
There are promising compounds that may work, but all options need to be studied to know how far away researchers are from developing a reliable, post-fertilization contraceptive, said Dr. Elizabeth Raymond, professor of gynecology at New York University and one of the authors.
"The political problem has prevented us from even finding out what the scientific problems are," Raymond said.
Is it abortion?
The United States government defines pregnancy as beginning when a fertilized egg becomes implanted in the uterus. This implies that a birth control method that allows fertilization but prevents implantation should not be considered as abortion. However, not everyone is comfortable with this definition, the researchers said.
It is thought that some current forms of birth control sometimes act after fertilization, by disrupting the implementation of the embryo, although how this happens and how often it might occur are debated. Nonetheless, the possibility that birth control may work in this way is often not mentioned by experts out of concerns over opposition to contraception, the researchers said.
"We should openly acknowledge that some of the most effective standard contraceptive methods probably act, at least in part, after fertilization," they said.
Intrauterine devices and low-dose hormonal contraceptives could sometimes prevent an embryo from implanting in the uterus, Raymond said.
Other examples include chronic use of most hormonal contraceptives, and even breast-feeding, both of which are thought to impair implantation by altering the uterus lining and hormone levels.
"People don't like to talk about that, because it's a touchy subject, but it is actually true." Raymond said.
An option for some women
An after-sex birth control pill is not likely to be the option that works for every woman, Raymond said. But it could certainly be appealing to some.
The scope of problems women have with current contraception options is perhaps best captured by practitioners.
"Every day in clinical practice, at least one woman tells me she has discontinued use of hormonal contraception because 'the pill makes me go crazy!'" said Dr. Ellen Wiebe, a clinician and professor of reproductive health at University of British Columbia in Vancouver, who was not involved with the editorial.
Studying women's experience with birth control pills, Wiebe and her colleagues found that 25 to 35 percent of women are sensitive to hormones in birth control pills, and experience negative emotional and sexual side effects.
"Some women feel great on birth control pills, it controls their acne and premenstrual syndrome (PMS), but others feel like they've got PMS all month instead of a few days," Wiebe said.
About 30 percent of women using hormonal contraception discontinue use because of dissatisfaction, and they frequently cite mood-related side effects as the reason, according to studies published in the journal Contraception in 2001 and 2007.
Other problems women have with current options are planning and convenience.
"Some women don't want to use a method all the time when they are only having sex once in a while. It just doesn't make sense to them," Raymond said.