Plan A, Plan B, and… Plan C?

In a democracy-driven country with almost 314 million people, it is no surprise that controversial issues are rarely resolved. One of the most debated topics in the United States has been reproductive rights. Should we teach comprehensive or abstinence-only education? Should abortion be legalized? Till what stage of pregnancy? What reproductive health services are required to be covered by employers? The list goes on.

Despite these debates, a plethora of new and improved contraceptive methods have been introduced over the past few decades. However, only a fraction of them are approved by the FDA. The following is a list of the four major methods of contraception approved in the United States:

  • Barrier method: physically blocking the sperm from reaching the egg. e.g. condoms, sponges, diaphragm, cervical cap
  • Hormones: interferes with ovulation. e.g. skin patch, vaginal ring, birth control pill
  • Implants: inserted into the uterus and releases hormones that prevent fertilization or implantation. e.g. intrauterine device (IUD)
  • Emergency contraception: a pill used three days after unprotected sex to prevent ovulation, fertilization, or implantation. e.g. Plan B, Next Choice, Ella

Currently there are few options for women if both birth control and the “morning-after” pill do not work, other than a clinical abortion. This is when she needs a “plan C”; a plan that does not depend on the political atmosphere: menstrual regulation.

As outlined by Francine Coeytaux, principal investigator at the Public Health Institute, “plan C” already exists and is legal in many other countries. The concept behind plan C is to induce menstruation and, in a sense, “flush” the uterus so that there is no possibility of a pregnancy. This concept arose from a technique called “menstrual extraction” which was originally practiced in California in the 1970s. A group of women developed this technique as a method of safely removing menstrual blood. The main difference between menstrual extraction and early termination abortion is that the former is not done in a clinical setting. This method is not widely practiced in the United States, but has been a common form of abortion in other countries such as Cuba, Bangladesh, and Mexico.

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Although menstrual extraction does not necessitate clinical equipment or a physician, the process still requires a certain skill level and opens the door to potential complications due to amateur attempts or unsanitary conditions. To circumvent the required technical expertise, researchers have turned to a pharmaceutical solution: a pill. This pill uses a combination of the hormones mifepristone and misoprostol to evacuate the contents of the uterus. The effectiveness and potential risks of this pill were recently studied on a population of women in Bangladesh. The study concluded that the pill can be safely used for menstrual regulation in women that have missed their periods. Although mifepristone is not legal in the United States, misoprostol is readily available and is primarily used for the induction of labor.

The FDA should further explore the implications of using the “menses inducer” pill as another alternative for women before they seek an abortion. It is especially imperative now more than ever for women to be offered more options since the debate over abortion and reproductive rights have not ceased. Offering a “plan C” will give women one more way of controlling their fertility, independent of political influence.

Can American women have a “plan C”?

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