Sir, - Prompted by your report "Monitoring of emergency contraception" (The Irish Times, May 10th) we are writing to clarify the difference between emergency contraception and medical abortion through the use of mifepristone. Emergency contraception is sometimes referred to as the "morning-after pill", while mifepristone is sometimes known by the trade name Mifegync or by the name RU-486. The two therapies are entirely different and it is important not to confuse them.
"Emergency contraception" refers to contraceptive methods that work after unprotected sex but before pregnancy. The limit for taking emergency contraception is typically 72 hours after unprotected intercourse, and this is well before a pregnancy can be established. Several safe and effective emergency contraceptive methods exist. The two most popular ones (Yuzpe regimen or levonorgestrol alone) involve simply taking a higher dose of ordinary oral contraceptives for one day. Emergency contraceptives are true contraceptives in that they prevent pregnancy, often by delaying or inhibiting ovulation. They will not cause an abortion if a woman is already pregnant at the time she takes the pills.
Mifepristone, by contrast, has been registered in the UK (and elsewhere) as an abortion pill. Women can use mifepristone, typically accompanied by another type of drug called prostaglandin, up to seven (or nine, as in the UK) weeks into a confirmed pregnancy. Used this way, mifepristone clearly causes an abortion.
Confusion can arise because mifepristone is a very versatile drug and has been studied (although never registered) for a number of indications related to women's health besides abortion. These include daily contraception (very low doses may prevent ovulation); emergency contraception (when taken within 72 hours, mifepristone does work to prevent pregnancy just as do the other methods of emergency contraception); early abortion (as was just registered in the UK); cervical ripening; and even labour induction. It is critical to note two facts, however. Mifepristone is not registered anywhere in the world for emergency contraception (this use is still experimental), and none of the methods of emergency contraception that are registered anywhere in the world will work to cause an abortion. All of them prevent pregnancy.
Emergency contraception and early medical abortion with compounds such as mifepristone are both important options for women. In order for women to understand their choices and make informed decisions, they need accurate information about these therapies, and the differences between them. Continuing efforts to educate women about the existence of these options are under way in many countries, and the media will play an important role in getting the correct information into the public discourse. We hope you will print this correction of your report so that women will have accurate information, and be better prepared to meet their reproductive health needs. There undoubtedly will be future stories on mifepristone and on emergency contraception from different countries. Please do all you can to make sure that accurate information is provided in this sensitive and important area. - Yours, etc.,
Kelly Blanchard, Executive Director, American Society for Emergency Contraception, PO Box 20433, New York 10017, USA.