Five Things to Know About the Morning-After Pill on Its 20th Anniversary

In 1993, the New York Times Magazineposited that the morning-after pill might be “the best-kept contraceptive secret in America.” Even many doctors had no idea there was a fallback contraceptive that could be used shortly after unprotected sex or cases of rape.

There was an information shortfall in large part because there was no contraceptive that was approved by the U.S. Food and Drug Administration (FDA) specifically for emergency use. Some providers worked around that absence by using the chemically similar estrogen and progestin medications that were approved for regular birth control. By upping the dosage, they created a suitable morning-after pill on their own. But drug makers couldn’t label or market those birth-control pills for emergency, post-coital use, since they weren’t FDA-approved for that purpose. It also spelled problems for federally funded clinics. Federal dollars couldn’t pay for an off-label medication hack, a makeshift morning-after pill that wasn’t officially approved.

To mark its anniversary here in the U.S., here are five things to know about the morning-after pill — as well as other emergency contraception.

1. Though it’s only been on the U.S. market for 20 years, the science behind the morning-after pill goes back almost a century.

In the 1920s, veterinarians discovered they could use concentrated estrogen to prevent pregnancy in animals shortly after they mated. In the next decades, that discovery led to attempts at preventing human pregnancies under similar circumstances. Birth-control pills, or low-dose estrogens, could be used proactively to prevent pregnancy, but when it was too late for that, high-dose estrogens were tested as a last-chance contraceptive. The first documented case was in the mid-1960s, when physicians used estrogen medications to prevent pregnancy in a 13-year-old rape victim.

In the 1970s, a Canadian physician named Albert Yuzpe spearheaded clinical trials to develop a combination of hormones, including estrogen and progestin, that could be used as a morning-after pill. He and his colleagues published the first studies on this multi-pill, high-dose hormone method in 1974, establishing a method that was safe and effective for reducing the chance of pregnancy up to 120 hours after unprotected sex.

3. By 1997, the FDA agreed with the need for a morning-after pill, and in 1998, PREVEN hit the market.

While ads on MTV brought awareness of EC to a younger generation of TV viewers, NBC did the same for a broader cross-section of Americans in 1997. An episode of the hospital drama ER that aired that spring included a brief storyline involving a victim of date rape who was advised to take birth control in high doses to prevent pregnancy. It was a sign the morning-after pill had entered the mainstream.

Also in 1997, the FDA validated EC more officially. As CNN reported, “the FDA said six brands of birth control pills were safe and effective as morning-after pills, the first federal acknowledgment of the emergency birth control method that European women have been prescribed for years.” Late that year, drug maker Gynétics applied for FDA approval of the PREVEN Emergency Contraceptive Kit, and the following September, it was given the green light for prescription use. A designated morning-after pill was finally available, though the estrogen-and-progestin combination pioneered by Dr. Yuzpe — now packaged under the name PREVEN — would soon be eclipsed by a new generation of emergency oral contraceptives.

About Matt

Matt has a background in human services, health disparities research, and administrative support at an academic health sciences center. In addition to Planned Parenthood Advocates of Arizona, he volunteers with Read Between the Bars, a program that sends books to people in Arizona’s prisons. In his free time, he enjoys reading, studying Spanish, and playing Scrabble.