Plan B, also known as the morning-after pill, can prevent an unplanned pregnancy if taken as soon as possible after unprotected sex. But women's health advocates say the pills have become a flashpoint in the abortion debate, and attempts to make them more readily available are being blocked.

"There are a lot of myths, unfortunately," said Karen Lustgarten, a spokeswoman for Planned Parenthood of South Palm Beach and Broward Counties Inc., "and one of those is that Plan B is an abortion pill. That's not what it is."

The contraceptive -- two tablets containing high doses of progestin, one of the hormones in birth control pills that block ovulation and prevent sperm and egg from uniting -- has been in use since 1999. Doctors can prescribe Plan B, and some make it available on a just-in-case basis, but fewer than 2 million doses are prescribed each year.

Efforts to make Plan B available over the counter have ignited controversy, with the Food and Drug Administration delaying a decision on whether to OK that move.

"It's already been proven safe and effective, and yet the FDA keeps delaying the decision to allow it to be sold over the counter," Lustgarten said. "It's a case of politics trumping science."

Tewannah Aman, executive director of Broward County Right to Life, said opponents of Plan B are concerned that it can prevent a fertilized egg from implanting in the womb, which would end a life.

"From our perspective, we focus on the life of the unborn, and we believe that at the moment of conception a life occurs. We don't know how many times [Plan B] prevents implantation, but every life is precious," Aman said. "We want to encourage abstinence and self-control."

Plan B's maker, Barr Pharmaceuticals, has been seeking approval from the U.S. Food and Drug Administration to sell the pills without a prescription, making them as accessible to women as aspirin or cough syrup. Such a move would prevent the delay and expense involved in visiting a doctor to seek a prescription, which can be an issue because pills are most effective when taken within 72 hours after a condom breaks or unprotected sex.

An FDA scientific advisory board recommended it be approved for over-the-counter sales, but FDA Commissioner Lester Crawford announced in August that the agency would indefinitely defer Barr's application for nonprescription sales. Crawford said the scientific data supported over-the-counter access for women over 17 and prescription-only access for women under 17, but he said the agency needed a 60-day period of public comment, followed by an indefinite period of rule-making, before making a decision.

"The recent decision announced by the commissioner about emergency contraception, which continues to limit women's access to a product that would reduce unintended pregnancies and reduce abortions, is contrary to my core commitment to improving and advancing women's health," Wood said in her resignation letter.

Last month the U.S. Government Accountability Office, the investigative arm of Congress, issued a report saying the FDA's decision to issue a "non-approvable" letter in May 2004 denying the Plan B application to go over the counter was an unusual move for the FDA. It said the FDA's actions did not follow the same procedures as the 67 other applications for drugs to be switched from prescription to over-the-counter sales the FDA handled between 1994 and 2004.

The investigation found that the FDA's high-level management was more involved in the review of Plan B than in other applications involving a switch to over-the-counter status. Five directors of FDA offices who reviewed the application, and who normally would have been responsible for signing the letter turning down Barr's application, disagreed with the decision and did not sign, the GAO said.

Investigators added that they got conflicting accounts of whether the decision not to approve was made before the reviews of the application were complete. Crawford did not respond to the GAO's request to be interviewed during its investigation.

Even though the morning-after pills are available by prescription, many women are unaware they have that option, said Charlene Beck, a nurse practitioner at the Planned Parenthood clinic in Boca Raton.

"It's really a well-kept secret," she said. "Most of the women have heard about it from a friend, and when they come in they are desperate. They don't want to get pregnant."

"Monday morning is the big day [when women seek emergency contraception]. They've had unprotected sex on Friday or Saturday night, and they're worried," Beck said.

She takes the opportunity to talk to them about avoiding sexually transmitted diseases, getting an annual pap smear and considering birth control pills. But said she finds resistance to the latter.

"Some women aren't using birth control pills because there's this myth that the hormones will make you fat, or make you infertile, or give you cancer," Beck said. "They say they want to use condoms instead, but if the condom breaks, they're willing to take the hormone in the morning-after pill because they're desperate."

Some experts say the pills can prevent an unwanted pregnancy if taken within 72 hours of unprotected intercourse. But Planned Parenthood says studies have shown they can offer protection within 120 hours. Some practitioners recommend the first pill be taken immediately and the second 12 hours later.

"It used to be 12 hours apart, but not only is it just as effective to give two at once, it prevents forgetting to take the second pill," she said.

About 10,000 public comments on the matter have been submitted to the FDA. There are at least two lawsuits pending, cases that seek to get the FDA to make the pills available without prescription. Oral arguments in one of the cases, filed by the Center for Reproductive Rights, are set for Thursday in U.S. District Court in New York City.

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