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Although Congress quashed a proposal in May that would have assured availability of the “morning-after” pill on military bases, emergency contraception drugs have been available on Pacific bases for some time, doctors and pharmacists say.

But while the military offers emergency contraception, not all doctors will prescribe it.

The hospital at Yokota Air Base in Japan carries the pill but some medical providers won’t prescribe it because of their own moral reservations, with some calling it “a form of abortion,” said Col. Steven M. Shaffer.

“In that case, a backup provider can be called in, so this may make for an extended wait,” said Shaffer, Yokota’s 374th Medical Group director of organizational compliance. “Our obstetrics providers have responded to the emergency department to prescribe the medicine when an emergency-room doctor had moral objections.”

Medical officials for all Air Force hospitals in Japan and Okinawa, the Army in South Korea and the Navy and Marine Corps on Okinawa confirmed they also provide emergency contraception.

Air Force officials in South Korea, including Osan and Kusan air bases, declined to comment, referring queries to Air Force officials in Washington, D.C.

“Emergency contraception is an accepted part of medical care and part of a treatment plan between a patient and a medical provider,” said Megumi Kurisaki, customer relations officer for U.S. Naval Hospital in Yokosuka, which covers naval facilities in Japan and Marine Corps Air Station Iwakuni.

Hospital personnel must perform medical histories and a physical before the pills are distributed, but for patients seeking them, it’s “as easy as a visit to the emergency room,” Shaffer added.

He said a few women each month come in for the emergency contraception, and Yokota hospital records show that about 40 prescriptions are issued every year.

The pill, which prevents about 80 percent of pregnancies, lowers the risk of becoming pregnant in a single episode of unprotected sex from 8 percent to 1 percent, according to Shaffer. Common side effects include bloating, abdominal pain, fatigue, nausea and vomiting.

“The sooner prescribed, the better,” he said. “And it must be used within 72 hours after having unprotected sex. The medicine does not protect against sexually transmitted diseases, and it’s not a replacement for planned contraceptive methods.”

At most hospitals in the Pacific, the pill is automatically offered to victims of rape or sexual assault.

According to some doctors at U.S. bases in Europe, the pill was once part of the military’s procedural response to rape. But that may no longer be the case.

In April, when officials from Washington and the U.S. Army Medical Department visited Europe to train advocates for sexual assault victims, no mention was made of emergency contraception.

Col. Denise Anderson, an administrator with the U.S. Office of the Surgeon General, detailed the rape treatment protocol, even mentioning the number of hairs pulled from a victim’s head for DNA testing. But asked whether the victim would be offered emergency contraception, she said no.

“We don’t put it out there. If they ask about it, we’ll counsel with them,” she said.

Anderson said offering the pills to rape victims might be offensive or interfere with their religious views.

Women’s advocates say an overarching Defense Department policy would make for consistent access to emergency contraception for military women.

Ted Miller, a spokesman for NARAL Pro-Choice America, said the Pentagon should act, especially in light of numerous reports in recent years of rapes in the military.

“In the context of the Defense Authorization Bill and what we’re learning about sexual assault in the military, this is one way to provide access to a certain population,” he said.

Morning-after pills — which are increased doses of the same hormones in birth control pills — are highly effective in preventing pregnancy if taken within 72 hours after sex. Although doctors say the pills act in the same manner as regular oral contraceptives and do no harm to an established pregnancy, the medication nonetheless has become a matter of national debate. Anti-abortion-rights and conservative groups oppose its use, saying itThe Food and Drug Administration, despite strong recommendation from its own expert committee, last year declined to make available a specially formulated and packaged emergency contraceptive, known as “Plan B,” without a prescription.

The American College of Obstetricians and Gynecologists, noting the drug was safe, easy to use and was most effective if taken soon after sex, called the FDA’s action “morally repugnant.” But a similar situation within the Defense Department went less noticed.

In February 2002, the DOD Pharmacy and Therapeutics Executive Council recommended Plan B be added to the Basic Core Formulary — a list of drugs available to all military care facilities.

The committee noted that its efficacy and reduced side effects — primarily less nausea and vomiting — made it the “drug of choice for emergency contraception,” and that doctors from three services supported the drug’s addition to the formulary.

But in May of that year, according to meeting notes, the council was informed that previous approval from Tricare, the military health-care program, had been rescinded, and that the matter was to be reviewed by the assistant defense secretary for health care.

Three years later, Plan B is still not on the Basic Core Formulary in the United States, and the emergency contraception debate has only grown louder.

Although at least seven U.S. states have joined Canada, Britain, Australia and other countries and made it available without a prescription, some pharmacists have refused to fill prescriptions or stock the drug, citing moral reasons.

Stripes reporters Juliana Gittler, T.D. Flack, Jennifer Svan, Greg Tyler and Fred Zimmerman contributed to this report.

Why the hesitation on offering Plan B?

Advocates of emergency contraception say easier access to the drugs could greatly reduce the number of unintended pregnancies — estimated at nearly half of all pregnancies in the United States — and have already significantly helped reduce the abortion rate.

Among that group are the American College of Obstetricians and Gynecologists, the American Academy of Family Practice and a host of women’s, pro-choice and privacy-rights groups.

Opponents of emergency contraception say it is abortion and that easy access to it could lead to sexual promiscuity. Among that group are right-to-life organizations, Christian conservatives and the Roman Catholic Church, which opposes all contraception.

Morning-after pills are not the same thing as the drug RU-486.

That drug, not available in the United States or on overseas military bases, can end a pregnancy of up to five weeks, when an embryo is about the size of a grain of rice, by causing alterations in the uterine lining.

But some on the religious right say they believe a fertilized egg is a human life, due the same protections as a human being.

For them, anything that interferes with the egg’s ability to implant is abortion.

Both Plan B and the older forms of emergency contraception use the same hormones as standard birth control pills and, experts say, work exactly the same way. They all are thought to suppress ovulation, prevent fertilization and inhibit implantation.

Emergency contraception is most effective if taken within 24 hours to 72 hours of unprotected intercourse.

Still, they are less effective than the standard regimen of birth control pills, which are more than 99 percent effective in preventing pregnancy. That’s one reason why they are not recommended as a routine form of birth control.

However, the American College of Obstetrician and Gynecologists recommends that women get emergency contraception to keep on hand before they need it, in the case of regular contraception failure, unprotected sex or sexual assault.

Doctors have known since the 1960s that a stronger dose of birth control pills could help prevent pregnancy but it was not routinely prescribed and few women knew it was an option. In 1997, the Federal Drug Administration approved commonly used birth control pills as being safe and effective for use as emergency contraceptives.

Two years later, the FDA approved Plan B for doctors to prescribe as an emergency contraceptive.

Since then, the specially packaged drug, consisting of two tablets to be taken 12 hours apart, has become the preferred method of emergency contraception.

—Nancy Montgomery

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Nancy is an Italy-based reporter for Stars and Stripes who writes about military health, legal and social issues. An upstate New York native who served three years in the U.S. Army before graduating from the University of Arizona, she previously worked at The Anchorage Daily News and The Seattle Times. Over her nearly 40-year journalism career she’s won several regional and national awards for her stories and was part of a newsroom-wide team at the Anchorage Daily News that was awarded the 1989 Pulitzer Prize for Public Service.
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