Access Barriers Disguised as Safety: Norplant, Bone Warnings, and the Emergency Contraception Delay
We made contraception harder to get, harder to use, and harder to access in emergencies. We called it safety. It was paternalism.
In 1999, a woman who missed her period after unprotected sex had one emergency contraception option: the Yuzpe regimen. Four high-dose oral contraceptive pills taken in two doses, twelve hours apart. The side effects were brutal. Nausea in 50% of women. Vomiting in 20%. And to get the prescription, she needed to find a provider willing to prescribe it, often within a 72-hour window, often on a weekend.
Plan B (levonorgestrel), a single-agent emergency contraceptive with superior efficacy and far fewer side effects, was available in Europe. It would not become available in the US until 2001, and would not be approved for over-the-counter sale until 2006, after years of politically motivated FDA delays.
This is the story of five contraceptive practices that shared a common feature: each created a barrier to access that was justified as safety but functioned as paternalism.
🎯 Free Subscriber Bottom Line: Five contraceptive practices created unnecessary barriers to access: Norplant’s design made removal traumatic; requiring an annual Pap for pill refills used screening as a contraceptive gatekeeper; the FDA’s DMPA bone density warning discouraged a safe method; the Yuzpe regimen for emergency contraception was inferior but standard for decades; and recommending the diaphragm as primary contraception meant tolerating a 12-17% failure rate when better options existed. Each barrier disproportionately affected young, low-income, and minority women.
Below, paid subscribers get: - Norplant: why the removal problem killed a good contraceptive - The annual Pap-for-pills requirement and its impact on contraceptive access - DMPA and the bone density black box: what the data actually show - The Yuzpe-to-Plan B transition and why it took so long - Diaphragm recommendations in the LARC era - How access barriers function as de facto population control.
