"We believe that the most effective way to utilize emergency contraception is to have it available over the counter, but we don't know how long it's going to be before it will happen," explains Purdon, president of ACOG. "It's better to be proactive and have a prescription tucked away and know what pharmacies you'll be able to go to if and when the occasion arises."

(Interestingly, in Washington state and several European countries, a third alternative is already available: Women can go straight to a pharmacist, who can prescribe and dispense emergency contraceptives, rather than visiting a doctor. This system is also being considered in Alaska and California.)

A major hurdle in the move toward over-the-counter adoption, however, is the fact that the emergency contraception products Plan B and Preven are being produced and marketed by small, independent pharmaceutical companies (Women's Capital Corp. and Gynetics, respectively), which lack the political clout and marketing resources to take on the massive task. For various reasons, none of the major pharmaceutical companies will touch emergency contraception. First, there's an economic disincentive: Since only 2 percent of all women ages 18-44 have ever used emergency contraception, the market is too small for the big players in the industry. (Of course, the market is arguably so small only because no one has marketed the product -- what Trussell describes as a "chicken and egg problem: Until people know about it, they won't buy it.") Second, companies also have worries about the legal liability for new contraceptive products: Pharmaceutical giant Wyeth-Ayerst, for example, was burned by Norplant, which was eventually pulled off the market after a series of expensive lawsuits. Last but certainly not least, there's the question of public controversy: Pharmaceuticals are extremely wary of provoking the kind of controversy that has plagued RU-486, the abortion-inducing oral drug.

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And controversy is certain to follow emergency contraception, as several recent developments show. Though Sen. Jesse Helms' attempt to block school-based clinics from distributing the morning-after pill did not make it to the Senate floor, observers think Helms isn't finished.

"We do think it will come up again -- it was simply a matter of energy. There was pressure to press the bill and Helms didn't have the energy to keep pushing. He was too busy fighting the Boy Scout issue," says Heather Boonstra, senior public policy associate for the Alan Guttmacher Institute. (Helms wanted to withhold federal funds from organizations that took action against the Boy Scouts because of their anti-gay policies.) "We do anticipate that it will come up again and this battle over access isn't over."

(This isn't the first time that Helms has tried to restrict access to emergency contraception. In January, he proposed a bill to "prohibit the provision of Federal funds to any State or local educational agency that distributes or provides morning-after pills to schoolchildren.")

The irony of Helms' amendment is that emergency contraception usage among teens is hardly widespread in the first place: Of the 1,400 school-based health centers in the U.S., only a small percentage actually dispense contraceptives on campus, and even fewer dispense emergency contraceptives. But pro-choice activists consider the Helms amendment to be a step closer to stricter and more widespread restrictions on emergency contraception. As a National Family Planning and Reproductive Health Organization press release puts it, "If [the amendment] is enacted, anti-family planning lawmakers are likely to renew efforts to restrict access to emergency contraception in other federal programs, and to impose parental consent requirements."

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