Wynn L L, Trussell James
Office of Population Research, Princeton University, Princeton, New Jersey 08544, USA.
Obstet Gynecol. 2006 Nov;108(5):1272-6. doi: 10.1097/01.AOG.0000237193.90586.53.
The debate over emergency contraceptive pill access in the United States revolves around speculations about Americans' sexual lives. The recently released internal U.S. Food and Drug Administration (FDA) memo that expresses fears that adolescents will form "sex-based cults" around emergency contraceptive pills echoes arguments made against the nonprescription switch at the 2003 FDA hearings. In these hearings, opponents argued that nonprescription access would lead to adolescent promiscuity and disease transmission and that adult predators would use the drug to facilitate the sexual abuse of young women. In contrast, proponents of expanded access to emergency contraceptive pills overwhelmingly portrayed their model user as a responsible adult who experiences a torn condom during consensual sex. These imaginations of American sexuality are tied to competing models of the role of medical providers in women's sexual decision making. Opponents of the nonprescription switch argued that women need a learned intermediary, not only to determine their need for emergency contraception, but also to educate them about proper sexual behavior and protect them from abuse. Proponents advocated putting more responsibility for sexual health decision making in the hands of women, not doctors, and complained about the moralizing scrutiny of medical providers. In the absence of nonprescription access to emergency contraception, advance prescription of emergency contraceptive pills can ensure that contraceptive education is not tied to a specific sexual act and therefore not perceived as a judgment about women's sexual decisions. However, advance prescription does not help women who lack access to health care or women who make sexual and contraceptive decisions without consulting physicians.
在美国，关于紧急避孕药获取途径的争论围绕着对美国人性生活的猜测展开。美国食品药品监督管理局（FDA）最近发布的内部备忘录表达了对青少年会围绕紧急避孕药形成“性邪教”的担忧，这与2003年FDA听证会上反对非处方销售的观点相呼应。在这些听证会上，反对者认为非处方获取会导致青少年滥交和疾病传播，而且成年掠夺者会利用这种药物便利对年轻女性的性虐待。相比之下，支持扩大紧急避孕药获取途径的人压倒性地将他们的典型用户描绘成在双方自愿性行为中避孕套破裂的负责任成年人。这些对美国性行为的想象与医疗服务提供者在女性性决策中角色的相互竞争模式相关。反对非处方销售的人认为女性需要一个有学识的中间人，不仅要确定她们对紧急避孕的需求，还要对她们进行适当性行为的教育并保护她们免受虐待。支持者主张将更多的性健康决策责任交到女性而非医生手中，并抱怨医疗服务提供者的道德审查。在无法非处方获取紧急避孕药的情况下，提前开具紧急避孕药的处方可以确保避孕教育不与特定性行为挂钩，因此不会被视为对女性性决策的评判。然而，提前开处方对那些无法获得医疗保健的女性或那些在不咨询医生的情况下做出性和避孕决策的女性没有帮助。
