I love Plan B. I’ve taken it four or five times. I love that it is available over the counter for people over 18. I love that its name is widely known.
I hate that its efficacy decreases with body weight, and that so many people don’t know this.
In trials of EC (emergency contraception), women with a BMI of 30 or higher got pregnant 3x more than non-obese women.* Ella, a ulipristal acetate EC, is possibly more effective than progestin-only EC, such as Plan B. The best EC for obese women is insertion of a copper IUD.
The fact that this wasn’t known until at almost a decade after the introduction of EC is a perfect example of how thin privilege has very serious affects for fat people. If a portion of the sample population used during development of the drugs had been obese, this would have been known at the time of the drugs’ introduction. Instead, fat people have been paying up to $80 for medication that may not work for them, and have risked pregnancy by no knowing they should pursue other options.
Hopefully now that this is known, drug companies will begin developing an EC that works for fat people. Ella might work for smaller fatties, but it isn’t available OTC. Copper IUDs have a greater than 99% efficacy rate,** but it can take days to get an appointment for one, and they are very expensive. These aren’t acceptable alternatives for fat people; we deserve effective, affordable and easily accessed EC.
Taking a higher dose of EC has not been proven to improve effective, and is not recommended.
(I say “people” rather than “women” in this post because not all people with uteruses are women. Trans-inclusivity is important to me. Please let me know in the comments when/if I slip up on other posts.)