Women do not know that emergency contraception is available because, to be marketed for such use, a drug or a device must have been labeled accordingly in the manufacturer's application to the federal Food and Drug Administration. In other words, a drug or a device may have medically appropriate uses within the safety limits approved by the FDA, but if these are not identified in initial or supplementary applications, they cannot be advertised or otherwise promoted by the manufacturer. Clinicians may still prescribe drug or device for an unlabeled purpose, but a woman may not know to ask her clinician. Manufacturers and distributers are reluctant to apply to the FDA to relabel existing drugs or devices because they fear backlash from anti-abortion groups, who object to their use to prevent implantation, according to the authors. Public awareness of emergency contraception is poor, and the functional distinction between emergency contraception and the action of abortifacient drugs is lost, the authors say.
Timing is also a significant factor, according to the authors.
To be effective, drugs used as emergency contraception must be begun within 48 to 72 hours after unprotected sex, depending on the drug. Similarly, an IUD must be inserted within five to seven days after unprotected sex. Women often lack sufficiently rapid access to clinical services. The authors cite as typical the example of the woman who calls her doctor's office the morning after a contraceptive failure, unsure what options may be available, but who is told by a receptionist that there is nothing to do but await her period. By the time the woman actually sees her clinician, emergency contraception is no longer an option.