We fight so much about sex in this country it is a wonder we agreed about it enough to create 290 million Americans. If they agree on nothing else, however, gladiators in the bedroom arena of reproductive politics ought to agree that American women should have access to emergency contraception without a prescription from a physician.

Used widely and appropriately, emergency contraception (EC) might prevent half of our 2.5 million unplanned pregnancies each year, and thereby, perhaps half of our 1 million elective abortions. That should make EC a no-brainer we could all support.

Emergency contraception is the use of birth-control hormones within 72 hours after intercourse to prevent pregnancy. It is prescribed most commonly in the kits “Plan B” and “Preven,” and is up to 80 percent effective in pregnancy prevention, especially if taken within 48 hours of intercourse. It is used routinely in emergency departments to prevent pregnancy after rape, and after consensual intercourse that was unplanned or in which there was failure of the usual contraceptive (missed birth-control pills, slipped diaphragm, condom failure, etc.).

In the United States, unlike several other developed countries, EC is only available by prescription. That means after the unplanned sex or diaphragm slippage, or both, you have to call the doctor if you want EC. That’s a call many women are understandably reluctant to make, for a medication most physicians would agree can be used safely without a prescription. The result of the prescription requirement and other issues is that only 25 percent of women use EC when they need it; hence millions of missed opportunities to prevent unplanned pregnancies and subsequent elective abortions.

There are a number of misconceptions about emergency contraception that have mired the initiative to move EC to over-the-counter (OTC) status. The most important of these has been the idea that EC only works by inducing abortion. While the exact mechanisms by which EC works are not completely clear, there are probably several. The most likely mechanisms probably prevent conception, as opposed to causing abortion.

Only one possible EC mechanism may involve prevention of implantation of a fertilized egg; that mechanism is an abortion if you believe life starts at conception, but not an abortion if you believe an egg and sperm merged is not yet a life. It does not abort an implanted pregnancy. Physiologically, this potential mechanism seems most likely to occur if the EC is not used until late in the 72-hour post-intercourse window. Rapid, easy access to EC without a prescription is therefore not only more likely to make EC effective in preventing pregnancy, but also less likely for its pregnancy prevention mechanism to involve interference with a fertilized egg.

Safety of EC has been another concern, but shouldn’t be. The Food and Drug Administration Reproductive Drug and OTC Advisory Committee recently voted 23 to 4 in favor of the FDA making EC available without a prescription. It did so because EC meets all FDA safety criteria for OTC status.

There are rare cases of complications after EC use, some of which have been used to scare lawmakers debating the issue. However, none of these complications have been causally linked to the EC itself; it is, in fact, far safer than pregnancy, elective abortion, or the Tylenol and Motrin sold OTC like candy in this country for years.

A final FDA decision is pending, but has been bogged down in the swamp of America’s sexual politics. This is no surprise, given how much of our public health and science policy, and thereby previously private issues of reproduction, are being influenced by the religious right.

Several of the EC misconceptions involve women themselves. There are myths that women who need EC are women who are having casual sex, that women will use EC instead of using regular birth control, and that OTC access to EC will encourage unmarried women, including teenage women, to have sex.

These arguments hint at a theme that runs through many arguments made by religious moralists in debates about sex; that women who have sex outside marriage have somehow done something wrong, and should have to live with the repercussions, i.e. an unplanned pregnancy or the chance of it. Such arguments do not stand up to scrutiny, however, and leave us with more unplanned pregnancies and elective abortions as the alternative.

More than 80 percent of American women are already having sex before marriage; it seems unlikely the other 20 percent are just waiting for access to EC without a prescription. About half of American women will have an unplanned pregnancy at some point, many of them during marriage; the problem is widespread and not simply limited to women having sex before marriage. More than half of women who have used EC have used it for some kind of contraceptive failure, not for prevention of pregnancy after unprotected sex. Studies have also shown that most women do not substitute EC for regular contraceptive use; most need it as backup, as … Plan B.

In short, EC users are us, our wives and lovers, our sisters, and our daughters. If you look across the breakfast table, half of the women there may need it at some point in their lives. Try telling them they are not smart enough to make good decisions about EC without a doctor’s prescription.

Prompted in part by the FDA’s consideration of the issue, the Maine Legislature has passed a bill that will allow specially trained Maine pharmacists to dispense EC without a physician’s prescription. Gov. John Baldacci is likely to sign it into law. Other states are considering similar legislation, and all are waiting for action of the FDA.

It is time for the FDA to approve OTC sales of emergency contraception, and for EC to be available in the neighborhood pharmacy without a prescription. Our U.S. senators ought to be pressuring the FDA on the issue. We ought to be able to agree on a woman’s right to emergency contraception without a prescription, if only because we should all agree that fewer elective abortions is a good thing. If we are not smart enough to agree on EC as a way to accomplish that, I am not sure we should be reproducing in the first place.

Erik Steele, D.O. is a physician in Bangor, an administrator at Eastern Maine Medical Center, and is on the staff of several hospital emergency rooms in the region.