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A month since the distribution of the over-the-counter version of the morning-after pill began, few shock waves have been registered in Western Pennsylvania.

"Now we can give it out to anyone 18 and over who wants it. Girls 17 and under can still get it through our health centers," said Kim Evert, president and CEO of Planned Parenthood of Western Pennsylvania, who added that the agency was only able to order the pills in mid-November, so there are no significant sales figures yet to report.

Carol Cox, a Barr Pharmaceuticals spokeswoman, said Plan B distribution went smoothly, but would not specify how many pills were issued. She said the company does not expect detailed sales information until February.

Plan B was the focus of bitter debate for years before the Food and Drug Administration, after repeated delays, declared in August that customers 18 and older should be able to buy it in pharmacies without a prescription.

The manufacturer, Barr Pharmaceuticals Inc., then needed to develop new packaging for the over-the-counter version; it announced the start of national distribution on Nov. 6.

Plan B, a high dose of a drug found in many regular birth-control pills, can lower the risk of pregnancy by up to 89 percent if taken within 72 hours of unprotected sex. Girls 17 and younger still need a prescription to buy Plan B, though an older person -- male or female -- could buy it over the counter on a teenage girl's behalf.

Supporters of Plan B had sought over-the-counter approval on the premise that wider availability would reduce the number of unplanned pregnancies and abortions.

Critics of the drug challenge those claims, arguing that Plan B instead will promote promiscuity and unsafe sex; they warn that men might coerce their underage sexual partners into using it. Some critics also consider the pill tantamount to abortion, although it differs from the abortion pill RU-486 and has no effect on women who are already pregnant.

In contrast, through her own research, and other scientific published studies, Dr. Melanie Gold, specializing in adolescent medicine at Children's Hospital, has found that access to emergency contraception did not result in young women having more unprotected sex.

Her study, published in 2004, focused on 301 young women, ages 15-20, with a mean age of 17. In a random selection, half were given emergency contraception in advance; the others were given the contraception as needed.

"The kids with advance contraception were not more likely to report having unprotected sex. ... They also reported higher condom use -- the exact opposite of what people were expecting," Dr. Gold said.

The study also found that those who had the contraceptive in advance were more likely to use it earlier, within 10 hours -- when it is most effective. With the availability now over the counter, she said more women can have that same advantage.

"At this point, they can get it ahead ... like having supplies of tampons at home ahead of time. You don't wait to buy a fire extinguisher. You want to have it when you need it," Dr. Gold said.

Range of prices

The cost of a standard two-pill pack varies. Ms. Evert said the Planned Parenthood health centers sell it for $20 and that pharmacies in the area charge more. CVS pharmacies sell Plan B for $44.99; Rite-Aid sells it for $39.99.

While some independent pharmacies are not stocking Plan B because of moral objections or perceived lack of demand, the pill is widely available. CVS Corp. and Rite-Aid Corp., as well as other major pharmacy chains including Walgreen Co., not only offer the pill throughout their networks, but also pledge to ensure that customers can buy Plan B onsite even if a given employee declines to provide service for reasons of conscience.

Patricia Epple, executive director of the Pennsylvania Pharmacists Association, said her organization has a non-binding policy that pharmacists agree to provide the requested medication, either directly or indirectly.

"I really haven't heard much buzz" from pharmacists in the state about selling Plan B over the counter in the past month, Ms. Epple said.

"If they really do have a conscientious objection ... they would make arrangements for patients to get it; to have some system in place, to have another pharmacist or pharmacy assistant give the patient the medication," she said.

Some concerns remain

Dr. Gold said efforts are continuing to expand the availability of Plan B to younger women.

"There is no scientific data to restrict over-the-counter sales to girls under age 18. There is data to support providing it to girls as young as 15." She said that girls are less likely to plan ahead to use birth control than women.

"It's sad that younger women are being discriminated against. The group that is least likely to look ahead, plan ahead."

The American Academy of Pediatrics, American College of Obstetricians and Gynecologists, and the Society for Adolescent Medicine advocate giving younger teens over-the-counter access to Plan B.

In a twist, some studies have found a resistance to using Plan B: Women don't always use the pill, even when they have it.

The fact that the teens studied by Dr. Gold kicked up their use of condoms surprised the researchers.

"I asked a bunch of kids why they thought teens with Plan B available used condoms more often and they said, 'Well, you have the emergency contraceptive at home, but you don't want to need it ... you don't want to use it.' It's almost a preventive state of mind," Dr. Gold said.

"Kids totally get it. They know that Plan B is less effective than other regular birth control and that it doesn't protect against [sexually transmitted disease]. [However] they still have the misperception that using it regularly is unhealthy," she added.

She said she doubts that the availability of Plan B would change teenage behavior.

Dr. Gold said there's more involved than just what contraceptive product is out there.

"I don't think, or any parent thinks, because there is now emergency contraception, their kids are going to throw out all they've been taught, all their beliefs."

'A backup method'

Also supporting access to Plan B for younger teens is Richard L. Baird Jr., president and CEO, of Adagio Health.

The contraceptive has been available for about three years at Adagio, which provides reproductive health care services in a 23-county service area. It has more than 30 sites -- including clinics and hospitals -- in Allegheny County.

Mr. Baird said in the past fiscal year ending June 30, among 76,000 clients seen in the 23 counties, 1,478 total units of Plan B (including prescriptions taken elsewhere) were given to young women under 18; another 5,467 were given to women age 18 and older.

"People don't use it as a primary method of contraception," Mr. Baird said. "It's only a backup method.

"I think it should be available for every person of child-bearing age," he said. "It's scientifically proven to be safe."

Planned Parenthood of Western Pennsylvania plans to continue to educate people on Plan B emergency contraception, Ms. Evert said, and will distribute the pill for free on "Free EC Day," which will be timed close to Valentine's Day.

The chapter received a $15,000 grant from the Women and Girls Foundation to monitor the availability of Plan B to women in Allegheny, Indiana and West-moreland counties.

"We want to let people know it's available, so we can identify communities where no one's selling it," Ms. Evert said.

For example, she said, she heard that some pharmacists in Cambria County will not sell it. "Even if pharmacies direct patients to Planned Parenthood, they're still limiting access to it."