It should not take a high school human development class to inform you that everything you’ve learned about emergency contraception does not apply to the average American woman.
Unfortunately, this is what happened for me in my most recent sex ed lesson, so let’s get our facts straight.
“Emergency contraception refers to methods of contraception that can be used to prevent pregnancy after sexual intercourse. These are recommended for use within five days but are more effective the sooner they are used after the act of intercourse,” according to the World Health Organization. Emergency contraception is often used after unprotected sex, in the event of failed contraception, such as a broken condom, and after sexual assault and rape.
One of the most common forms of emergency contraception is the levonorgestrel pill, better known by the brand names that sell it, such as Plan B One-Step, Julie and Econtra One-Step. These are often referred to as “morning-after pills,” because the sooner they are taken after sex, the more effective they are in preventing unwanted pregnancy.
Shockingly, recent studies have shown that the effectiveness of many of these morning-after pills decreases in women over 165 pounds.
It’s crucial to remember that the average American woman is estimated by the CDC to weigh over this threshold, at around 171 pounds.
There are, of course, other options for emergency contraception that don’t have this weight limit, but they aren’t nearly as accessible — and why should some women have to resort to other options in the first place? Nevertheless, I find it important to detail a few other options for the sake of education.
In terms of a pill, Ella is an alternative morning-after pill that is largely effective in women up to 195 pounds, as it contains ulipristal acetate rather than levonorgestrel. Interestingly, Ella boasts a higher rate of overall effectiveness than Plan B.
Some doctors also recommend the copper or hormonal IUD as a form of emergency contraception. Short for Intrauterine Device, an IUD is a small device inserted into the uterus, and holds no BMI limit. It’s also one of the most effective forms of birth control out there.
But the socioeconomic barriers to these alternative methods of emergency contraception are prominent. Ella is more expensive than Plan B without insurance, requires a prescription and may not be available at some pharmacies.
The copper IUD is also significantly more expensive. Furthermore, like other emergency contraception methods, it works better the sooner it is inserted, with medical professionals recommending getting the procedure within five days after unprotected sex. In other words, this method requires the privilege of having time to spare for an IUD insertion in any given five-day period — and that’s if you can get an appointment.
The IUD procedure is also reportedly more painful than taking a pill. In addition, I believe the lack of anesthesia during the procedure is deeply rooted in the historical invalidation of women’s pain in the medical field, but that’s a column for another day. Lastly, inserting a copper IUD may have longstanding impacts on the patient’s sex life and would likely interfere with pregnancy if not removed.
Accessible emergency contraception should not be a privilege.
With so many Americans living under the illusion that common levonorgestrel pills work consistently for all women, it’s clear there’s a lack of education regarding these pills’ weight limits in both their marketing and mainstream media. We as a society cannot address disparities without first recognizing their existence, meaning this false narrative is intentional.
By promoting the notion that the most widespread, socioeconomically accessible emergency contraception will have an equal success rate among all women, larger bodies are further ostracized and discriminated against. Bodies shouldn’t have to change to fit the healthcare industry — it is the industry’s job to accommodate all kinds of them.
Another problematic aspect of these limits is how often patients aren’t informed of weight thresholds before purchasing emergency contraception.
Much of this can be attributed to stigma around open discussions of weight. And, hey — in the interest of full honesty — this is a stigma I just might be able to get behind. When these discussions often inevitably lead to comparison, we attach disproportionate shame to mere numbers on a scale, so why open that door in the first place? Yet while there is some value in the lack of widespread discussion and comparison between weights, medical spaces should not abide by the same social norms, and instead recognize that, in the context of emergency contraception, fully informing patients is beyond necessary.
When it comes down to risking a life-altering unwanted pregnancy or offending a patient, the decision is clear: speak up.
However, some women also report being denied morning-after pills due to the weight limits. It’s imperative to understand that, other than ineffectiveness, no harm has been proven to result from women of larger weights taking the pills. Denying anyone emergency contraception only further exacerbates the lack of agency and bodily autonomy of larger women that led the industry into this exclusive mess.
Emergency contraception’s little-known weight limits boil down to misogynistic disparities within the field of healthcare. The fact that these inequalities have only recently gained cultural attention, rather than being incorporated into the marketing of morning-after drugs from their inception, demonstrates profit-driven business models.
If there’s one thing writing this column has taught me this year, it’s that body image is as much a product of social, political and economic systems of suppression, misogyny and stigma as it is an internal struggle. Weight limits on morning-after contraceptive pills are perhaps the epitome of that intersection, because at the end of the day, birth control is about autonomy. It’s about having the right to pleasure, sexual freedom and agency over your own body. Those rights should not be conditional, and those conditions should not be dependent upon socially constructed hierarchies.
In only accommodating the sexual needs of smaller women, weight limits hold larger women to a higher, harmful and unrealistic standard of sexual activity, restricting and complicating their lifestyles in ways many smaller women never have to consider.
Ultimately, the weight bias and discrimination in the emergency contraception industry are a scientific example of the cultural idealization of thinness and its very tangible consequences. It is evident that the emergency contraception industry is in dire need of change. Whether it comes in the form of newer, more exhaustively studied morning-after pills, reduced stigma around weight in pharmacies and the medical field, or increased socioeconomic accessibility to more inclusive forms of emergency contraception, it all starts with a conversation.
The movement for female bodily autonomy should not leave anyone behind.
Ms. Geffen • May 19, 2026 at 10:42 pm
Wow, Clara – I had no idea! This is such a well-written article with crucial information for all. Thank you for sharing so clearly and passionately. Your conclusion, “Ultimately, the weight bias and discrimination in the emergency contraception industry are a scientific example of the cultural idealization of thinness and its very tangible consequences,” is a powerful one. Great article.