March 29, 2006

Contraception in the Crosshairs

By Phoebe Connelly

In March, Wal-Mart announced that it would carry Emergency Contraception (EC)—commercially sold as Plan B—for the first time in the seven years that the drug has been on the market. Reproductive rights activists around the nation lauded the decision both as a step forward for women’s access to reproductive technology and a victory for activists fighting Wal-Mart’s retrograde social policies. However, the victory is only partial, because while Wal-Mart now stocks EC, it, along with many other companies, does not require its pharmacists to dispense it.

Across the nation, pharmacists have come out as “conscientious objectors,” refusing to dispense EC, and in some cases, any contraception, to women who come in with a prescription. “If you really understand what the science of emergency contraception is,” says Destiny Lopez, head of the Institute for Reproductive Health Access’ “Back up Your Birth Control” campaign, which works to promote awareness of and access to EC, “you’re essentially opposing birth control.”

Plan B, the only commercial form of EC currently available, contains a high dose of one the hormones—progestin—found in birth control pills. As such, it prevents ovulation and fertilization. If taken within 72 hours, it can reduce the chance of pregnancy by 89 percent. That’s where the problem with pharmacists comes in.

First, consider the time it takes to get ahold of a doctor or get an appointment. For a woman without insurance or a primary care physician, this can take days. Factor in transportation, securing last-minute childcare or obtaining time off work. Having overcome these hurdles, a woman could still be told to travel elsewhere to get her prescription filled. Soon the hours when EC is most effective have passed.

“It’s a time-sensitive method: a woman needs to get it as soon as possible in order for it to be most effective,” says Lopez. “Often, women living in rural areas only have one pharmacist they can go to in their communities.”

Last November, Walgreens pharmacist John Menges refused to comply with an Illinois regulation requiring pharmacists to dispense EC. He is now out of a job, having refused a job transfer 30 miles across state lines to Missouri. “It just hurts,” he told the Chicago Tribune. “But I’m not going to compromise my beliefs.”

Menges is representative of a growing segment of the pro-life movement that opposes contraception outright. “The right-to-life movement claims that the most commonly used forms of birth-control—the pill, the patch, the IUD, aren’t contraception—they’re abortion,” says Cristina Page, author of How the Pro-Choice Movement Saved America. “And they’re using the same exact techniques that won the abortion debate to attack the family planning techniques that most Americans use.”

“Conscientious objectors” are being backed and promoted by groups like Pharmacists for Life, whose underlying goal is to undermine women’s access to birth control altogether. And the Bush administration, along with state politicians around the nation, is right there with them.

Sen. Rick Santorum (R-Pa.) has come out against birth control. “I don’t think it’s a healthy thing for our country,” he said in 2005. Matt Blunt, the Republican governor of Missouri, conflates EC with abortion and has made decreasing access to EC a legislative priority for 2006. And the U.S. Senate is currently considering the Health Insurance Marketplace Modernization and Affordability Act (HIMMAA), a bill introduced by Sen. Mike Enzi (R-Wyo.) that would override state laws requiring health insurance companies to cover contraceptive costs.

There’s another front to this battle—making EC available over the counter. In 2005 the FDA bowed to political pressure and used a “pocket veto” to table consideration of this issue. Susan Wood, then-director of the Office for Women’s Health resigned, saying, “I can no longer serve as staff when scientific and clinical evidence, fully evaluated and recommended for approval by the professional staff here, has been overruled.”

The fight has been picked up by members of Congress. Last summer Sens. Patty Murray (D-Wash.) and Hillary Clinton (D-N.Y.) blocked the confirmation of Lester Crawford for FDA commissioner until a promise was made by Health and Human Services Secretary Mike Leavitt to reconsider Plan B for over-the-counter sales—a promise he reneged on. While careful to confine their comments to the scientific rigour of the FDA, the two are continuing the fight. They answered Bush’s mid-March nomination of Andrew Von Eschenbach to head the FDA with their intention to hold up the nomination until the FDA has ruled on Plan B.

Speaking to the press, Clinton declared, “We want the science to decide, not the ideology.”

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Phoebe Connelly is the assistant editor at In These Times.

What Happens When There Is No Plan B?
By Dana L.
Sunday, June 4, 2006



The conservative politics of the Bush administration forced me to have an abortion I didn't want. Well, not literally, but let me explain.

I am a 42-year-old happily married mother of two elementary-schoolers. My husband and I both work, and like many couples, we're starved for time together. One Thursday evening this past March, we managed to snag some rare couple time and, in a sudden rush of passion, I failed to insert my diaphragm.

The next morning, after getting my kids off to school, I called my ob/gyn to get a prescription for Plan B, the emergency contraceptive pill that can prevent a pregnancy -- but only if taken within 72 hours of intercourse. As we're both in our forties, my husband and I had considered our family complete, and we weren't planning to have another child, which is why, as a rule, we use contraception. I wanted to make sure that our momentary lapse didn't result in a pregnancy.

The receptionist, however, informed me that my doctor did not prescribe Plan B. No reason given. Neither did my internist. The midwifery practice I had used could prescribe it, but not over the phone, and there were no more open appointments for the day. The weekend -- and the end of the 72-hour window -- was approaching.

But I needed to meet my kids' school bus and, as I was pretty much out of options -- short of soliciting random Virginia doctors out of the phone book -- I figured I'd take my chances and hope for the best. After all, I'm 42. Isn't it likely my eggs are overripe, anyway? I thought so, especially since my best friend from college has been experiencing agonizing infertility problems at this age.

Weeks later, the two drugstore pregnancy tests I took told a different story. Positive. I couldn't believe it.

I'm still in good health, but unlike the last time I was pregnant, nearly a decade ago, I'm now taking three medications. One of them, for high cholesterol, is in the Food and Drug Administration's Pregnancy Category X -- meaning it's a drug you shouldn't take if you're expecting or even planning to get pregnant. I worried because the odds of having a high-risk pregnancy or a baby born with serious health issues rise significantly after age 40. And I thought of the emotional upheavals that an unplanned pregnancy would cause our family. My husband and I are involved in all aspects of our children's lives, but even so, we feel we don't get enough time to spend with them as it is.

I felt sick. Although I've always been in favor of abortion rights, this was a choice I had hoped never to have to make myself. When I realized the seriousness of my predicament, I became angry. I knew that Plan B, which could have prevented it, was supposed to have been available over the counter by now. But I also remembered hearing that conservative politics have held up its approval.

My anger propelled me to get to the bottom of the story. It turns out that in December 2003, an FDA advisory committee, whose suggestions the agency usually follows, recommended that the drug be made available over the counter, or without a prescription. Nonetheless, in May 2004, the FDA top brass overruled the advisory panel and gave the thumbs-down to over-the-counter sales of Plan B, requesting more data on how girls younger than 16 could use it safely without a doctor's supervision.

Apparently, one of the concerns is that ready availability of Plan B could lead teenage girls to have premarital sex. Yet this concern -- valid or not -- wound up penalizing an over-the-hill married woman for having sex with her husband. Talk about the law of unintended consequences.

By late August 2005, the slow action over Plan B led the director of the FDA's Office on Women's Health to resign her post. The agency's delay on the drug, she wrote in an e-mail to her colleagues, "runs contrary to my core commitment to improving and advancing women's health." As recently as April 7, Steven Galson, director of the FDA's Center for Drug Evaluation and Research, said that the agency still needed time to work on the issue.

Unfortunately, time was the one thing I didn't have.

Meanwhile, I hadn't even been able to get Plan B with a prescription that Friday, because in Virginia, health-care practitioners apparently are allowed to refuse to prescribe any drug that goes against their beliefs. Although I had heard of pharmacists refusing to fill prescriptions for birth control on religious grounds, I was dumbfounded to find that doctors could do the same thing.

Moreover, they aren't even required to tell the patient why they won't provide the drug. Nor do they have to provide a list of alternative sources. I had asked the ob-gyn's receptionist if politics was the reason the doctor wouldn't prescribe Plan B for me. She refused to answer or offer any reason, no matter how much I pressed her. By the time I got on the phone with my internist's office and found that he would not fill a Plan B prescription either, I figured it was a waste of time to fight with the office staff. To this day, I don't know why my doctors wouldn't prescribe Plan B -- whether it was because of moral opposition to contraception or out of fear of political protesters or just because they preferred not to go there.

In any event, they were also partly responsible for why I was stuck that Friday, and why I was ultimately forced to confront the decision to terminate my third pregnancy.

After making the decision with my husband, I was plunged into an even murkier world -- that of finding an abortion provider. If information on Plan B was hard to come by, and practitioners were evasive on emergency contraception, trying to get information on how to abort a pregnancy in 2006 is an even more Byzantine experience.

On the Internet, most of what I found was political in nature or otherwise unhelpful: pictures of what your baby looks like in the womb from week one, and so on.

Calling doctors, I felt like a pariah when I asked whether they provided termination services. Finally, I decided to check the Planned Parenthood Web site to see whether its clinics performed abortions. They did, but I learned that if I had the abortion in Virginia, the procedure would take two days because of a mandatory 24-hour waiting period, which requires that you go in first for a day of counseling and then wait a day to think things over before returning to have the abortion. Because of work and the children, I couldn't afford two days off, so I opted to have the procedure done on a Saturday in downtown D.C. while my husband took the kids to the Smithsonian.

The hidden world of abortion services soon became even more subterranean. I called Planned Parenthood two days in advance to confirm the appointment. The receptionist politely informed me that the organization never confirms appointments, for "security reasons," and that I would have to just show up.

I arrived shortly before 10 a.m. in a bleak downpour, trusting that someone had recorded my appointment. I shuffled to the front door through a phalanx of umbrellaed protesters, who chanted loudly about Jesus and chided me not to go into that house of abortion.

All the while, I was thinking that if religion hadn't been allowed to seep into American politics the way it has, I wouldn't even be there. This all could have been stopped way before this baby was conceived if they had just let me have that damn pill.

After passing through the metal detector inside the building, I entered the Planned Parenthood waiting room; it was like the waiting room for a budget airline -- crammed full of people, of all races, and getting busier by the moment. I was by far the oldest person there (other than one girl's mom). The wait seemed endless. No one looked happy. We were told that the lone doctor was stuck in Cherry Blossom Parade traffic.

He finally arrived, an hour and a half late.

The procedure itself took about five minutes. I finally walked out of the building at 4:30, 6 1/2 hours after I had arrived.

It was a decision I am sorry I had to make. It was awful, painful, sickening. But I feel that this administration gave me practically no choice but to have an unwanted abortion because the way it has politicized religion made it well-nigh impossible for me to get emergency contraception that would have prevented the pregnancy in the first place.

And to think that, all these years after Roe v. Wade became the law of the land, this is what our children have to look forward to as they approach their reproductive years.