Oh, Oh... Uh Oh! Time for Plan B
By Kari Lydersen
ads Planned Parenthood uses to promote the availability of the morning
after pill pretty much say it all. Youre being responsible
and using a condomthe best form of protection against sexually transmitted
diseases and unplanned pregnancyand then bam, the condom breaks.
In a worst case scenario, a woman might cross her fingers and hope for
the best after this experience, and end up pregnant, then have to have
an abortion or maybe even bear a child she isnt ready for because
of the accident. In the better case scenario, there is Plan B.
Plan B, or the morning after pill, as it is more commonly known, is actually
two pills to be taken 12 hours apart that can safely be used to avoid
an unwanted pregnancy if taken within 72 hours of unprotected sex. Since
1999, the pill has been available by prescription only in the U.S. It
is available in 101 countries in the world, in 33 of them without a prescription.
The maker of the pill, New Jersey-based Barr Pharmaceuticals, has been
petitioning the Food and Drug Administration (FDA) to make the pills available
over the counter. But on May 6 the FDA turned down the proposal because
it said the company didn't prove the drug could be safely used by young
teenagers without a doctor's support.
In so doing the FDA ruled counter to its expert advisory panel, which
in December had voted 23-4 to approve over the counter sales. Doctors
and scientists on the panel and otherwise advising the FDA said selling
the pills over the counter is a good ideathey are safe and easy
to use, it is obviously easy to know when they are needed, and studies
have shown access to the pill doesnt lead to a reduction in condom
use or increase in risky sex.
But social conservative forces lobbied against the move, just as they
have opposed access to abortion, condoms and information about contraception
for women in general and teenagers in particular. And it appears that
the FDA bent to their influence, despite the advice of its advisory panel
and what would appear to be common sense.
The FDA's official reasoning that the company didn't prove teen girls
could understand the pill's label and safely use it without a doctor's
advice was contrary to basic logic. The pills are exceedingly easy to
take, just pop them in your mouth 12 hours apart. And it is even simpler
to know when to take themafter unprotected sex. The pills have only
minor possible side effects such as nausea and an irregular next menstrual
cycle; there are already plenty of drugs available over the counter that
could be far more destructive if used incorrectly.
But after I talked to several groups of teenage girls at alternative high
schools in Chicago, it became apparent that most teens don't know much
about the pill or how to use it, and in general they don't think it should
be available over the counter.
"You can take it before you have sex to prevent pregnancy,"
said one girl.
"If you're already pregnant it could make you have a baby with birth
defects," said another.
"If a doctor doesn't prescribe it, you don't know how it could affect
your body; everyone's different and might not react to it well,"
said a third.
"You need to just use condoms, that's the best," said another.
These responses show how extremely important it is to take the opinions
and level of knowledge of teenage girls into consideration when making
a policy decision like this, something Barr Pharmaceuticals apparently
didn't do well enough, since their label comprehension study included
only 29 girls under 17 out of 585 total participants. (The FDA may still
approve the pill for sale over the counter if Barr Pharmaceuticals undertakes
another study that shows teens age 16 and younger can adequately interpret
the label on their own.)
But I don't think the girls' response, or the reasons the FDA gave for
their decision, mean we should keep the pill available by prescription
only. High school students I've talked to also have a lot of other bad
information about contraception and STDsthat HIV and AIDS are two
separate viruses, that married people can't get STDs, that herpes is a
fatal disease. I think what this all points to is that much more comprehensive
and medically detailed and accurate sex education is needed in junior
high and high schools around the country, and all the options for contraception
including the morning after pill must be included in that education. That
way, girls (and later women) will have the information they need to make
good decisions about their sexuality, contraception methods and medical
careeven those who don't regularly visit doctors.
Though ideally all women and girls would get regular check-ups and any
other health care they might need, that is not a reality for many people.
Where the morning after pill is concerned, making it available over the
counter will doubtlessly prevent unwanted pregnancies and all the physical
and social complications they entail.
Women who are uncomfortable with visiting doctors or answering questions
about their sexuality are less likely to make an appointment to get a
prescription for the pill than they are to anonymously buy one at the
local drugstore. And getting a prescription involves at least one initial
visit with a doctor, which for someone without insurance can cost $50
or more plus about $20 for the pill.
"These are girls who aren't getting much health care anyway, and
for them these hurdles are too high," noted Jessi Jackson, resource
coordinator for Girl Talk, a Chicago program that fosters dialogue and
self-esteem among girls who are incarcerated in the juvenile detention
system. "Girls can be really intimidated by things like this, so
the fewer barriers there are the more likely they will be to use it. They
might not make an appointment with a doctor within a few days, they will
just hope they don't get pregnant. If they can get it over the counter
that makes it a lot easier."
Even though Planned Parenthood and other womens health clinics do
a good job of providing access to the morning after pill, advertising
it in posters and pamphlets, the fact that the pill is obtainable by prescription
only does greatly reduce its availability.
For one thing time is of the essencethe pill must be used within
three days of sex, and it is more effective the sooner it is used. But
the prescription issue means women are at the mercy of clinic schedules
and locations. Especially teenagers or women who in one way or another
have limited mobility or freedom might have trouble getting to a clinic
within 72 hours. If you work full-time and cant get away during
the hours the clinic is open, you may be more likely to take the risk
of an unwanted pregnancy than to forfeit a few hours pay or risk
angering your boss.
And if you are a teenager whose parents dont know youre having
sex, or a married woman whose husband doesnt approve of emergency
contraception, the steps involved in getting to a clinic and explaining
your absence could easily be enough to dissuade you from going. If you
can buy the pill at Walgreens in advance and keep it stowed away in a
drawer for an emergency like this, however, youd be much more likely
to use it.
As with other controversies over reproductive rights, the conservative
and religious parties lobbying against the over-the-counter availability
of the pill are framing their arguments as being concerned with womens
health. They say the availability of the pill will lead to reduced condom
use and an increase in sexually transmitted diseases, even though various
medical studies and doctors who have testified on the issue take positions
to the contrary. The pills cost alone means it is unlikely to ever
be used as a regular part of intentionally unprotected sex. And the issue
of sexually transmitted diseases is one that needs to be and usually is
dealt with separately from the pregnancy issue, since many other forms
of contraception including birth control pills and IUDs also don't prevent
diseases. Singling out the morning after pill as something that will increase
promiscuity and unprotected sex is simply manipulative and inaccurate.
Right-wing pundits have also said that making the pill available over
the counter would mean men (or other women) could purchase the pill and
slip it to women or girls secretly to prevent them from conceiving a wanted
child. Though there might be a small number of situations where something
like this would happen, again it is an argument that twists reality on
its headits safe to say that in the majority of cases where
a male partner is trying to manipulate a womans reproduction, it
is by trying to prevent her access to contraception or otherwise limit
her control over her own body. In other words, a husband or boyfriend
is far more likely to pressure a woman not to take the pill or to be dismissive
of the risk of pregnancy than he is to slip the pill into her drink.
Insinuations that the pill isnt healthy for women are also inaccuratethe
pill is essentially a strong dose of the same hormones and chemicals in
birth control pills, and has virtually no side effects or long-term effects.
An abortion is far more disruptive and stressful for a womans health
than using the morning after pill.
Every year thousands women of all ages, and young women and girls in particular,
see their lives changed forever because of unwanted pregnancies. Many
unwanted pregnancies are avoided with the availability of the pill by
prescription as it is now, but many more could be avoided if the pill
were affordably and easily available over the counter. The idea that a
woman should have to undergo an abortion or bear a child she isnt
ready for just because of a lapse of judgment or a broken condom, when
this situation is fully avoidable with the pill, is a sad statement about
the priorities of the Food & Drug Administration.
Kari Lydersen is a writer for AlterNet, www.alternet.org.