Oh, Oh, Oh,..Uh Oh!

By Kari Lydersen, AlterNet. Posted May 12, 2004.

“Oh, oh, oh…uh,oh!”

The ads Planned Parenthood uses to promote the availability of the “morning after pill” pretty much say it all. You’re being responsible and using a condom -- the best form of protection against sexually transmitted diseases and unplanned pregnancy -- and 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 isn’t 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, 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 idea – they are safe and easy to use, it is obviously easy to know when they are needed, and studies have shown access to the pill doesn’t 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 was 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 them -- after 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 STDs -- that 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 care -- even 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 doubtless 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.

Liked this story? Get top stories in your inbox each week from AlterNet! Sign up now »