Oh, Oh, Oh,..Uh Oh!
Oh, oh, oh
The ads Planned Parenthood uses to promote the availability of the morning after pill pretty much say it all. Youre 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 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, 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 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 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.
"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 which 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 essence the 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 dont 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 head its 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 inaccurate -- the 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.