No Rx Required

The Fight to Make Morning-After Pills Available Over the Counter

Even if the average American woman continuously uses birth control throughout her reproductive years, she will have two unintended pregnancies. In real life, our reversible methods of contraception are highly unreliable: People forget to take some of their birth control pills, while condoms tear and slip—or the supply of either unexpectedly runs out. Many women find present birth control so awkward and uncomfortable that continuous use is not even a reality. And so, half the 6.3 million pregnancies in America each year are accidents.

Yet it has been known for 30 years that there is a second chance to prevent pregnancy: If you haven't used birth control properly before sex, you can still use it immediately afterward. Since 1999, there have been two FDA-approved prescription drugs made specifically for this purpose. A bill expected to be introduced this week in the New York State Assembly would make these drugs available without a prescription.

Studies show that emergency contraceptives can prevent up to 90 percent of pregnancies if used within three days of unprotected sex. When used during the first 12 hours, they are nearly 100 percent effective, but their efficacy steadily declines after that. These drugs "could reduce the number of abortions by half, but women just don't know about them," says James Trussell, a faculty associate at Princeton University's Office of Population Research. "And even if women know about these drugs, then they need to get them very quickly. And not many people can go to the doctor, get a prescription, and have it filled in 12 hours."

illustration by Frances Jetter
illustration by Frances Jetter

The assembly bill would set up a system for dispensing emergency contraception directly through drug stores, bypassing the need to go to a doctor first. Interested pharmacists would enter into collaborative agreements with a physician. The state would then certify them to provide the pills along with appropriate patient screening and counseling in their use. A three-year-old system like this in Washington state has distributed morning-after pills to over 25,000 women. Several European countries, including Britain and France, have instituted similar programs in the past year.

"Women should have the fullest range of health care," says Amy Paulin, a Democrat from Westchester, the New York bill's main sponsor. "We want to reduce the high rate of unwanted pregnancies and abortions in New York. My bill gives women access to a less invasive procedure that helps them be in charge of their own bodies."

Several measures now before the New York legislature reflect a growing interest in emergency contraception. But religious objections have stalled their progress. The controversial Women's Health and Wellness Act would mandate health insurance coverage for a variety of health services, including emergency contraception. The bill passed the senate and assembly but is now held up because the senate approved an exemption for institutions owned by churches that object to birth control.

Another pending bill would mandate that hospital emergency rooms provide emergency contraceptives to women who have been raped. This bill has been stagnating in the senate for the past two years, reportedly due to the opposition of Majority Leader Joseph Bruno. The bill's chief sponsor, Upper West Side Democrat Eric Schneiderman, says opposition from the New York State Catholic Conference is "critical." The conference, which lobbies on behalf of the state's dioceses, wrote to legislators last year objecting to the inclusion of Catholic hospitals in the bill's requirement to "provide state-mandated contraception and abortifacient treatment to rape victims."

Kathleen Gallagher, the state Catholic Conference's associate director, explained, "We oppose the bill because the state would impose a moral mandate on religious facilities, damaging religious freedom. Catholic hospitals would give drugs to prevent eggs from being released, but if drugs prevent implantation [of a fertilized egg], then they will not provide them."

Gallagher went on, "We would very likely oppose the pharmacy bill because it would include anybody, including a 14-year-old. It's very dangerous for a minor to get such treatment without understanding how the drugs work or when to take them. Would she really understand the risks involved, the counseling that she received without her parents' advice?"

Parental consent is not even required for abortion in New York, and no state has such a provision for birth control. Yet disagreement over adding parental consent killed a bill similar to New York's that had passed both houses of the Virginia legislature this winter. Paulin took strong exception to including a parental consent provision: "On its face, this is a bad idea because it prevents teenagers' timely access. I had a good relationship with my parents when I was a teenager, and I still couldn't have talked to them about having unprotected sex."

Opposition to emergency contraceptives arises over a highly sensitive semantic point. Emergency contraceptives probably act like regular birth control pills do, but nobody is quite sure how these pills work. They are likely to delay or block ovulation, but not always. Should a woman's egg mature and become fertilized, oral contraceptives also cause a women's uterus to be unprepared for the egg's implantation and development. Fundamentalists generally define human life as beginning with fertilization and regard oral contraceptives as potential abortifacients. But the 40,000-member American College of Obstetricians and Gynecologists has long held that implantation—not fertilization—is the real beginning of pregnancy.

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