How Many Steps Does it Take to Get to Plan B?

After a thorough, decade-long review of evidence gathered by the Center for Drug Evaluation and Research, The U.S. Food and Drug Administration (FDA) finally decided to expand access to emergency contraception, also known as Plan B One-Step, or the morning-after-pill. FDA approval would have made Plan B One Step available in stores on the same shelves as condoms and pregnancy tests, “giving all women at risk of unintended pregnancy…access to this safe and effective [albeit highly time-sensitive] backup contraceptive method without having to ask a pharmacist or get a prescription from a doctor.”

But in walks Kathleen Sebelius, Secretary of the Department of Health and Human Services, and all of a sudden the FDA’s recommendation is overruled. We’re right back where we started: people age 17 or over (who have a state-issued photo ID to prove their age) can buy Plan B One Step from “behind the counter,” while people younger than 17 will need to go to their doctor and get a prescription.

So, some of you may be asking: what’s the big deal, anyway? Don’t most medications require a prescription?

Here’s the problem: Plan B One Step is effective for 72 hours. The sooner you take it after having sex that may result in pregnancy, the more likely it is to prevent pregnancy. Eliminating additional barriers (e.g. finding a doctor who will prescribe it to you and booking an appointment with that doctor, traveling to that doctor’s office, finding a pharmacist who won’t stigmatize you and refuse to fill your prescription under a conscience clause) will ensure that more people get to purchase emergency contraception when they need it most. What if you don’t have a doctor? What if you don’t have insurance or are under-insured? What if you don’t have the money or transportation to get to the nearest clinic or doctor’s office? What if you can’t get out of school or out of work during the times that the doctor’s office or the clinic is open? What if you don’t have a government issued ID in order to prove your age (recent data shows that 18% of U.S. citizens ages 18 to 24 don’t)? All of this on top of the to the day-to-day responsibilities of being a young person. Time is tick, tick, ticking and the pill is going to be less effective, or ineffective once you finally access it (if you get to access it at all).

It goes without saying, but I’m going to say it anyway: This decision will most harshly effect young people of color, low-income people, and immigrants who are disproportionately uninsured or under-insured and will face more obstacles to accessing care.

Sebelius argued that her main concern is protecting young people, especially those as young as 11 years old, from potential adverse health effects, saying “It is commonly understood that there are significant cognitive and behavioral differences between older adolescent girls and the youngest girls of reproductive age” which would inhibit younger girls from being able to fully comprehend and make proper use of emergency contraception. Yet the Center for Drug Evaluation and Research had already done careful research and determined,

“…that the product was safe and effective in adolescent females, that adolescent females understood the product was not for routine use, and that the product would not protect them against sexually transmitted diseases. Additionally, the data supported a finding that adolescent females could use Plan B One-Step properly without the intervention of a healthcare provider.”

Considering that, “fewer than 1% of 11-year-old girls are sexually active, but almost half of girls have had sex by their 17th birthdays, and most of these begin at age 15 or 16,” Sebelius’ decision seems way off fourth base, and fertile ground for an increase in unintended pregnancies (yes, puns fully intended).

After coming under fire from the reproductive health community, Obama made a statement in support of Sebelius’ overruling:

“As the father of two daughters, I think it is important for us to make sure that we apply some common sense to various rules when it comes to over the counter medicine. And as I understand it, the reason Kathleen made this decision is that she could not be confident that a 10-year-old or an 11-year-old going to a drugstore should be able — alongside bubble gum or batteries — be able to buy a medication that potentially, if not used properly, could end up having an adverse effect. And I think most parents would probably feel the same way.”

Obama’s stated commitment to science and evidence-based health care policy seems pretty shaky these days, and in this case all too reminiscent of the previous administration’s unwavering opposition to empiricism, as The New York Times recounts.

Dr. Susan Wood, a former F.D.A. assistant commissioner who resigned in 2005 to protest the Bush administration’s handling of Plan B, said that there were many drugs available over the counter that had not been studied in pre-adolescents and that were far more dangerous to them.

“Acetaminophen can be fatal, but it’s available to everyone,” Dr. Wood noted. “So why are contraceptives singled out every single time when they’re actually far safer than what’s already out there?”

Now the same doctor who resigned in protest during the Bush administration called Sebelius’s intervention “appalling,” as

one of several critics who accused Sebelius of bowing to political pressure rather than letting the FDA’s scientists do their jobs. “We expected this kind of action from the Bush administration, so it’s doubly disheartening and unacceptable that this administration chose to follow this path,” NARAL Pro-Choice America said in a statement.

Some advocates in opposition to Sebelius’ decision have argued that it will increase teen pregnancy and therefore condemn teens to a “life on the slow track.”

Can’t we come out against this decision without reinforcing the narrative that young parents can’t be good parents and successful people? All young people, including young parents, need respect and support — NOT stigma, shaming, and doomsday forecasts.

Reproductive Justice is about increasing access to and support for all reproductive decisions for all people, all off the time—not for some reproductive decisions for some people, some of the time. We should all be able to have a child, not have a child, and parent the child(ren) we have. No shame. No shade.

If you want to rouse a few rabbles, sign the petition demanding that President Obama quit playing politics with young people’s lives, keep his word, and hold his own administration accountable by urging the Secretary to reverse the decision. While you’re waiting for Sebelius to bring her feelings along for a ride on the science and stats train, make sure to check out these resources from organizations that are doing work to increase access to contraceptives and other vital reproductive health services, as well as supporting young moms and strong families instead of shaming and blaming:


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