Contraception in the Crosshairs

In March, Wal-Mart announced that it would carry Emergency Contraception (EC) – commercially sold as Plan B – for the first time in the seven years that the drug has been on the market. Reproductive rights activists around the nation lauded the decision both as a step forward for women’s access to reproductive technology and a victory for activists fighting Wal-Mart’s retrograde social policies. However, the victory is only partial, because while Wal-Mart now stocks EC, it, along with many other companies, does not require its pharmacists to dispense it.

Across the nation, pharmacists have come out as ​“conscientious objectors,” refusing to dispense EC, and in some cases, any contraception, to women who come in with a prescription. ​“If you really understand what the science of emergency contraception is,” says Destiny Lopez, head of the Institute for Reproductive Health Access’ ​“Back up Your Birth Control” campaign, which works to promote awareness of and access to EC, ​“you’re essentially opposing birth control.” 

Plan B, the only commercial form of EC currently available, contains a high dose of one the hormones – progestin – found in birth control pills. As such, it prevents ovulation and fertilization. If taken within 72 hours, it can reduce the chance of pregnancy by 89 percent. That’s where the problem with pharmacists comes in.

First, consider the time it takes to get ahold of a doctor or get an appointment. For a woman without insurance or a primary care physician, this can take days. Factor in transportation, securing last-minute childcare or obtaining time off work. Having overcome these hurdles, a woman could still be told to travel elsewhere to get her prescription filled. Soon the hours when EC is most effective have passed.

“It’s a time-sensitive method: a woman needs to get it as soon as possible in order for it to be most effective,” says Lopez. ​“Often, women living in rural areas only have one pharmacist they can go to in their communities.” 

Last November, Walgreens pharmacist John Menges refused to comply with an Illinois regulation requiring pharmacists to dispense EC. He is now out of a job, having refused a job transfer 30 miles across state lines to Missouri. ​“It just hurts,” he told the Chicago Tribune. ​“But I’m not going to compromise my beliefs.”

Menges is representative of a growing segment of the pro-life movement that opposes contraception outright. ​“The right-to-life movement claims that the most commonly used forms of birth-control – the pill, the patch, the IUD, aren’t contraception – they’re abortion,” says Cristina Page, author of How the Pro-Choice Movement Saved America. ​“And they’re using the same exact techniques that won the abortion debate to attack the family planning techniques that most Americans use.”

“Conscientious objectors” are being backed and promoted by groups like Pharmacists for Life, whose underlying goal is to undermine women’s access to birth control altogether. And the Bush administration, along with state politicians around the nation, is right there with them. 

Sen. Rick Santorum (R-Pa.) has come out against birth control. ​“I don’t think it’s a healthy thing for our country,” he said in 2005. Matt Blunt, the Republican governor of Missouri, conflates EC with abortion and has made decreasing access to EC a legislative priority for 2006. And the U.S. Senate is currently considering the Health Insurance Marketplace Modernization and Affordability Act (HIMMAA), a bill introduced by Sen. Mike Enzi (R-Wyo.) that would override state laws requiring health insurance companies to cover contraceptive costs. 

There’s another front to this battle – making EC available over the counter. In 2005 the FDA bowed to political pressure and used a ​“pocket veto” to table consideration of this issue. Susan Wood, then-director of the Office for Women’s Health resigned, saying, ​“I can no longer serve as staff when scientific and clinical evidence, fully evaluated and recommended for approval by the professional staff here, has been overruled.”

The fight has been picked up by members of Congress. Last summer Sens. Patty Murray (D-Wash.) and Hillary Clinton (D-N.Y.) blocked the confirmation of Lester Crawford for FDA commissioner until a promise was made by Health and Human Services Secretary Mike Leavitt to reconsider Plan B for over-the-counter sales – a promise he reneged on. While careful to confine their comments to the scientific rigour of the FDA, the two are continuing the fight. They answered Bush’s mid-March nomination of Andrew Von Eschenbach to head the FDA with their intention to hold up the nomination until the FDA has ruled on Plan B. 

Speaking to the press, Clinton declared, ​“We want the science to decide, not the ideology.”