Morning-After Pills Aren’t Abortion: Why Ban Them?
NEW YORK — The San Bernardino County Board of Supervisors, apparently concerned that it might be promoting a form of abortion, has asked its county clinics to stop distributing emergency contraception, better known as the morning-after pill. The pills, they maintain, encourage promiscuity among teens, a claim disputed by county records, which demonstrate that poor adult women without access to family planning are pills’ primary users. Emergency contraception has harmful “side effects,†they insist, ignoring ample scientific evidence that it poses none.
Here we go again. What we need is common ground in discussing women’s choices about family planning. What we get is another blast of righteous moral indignation--one more annoying round in the explosive debate over choice that has poisoned America’s politics for too long.
When will the debate over reproductive rights in America move beyond the “clash of absolutes� When will we finally recognize that the plain facts of the matter have altered dramatically in the nearly three decades since Roe vs. Wade became the law of the land?
Today a woman’s decision to prevent or terminate an unwanted pregnancy involves any number of options that were not available to her back then. For many women these new considerations alter the moral circumstances as well. We need to account for these developments.
There are two theories about how emergency contraception (EC) works. Doctors say it sometimes actually prevents the union of egg and sperm by altering the hormonal chemistry necessary to support fertilization. Alternatively, it interrupts the development of the fertilized ovum by preventing it from nesting in the uterine wall. In either case, EC works before there is technically no pregnancy, which is medically defined as requiring implantation.
For years private physicians have routinely broken up packages of standard birth control pills and administered consecutive double doses of them to women reporting fear of unprotected sex. The only occasional side effect is moderate nausea. Yet pill manufacturers, fearing protests by antiabortion forces (or perhaps also fearing a decline in their more lucrative sales of once-a-day oral contraception) refused to market a dedicated EC product. And the Food and Drug Administration only recently approved one, after nearly a decade of effort by nonprofit reproductive rights groups. With limited resources, advocacy groups like Planned Parenthood are now training clinicians and pharmacists in the new method and also advertising it directly to consumers through telephone hotlines and on the Internet. Still, only a fraction of the population knows about it.
This situation, however, may be changing. The morning-after pill has already proved so safe and successful that the state of Washington last year passed legislation to permit its sale without a prescription through pharmacists, and other states are now looking into the matter. Eight California counties are participating in a pilot project in pharmacy access. And the FDA recently agreed to consider an application to switch the pill to over-the-counter status--an application endorsed by the powerful American College of Obstetrics and Gynecology (ACOG). In the meantime, ACOG has recommended that doctors offer patients advance prescriptions so they can have emergency contraception at the ready.
It is puzzling why so many conservative groups oppose emergency contraception. Despite the near-universal availability of contraception in this country, there are still an estimated 3 million unwanted pregnancies reported each year, nearly half of which now result in abortion. The morning-after pill may in turn prevent half of these. The method is especially important as a backup to condoms, which as a result of successful education campaigns, are now widely used to protect against sexually transmitted disease. Condoms also work as prophylactics, of course, and recent research shows that their greater availability actually accounts for a significant percentage of the substantial decline in adolescent pregnancy that has been achieved in this country in the past decade--a welcome if often unheralded decline of nearly 20%. The only problem is that, even with good intentions, condoms have a high contraceptive failure rate and need a “Plan B,†as one of the new emergency contraception products is being called.
One encouraging sign is that not all antiabortion groups have vilified emergency contraception. Earlier this year, Virginia’s General Assembly came within a few votes of passing a bill to permit pharmacists to prescribe the pill, and the National Right to Life Committee took no position in the debate. Though some conservatives in the state remain opposed, others have listened to the testimony and offered support.
On the matter of San Bernardino’s public health clinics, however, it is the Bush administration that must keep an open mind. So far, health officials have resisted stopping distribution of the pills, citing a federal mandate that they do so in the absence of a waiver. Such waivers are granted only in “exceptional circumstances,†which the San Bernardino supervisors maintain is the case there. The impasse between county supervisors and state health officials must be resolved in Washington. With the decision now in the hands of the Department of Health and Human Services, the entire country is watching to see whether reason or politics prevails.
