It started around February, when Republicans were still eager to
talk about contraception. The Obama administration, or so Mitt Romney
charged
in Colorado, was forcing religious institutions to provide
“morning-after pills –in other words abortive pills — and the like, at
no cost.”
It was, of course, a lie. Romney was conflating two different pills:
emergency contraception, known as the morning-after pill, which prevents
a pregnancy; and chemical abortion, or mifepristone, which ends a
pregnancy of up to seven weeks’ gestation and isn’t covered under the
new guidelines. Since both pills were marketed in the U.S. around the
same time, even some pro-choicers have gotten confused. But Colorado
happens to be the epicenter of people confusing them on purpose. It’s
the birthplace of the Personhood movement and home to Focus on the
Family, both of which have strategically called emergency contraception
“abortion” on the scientifically unproven basis that they could block a
fertilized egg from implanting.
There are a host of ironies here. Obama has earned the renewed
support of reproductive-rights advocates by requiring health insurers to
cover contraception, but the Center for Reproductive Rights is still
taking him to court – with oral hearings being held this week before a
New York federal court -– for overruling the FDA’s recommendation to
lift the prescription requirement on emergency contraception for women
under 17. That litigation has been winding its way through the system
for over a decade, throughout the Bush-era politicization of the FDA,
eventually resulting in a federal judge concluding that “the FDA
repeatedly and unreasonably delayed issuing a decision on [the emergency
contraception pill] Plan B for suspect reasons.” The FDA was ordered to
explain why Plan B shouldn’t be available over the counter for girls 13
and up. When the Obama administration overruled the FDA’s
recommendation to make it over the counter, U.S. District Judge Edward
Korman suggested the Center for Reproductive Rights reopen its case.
“It seems to me that what we’re going through is a rerun of what
happened before,” Korman remarked, referring to politics trumping the
recommendations of medical professionals.
The Obama administration’s unspoken but unmistakable fear was of an election-cycle attack line that Michele Bachmann would
use anyway:
That teenage girls would be able to get Plan B from “the grocery store
aisles next to bubble gum and next to M&Ms.” That was, in fact, an
echo of the language President Obama himself
used to
invoke a highly unsupported bogeyman: that “a 10-year-old or
11-year-old going to a drugstore would be able to, alongside bubble gum
or batteries, … buy a medication that potentially if not used properly
can have an adverse effect.”
But there is another twist, so far mostly overlooked: Emergency contraception
won’t be
covered by insurance for everyone, since it’s available
over-the-counter for those who can show I.D. proving that they’re 17 or
older. They’ll still have to fork over around $50 a pop. But as long as
girls 16 and younger need a prescription for the morning-after pill and
they have insurance, it will be fully covered — effectively free. The
same goes for women older than 17 who decide to jump through the hoops
of getting a prescription, either for over-the-counter Plan B or the
prescription-only generic and Ella versions.
As much as pro-choice advocates want to lift the barriers that make
emergency contraception hard to get — because it’s more effective the
faster you use it — one of those barriers, the prescription requirement,
also mitigates another, the high cost. Said Adam Sonfield, a senior
public policy associate at the Guttmacher Institute, of this catch-22,
“It presents a tradeoff between cost and access.”
– – — – — – — – — – — – — – — – — – — – — – — – –
Part of the reason people get confused about emergency contraception
and abortion is because lots of people are confused about the basic
biology of pregnancy: specifically, that it doesn’t necessarily happen
instantaneously and that sperm can live in the body for several days,
during which time a woman can ovulate and an egg can potentially be
fertilized and implant. Regular use of hormonal contraception prevents
ovulation and the chance for fertilization; emergency contraception
essentially works the same way except that it’s taken after sex, by
which point ovulation may have already happened. But according to recent
studies, there is no evidence that taking emergency contraception after
ovulation and fertilization will stop the egg from implanting.
But the misinformation and misunderstanding have created a
contradictory public health picture when it comes to emergency
contraception. In some ways, it’s become more accessible. In 2010, the
U.S. approved a longer-acting French variant of Plan B, known as Ella,
and there are scattered experiments in convenient delivery, from a
birth-control
vending machine at Shippensburg University in Pennsylvania to a new
bike messenger service in London, both of which caused minor news sensations. The annual “Back Up Your Birth Control”
campaign
has been promoting the line “EC=BC,” emphasizing that emergency
contraception is birth control, not abortion — just in case that is a
barrier for women who are considering taking it. And the Center for
Reproductive Rights’ petition did manage to lower the age restriction
from 18 to 17.
But there are more disturbing suggestions that misinformation is triumphing. A recent Boston Medical Center study
found
that many pharmacists were still often misinformed about the age
requirement and were even more likely to wrongly refuse emergency
contraception to 17-year-olds in low-income neighborhoods, where the
rate of unintended pregnancy is higher. In Honduras, the Supreme Court
upheld the
criminalization of emergency contraception, which means women who use
it could be jailed. Personhood initiatives, which oppose the
morning-after pill, have so far failed in Colorado, Mississippi and
Oklahoma, but they’ve introduced false doubts by providing even more
opportunities for
pundits and candidates to say “the morning-after abortion pill.”
It’s a problem that dates back decades: When, throughout the ’90s,
the U.S. considered approving a French chemical abortion pill known as
RU-486, it was widely called the “morning-after abortion pill,”
including,
often,
in the New York Times. The distinction wasn’t pressed by the pro-choice
community itself. “At the time, the prevailing medical wisdom was that
there is a continuum rather than a bright line between EC and
mifepristone,” said Gloria Feldt, who was president of Planned
Parenthood at the time, with the benefit providing more options for
women who did not wish to be pregnant. “It was also assumed that a
formulation of mifepristone would eventually be made for use as a true
‘morning-after’ pill.” The widespread belief, she recalled, was that a
chemical abortion pill would “solve all the abortion debate problems and
guarantee privacy.”
Another problem was that although doctors and non-professionals had
been giving women high dosages of regular birth control pills for
decades as a form of emergency contraception, the science of exactly how
emergency contraception worked remained unclear. The medical definition
of pregnancy remains “implantation of a fertilized egg,” but let’s say
you believe, as the Catholic Church does, that fertilization itself
creates a human life. Anti-choice advocates obsess over what would
happen if a woman who took emergency contraception
did happen to ovulate anyway and an egg
potentially
was fertilized, which is enough reason for some of them to call
postcoital contraception “abortion.” They have claimed that hormonal
contraception makes the lining of the endometrium inhospitable to a
fertilized egg, constituting “murder.” Even the official packaging for
Plan B, the single-step version of emergency contraception, suggests
that “in addition” to blocking ovulation and fertilization, “it may
inhibit implantation (by altering the endometrium).”
Except that we now know it
doesn’t, even if you walk down
the path of remote maybes, which requires you to believe that a zygote,
which may not implant for unknowable reasons, has the same rights as a
living woman who doesn’t want to be pregnant. As Princeton’s Kelly
Cleland
pointed out
recently, “The science has evolved considerably in the last 13 years.
Newer evidence, published since the Plan B label was approved, provides
compelling evidence that levonorgestrel EC (LNG EC) works before
ovulation, but not after.” The International Consortium for Emergency
Contraception and the International Federation of Gynecology &
Obstetrics also
note that two
new studies have shown conclusively that if a woman has ovulated and an
egg has been fertilized, it’s too late for emergency contraception to
work. They recommended that the language on the product labeling be
changed.
Of course, scientific evidence has rarely had much place in this
debate. In the meantime, even the most non-ideological news sources keep
making the mistake alongside the ideologues. Last week, a furor erupted
after the Associated Press reported that “Women seeking to take
emergency contraception like the so-called ‘morning after’ pill would
have to do so in the presence of a doctor under a bill before the
Alabama legislature.” That is, until Erin Gloria Ryan from Jezebel
read
the actual bill and saw that it was, in fact, a law meant to limit
chemical abortion, not emergency contraception. (A spokesperson for the
AP said a correction was being prepared). “The confusion over this issue
is probably one of the reasons emergency contraception hasn’t had as
positive an impact as hoped when it comes to lowering the abortion
rate,”
wrote
Amanda Marcotte at RH Reality Check. “If women think it is some kind of
abortion-ish thing, they probably think taking it is a big deal,
instead of thinking of it more like taking the pill, since it’s
basically the same thing.”
But talk about moved goalposts. If ’90s-era advocates had hoped that
the ability to end a pregnancy in the safety of your home with RU-486 —
the actual abortion pill, not the morning-after one — would defuse the
abortion debate, their more recent counterparts hoped to take it to the
next technological level by providing “tele-med” abortions. They would
involve doctors seeing a woman over webcam with a nurse practitioner
physically present, helping women in remote areas with ever-dwindling
options for safe abortions to access them. But four states have already
passed
requirements meant to undercut these options by forcing a doctor’s
presence, and the bill the Associated Press misreported was aiming to
add Alabama to the list. All in all, there have been fewer gamechangers,
and more cases of one step forward, two steps back.
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