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Post-Election, 'Morning After' Pill Advocates Want Age Rules Revisited

Dec 7, 2012
Originally published on December 7, 2012 9:20 am

Friday marks a not-so-happy anniversary for some of President Obama's biggest supporters: It's exactly one year since Health and Human Services Secretary Kathleen Sebelius decided not to lift the age restrictions on availability of the so-called morning-after pill, Plan B.

But now, with the election safely behind them, backers of the pill are hoping the administration may be willing to revisit the issue.

"We are asking Secretary Sebelius to go back and take another look at the science, the medical evidence ... and see if there's a way to come to agreement to make this product more easily available to the women who need it," says Kirsten Moore, president and CEO of the Reproductive Health Technologies Project.

Moore points out that during the past year, the American Congress of Obstetricians and Gynecologists has recommended that all birth control pills be sold over the counter, while the American Academy of Pediatrics has recommended routine advance prescription of the morning-after pill to teen girls.

Over-The-Counter Access

Since 2009, emergency contraceptives have been available under what's known as a split label. That means those ages 16 and under need a prescription for the product, which is really just a high dose of regular birth control pills. It is not the same as the abortion pill, RU-486.

But the split label also means that even those old enough to buy the product without a prescription must ask a pharmacist for it — and show ID. Moore says that's not the ideal situation for a product that works best when taken as soon as possible: Plan B is most effective if taken within 24 hours of unprotected intercourse.

"Having Plan B on the shelf between condoms and pregnancy test kits is where it belongs, not behind the counter," she says.

Plus, when it's behind the counter, it's not just younger women who may have trouble getting it. Last year, Oklahoma law student Hilary McKinney went to a nearby Target with her fiance after his condom broke. She sent him to the pharmacy counter to pick it up. But the pharmacist wouldn't sell it to him.

McKinney returned to the counter and confronted the pharmacist, she says, "and she looked at me and said, 'I can't sell it to men. Who knows what they could be doing with it?' "

For the record, Plan B is supposed to be available to anyone 17 or older without a prescription, male or female. (The FDA originally approved the drug without prescription for those ages 18 and over in 2006; it lowered the age to 17 after a judge's order three years later.)

McKinney, who now practices family law in Tulsa, says her experience is an example of why she thinks the product ought to be much more easily available.

"We never invited this pharmacist into making our reproductive choices with us," she says. "And she shouldn't have intervened in what is a legal, safe, effective way of preventing a pregnancy, which is what we were trying to do."

Last December, with a Democratic administration, Plan B advocates were sure the age restriction would be lifted. And that's what FDA commissioner Margaret Hamburg recommended. But she was overruled by Sebelius, who said she was worried about use by the youngest teenagers.

However, many people assumed the decision was a political one. Catholics were already up in arms about contraceptives being required under the federal health law, and it was thought that the administration didn't want to add any more fuel to the fire with the election approaching.

A New Political Climate?

Now, however, things are different, Moore says.

"The voters said very clearly this past November that when it comes to women's health, they think that prevention is a good thing; providing contraception is a good thing; reducing barriers to access, whether it be cost, is a good thing," she says. "And they supported a candidate who clearly made that a part of his message."

Moreover, Moore says, she thinks the election shows that there would be no political price to be paid by the administration for making what advocates say is the science-based decision.

"If there was concern that doing the right thing by emergency contraception was going to get people into trouble," she says, "I think that question's been asked and answered politically."

That is not to suggest that the political opposition to making Plan B more widely available has disappeared.

"The reality is if it's easier to obtain, then it becomes not 'Plan B' but 'Plan A,' " says Wendy Wright, a vice president at the Catholic Family and Human Rights Institute. "It becomes the choice of first resort rather than last resort."

Wright also says younger girls are more at risk of being abused and need the contact with a medical professional ensured by requiring a prescription.

"If young girls are sexually active, they're very likely the victims of sexual abuse, and a medical exam provides the opportunity for someone to intervene to rescue a girl who is being sexually abused," Wright says. "And so it really is in the best interest of girls, having the morning-after pill only through prescription to ensure that not only are her medical needs being met, but also to ensure that she's not being abused."

The Obama administration, meanwhile, had no comment as to whether it plans to revisit its decision to keep the current age restrictions in place.

Copyright 2013 NPR. To see more, visit http://www.npr.org/.

Transcript

DAVID GREENE, HOST:

It has been one year since the Obama administration made an important decision about what's commonly known as the morning after pill. The Secretary of Health and Human Services left age restrictions in place, disappointing many of President Obama's supporters. Now with the presidential election over, backers are hoping the administration will revisit the issue. Here's NPR's Julie Rovner.

JULIE ROVNER, BYLINE: Since 2009, emergency contraceptives have been available under what's known as a split label. That means those ages 16 and under need a prescription for the product, which is really just a high dose of regular birth control pills. But it also means that even those old enough to buy the product without a prescription must ask a pharmacist for it and show ID.

Kirsten Moore of the Reproductive Health Technologies Project says that's not the ideal situation for a product that works best when taken as soon as possible. Plan B is most effective if taken within 24 hours of unprotected intercourse.

KIRSTEN MOORE: Having Plan B on the shelf between condoms and pregnancy test kits is where it belongs, not behind the counter.

ROVNER: That's because when it's behind the counter, it's not just younger women who may have trouble getting it. Last year, Oklahoma law student Hilary McKinney went to a nearby Target with her fiance after their condom broke.

HILARY MCKINNEY: And when we got there, I sent him over to the pharmacy counter to pick it up, and he came back a few minutes later and he said the pharmacist won't sell it to me. And I said, why? He said, well, because they say they can't sell it to men.

ROVNER: McKinney returned to the counter and confronted the pharmacist.

MCKINNEY: And she looked at me and said, I can't sell it to men. Who knows what they could be doing with it?

ROVNER: Now for the record, Plan B is supposed to be available to anyone 17 or over without a prescription, male or female. McKinney, who now practices family law in Tulsa, says it's an example of why she thinks the product ought to be much more easily available.

MCKINNEY: We never invited this pharmacist into making our reproductive choices with us. And she shouldn't have intervened in what is a legal, safe, effective way of preventing a pregnancy, which is what we were trying to do.

ROVNER: Which brings us to last December, with a Democratic administration, Plan B advocates were sure the age restriction would be lifted. And that's what FDA commissioner Margaret Hamburg recommended. But she was overruled by Health and Human Services Secretary Kathleen Sebelius. Sebelius said she was worried about use by the youngest teenagers, but most people assumed the decision was a political one.

Catholics were already up in arms about contraceptives being required under the federal health law. It was assumed the administration didn't want to add any more fuel to the fire with the election approaching. Now, however, says Plan B advocate Moore, things are different.

MOORE: The voters said very clearly this past November that when it comes to women's health, they think that prevention is a good thing, providing contraception is a good thing, reducing barriers to access, whether it be cost, is a good thing. And they supported a candidate who clearly made that a part of his message.

ROVNER: Moreover, Moore says, she thinks the election showed that there would be no political price to be paid for making what advocates say is the science-based decision.

MOORE: If there was concern that doing the right thing by emergency contraception was going to get people into trouble, I think that question's been asked and answered politically.

ROVNER: Of course, there is still a lot of opposition to making Plan B more widely available. Wendy Wright is with the Catholic Family and Human Rights Institute.

WENDY WRIGHT: The reality is that if it's easier to obtain, then it becomes not Plan B, but Plan A. It becomes the choice of first resort, rather than last resort.

ROVNER: Wright also says younger girls who are sexually active are more at risk of being abused, and need the contact with a medical professional ensured by requiring a prescription.

WRIGHT: And so it really is in the best interest of girls to continue having the morning after pill available only through prescription to ensure that not only are her medical needs being met, but also to ensure that she's not being abused.

ROVNER: Meanwhile, the Obama administration had no comment as to whether it plans to revisit its decision to keep the current age restrictions in place. Julie Rovner, NPR News, Washington. Transcript provided by NPR, Copyright NPR.