Bitter Pill: How DC’s Pharmacies Fail Women

Amanda Hess

Pharmacists in D.C. can and do refuse to provide women's health care based on such "personal views" as latent sexism, unsubstantiated medical opinion, or whim.

For most professionals, an acceptable excuse is required to miss
work: a swollen appendix, ailing grandmother, whiplash, at the very
least.

Pharmacists, on the other hand, may refuse to do their jobs for any
old reason – or for none at all. We’re talking about birth control, of
course. In the District, for example, pharmacists are not required to
provide such products, especially if their "personal views" won’t allow
it. According to NARAL Pro-Choice America, only six states bar
pharmacists from withholding birth control prescriptions/doing their
jobs: California, Illinois, Maine, Nevada, New Jersey, and Washington.

That means that D.C. is a hotbed of the ultimate bullshit defense
for denying health care to women. Pharmacists here can refuse to
provide women’s health care based on such "personal views" as latent
sexism, unsubstantiated medical opinion, or whim. Some other "personal
views" local pharmacies have offered up:

It’s private. A pharmacy’s trust factor often
relies on its adherence to privacy – its hushed consultations, the 3-foot
courtesy bubble between customers, pills wrapped in nondescript white
paper packaging. For contraception allies, these conventions help keep
birth control a personal transaction not subject to political
interference. But right across the counter, the "privacy" excuse allows
pharmacists to deny you access to contraception at any time while
shirking explanation and accountability-no questions asked. A flack for
Wellington Pharmacy defers to the privacy excuse – "it’s a relationship
between a person and their physician" – as to why the pharmacy,
affiliated with Catholic-leaning Providence Hospital, provides Viagra
but no birth control.

Appreciate our work?

Vote now! And help Rewire earn a bigger grant from CREDO:

VOTE NOW

This pharmacy is here to deny your rights. Those
not interested in providing medications to humans can choose from a
host of careers that are not involved in providing medications to
humans. And yet, the D.C. area is home to several anti-contraception
advocates that insist upon going the pharmaceutical route. For all
these pharmacies gets wrong about women’s health – namely, their
positions on condoms, birth control, and the morning-after pill – they
often get one thing right: At the most fanatical anti-contraception
outfits, women at least know what they’re not getting. America’s latest
pro-life pharmaceutical poster child, Chantilly’s Divine Mercy Care
Pharmacy, defied the tight-lipped industry standard with its grand
opening last fall. Holy water slicked the shelves. A bishop blessed the
operation. The AP took video. But though the DMC is the only local
pharmacy affiliated with anti-contraception group Pharmacists for Life
International, it’s less dangerous than the other area pharmacies
quietly denying access to birth control.

They’ve got inventory issues. On a recent Saturday,
I contacted 10 local CVS pharmacies to see if they had the
morning-after pill in stock. Nine did. The pharmacist at the one that
didn’t informed me that his store’s Plan B shipments arrived on
Tuesdays, so I would just have to wait 72 hours to get my hands on the
pill. Never mind that the effectiveness of Plan B decreases with each
hour after unprotected sex, and that after 72 hours, its chances of
preventing pregnancy are kaput. The representative at another CVS that
did have the pill informed me they only had two pill packs left on the
shelf. They, too, received new shipments only once a week, on Tuesdays,
so my chances of getting the morning after pill depend on a guessing
game of how many condoms broke in the District of Columbia in any given
week. Here’s a tip, CVS shoppers: If you’re going to need to use the
morning-after pill, just make sure that morning falls on a Wednesday.

They’re weirdos. Though it’s not uncommon for
pharmacists to operate behind a shield of privacy, some display a
distaste for discussing women’s health that borders on good
old-fashioned sexism. When it comes to contraception, pharmacists are
often skittish about discussing the most basic aspect of their
business – which prescriptions they will fill and which they will not.
And it’s not just pharmacies with moral motivations against
contraception that aren’t talking. In a telephone interview, the
proprietor at Dupont’s Tschiffely Pharmacy refused to discuss whether
the shop dispensed the morning-after pill. But when I stopped in to try
to pick up a pill pack, Plan B was in stock and offered with a smile.
Georgetown’s Dumbarton Pharmacy, meanwhile, declined to discuss its
contraceptive options at all. Playing coy with contraceptive options is
less cute when women need to locate them instantly in order for them to
work. No other common, FDA-approved, over-the-counter medication would
receive such silent treatment from pharmacists.

Even chain stores like Rite Aid and CVS, which have national
policies that adhere to the contraception-access requirement of the six
aforementioned states, must draft elaborate plans by which to protect
their pharmacists’ idiosyncrasies. Sometimes, those quirks mean losing
business. Take Rite Aid’s policy, which outlines a three-step plan by
which a pharmacist can avoid personally filling your birth control
prescription: 1) Have another technician fill the prescription; 2) if
there is no other technician on hand, contact the closest Rite Aid to
dispense the medication, then have the prescription delivered back to
the customer’s preferred Rite Aid location; 3) if no other local Rite
Aid pharmacist will consent to dispensing birth control, locate the
nearest competitor that will fill the customer’s need, then follow
through until that need is met.

They don’t trust you – or your doctor. Cathedral
Pharmacy owner Paul Beringer, a Catholic, will not provide the
morning-after pill. "I consider it abortion," he says. Non-emergency
contraception is dispensed on a case-by-case basis – meaning that the
pharmacist can nullify the decision of your medical doctor because he
thinks a prescription might be faked, is uncomfortable dispensing
contraception to women under the age of 18, or otherwise wishes to
impose his "personal views" on your body.

They fear your vagina. Target Pharmacy provides
prescription birth control as well as the morning-after pill. Other
women’s health products, however, aren’t available even with a doctor’s
signature.

Parker, 27, who declined to give her full name, came to the pharmacy
straight from work with a prescription from her gynecologist’s office.
It was 5:30 p.m. and raining, and she needed to fill the prescription
that evening in order to prep for a procedure scheduled for the next
morning.

But Target’s pharmacist refused to fill the prescription because the
doctor instructed that the pill was to be inserted vaginally. Parker’s
doctor had prescribed her Cytotec, an FDA-approved treatment for
ulcers. The medication is also routinely prescribed off-label to dilate
the cervix to induce labor in pregnant women, or, in Parker’s case, to
aid in the insertion of an IUD. Parker – who wasn’t pregnant – learned
later that the medication can also be used to induce abortion.

The pharmacist, who did not give her name, says she rebuffed
Parker’s prescription because she disagreed with the doctor’s
insistence on vaginal insertion."That’s not how it’s supposed to be
prescribed," she says. "It’s supposed to be taken orally."

The pharmacist says she tried to call Parker’s doctor’s office but
wasn’t able to reach anyone at the late hour. Parker says the
pharmacist never picked up the phone while she was there and that she
had to beg her to consult her doctor before she got an explanation – that
the office would be closed and there was nothing she could do.

Parker left the pharmacy in tears. "I got a little hysterical," she
says. "I couldn’t believe that this pharmacist, who has less training
than my doctor, would deny me this medication that I needed, because it

was specified that it went in the vagina?"

After asking for the name of a supervisor, Parker took solace in
Columbia Heights’ other chain pharmacy. Still red-eyed, she crossed the
street to the CVS. There, "a very nice, flirtatious Latino man filled
my prescription, no questions asked."

This article was first published on The Sexist blog at the Washington City Paper.

Commentary Contraception

Hillary Clinton Played a Critical Role in Making Emergency Contraception More Accessible

Susan Wood

Today, women are able to access emergency contraception, a safe, second-chance option for preventing unintended pregnancy in a timely manner without a prescription. Clinton helped make this happen, and I can tell the story from having watched it unfold.

In the midst of election-year talk and debates about political controversies, we often forget examples of candidates’ past leadership. But we must not overlook the ways in which Hillary Clinton demonstrated her commitment to women’s health before she became the Democratic presidential nominee. In early 2008, I wrote the following article for Rewirewhich has been lightly edited—from my perspective as a former official at the U.S. Food and Drug Administration (FDA) about the critical role that Clinton, then a senator, had played in making the emergency contraception method Plan B available over the counter. She demanded that reproductive health benefits and the best available science drive decisions at the FDA, not politics. She challenged the Bush administration and pushed the Democratic-controlled Senate to protect the FDA’s decision making from political interference in order to help women get access to EC.

Since that time, Plan B and other emergency contraception pills have become fully over the counter with no age or ID requirements. Despite all the controversy, women at risk of unintended pregnancy finally can get timely access to another method of contraception if they need it—such as in cases of condom failure or sexual assault. By 2010, according to National Center for Health Statistics data, 11 percent of all sexually experienced women ages 15 to 44 had ever used EC, compared with only 4 percent in 2002. Indeed, nearly one-quarter of all women ages 20 to 24 had used emergency contraception by 2010.

As I stated in 2008, “All those who benefited from this decision should know it may not have happened were it not for Hillary Clinton.”

Now, there are new emergency contraceptive pills (Ella) available by prescription, women have access to insurance coverage of contraception without cost-sharing, and there is progress in making some regular contraceptive pills available over the counter, without prescription. Yet extreme calls for defunding Planned Parenthood, the costs and lack of coverage of over-the-counter EC, and refusals by some pharmacies to stock emergency contraception clearly demonstrate that politicization of science and limits to our access to contraception remain a serious problem.

Appreciate our work?

Vote now! And help Rewire earn a bigger grant from CREDO:

VOTE NOW

Today, women are able to access emergency contraception, a safe, second chance option for preventing unintended pregnancy in a timely manner without a prescription. Sen. Hillary Clinton (D-NY) helped make this happen, and I can tell the story from having watched it unfold.

Although stories about reproductive health and politicization of science have made headlines recently, stories of how these problems are solved are less often told. On August 31, 2005 I resigned my position as assistant commissioner for women’s health at the Food and Drug Administration (FDA) because the agency was not allowed to make its decisions based on the science or in the best interests of the public’s health. While my resignation was widely covered by the media, it would have been a hollow gesture were there not leaders in Congress who stepped in and demanded more accountability from the FDA.

I have been working to improve health care for women and families in the United States for nearly 20 years. In 2000, I became the director of women’s health for the FDA. I was rather quietly doing my job when the debate began in 2003 over whether or not emergency contraception should be provided over the counter (OTC). As a scientist, I knew the facts showed that this medication, which can be used after a rape or other emergency situations, prevents an unwanted pregnancy. It does not cause an abortion, but can help prevent the need for one. But it only works if used within 72 hours, and sooner is even better. Since it is completely safe, and many women find it impossible to get a doctor’s appointment within two to three days, making emergency contraception available to women without a prescription was simply the right thing to do. As an FDA employee, I knew it should have been a routine approval within the agency.

Plan B emergency contraception is just like birth control pills—it is not the “abortion pill,” RU-486, and most people in the United States don’t think access to safe and effective contraception is controversial. Sadly, in Congress and in the White House, there are many people who do oppose birth control. And although this may surprise you, this false “controversy” not only has affected emergency contraception, but also caused the recent dramatic increase in the cost of birth control pills on college campuses, and limited family planning services across the country.  The reality is that having more options for contraception helps each of us make our own decisions in planning our families and preventing unwanted pregnancies. This is something we can all agree on.

Meanwhile, inside the walls of the FDA in 2003 and 2004, the Bush administration continued to throw roadblocks at efforts to approve emergency contraception over the counter. When this struggle became public, I was struck by the leadership that Hillary Clinton displayed. She used the tools of a U.S. senator and fought ardently to preserve the FDA’s independent scientific decision-making authority. Many other senators and congressmen agreed, but she was the one who took the lead, saying she simply wanted the FDA to be able to make decisions based on its public health mission and on the medical evidence.

When it became clear that FDA scientists would continue to be overruled for non-scientific reasons, I resigned in protest in late 2005. I was interviewed by news media for months and traveled around the country hoping that many would stand up and demand that FDA do its job properly. But, although it can help, all the media in the world can’t make Congress or a president do the right thing.

Sen. Clinton made the difference. The FDA suddenly announced it would approve emergency contraception for use without a prescription for women ages 18 and older—one day before FDA officials were to face a determined Sen. Clinton and her colleague Sen. Murray (D-WA) at a Senate hearing in 2006. No one was more surprised than I was. All those who benefited from this decision should know it may not have happened were it not for Hillary Clinton.

Sometimes these success stories get lost in the “horse-race stories” about political campaigns and the exposes of taxpayer-funded bridges to nowhere, and who said what to whom. This story of emergency contraception at the FDA is just one story of many. Sen. Clinton saw a problem that affected people’s lives. She then stood up to the challenge and worked to solve it.

The challenges we face in health care, our economy, global climate change, and issues of war and peace, need to be tackled with experience, skills and the commitment to using the best available science and evidence to make the best possible policy.  This will benefit us all.

News Human Rights

What’s Driving Women’s Skyrocketing Incarceration Rates?

Michelle D. Anderson

Eighty-two percent of the women in jails nationwide find themselves there for nonviolent offenses, including property, drug, and public order offenses.

Local court and law enforcement systems in small counties throughout the United States are increasingly using jails to warehouse underserved Black and Latina women.

The Vera Institute of Justice, a national policy and research organization, and the John D. and Catherine T. MacArthur Foundation’s Safety and Justice Challenge initiative, released a study last week showing that the number of women in jails based in communities with 250,000 residents or fewer in 2014 had grown 31-fold since 1970, when most county jails lacked a single woman resident.

By comparison, the number of women in jails nationwide had jumped 14-fold since 1970. Historically, jails were designed to hold people not yet convicted of a crime or people serving terms of one year or less, but they are increasingly housing poor women who can’t afford bail.

Eighty-two percent of the women in jails nationwide find themselves there for nonviolent offenses, including property, drug, and public order offenses.

Appreciate our work?

Vote now! And help Rewire earn a bigger grant from CREDO:

VOTE NOW

Overlooked: Women and Jails in an Era of Reform,” calls attention to jail incarceration rates for women in small counties, where rates increased from 79 per 100,000 women to 140 per 100,000 women, compared to large counties, where rates dropped from 76 to 71 per 100,000 women.

The near 50-page report further highlights that families of color, who are already disproportionately affected by economic injustice, poor access to health care, and lack of access to affordable housing, were most negatively affected by the epidemic.

An overwhelming percentage of women in jail, the study showed, were more likely to be survivors of violence and trauma, and have alarming rates of mental illness and substance use problems.

“Overlooked” concluded that jails should be used a last resort to manage women deemed dangerous to others or considered a flight risk.

Elizabeth Swavola, a co-author of “Overlooked” and a senior program associate at the Vera Institute, told Rewire that smaller regions tend to lack resources to address underlying societal factors that often lead women into the jail system.

County officials often draft budgets mainly dedicated to running local jails and law enforcement and can’t or don’t allocate funds for behavioral, employment, and educational programs that could strengthen underserved women and their families.

“Smaller counties become dependent on the jail to deal with the issues,” Swavola said, adding that current trends among women deserves far more inquiry than it has received.

Fred Patrick, director of the Center on Sentencing and Corrections at the Vera Institute, said in “Overlooked” that the study underscored the need for more data that could contribute to “evidence-based analysis and policymaking.”

“Overlooked” relies on several studies and reports, including a previous Vera Institute study on jail misuse, FBI statistics, and Rewire’s investigation on incarcerated women, which examined addiction, parental rights, and reproductive issues.

“Overlooked” authors highlight the “unique” challenges and disadvantages women face in jails.

Women-specific issues include strained access to menstrual hygiene products, abortion care, and contraceptive care, postpartum separation, and shackling, which can harm the pregnant person and fetus by applying “dangerous levels of pressure, and restriction of circulation and fetal movement.”

And while women are more likely to fare better in pre-trail proceedings and receive low bail amounts, the study authors said they are more likely to leave the jail system in worse condition because they are more economically disadvantaged.

The report noted that 60 percent of women housed in jails lacked full-time employment prior to their arrest compared to 40 percent of men. Nearly half of all single Black and Latina women have zero or negative net wealth, “Overlooked” authors said.

This means that costs associated with their arrest and release—such as nonrefundable fees charged by bail bond companies and electronic monitoring fees incurred by women released on pretrial supervision—coupled with cash bail, can devastate women and their families, trapping them in jail or even leading them back to correctional institutions following their release.

For example, the authors noted that 36 percent of women detained in a pretrial unit in Massachusetts in 2012 were there because they could not afford bail amounts of less than $500.

The “Overlooked” report highlighted that women in jails are more likely to be mothers, usually leading single-parent households and ultimately facing serious threats to their parental rights.

“That stress affects the entire family and community,” Swavola said.

Citing a Corrections Today study focused on Cook County, Illinois, the authors said incarcerated women with children in foster care were less likely to be reunited with their children than non-incarcerated women with children in foster care.

The sexual abuse and mental health issues faced by women in jails often contribute to further trauma, the authors noted, because women are subjected to body searches and supervision from male prison employees.

“Their experience hurts their prospects of recovering from that,” Swavola said.

And the way survivors might respond to perceived sexual threats—by fighting or attempting to escape—can lead to punishment, especially when jail leaders cannot detect or properly respond to trauma, Swavola and her peers said.

The authors recommend jurisdictions develop gender-responsive policies and other solutions that can help keep women out of jails.

In New York City, police take people arrested for certain non-felony offenses to a precinct, where they receive a desk appearance ticket, or DAT, along with instructions “to appear in court at a later date rather than remaining in custody.”

Andrea James, founder of Families for Justice As Healing and a leader within the National Council For Incarcerated and Formerly Incarcerated Women and Girls, said in an interview with Rewire that solutions must go beyond allowing women to escape police custody and return home to communities that are often fragmented, unhealthy, and dangerous.

Underserved women, James said, need access to healing, transformative environments. She cited as an example the Brookview House, which helps women overcome addiction, untreated trauma, and homelessness.

James, who has advocated against the criminalization of drug use and prostitution, as well as the injustices faced by those in poverty, said the problem of jail misuse could benefit from the insight of real experts on the issue: women and girls who have been incarcerated.

These women and youth, she said, could help researchers better understand the “experiences that brought them to the bunk.”

credo_rewire_vote_3

Vote for Rewire and Help Us Earn Money

Rewire is in the running for a CREDO Mobile grant. More votes for Rewire means more CREDO grant money to support our work. Please take a few seconds to help us out!

VOTE!

Thank you for supporting our work!