Got Birth Control? Today, Back It Up!

Amy Boldosser

Sales of Plan B have doubled since it became available OTC and surveys show most major pharmacy chains are now stocking it. Yet myths about EC are still prevalent and very real barriers to access remain.

Wednesday, March 25 is Back Up Your Birth Control Day!

Back Up Your Birth Control
is a national campaign to raise awareness of and expand access to
emergency contraception (EC). As
we celebrate the eighth annual BUYBC Day of Action, hundreds of advocates and health
care providers across the country will help spread the message that EC is a
safe and effective way for women to prevent pregnancy after unprotected sex.
This is a crucial time to expand education about EC. In the current economic
climate when women are losing jobs and health
coverage, they need to know how to back up their birth control
(or replace the regular birth control methods they can no longer afford) with
EC more than ever. We hope you’ll join us in raising awareness of what has
often been called "the best kept secret in women’s health" – emergency contraception.

On August 24, 2006, when the FDA approved Plan B for over-the-counter (OTC)
sale without a prescription to women and men ages 18 and older, I was working
to expand access to EC for low-income women and teens in Title X clinics. A
colleague approached me that afternoon and said "well, I guess you’ll be
looking for a new job. Now that EC is available over-the-counter, the access
problem is solved!" How I wish that were true.

From the first BUYBC Day in 2002 to today we can look proudly at Rosie the
Riveter, our BUYBC "poster woman," and say, "You’ve come a long way, baby." Sales
of Plan B have doubled since it became available OTC and surveys show most
major pharmacy chains are now stocking it. Advocacy organizations, departments
of health, campus groups, pharmacist’s associations, and medical providers have
created a wide variety of EC education and outreach campaigns. Yet despite
these efforts and increased availability, myths about EC are still prevalent and
very real barriers to access remain.

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Results of annual surveys of BUYBC participants consistently rank lack of
awareness of EC and of how to access EC as the primary barriers to EC access,
ahead of other barriers like cost or age restrictions. Women can’t be empowered
to back up their birth control and prevent unintended pregnancy if they don’t
know about EC, and have the facts on how it works or where they can access it.

education is needed to address the barriers to EC access by teens, low-income
and immigrant women created by the FDA decision. The
recent court ruling in the Center for Reproductive Rights case against the FDA
will soon expand access to EC OTC to 17 year old women. The ruling also means
that the FDA will need to reconsider the sale of Plan B OTC to women of all ages;
however, no timeline is provided for how soon that might happen. In the
meantime, teens must still obtain a prescription in order to access EC, despite
a lack of any scientific evidence demonstrating EC is unsafe for them.

high cost of EC OTC, usually $40-70, poses a significant barrier to low-income
women, or to those whose budgets are tight right now. Only eight state Medicaid
programs currently cover EC OTC, and efforts to expand this number are being
severely challenged by state budget cuts. The need to show government issued ID
as proof of age is a barrier for undocumented women and men. And the fact that
Plan B is kept behind the pharmacy counter creates a barrier to access outside
regular pharmacy hours, and the potential for pharmacists refusing to dispense
EC. Since EC is most effective the sooner it is taken after unprotected sex,
the delay caused by seeking a prescription, trying to get the money together,
or finding a pharmacy that’s open can significantly increase a woman’s risk of
unintended pregnancy. Education and outreach campaigns, like BUYBC, can help
women identify sources of free or low-cost EC, raise awareness among teens of
their right to access contraception including EC, and help undocumented people
exercise their rights to reproductive healthcare.

must also continue to dispel myths about EC, particularly the misinformation promoted
by anti-choice forces categorizing EC as an abortifacient.
Despite solid scientific evidence which proves that EC works primarily by preventing
ovulation and secondarily preventing fertilization and that EC will not
interrupt or harm an established pregnancy, proposed state laws like the "fetal
" amendment defeated in Colorado and a new law in Texas, and federal
laws such as the Bush era HHS
continue to attempt to classify EC as an abortifacient. Lawmakers
continue to allow carve outs for emergency contraception in Family Planning
Waivers, refusal laws, and by health insurance companies. Even the recent
victory fixing the provision in the 2005
Deficit Reduction Act
, which restored discount birth control pricing for
college and safety net clinics and was a victory for women’s access, doesn’t
impact EC prices since EC was never included in the birth control methods that
qualify for nominal pricing. This means that while we wait to see whether the
drug companies will restore the discounts and for lower cost birth control to
come back to campus next school year, EC will remain an important but
potentially expensive option.

of young people in abstinence-only programs have also been receiving
this misinformation about how EC works. A nationwide survey conducted by the Kaiser
Family Foundation
found that over 25% of teens surveyed believed that EC
causes abortion. This misconception must also be addressed in order to increase
access to EC for rape survivors. Currently only 16
states require emergency rooms (ER) to provide EC to rape survivors even though
timely access to EC is critical to reduce the additional trauma of a pregnancy
due to rape. Women must know they have the right to request EC, or EC
information, and lawmakers in the remaining states must be urged to stop
putting politics before science and make EC in the ER available for all

Now is a crucial time to raise awareness of EC, not just because women need
affordable access to birth control more than ever but also because there is
hope for expanded access on the horizon. President Obama’s stated
to "ensuring that scientific data is never distorted or
concealed to serve a political agenda and that we make scientific decisions
based on facts, not ideology," seems to be a direct rebuff to the political
machinations within the FDA that created the OTC barriers and the politics that
have prevented women from having timely and affordable access to EC for too
long. In addition to the win in the courts, new
staff at FDA could be poised to remove some of these barriers. The possibility
of a generic form of EC becoming available this fall when the patent on Plan B
expires could also improve access for low-income women. Advocates across the
country are continuing to fight for Medicaid coverage for EC OTC, and to ensure
that universal health care plans include coverage for EC.

While advocates work for policy gains, we must continue to raise awareness
about EC and empower women with a second chance to prevent unintended pregnancy.
Please join the activists across the country who are participating in the Back
Up Your Birth Control Day of Action. Visit this link to learn how.

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.

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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 Health Systems

Complaint: Citing Catholic Rules, Doctor Turns Away Bleeding Woman With Dislodged IUD

Amy Littlefield

“It felt heartbreaking,” said Melanie Jones. “It felt like they were telling me that I had done something wrong, that I had made a mistake and therefore they were not going to help me; that they stigmatized me, saying that I was doing something wrong, when I’m not doing anything wrong. I’m doing something that’s well within my legal rights.”

Melanie Jones arrived for her doctor’s appointment bleeding and in pain. Jones, 28, who lives in the Chicago area, had slipped in her bathroom, and suspected the fall had dislodged her copper intrauterine device (IUD).

Her doctor confirmed the IUD was dislodged and had to be removed. But the doctor said she would be unable to remove the IUD, citing Catholic restrictions followed by Mercy Hospital and Medical Center and providers within its system.

“I think my first feeling was shock,” Jones told Rewire in an interview. “I thought that eventually they were going to recognize that my health was the top priority.”

The doctor left Jones to confer with colleagues, before returning to confirm that her “hands [were] tied,” according to two complaints filed by the ACLU of Illinois. Not only could she not help her, the doctor said, but no one in Jones’ health insurance network could remove the IUD, because all of them followed similar restrictions. Mercy, like many Catholic providers, follows directives issued by the U.S. Conference of Catholic Bishops that restrict access to an array of services, including abortion care, tubal ligations, and contraception.

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Some Catholic providers may get around the rules by purporting to prescribe hormonal contraception for acne or heavy periods, rather than for birth control, but in the case of copper IUDs, there is no such pretext available.

“She told Ms. Jones that that process [of switching networks] would take her a month, and that she should feel fortunate because sometimes switching networks takes up to six months or even a year,” the ACLU of Illinois wrote in a pair of complaints filed in late June.

Jones hadn’t even realized her health-care network was Catholic.

Mercy has about nine off-site locations in the Chicago area, including the Dearborn Station office Jones visited, said Eric Rhodes, senior vice president of administrative and professional services. It is part of Trinity Health, one of the largest Catholic health systems in the country.

The ACLU and ACLU of Michigan sued Trinity last year for its “repeated and systematic failure to provide women suffering pregnancy complications with appropriate emergency abortions as required by federal law.” The lawsuit was dismissed but the ACLU has asked for reconsideration.

In a written statement to Rewire, Mercy said, “Generally, our protocol in caring for a woman with a dislodged or troublesome IUD is to offer to remove it.”

Rhodes said Mercy was reviewing its education process on Catholic directives for physicians and residents.

“That act [of removing an IUD] in itself does not violate the directives,” Marty Folan, Mercy’s director of mission integration, told Rewire.

The number of acute care hospitals that are Catholic owned or affiliated has grown by 22 percent over the past 15 years, according to MergerWatch, with one in every six acute care hospital beds now in a Catholic owned or affiliated facility. Women in such hospitals have been turned away while miscarrying and denied tubal ligations.

“We think that people should be aware that they may face limitations on the kind of care they can receive when they go to the doctor based on religious restrictions,” said Lorie Chaiten, director of the women’s and reproductive rights project of the ACLU of Illinois, in a phone interview with Rewire. “It’s really important that the public understand that this is going on and it is going on in a widespread fashion so that people can take whatever steps they need to do to protect themselves.”

Jones left her doctor’s office, still in pain and bleeding. Her options were limited. She couldn’t afford a $1,000 trip to the emergency room, and an urgent care facility was out of the question since her Blue Cross Blue Shield of Illinois insurance policy would only cover treatment within her network—and she had just been told that her entire network followed Catholic restrictions.

Jones, on the advice of a friend, contacted the ACLU of Illinois. Attorneys there advised Jones to call her insurance company and demand they expedite her network change. After five hours of phone calls, Jones was able to see a doctor who removed her IUD, five days after her initial appointment and almost two weeks after she fell in the bathroom.

Before the IUD was removed, Jones suffered from cramps she compared to those she felt after the IUD was first placed, severe enough that she medicated herself to cope with the pain.

She experienced another feeling after being turned away: stigma.

“It felt heartbreaking,” Jones told Rewire. “It felt like they were telling me that I had done something wrong, that I had made a mistake and therefore they were not going to help me; that they stigmatized me, saying that I was doing something wrong, when I’m not doing anything wrong. I’m doing something that’s well within my legal rights.”

The ACLU of Illinois has filed two complaints in Jones’ case: one before the Illinois Department of Human Rights and another with the U.S. Department of Health and Human Services Office for Civil Rights under the anti-discrimination provision of the Affordable Care Act. Chaiten said it’s clear Jones was discriminated against because of her gender.

“We don’t know what Mercy’s policies are, but I would find it hard to believe that if there were a man who was suffering complications from a vasectomy and came to the emergency room, that they would turn him away,” Chaiten said. “This the equivalent of that, right, this is a woman who had an IUD, and because they couldn’t pretend the purpose of the IUD was something other than pregnancy prevention, they told her, ‘We can’t help you.’”


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