Reproductive rights advocates have something to cheer about: A federal judge ruled last week that the U.S. Food and Drug Administration (FDA) must allow universal access to Plan B over-the-counter for all ages. But anti-choice proponents want to have the last word on emergency contraception (EC), also known as the morning-after pill. Their strategy to limit access includes claiming that EC is unsafe for adolescents.
After Judge Edward Korman’s ruling, Charmaine Yoest of Americans United for Life said: “This decision allows the abortion industry to gamble with young girls’ health in distributing a life-ending drug, with no real understanding of the long-term implications on their bodies.”
A spokeswoman for the U.S. Conference of Catholic Bishops stated that the court’s action “undermines parents’ ability to protect their daughters … from the adverse effects of the drug itself.”
Once again, the anti-choice community is using inaccurate information to limit women’s and girl’s reproductive rights. There is no evidence that Plan B is a “life-ending drug:” EC is not the abortion pill. It works by preventing or delaying ovulation and does not interfere with implantation of a fertilized egg or with an existing pregnancy.
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Nor do any studies demonstrate that EC has “adverse effects” let alone “long-term implications” for girls’ bodies. Plan B is safer than aspirin: It has few or no immediate side effects and no long-term side effects. In fact, the drug meets all of the FDA’s objective criteria for switching a drug from prescription to non-prescription status: It is non-toxic, it is impossible to overdose on it, it has no harmful effects on a woman or teen or a possible pregnancy, and it is not addictive. Girls and women are able to self-diagnose their risk and understand how to use EC from simply reading the label. Finally, Plan B does not require any medical screening or intervention from a health care worker to use it safely.
FDA Commissioner Margaret Hamburg recognized EC’s safety in December 2011 when she confirmed evidence of Plan B’s suitability for all ages without requiring a prescription. What’s more is that her approval for universal over-the-counter EC access has been endorsed by the American Academy of Pediatrics, the American College of Obstetricians and Gynecologists, and the Society of Adolescent Health and Medicine.
Judge Korman also took compelling scientific evidence for Plan B’s safety into account. He wrote in his opinion that Secretary of Health and Human Services Kathleen Sebelius’ countermand of FDA decision-making was “politically motivated, scientifically unjustified, and contrary to agency precedent.”
In 2011, Secretary Sebelius claimed her actions were based on lack of evidence that the drug was safe for girls as young as eleven. Judge Korman was right to counter that “the number of 11-year-olds using these drugs is likely to be miniscule.” A study published last week in Pediatrics bolsters his assertion: According to author Lawrence Finer, only 0.6 percent of 10-year-olds, 1.1 percent of 11-year-olds and 2.4 percent of 12-year-olds have ever had sex.
In the words of the federal judge, claiming that Plan B is unsafe for 11-year-olds is an “excuse to deprive the overwhelming majority of women of their right to obtain contraceptives without unjustified and burdensome restrictions.”
Curiously enough, Secretary Sebelius has made no move to impose an age limit on purchasing aspirin, an over-the-counter drug that is linked to Reye’s syndrome in children under age 16. Nor has the FDA restricted children’s access to energy drinks, despite the fact that over a dozen deaths have been linked to highly-caffeinated beverages that are marketed to youth.
There is no doubt, then, that Secretary Sebelius’ actions to limit EC, one of the safest drugs on the market, were political. The timeline of events indicates as much: The secretary’s FDA override took place in December 2011 immediately before she announced President Obama’s controversial contraceptive mandate one month later
When responding to Judge Korman’s decision, anti-choicers perhaps sensed that evidence-based arguments are effective in the courts. As a result, their offensive tactics have slightly shifted gears from making claims about EC’s safety to arguing that universal EC access potentially coerces girls and increases the risk of untreated STDs.
For example, Anna Higgins, director of the Center for Human Dignity at the Family Research Council, said, “There is a real danger that Plan B may be given to young girls, under coercion or without their consent.”
Donna Harrison of the American Association of Pro-Life Obstetricians and Gynecologists said in a statement, “You’re taking girls at highest risk of STD and isolating them from medical care.”
Harrison’s statement, however, misses the crux of why emergency contraception is important: It is to be used in an emergency. STD education, screening, and treatment are obviously vital components of sexual and reproductive health. Girls who have been sexually violated and potentially exposed to HIV are especially in dire need of HIV prophylaxis. But there is no conclusive evidence that providing EC to adolescents increases their risk of STDs or contributes to a rise in risk-taking behavior. Moreover, if a girl fears that she may become pregnant, she must be able to access EC as soon as possible — Plan B is most effective within 72 hours, and only up to five days, after unprotected sex.
The arguments posed by Higgins, Harrison, and others are not about the health and safety of women and girls: Rather, their claims about EC’s safety are proxies for moral disapproval of sex.
What’s really at stake here is the anti-choice movement’s desire to punish women and adolescents for their sexuality with the threat of unwanted pregnancy. This ironically poses more risks to women’s and girl’s health than allowing universal EC access.
Don Downing, Clinical Professor at the Institute for Innovative Pharmacy Practice at the University of Washington, explained to me over email: “Unintended pregnancies are a public health issue and a public health model is needed for best results in lowering unintended pregnancy rates. Making EC available to communities in the most unfettered way possible, through over-the-counter access, is an important new public health strategy.”
Penalizing women and girls for their sexuality with forced pregnancy is also unconstitutional. The Supreme Court of the United States has upheld teenager’s reproductive rights as a public health imperative that cannot be arbitrarily limited to simply “protect” morality. In Carey v. Population Services International (1977), the Court ruled that adolescents possess the right to privacy and therefore the right to access contraceptives. Seven of the nine justices decided that, in the absence of compelling scientific evidence, states cannot use moral protection claims to prohibit pharmacies and other vendors from distributing non-prescription contraceptives to youth. The Court had already affirmed six years prior, in Eisenstadt v. Baird, the rights of unmarried individuals to access to contraception. In that case, the Court said it would be “plainly unreasonable to assume” that a state would authorize unwanted pregnancy’s psychological and physical risks as a “punishment for fornication.”
After the landmark EC ruling last week, Nancy Northup, President of the Center for Reproductive Rights, remarked: “Today science has won over politics.” She could not have been more correct. The scientific evidence for EC’s safety is extensive and clear. Judge Korman thus recognized that politically motivated interference with the FDA’s approval process impedes women’s and girl’s constitutional rights to privacy and decision-making.
The Obama administration can now allow the FDA to move forward. This will ensure that women and girls have full access to emergency contraception in the most convenient settings—on the shelf of drug stores and supermarkets without the current onerous restrictions and ID requirements. Let’s hope that the president swiftly translates last week’s legal decision into meaningful action.
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