AfterPill is the first emergency contraception to be sold exclusively online. The company offers one dose of EC for $20, plus a $5 flat-rate shipping fee, making it roughly half the price of Plan B One-Step.
A health-care company founded last fall is looking to increase the number of women using emergency contraception (EC) in one simple way: by cutting its price in half.
The U.S. Food and Drug Administration in June 2013 approved the sale of Plan B One-Step, a brand-name variety of EC, over the counter to people of all ages. The FDA also announced that manufacturers of generic versions of Plan B One-Step could apply for over-the-counter sale.
The move was heralded as a success for contraception access, since women previously had to get their doctors to write a prescription for Plan B.
But over-the-counter access came with a price: On average, stores like CVS sell one pill, or one dose of Plan B, for $48, according to the American Society for Emergency Contraception. Generic versions aren’t much cheaper, averaging just over $41 at the same stores.
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AfterPill, which is sold only online and is also a generic version of Plan B, offers one dose of EC for $20, plus a $5 flat-rate shipping fee.
Jamie Barickman, managing director of Syzygy, which started selling AfterPill in July, told Rewire in a phone interview that Syzygy was able to reduce the price by selling AfterPill only online. “Forty or 50 dollars at retail is very high,” he said. “So we try to reduce the price at retail by marketing it directly to the consumer.”
An average heterosexual American woman spends the vast majority of her reproductive life trying not to get pregnant. A woman who wants two children, for example, will spend about five years trying to become pregnant, pregnant, or postpartum, and three decades avoiding pregnancy, according to the Guttmacher Institute.
At the same time, more than 50 percent of Americans say they have had unprotected sex with a new partner at least once, and half of pregnancies are unintended.
Enter the morning-after pill. Billed as a last-ditch effort to prevent pregnancy, most people report using EC either because they used no contraception while having sex or they think the method they used didn’t work.
Even though EC is both safe and effective, it’s was not widely used until more recently—only 11 percent of women reported ever using emergency contraception between 2006 and 2011, for example—in large part due to lack of access to and widespread misinformation about the method, as well as age limitations on its purchase.
The AfterPill website bills itself as a discreet alternative to buying EC at the store, where interacting with a cashier is inevitable.
“AfterPill™ is personal and private,” the website reads. “No embarrassing questions. No disapproving looks.”
AfterPill is packaged in unmarked boxes with no brand logo or description displayed on the outside.
Being able to purchase the pill online also removes other barriers to access, according to Kelly Cleland, a research specialist in the office of population research at Princeton University. For one, “stores are not consistently stocking emergency contraception on shelves, and people still have to go ask the pharmacist.” While some people feel comfortable approaching the pharmacist for EC, others don’t, and will instead leave empty handed.
Even though Plan B and its generics can now legally be sold over the counter to people younger than 17, pharmacists and cashiers still incorrectly turn people away. For instance, a recent study found that 20 percent of men trying to by EC are incorrectly denied.
“I think it’s a great thing for people to have all sorts of different options and for many women,” says Cleland, who also runs Princeton’s emergency contraception website. “People should have access to whatever method works for their lifestyle.”
There are some downsides to the new pill. For example, AfterPill cannot process any insurance, which means that women who get EC prescriptions from their doctors can’t use them to buy AfterPill, so their insurance will not cover the cost.
And, of course, there’s the problem of timing. The AfterPill website says it will arrive up to a week after purchase, which raises questions about its utility in an emergency and sets it apart from other ECs that can be bought at a local store after unprotected sex.
Barickman, for his part, acknowledges that AfterPill can’t be used in the way conventional ECs are used.
But, he said, because AfterPill is relatively cheap, it can actually encourage women to plan for contraception emergencies. Planning ahead for unprotected sex is like buying a fire extinguisher in case of a fire, and the cheaper EC is, said Barickman, the more likely women will order it in advance.
The sooner you take emergency contraceptives after having unprotected sex, the more likely it is to work, so “there’s an efficacy benefit of having the product on hand.”
On Tuesday the Roberts Court turned away a challenge by a pharmacy-owning family who claimed a Washington state law that requires pharmacies to stock Plan B or other emergency contraception violated their religious beliefs.
The Supreme Court on Tuesday refused to hear a challenge by a pharmacy owner who claimed religious objections to a Washington law requiring pharmacies to stock and dispense Plan B or other emergency contraception.
In 2007, the Washington State Board of Pharmacy adopted rules governing the mandatory stocking and delivery of emergency contraception. The rules do not require any individual pharmacist to dispense medication in conflict with their religious beliefs. Instead, if a pharmacy employs a pharmacist who objects to dispensing emergency contraception for religious reasons, the pharmacy must keep on duty at all times a second pharmacist who does not object to dispensing those drugs.
The Stormans family—who own a local grocery store and pharmacy in Olympia, Washington—challenged the rules in 2012, arguing that the rules required them to violate their religious beliefs. Those beliefs, they said, include a conviction that life begins at conception; therefore, emergency contraception acts as an abortifacient, which they also object to providing.
The medical community does not consider emergency contraception to be an abortifacient.
A district court agreed with the Stormans that the rules could force them to violate their religious beliefs by stocking the medication. But in 2015, the U.S. Court of Appeals for the Ninth Circuit reversed and rejected the Stormans’ claim.
On Tuesday the Supreme Court let stand that Ninth Circuit ruling. However, Chief Justice John Roberts and Justices Samuel Alito and Clarence Thomas dissented from that decision. Writing for the dissenting justices, Alito called the case “an ominous sign” for religious liberties protections in the country.
“There are strong reasons to doubt whether the regulations were adopted for—or that they actually serve—any legitimate purpose,” wrote Alito. “And there is much evidence that the impetus for the adoption of the regulations was hostility to pharmacists whose religious beliefs regarding abortion and contraception are out of step with prevailing opinion in the State. Yet the Ninth Circuit held that the regulations do not violate the First Amendment, and this Court does not deem the case worthy of our time,” continued Alito.
“If this is a sign of how religious liberty claims will be treated in the years ahead, those who value religious freedom have cause for great concern,” he continued.
American Civil Liberties Union Deputy Legal Director Louise Melling disagreed with Justice Alito’s assessment of the case. “The court properly refused to take this case,” Melling said in a statement following the order. “When a woman walks into a pharmacy, she should not fear being turned away because of the religious beliefs of the owner or the person behind the counter. Open for business means opens for all,” said Melling.
“Refusing someone service because of who they are—whether a woman seeking birth control, a gay couple visiting a wedding catering company, or an unwed mother entering a homeless shelter—amounts to discrimination, plain and simple. Religious freedom is a core American value and one that we defend, but religious freedom does not mean a free pass to impose those beliefs on others,” Melling wrote.
Meanwhile, Alliance Defending Freedom Senior Counsel Kristen Waggoner, who represented the plaintiffs in the case, expressed disappointment in the decision. “All Americans should be free to peacefully live and work consistent with their faith without fear of unjust punishment, and no one should be forced to participate in the taking of human life,” said Waggoner in a statement after the denial. “We had hoped that the U.S. Supreme Court would take this opportunity to reaffirm these long-held principles.”
Rather than allocating money toward licensed centers that could provide care from trained professionals, or toward strengthening social safety nets, Georgia is poised to join a slate of 22 other states directing public funds to crisis pregnancy centers.
When Georgia resident Rebecca DeHart started experiencing the worst pain she’d ever felt, she turned to what she thought was a medical facility that could provide her care as an uninsured patient.
“I was crying, again I had not ever been in so much pain in my life. I was in tears, at the counter, I thought it was a medical facility. And I said ‘I need to see the doctor, I might have an ectopic pregnancy,'” DeHart testified during a recent Georgia House Health and Human Services Committee hearing.
“She put the [pregnancy] test kind of on a shelf above my head and she said, ‘We’ll get to your results but I want you to look at some things first.’ And she gave me a series of pamphlets …. It wasn’t until I opened a baby announcement with pictures of fetuses on the inside that I understood what was happening,” DeHart said.
DeHart had sought help at a crisis pregnancy center (CPC), one of thousands of facilities around the country whose primary goal is to dissuade patients from having an abortion.
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Georgia is facing a health-care crisis; it has one of the highest maternal mortality rates in the nation. It also ranks poorly on infant health and mortality. March of Dimes gave Georgia a “D” for preterm births in its 2015 Premature Birth Report Card, noting in an accompanying press release that “Babies who survive an early birth often face serious and lifelong health problems, including breathing problems, jaundice, vision loss, cerebral palsy and intellectual delays.” The organization also cited preterm or premature births as the leading cause of infant death.
These are symptoms of a wider problem in Georgia: an overall lack of access to facilities where patients, particularly those in rural areas, can obtain comprehensive reproductive health-care services.
Yet rather than allocating money toward licensed centers that could provide care from trained professionals, or toward strengthening social safety nets, Georgia is poised to join a slate of 22 other states directing public funds to CPCs. On Republican Gov. Nathan Deal’s desk right now is SB 308, which creates a potential $2 million grant program to fund CPCs. Deal has until May 3 to veto the legislation. If he does not, it will automatically become law.
In order to qualify to receive funding, an organization need only be a nonprofit operating for at least one year, “whose mission and practice is to provide alternatives to abortion services to medically indigent women at no cost.”
CPCs use deceptive tactics—like lying about the services they provide or implying they are a fully staffed medical clinic when they are not—to get pregnant folks in the door. Their sole goal is to keep these people from having abortions, including by providing medically inaccurate or misleading information about abortion procedures. As Georgia Life Alliance, an affiliate of the anti-choice National Right to Life organization, wrote on its blog in support of SB 308, “The open doors and compassionate support of Georgia’s pregnancy care centers are the most effective tool we have to reach the abortion-minded woman.”
Still, proponents of SB 308 have framed the grant program as a way to address pregnant Georgians’ need for care, especially when they do not choose abortion. “When our party has been a party pushing for decreased access to abortion facilities, and has so stressed the need not to have an abortion, I think we have a moral responsibility to say, ‘If you make the choice, if you choose life, and you need help, we’ll be there to help you,” said the bill’s house sponsor, Rep. Sharon Cooper (R-Marietta), during debate on the house floor last month.
The bill lists quite a few services that the grant program will fund, including pregnancy tests, sexually transmitted infection tests, and ultrasounds; nutrition education; housing, education, and employment assistance; adoption services; parenting education; baby supplies like clothing, car seats, and cribs; and information on receiving Medicaid coverage.
The bills’ opponents, however, expressed concern about the accessibility and quality of those services at CPCs.
“These CPCs, in large part, are simply not equipped to handle pregnant women’s care. Some of them provide only counseling and pregnancy testing,” said Sen. Nan Orrock (D-Atlanta) in opposition to the bill during debate on the senate floor. “Only a limited number of them provide ultrasound and sexually transmitted disease testing. And many [CPCs] have to refer out for prenatal and emergency care services.”
This was the case for Rebecca DeHart, who testified during the public committee hearing days before the bill went to the house floor. DeHart’s pregnancy test came back negative—she did not have an ectopic pregnancy—but she was still in a lot of pain.
“In the end … I had a cyst the size of an orange that burst on my ovary,” DeHart said she learned after going to a health clinic in her hometown, as the CPC was unable to diagnose or treat her medical condition.
DeHart, who is now the executive director of the Democratic Party of Georgia, said she was ultimately able to have a healthy pregnancy when she was ready, but the burst cyst did result in damage to one of her ovaries. “I am very happy that did not prohibit me, even though my ovary is damaged, from being able to have children later,” she said.
“A lot of these crisis pregnancy centers don’t have medical staff on board, and if they do, they are nurse practitioners, or maybe just sonographer technicians that might or might not have the ability to diagnose actual issues with high-risk pregnancies,” said Molly “MK” Anderson, public policy associate and lobbyist at the Feminist Women’s Health Center (FWHC), in an interview with Rewire. FWHC is a key opponent of the bill, with Anderson leading its lobbying and advocacy work.
Despite concerns about the quality and competency of care CPCs can provide, pregnant Georgians with few options may continue turning to them for services, a prospect that is only made more probable by this grant program.
The Georgia Obstetrical and Gynecological Society predicted that by 2020, 75 percent of Primary Care Service Areas (PCSA) outside Atlanta, “will lack sufficient obstetric services.” PCSAs are geographic regions based on Medicare patient travel to their primary care providers; Georgia has 159 counties, but 82 PCSAs outside Atlanta.
It was also hard to miss the talk at the capitol—from both Republicans and Democrats—about Georgia’s rural hospital closures. This growing problem, coupled with an existing lack of OB-GYNs, means pregnant Georgians find themselves with few options to receive care before, during, and after a pregnancy.
According to the Georgia Maternal and Infant Health Research Group (membership login required), “24 percent of all pregnant women in Georgia now drive more than 45 minutes to access their obstetric provider. These women are 1.5 times more likely to deliver preterm than women who drive less than 15 minutes.”
This lack of access also impacts the ability of pregnant Georgians to manage conditions—such as diabetes, high blood pressure, or anemia—that can become exacerbated by pregnancy, as well as to receive critical care during a high-risk pregnancy.
There are also disturbing racial disparities in access, or lack thereof, and maternal deaths. Throughout the country, Black women are approximately four times as likely to die from pregnancy complications as white women; however, this is not necessarily tied to a greater risk of an underlying complication.
“[I]n a national study of five medical conditions that are common causes of maternal death and injury… black women did not have a significantly higher prevalence than white women of any of these conditions. However, the black women in the study were two to three times more likely to die than the white women who had the same complication,” a 2011 report from the Association of Reproductive Health Professionals stated.
Democrats in both chambers asked why money was being allocated for the CPC grant program, but not for Medicaid expansion, which could potentially be a boon for both rural hospitals and Georgians who are or may become pregnant. For that matter, even as proponents of the bill articulated a need for pregnant people to receive support services, legislation to reduce access to government safety nets gained traction in both chambers: Rep. Cooper, the house sponsor of SB 308, was also the house sponsor of a bill to reduce the maximum time a person can receive cash assistance from the Temporary Assistance for Needy Families (TANF) program.
“And when we are considering bills like SB 389 to cut TANF benefits and make it harder on families with children, I think you can see the hypocrisy in passing SB 308. And additionally when we refuse to expand Medicaid to hundreds of thousands of Georgians, yet we want to give money for what is being seen as health-care services, I think you can see the hypocrisy in that as well,” said Rep. Dar’shun Kendrick (D-Lithonia) in opposition to the bill during debate on the house floor.
Both sides agree on at least one thing: SB 308 is about reducing the number of abortions. But providing grant money to CPCs to expand their reach, at a time when many Georgians struggle to access the reproductive health-care services they need, is dangerous policy. For pregnant Georgians seeking to carry a pregnancy to term, and those seeking to terminate a pregnancy, CPCs just won’t cut it.
“We are talking about facilities that offer services that are free—free pregnancy tests, free ultrasounds—and that often attracts people who are uninsured, who are in our [Medicaid] coverage gap, or don’t feel safe going to a provider,” FWHC’s Anderson said. “And these are folks who need care, need comprehensive care, need professionals who actually know what they are doing to provide care.”
“[SB 308] was under the guise of being comprehensive health care. Which I thought was a total sham,” said Oriaku Njoku, co-founder and executive director of Access Reproductive Care – Southeast (ARC-SE), referring to the extensive comments made by supporters of the bill in both chambers, in an interview with Rewire. ARC-SE was involved in the opposition to the bill at the state capitol.
“And the reason I say that is because when you are talking about comprehensive health care, to me that also includes abortion access, it also includes trans health, it also includes maternal mortality, infant mortality, like all of these things are included,” Njoku said. “And I definitely feel that this was a missed opportunity to do right by Georgians.”
This bill passed 31 to 16 in the senate along party lines, while the house saw a vote of 103 to 52, with several Republican members choosing to walk—that is, skip voting—rather than vote against their party. Gov. Deal has until May 3 to veto the bill; otherwise, SB 308 will become law.