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May 02, 2013 1:19 PM Plan B Confusion

By Ed Kilgore

The brouhaha over the current legal standard for non-prescription access to the Plan B “emergency contraception” pill involves a blizzard of cross-talk and hyperbole, and likely a futile or even counter-productive effort by the Obama administration to “compromise” between irreconcilable positions. But some interesting fault lines are emerging among antichoicers, who aren’t as united on the issue as they used to be.

To most reproductive rights advocates, scientists, and health care professionals, this is a bit of a no-brainer: Plan B is a reasonably safe medication for any post-pubescent woman that is far from 100% effective, but is a far superior alternative to an unwanted pregnancy that could lead to a clinical abortion or an abandoned child, not to mention terrible choices and consequences for the woman involved. The pill isn’t any more dangerous—and is probably far less dangerous—for teenagers. So setting age limits on non-prescription access to this drug, as opposed to others (as the Obama administration continues to seek to do in defiance of both FDA recommendations and a federal district court ruling) makes no sense, particularly since the consequences for young women of an unwanted pregnancy tend to be relatively dire.

But to many, perhaps most, antichoice activists, and to the U.S. Catholic Church (at least in its official positions), Plan B does not represent “emergency contraception,” but (at least “potentially”) an abortifacient, which means a baby-killing pharmaceutical that not only physically destroys a human being but involves the “pregnant” woman in a soul-destroying sin.

What’s interesting is that this isn’t a universal position among Catholic or evangelical (or presumably, other) antichoichers any more. Germany’s Catholic bishops recently dropped their opposition to the administration of Plan B to rape victims in Catholic hospitals on grounds that research shows the medication operates by inhibiting fertilization rather than implantation of a fertilized ovum in the uterine wall. Some opponents of legalized abortion, moreover, probably accept the medical profession’s standard definition of pregnancy as beginning with implantation, not fertilization, which moots the “abortifacient” argument for banning Plan B and IUDs altogether (and also heads off the even more radical idea, which some “personhood initiative” supporters semi-covertly support, of banning the estrogen “pills” that many millions of women take every day).

But even as anti-choicers argue with each other as to whether Plan B is a murder machine or ethically neutral, conservatives generally are retreating to the common ground of regarding the issue as one primarily involving the sexual behavior of young women and “parental control.”

Dr. Mary Davenport, recent president of the American Association of Pro-Life Obstetricians and Gynecologists, acknowledged that her group’s opposition to Plan B is rooted in broader concerns about casual sexual activity, teenage pregnancy and single motherhood.
“Fear of pregnancy is a deterrent to sexual activity,” Dr. Davenport said. “When you introduce something like this, it changes people’s behaviors, and they have more risky sex. Teens will be counting on this morning-after pill to bail them out, and they’ll have more casual encounters.”

There is zero empirical evidence for this widely-held proposition, and a lot pointing in the exact opposite direction. What we do know is that teenaged women are disproportionately likely to be forced into nonconsensual sex (whether or not it fits the legal definition of rape), and to rely on unreliable condoms for birth control, for the obvious reason that other methods aren’t available without prescriptions. Besides, the “common-sense” belief that pregnancy is an effective deterrent to teen sex should be balanced against the common-sense experience of most adults that teenagers won’t base the decision to have or not have sex on mathematical probabilities based on the availability of a less-than-totally effective pill taken later.

In any event, the “reasonable” or “compromise” approach of the Obama administration won’t cut any ice among antichoicers who think we’re talking about pharmaceutical homicide; among cultural conservatives in a panic about the sexuality of young women; or among health professionals and pro-choice advocates who regard this is a simple matter of letting people take a simple available step to protect themselves from the devastating consequences of an accident or mistake—or in far too many cases, of an unreported crime.

UPDATE: Well, things get even more complicated on the antichoicers’ treatment of Plan B. Turns out the position of the German Bishops I touted above as a significant change actually reflects the standing policy of the U.S. Bishops—and the Vatican—with this wrinkle: a rape victim in a Catholic hospital who asks for Plan B has to be tested to calculate if it’s likely she hasn’t ovulated recently before it is administered, so to avoid the possibility that the medication will interfere with uterine implantation of a fertilized ovum. Wow. I can’t imagine a system more cruelly designed to make it clear to the rape victim that she is nothing more than the vessel for reproduction.

Ed Kilgore is a contributing writer to the Washington Monthly. He is managing editor for The Democratic Strategist and a senior fellow at the Progressive Policy Institute. Find him on Twitter: @ed_kilgore.

Comments

  • Gandalf ndalf on May 02, 2013 2:39 PM:

    Well as we all know "every sperm is sacred".

  • Barbara on May 02, 2013 2:51 PM:

    I think the president/Sebelius is wrong to appeal, because overturning the FDA was wrong, but I want to make sure everyone understands that the biggest issue with the prior rules wasn't so much that young girls couldn't buy the medication, because there are only a few who would and of those, many could tap an older friend or relative -- the biggest issue was that ALL women of whatever age faced the hurdle that this drug was not available on the shelf but was behind a pharmacy counter even though a prescription wasn't required. This made a time sensitive drug much less available because even drug stores and supermarkets open 24 hours a day rarely have a pharmacy that is staffed and open all the time.

    That aspect of the rule is going to change whatever happens to the age restriction.

  • c u n d gulag on May 02, 2013 3:02 PM:

    Maybe this is done under the presumption that, if they openly can't get this until they're 15, younger girls will "Just Say No" to sex.
    Which is pretty stupid, since that hasn't worked since we started to be able to record history - and there's no indication that it ever worked before that, either.

    Ok, let's say for a second that maybe this will work with their boyfriends - but will it work with their fathers, uncles, brothers, and cousins?

    And yes, while I'm trying to be a bit glib, I just want to point out that incest is still a much larger problem in this country, than it should be.

    I couldn't find any reliable statistics on this, and all I could find was this, saying Alabama and Alaska had the highest rates:

    http://www.kgbanswers.com/what-state-has-the-highest-rate-of-incest/3962935

    That seems to be anecdotal. And I suspect that a lot, if not most, cases, go unreported, so statistics are hard to come by.

    But, as with virtually all of our social ills, would it shock anyone if incest is highest in the Bible Belt states? They all seem to have a disproportionate amount of trouble, considering their lower population levels.

    Here are the laws, state by state, if anyone's interested:

    http://www.drabruzzi.com/selected_state_incest_laws.htm

  • Peter C on May 02, 2013 3:10 PM:

    Sex is a powerful biological force. One doesn't need a very wide exposure to Biology to grasp this. The idea that such a force could be tamed and controlled by mere social, legal, or religious conventions is ridiculous and naive. It's a losing proposition; literature from all cultures show that all such efforts often fail with tragic results, despite the best of intentions.

    We need to change strategy and seek to minimize the negative consequences of this force. In my mind, that means public health, fact-based education, female empowerment, and planning parenthood.

    Government and the power of the state is no place for cultural and religious dominance struggles. Our American system correcly places the government outside such conflicts. If individual religions or cultures wish to tilt at windmills and try to control sexuality, they are free to try WITHIN A RELIGIOUS CONTEXT. But they need to keep their hands off governmental levers of power. Our government may not establish a religion.

  • Sgt. Gym Bunny on May 02, 2013 3:32 PM:

    I'm sorry, but I'm just not seeing millions of girls poppin' Plan B little Skittles any time soon. As I mentioned yesterday, there's only ONE pill in the damn box, and guess what? That pill costs damn-near $50. Unless a teenage girl has got money to splurge after frequent unprotected sexual encounters, I don't find it likely that teens will now start floozying it up en masse.

    And besides, unless my math skills ain't right, if a teenager is going to be ho-bag or something, it would be more economically feasible to just get on The Pill/Ring/Shot or the IUD as opposed to buying a $50 pill every weekend. Plan B isn't really a good/convenient form of BC compared to other methods that are already available (and don't have an age restriction).

    Personal Disclaimer: I've actually had to use Plan B twice in my life over a period of approximately 5 years. If I had to use it twice, why didn't I just get on the pill? Because, I tend to not be sexually active. I don't get laid enough to justify being on daily/monthly/quarterly BC or an IUD. (Really I'd take more doses of BC than I would actually be getting laid in an entire year!!) Plan B would probably be more convenient for the once-in-a-whilers or the already-on-BC-but-forgot-my-dose crowd rather than the young, uninitiated harlot brigade.

    But maybe it's the new gateway drug!!!!! clutches pearls

  • Sisyphus on May 02, 2013 3:56 PM:

    Anyone who is haranguing, or more often, shaming and screaming at, a girl who has to make a profoundly painful and difficult choice about any unwanted pregnancy, whether discovered the next morning, or weeks later, is someone who instantly loses whatever moral credibility they might have tried to claim as far as I can see. When someone is scared and hurting, basic human decency, let alone a developed sense of morality, should lead these so-called moral people of God to do everything they can to try and help get these women through these problems. I'm not a biblical scholar, but I think Jesus would have been more on board with working to make sure that these sorts of things didn't have to happen, than with shaming or screaming at those who did use these medications.

  • fostert on May 02, 2013 4:48 PM:

    Umm 95% effective is "far from 100% effective"? So, "far" is 5%? Cut the hyperbole and use real numbers. And yes, the effectiveness drops to 90% at 72 hours. That still doesn't sound very far from effective. Compare that to say, aspirin for a headache. What's that? 50% effective? For me, it's 0%, it doesn't work at all. But it supposedly works sometimes for some people.

  • TooManyJens on May 02, 2013 6:56 PM:

    The effectiveness is nowhere near 90 or 95%. It's better than nothing and still worth having, but it's not all that effective. (I think it's more in the neighborhood of 50%, but I have to be somewhere in 5 minutes so I can't check right now.)

  • D Gary Grady on May 02, 2013 11:06 PM:

    TooManyJens: According to WebMD's page on Plan B, "If you take it within 72 hours after you've had unprotected sex, Plan B One-Step can reduce the risk of pregnancy by up to 89%. If you take Plan B One-Step within 24 hours, it is about 95% effective."

    See http://women.webmd.com/guide/plan-b

  • Gretchen on May 03, 2013 10:58 AM:

    I wish discussions on this subject focused more on what happens if Plan B isn't available, and the girl gets pregnant. People talk about possible side-effects of taking this pill, as if there were no side efffects if she didn't take it. If she doesn't take it, and gets pregnant, that's a very big side-effect. For one thing, 30% of pregnancies now end it a c-section. So if the choice is the nausea and heavy bleeding that may result from Plan B, or the strong possibility of abdominal surgery, shouldn't that be part of the conversation? Not to mention all the possibilities of pre-eclampsia, gestational diabetes, and all the rest of it. Pro-lifers tend to hand-wave on this subject: "Just have the baby and give it up for adoption", as if going through a pregnancy involved having a bump under your shirt until it goes away.