By Cynthia L. Cooper
Thursday, March 7, 2002
Lawmakers, advocates and distributors of emergency contraceptive pills seek to set the agenda of the public debate on the issue this month. They'll unveil proposed laws to broaden distribution, especially to rape victims, and a public awareness campaign.
(WOMENSENEWS)--U.S. Sen. Patty Murray, a Democrat from Washington state, and Congresswoman Louise Slaughter, a New York Democrat, introduced congressional legislation on Wednesday that would allocate $10 million annually for five years to educate health care providers and the public about emergency contraception. It was one of the first salvos in a muscular new campaign in March designed to raise the profile of the emergency contraception products with lawmakers, regulators, health-care providers and the American public.
The initiatives include legislative proposals at the state and federal level, regulatory activities, trial tests and a high-profile ad campaign for emergency contraceptive pills, which can prevent unintended pregnancies in the hours and days after unprotected sex.
Once called "morning-after" pills, two emergency contraception products received approval from the U.S. Food and Drug Administration in the past four years: Preven, a combination of estrogen and progestin, and Plan B, a progestin-only pill. The pills work by delaying ovulation, inhibiting fertilization or preventing implantation of a fertilized egg in the uterine wall, after which pregnancy begins.
The FDA has not approved either product for use without a prescription, although women in many countries, including Belgium, England, Finland, France, Israel, Norway, Portugal, South Africa and Sweden, may buy the pills through direct pharmacy sales, either over the counter or after speaking with a pharmacist.
"It's an insult to American women," said Dr. David Grimes, vice president of Family Health International in North Carolina.
Grimes said that the need to get a prescription slows women's usage and the effectiveness of emergency contraceptive pills. Although the pills work for up to 72 hours after intercourse, the success rate is highest if they are taken within the first day.
Women report a general lack of knowledge about emergency contraception. A 2000 telephone survey by the Kaiser Family Foundation showed that 56 percent of the 500 women of reproductive age surveyed didn't know that emergency contraception was available in the United States.
"This is a product with a huge public health benefit," said Jane Hutchings, senior program officer for Program for Appropriate Technology in Health, a nonprofit organization in Seattle. "Everyone knows about Viagra," she said, referring to the pill for male impotence, "but unintended pregnancy has real consequences in people's lives. I would have hoped we would be further along nationally than we are now."
Other programs are attempting to speed the process for obtaining the products by permitting the pills to be purchased directly from a pharmacist without a physician's prescription, something the American Medical Association supports. A "citizen's petition" to permit over-the-counter sales has been pending before the Food and Drug Administration since February 2001. No action has been taken, although an answer was expected within 180 days.
"It's still under review," said agency spokesperson Susan Cruzan.
Sharon Camp, president and chief executive officer of Women's Capital Corporation, which distributes Plan B, said, "It's safe, non-addictive, an eminently self-diagnosed condition and a simple regimen. The only opposition at present is likely to come from groups that oppose all methods of birth control and they have sought to confuse the public by calling it an abortifacient."
Only FDA action could make the products available to women in all states, but the agency has remained leaderless since President George W. Bush took office and released former Commissioner Dr. Jane Henney, who had overseen the initial approval of Plan B. On Feb. 25, the Bush administration appointed a deputy commissioner, Dr. Lester M. Crawford Jr., a veterinarian.
Some states aren't waiting for the FDA to act. West Coast women already have access to drugstore dispensation under laws passed in California and Washington state, and through a test project in Alaska. Four more states--Hawaii, Minnesota, New Hampshire and New York--also have legislation pending to permit pharmacists to provide women with emergency contraception.
"The key element to legislative success in California was having a neutral sponsor which was a public health institute, able to focus on policy issues and the consequences of unintended pregnancy and reducing the need for abortion," said Jane Boggess, program director for the Public Health Institute in Oakland, Calif. A similar bill introduced by Planned Parenthood had failed in the past, she said.
Although conservatives and anti-contraception religious entities sometimes try to equate the methods of pregnancy prevention with abortion, "the Republican party in California, while extremely conservative, didn't take the bait," said Boggess.
Under collaborative agreements permitted by the California law, pharmacists can obtain special training and make an arrangement with a physician or other health provider to provide emergency contraception without a doctor's visit. Already 100 pharmacies, mostly in the San Francisco Bay area, are participating, said Boggess, with the number expected to reach 500 by the end of the year.
Meanwhile, Camp, the Plan B distributor, is pursuing a second tack with the FDA, funding research to prove that women can use the product on their own. A soon-to-be-published study shows that between 80 to 98 percent of women could read the label and understand the key messages about how and when to take the pills, Camp said.
Also on Wednesday, the Women's Capital Corporation sent an application to Canada that is expected to result in direct sales of Plan B without a doctor's prescription before the year's end.
"When American women see it move forward in Canada, we will see more furor for it to move similarly fast here," Camp said.
Until emergency contraception is available without delays, women should seek advance prescriptions so that they have them on hand when needed, advocates say. Earlier this month, the American College of Obstetrics and Gynecology sent letters to 40,000 physicians urging that they provide advance prescriptions for their patients.
On March 20, 100 medical and advocacy organizations will unveil a public awareness campaign called "Back Up Your Birth Control." Using a graphic of Rosie the Riveter with a heart-shaped biceps tattoo that says "EC," the organizations urge sexually active women to seek a prescription in advance of actual need for those broken-condom moments.
"A critical mass is building on EC," said Kirsten Moore, president of the Reproductive Health Technologies Project in Washington, a nonprofit organization that is coordinating the campaign. "Pieces are falling into place on the supply side. Now is the time to push the demand side."
A study released last fall by the Texas Abortion and Reproductive Rights Action League Education Fund found that 67 percent of surveyed hospitals in Texas did not provide emergency contraception to rape survivors.
The plight of rape victims was underscored by an Illinois woman who provided handwritten testimony to state legislators last year, describing her ordeal in the emergency room of a religious hospital after being raped by two men at gunpoint. The hospital refused to tell her or a friend who accompanied her about access to emergency contraception. By the time the rape survivor was able to get to her own doctor, it was too late to prevent a pregnancy.
"It's like being violated again and again," the woman wrote. In July, Illinois became the first state to require hospitals to provide rape survivors with accurate information about emergency contraception.
Legislation now pending in 12 states--Arizona, California, Florida, Hawaii, Kansas, Maryland, Minnesota, New Jersey, New York, South Dakota, Wisconsin and Washington--would require hospitals or law-enforcement agencies to provide emergency contraception or information to rape survivors. Legislation pending in Illinois would further strengthen its law. Virginia introduced this legislation, but it was not passed.
Later this month, legislation titled "Emergency Contraception for Rape Survivors" will be introduced in Congress, jointly sponsored by members of the bipartisan Pro-Choice Caucus. The bill would withhold federal funds from hospitals unless they make emergency contraception available without cost to victims of sexual assault and distribute medically accurate information about it.
"We want to work up some support for it," said a spokesperson for co-sponsor Rep. Diana DeGette, a Colorado Democrat, "but in this political climate, if I were a betting woman, I would say it wouldn't pass."
Cynthia L. Cooper is a freelance writer in New York who writes frequently about reproductive health issues.
Back Up Your Birth Control:
Center for Reproductive Law and Policy:
Consortium for Emergency Contraception database: