Seeking a Contraceptive in an Emergency
When a condom broke last winter, Grace Stering, then 25, and her fiancé knew that they still had a good chance to prevent an unintended pregnancy. Stering went to her local drugstore and asked for Plan B, an emergency contraceptive commonly known as the "morning-after pill," which had recently become available over the counter. To her surprise, the pharmacist refused to sell it to her, telling her that he thought using the pill was ethically wrong.
"He made me feel like I was a horrible person for even asking," recalls Stering.
Sales of Plan B have doubled since it was approved for over-the-counter sale last winter, but that doesn't mean it's always simple to get it. Since the drug is available only with a prescription for people under 18, it's kept behind the counter, and an ID is required. In many states, pharmacists with moral objections may choose not to sell the pill, or a pharmacy may not carry it. Several states now have laws requiring pharmacists to distribute the drug when asked, opting out only if the patient can get the medication from another pharmacist in the same visit. In Washington State last week, two pharmacists filed a lawsuit challenging one such law, arguing that it infringes on their right to opt out of a practice they consider immoral.
Many pharmacists argue that they should not be required to participate in practices they consider morally questionable, such as assisted suicide, abortion, or contraception. The American Pharmaceutical Association has sought the middle ground by stating that while "pharmacists must have the ability to 'step away,' there needs to be a system in place to assure patient access to legally prescribed, clinically safe medication."
But others argue that contraception is a basic human right. In June, Democratic Rep. Carolyn Maloney of New York introduced a bill in Congress that would require pharmacies to ensure that emergency contraception and other forms of birth control are available without delay. Her bill, like existing state laws, would allow a pharmacist to opt out—but only if the medication could be obtained in the same pharmacy visit.
The controversy surrounding Plan B stems mainly from its potential to prevent implantation of a fertilized egg, which some people regard as abortion. However, most U.S. medical organizations, including the American Medical Association and the American College of Obstetrics and Gynecology, define pregnancy as beginning at implantation, not fertilization. Plan B works primarily to prevent ovulation and thus fertilization, but it may occasionally prevent implantation of a fertilized embryo. Some critics of the pill have also argued that widespread availability of emergency contraceptives would encourage young women to stop using other forms of birth control or to have more unprotected sex.
Reproductive rights groups have championed the wider availability of emergency contraceptives as a possible panacea for unintended pregnancies, but several recent studies show that improved access to emergency contraceptives doesn't necessarily help in that way. James Trussell, director of the office of population research at Princeton University and coauthor of several recent studies on the topic, says that the pills didn't reduce pregnancy rates in studies because women didn't always take them when they needed to. "Emergency contraceptive pills don't work if they aren't used," says Trussell. "They are not a talisman."
However, the same body of research that disappointed some birth control advocates has also disproved one of their opponents' arguments: The studies found that making emergency contraceptives widely available caused no change in contraceptive use or the incidence of sexually transmitted infections.
Plan B is sometimes effective up to five days after unprotected sex, but the sooner it's taken, the more likely it is to work, doctors say. Family planning experts advise sexually active women to keep some at home as a backup to their regular birth control method. "You don't want to be scrambling around trying to find it when you need it," explains Linda Prine, associate professor of family medicine at Albert Einstein College of Medicine in New York.
"Everyone has a first-aid kit in case of emergency," says Hannah Shacter, a medical student who in March authored a study on emergency contraceptives. "This is something to add to it if you're sexually active."