FDA poised to put emergency contraception on drugstore shelves

The Politics of Plan B from Media Education Foundation on Vimeo.

On Wednesday, the Food and Drug Administration will announce whether it will approve making Plan B (the brand name for emergency contraception or the morning after pill) available for purchase on drugstore shelves - that’s right, next to the condoms and pregnancy tests. Reproductive justice advocates I’ve spoken to over the last few days all think the same thing: they’re going to approve it. I sure hope so.

Kirsten Moore, for example, President & CEO of Reproductive Health Technologies Project, says “While FDA has toyed with women’s health before, all signs point to them doing the right thing at last and letting the science dictate their policy decisions.”

I’m pretty damn optimistic too. The FDA has a lot of embarrassing history to make up for surrounding Plan B. This would be a step away from their ideologically driven past toward the drug, a progressive pro-science move that could restore a bit of that tarnished reputation.

Obviously, if the FDA does pull the trigger - conservatives are going to lose their collective shits. A quick refresher course in the sordid FDA/Plan B history (you can also find this info in The Purity Myth) and what we can expect if Plan B becomes available on drugstore shelves:

The FDA approved emergency contraception for prescription use in 1998. Despite the fact that major medical associations pushed for over-the-counter availability in 2000, the FDA didn’t even begin to consider the possibility until 2003. That’s the year the FDA went against an independent joint advisory committee recommendation to make the drug available over the counter; instead they reiterated that it would not be available without a prescription.

As you may remember, the concerns the FDA cited over emergency contraception were not about women’s health or the safety of efficacy of the drug. Instead, they were worried about young women getting all slutty. Dr. W. David Hager, one of the FDA committee members who voted against EC’s over-the-counter approval and a key player in making sure Plan B got held up, told The New York Times: “What we heard today was frequently about individuals who did not want to take responsibility for their actions and wanted a medication to relieve those consequences.” Some things to keep in mind about Hager: in suggested in a book he wrote that women could cure PMS with prayer, and his wife accused him of rape. So yeah, a bit scary that he was in charge of women’s health.

It later came to light that FDA medical official Janet Woodcock wrote in an internal memo that over-the-counter status for Plan B could cause “extreme promiscuous behaviors such as the medication taking on an ‘urban legend’ status that would lead adolescents to form sex-based cults centered around the use of Plan B.” It has Lifetime Original Movie written all over it. Of course this but-it-will-make-girls-slutty argument is hardly new. It’s the same excuse legislators have given when attempting to limit women’s access to birth control, and more recently, to the HPV vaccine.

Ultimately, the FDA/EC debacle became a real crisis. In 2005, Susan Wood, director of the Office of Women’s Health and assistant commissioner for women’s health, resigned in protest. It wasn’t until July 2006—after protests were launched and complaints lodged from female legislators and local activists (nine of whom got arrested in front of FDA headquarters), and the Government Accountability Office issued a report about how politicized and “unusual” the process was—did the FDA approve EC for over-the-counter sales.

Unfortunately, the drug was made available only to women eighteen and older, so the very people who need EC most—young women—were deprived. Once again, this restriction was put in place because of the FDA’s fear that young women would become promiscuous. In 2009, after a federal judge ruled that the FDA made their age restrictions “arbitrarily” and for ideological reasons, the FDA was court ordered to make Plan B One Step (which has one pill instead of two) available over-the-counter to those 17 years old and older and to review the age restriction in its entirety. The FDA complied with the former, but failed to do the latter. In 2010, the Center for Reproductive Rights took the FDA to court for ignoring this court order.

Earlier this year the pharmaceutical company that makes Plan B - Teva - gave the FDA new data showing that anyone, even adolescents, can use the drug safely and effectively without a pharmacist or doctor overseeing them; they asked the FDA to approve Plan B without an age restriction. The review deadline for the FDA is Wednesday - and while there’s no guarantee they’ll make this deadline, or that they’ll do the right thing, reproductive justice folks in the know are feeling optimistic. 

If the FDA’s approval goes through as expected, you can expect to see conservative opponents make the following (bullshit) arguments:

• Plan B kills babies. This argument is being made by anti-choicers who believe that life starts at conception and that Plan B works by preventing the implantation of a fertilized egg. Actually, the most recent studies indicate that EC works by preventing ovulation or fertilization, not implantation. But even if it did - so what? A zygote does not a person make. These are the same folks who want to make birth control of all sorts illegal. No logic/concern for women to be found there.

• Making Plan B more accessible will make girls slutty. Been there, done that. A ridiculous argument with no basis in fact. This is a transparent scare tactic that conservatives use when it comes to anything having to do with women’s health. Condoms don’t make kids more likely to have sex, they make them more likely to have protected sex. The same is true for EC. Not to mention, what’s wrong with having sex?

• Making Plan B more accessible will make girls vulnerable to predators. I think if conservatives are worried about young women being sexually assaulted, they should be supporting VAWA and cutting out all of their vicim-blaming bullshit. Having a safe contraceptive available to young women doesn’t make them more likely to be assaulted. This is the same argument used to try to defund Planned Parenthood - these people don’t care about children or young women, they care about their traditional gender and purity norms.

• Parents have a right to know what their kids are up to. I understand the fear that parents have about their children - but the truth is a lot of kids do speak to their parents about their sexual activity. One third of teens say parents influence their decisions around sex and teens are more likely to get their information about contraception, pregnancy and sexuality from family members than from friends. Research also indicates that requiring minors to inform parent before they can access contraception delays or prevents them from seeking reproductive health services, and it does not reduce their sexual activity.

Why Plan B on-the-shelf is such an important milestone in reproductive health access:

• It does away with the discriminatory/silly age restriction. The age limit on Plan B never made sense. Not only did it keep emergency contraception out of the hands of those who need it most, but in many states, teen girls can obtain abortions without parental permission, but can’t access a drug that can stop them from getting pregnant. Makes. No. Sense.

• It cuts out the middleman pharmacist - who may be an extreme anti-choicer. Too many people who have gone to the pharmacy for Plan B (or even just for birth control pills) have been denied by extremist pharmacists who insert themselves in others’ personal medical decisions. (Remember this pharmacist who wrote to a newspaper about how he just lies about EC availability so women won’t be able to access the drug?) Plan B on-the-shelf does away with all that nonsense.

• It’s safe, effective, and cuts down on the number of unwanted pregnancies. Moore says, “We know from studies that Plan B One-Step is safe enough for anyone at risk of an unintended pregnancy to use without a doctor or health care professional looking over her shoulder. And we know from real world experience that telling someone in a white coat that you (or your partner) failed to use contraception - or your method failed you - is not the highlight of anyone’s day. Having [emergency contraception] on the shelf will enable more women to take timely action to prevent an unwanted pregnancy.” And really - despite all the moral panic hoopla - isn’t that what this is all about?

So keep your fingers crossed for tomorrow. And if this does happen - and Plan B is available on drugstore shelves - we should be throwing a big ole thank you party to all of the amazing reproductive health and justice organizations that have been holding the FDA’s feet to the fire for years. Because this breakthrough in women’s health will be thanks to them.