JONATHAN COHN DECEMBER 8, 2011
The Obama Administration has done plenty to protect reproductive rights and access to contraception. Abroad, it rescinded the Mexico City directive prohibiting federal assistance to global health organizations that promote or perform abortion services. At home, it has poured significant new money into family planning clinics. And that’s not to mention the fact that Obama has put on the Supreme Court two women likely to support a woman’s right to have an abortion. Allies on the left cheered all of these moves—and appropriately so.
But on Wednesday, Health and Human Services Secretary Kathleen Sebelius announced that her agency would not allow girls younger than 17 to get emergency contraception, known as Plan B, without a prescription. In so doing, the Obama Administration kept in place a policy that many had expected the administration to repeal—and it defied the recommendation of its own Food and Drug Administration, something that apparently has never happened before.
Now those same administration allies are furious. “This decision is stunning,” said Susan Wood, who had resigned from the FDA in 2005 over a similar decision made during the Bush years. “A frustrating example of politics trumping science” is the way Jessica Arons, director of the Women’s Health and Rights program at the Center for American Progress, described it.
From the looks of things, these and other critics have reason to be angry.
Plan B has been the subject of political controversy for many years. Some conservatives believe it is a form of abortion, because, in theory, it could stop a fertilized egg from implanting into a woman’s uterus. (Actually, that happens all the time, either naturally or because of other forms of contraception.) Some conservatives also believe access to Plan B will encourage teenagers to have more sex. (As far as I know, the data have never shown this.)
For a while, the Bush Administration refused to allow over-the-counter sales to girls and women of any age, arguing that it posed safety risks. But scientists overwhelmingly disagreed. Plan B is simply a higher-than-normal dose of the same drugs in standard oral contraceptives, which millions of women have been taking regularly for decades. Researchers had checked to see whether Plan B was somehow more dangerous. They had found that it wasn’t.
Eventually the Bush Administration relented—and the Obama Administration, once in office, went out of its way to make sure that Plan B, like all contraception, was among the preventative services that health insurers must cover, without out-of-pocket expenses, under the Affordable Care Act. But that still left the question of whether girls and women under 16 could get the drug on their own, over the counter, or whether they’d need a prescription first.
The argument for wider access is pretty simple: Young people already have over-the-counter access to all kinds of medicines that, if taken improperly, leads to real harm. Overdosing on acetaminophen (the active ingredient in Tylenol) and ibuprofen, for example, can cause severe liver damage. But girls who had unprotected sex might be reluctant to approach a health professional with prescription-writing capabilities, for some of the same reasons they might be reluctant to approach a parent. (In most cases, the experts say, girls would still get guidance—but from counselors and school nurses, whom they know and trust.)
What’s more, Plan B’s effectiveness diminishes as time after intercourse passes—and actual pharmacists, as opposed to drug stores and supermarkets, aren’t always easy to find right after sex. Putting Plan B over the counter would presumably lead to greater use of Plan B, reducing unwanted pregnancies and, by the way, abortions as well.
In ruling to keep Plan B behind the counter, Sebelius cited a very specific concern: The fact that some girls start having sex at very young ages—13, 12, even 11—and might not have enough cognitive development to take the drug properly. My understanding is that the concern isn’t simply that very young girls will take the drug on their own, potentially misreading the directions, but that they’ll start to use the pill as a regular form of contraception—potentially getting higher, dangerous levels of hormones.
But the FDA examined this issue, among others. As Maggie Fox of National Journal reported on Wednesday, Teva, the drug’s manufacturer, had provided the FDA with studies on 11- to 16-year-olds. “The FDA based its decision on years of data about adolescent health,” says Stanford University's Lee Sanders, a pediatrician and leading scholar on health literacy. “That includes research on the specific question of how adolescents will use contraception.”
Might Sebelius or some of her advisors be genuinely worried those studies are flawed—or, at least, not sufficiently conclusive? Sure. It's not a crazy argument. But is that grounds for taking a position virtually every leading medical association rejects? For overruling not just FDA staff but also the commissioner, Margaret Hamburg, who just happens to be one of the nation's most experienced and respected experts on public health? In Wednesday's official announcement, Hamburg made clear that FDA “carefully considered whether younger females were able to understand how to use Plan B” and “determined that the product was safe and effective in adolescent females, that adolescent females understood the product was not for routine use.”
That’s why it’s likely politics played a major role here. Most likely, the White House didn’t want critics—like, say, the eventual Republican nominee for president—saying that Obama wants 12-year-old girls to have sex. Obama wouldn’t be saying that, of course, but when has that ever mattered? The concern probably isn’t the Christian right so much as culturally conservative swing voters. Or, to put it more bluntly, the worry here wouldn't be Kansas. It’d be Ohio.
If administration officials admitted this—and they certainly haven’t, at least to me—they’d probably point out that a Romney or Gingrich administration would be far worse, not just on access to emergency contraception but on reproductive freedom in general. That’s true! But this decision will have real consequences, right away: More young girls will have unwanted pregnancies. Whether you interpret this as an indictment of the administration or an indictment of our political times, it’s disheartening.
Update: I added a sentence pointing out that other over-the-counter drugs are extremely dangerous when taken incorrectly.