Friday, December 9, 2011

Playing Politics with the Morning After Pill

Lorraine
We try to stay away from politics here but yesterday brought news that infuriated me: An over-the-counter and safe method of birth control called Plan B--that is, The Morning After Pill--will continue to be denied to teenage girls under 17. Under 17 you need a prescription--that is, tell a doctor who may tell your mother, and anyway, by the time you get that script, it is likely to be too late for Plan B.

But you know what? A whole lot of teens have unprotected sex the first time because they are not planning on having sex. The Obama administration's head is in the sand on this issue, only slightly less buried than the previous Bush administration's, which allowed Plan B to be sold without a script only to those 18 and over. In 2009 after a federal court judge excoriated the FDA for placing politics and ideology ahead of public health, the Obama administration lowered the age to 17.

ARE THEY NOT READING THE SAME STATISTICS WE ARE?
Yet almost half of all teenage girls have had sex before their 17th birthday. Not everyone wants to tell their parents or the family doctor she is planning on having sex, not every teenage boy carries a condom in his wallet because...maybe tonight, so let us assume that a lot of teenagers under 17 will have intercourse without some kind of birth control. In fact, because many teens have no access to easily obtainable birth control, the United States has the highest rate of unintended pregnancies of young people in the developed world. That disturbing trend translates into one of the highest rates of teenage abortion and adoption anywhere. This is appalling. Not only is this inane restriction pushing the abortion rate, it is also serves to increase the number of teenagers who will give their babies up for adoption, and both will spend their lives with the sad and lingering consequences of that harrowing decision.

Yet Plan B is safe. After a careful and lengthy study the Food and Drug Administration found that Plan B was not only safe and effective, but also that adolescent girls can understand how to use it and what it does (prevent pregnancy), and what it doesn't do (prevent sexually transmitted disease). Plan B contains 1.5 milligrams of the female hormone progesterone, a slightly higher amount than is found in low-dose birth control pills, and considerably less than what is prescribed for other conditions.* It should be taken as soon as possible after unprotected sex because with time it loses effectiveness. Advocates for years have pushed to make it readily available to anyone who needs it. The American Medical Association, the American Congress of Gynecologists and Obstetricians, The American Academy of Pediatrics, and the expert advisory committee of the FDA all approved the sale of the drug to women and girls--yes, adolescent girls--of any age. If you are old enough to need it, you should be able to get it.

Women who have unprotected sex have approximately a 20 percent (one in five) chance of becoming pregnant. Taken within three days, Plan B cuts that risk to 2.5 percent (one in 40). "Very few medications are this simple, convenient and safe," Dr. Kathleen Hill-Besinque, of the University of Southern California School of Medicine, told The New York Times.

Had it been available, Plan B would have prevented my own pregnancy because I knew at the time I had sex I was likely to be ovulating (the old-fashioned rhythm method pushed by the Catholic Church taught me that), but the man involved was persuasive and I was in love. Would I have been at the drug store that very evening? You bet I would. But if I had had to wait for a doctor's appointment the following Monday to get a prescription in a city where I did not have a doctor--as was the case--it would have been too late, just as it will be too late for a teenager shy of 17.

POLITICS OVER PUBLIC HEALTH WHEN SEX IS INVOLVED
The FDA was about to approve the over-the-counter sale of Plan B, but for the first time ever, the Health and Human Services Secretary, Kathleen Sebelius, overruled the FDA. Her argument? Girls 11 or 12 would have difficulty understanding what Plan B was or how to use it. Apparently the fact that fewer than one percent of 11-year-old girls are sexually active, according to the Guttmacher Institute, was lost on her.

http://upload.wikimedia.org/wikipedia/commons/thumb/2/2f/MargaretSanger-Underwood.LOC.jpg/220px-MargaretSanger-Underwood.LOC.jpg
Margaret Sanger
But what was not lost is the evangelical criticism in an election cycle: While the drug’s principal effect taken as described here is to prevent ovulation, Plan B may also make the lining of the uterus less hospitable to a fertilized egg, making it anathema to anti-abortion activists. However, Plan B has no effect on established pregnancies. It is not an abortion pill nor is it related to RU-486, which is an abortion drug.

ABORTION AND ADOPTION RATES WILL STAY HIGH
Teenage girls today are often under considerable pressure to have sex, according to numerous surveys--way beyond what it was like in earlier decades. Many will give in. Whether the sex is half-halfhearted or not will not alter the odds whether pregnancy results; it's simply the luck of the draw. The morning after, when the high emotions and the pressure of the night before are long gone, is exactly when birth control needs to be available to teenage girls. Continuing to restrict the sale of The Morning After pill will assure that the abortion and adoption rates will continue to soar over other developed nations. In the U.S., we have a population nearly six times greater than that of England and Wales, but more than a hundred times the number of infant adoptions each year. This is not only unnecessary, but catastrophic. Let us be clear: giving up a child destroys whatever life you had before. It changes you forever. You do not have a baby, walk away and forget. Open adoption does not solve all ills.

The regressive thinking of the Obama administration is blatant politics that harks back to a time nearly a century ago when Margaret Sanger was arrested for distributing a pamphlet called Family Limitation. The details have changed, but we as a country have not yet comes to terms with sex. Sixteen- and fifteen-year-olds are having sex. Let them have easy access to birth control. This ruling will only continue to punish teenage girls. --lorraine
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* For other uses of progesterone, see my comment below.
For more on the lifelong effects of giving up a child, on both mother and child, see:  Response to The Adoption Option

18 comments :

  1. I'm going to get attacked for this and since I'm no expert on the morning-after pill,correct me if I'm wrong, but isn't it sometimes dangerous,causing hemorrhaging in some people who may have susceptibility to bleeding.Therefore,I'm not so sure it should be given without some sort of supervision

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  2. The evangelicals oppose Plan B not only because they consider it a sort of abortion but also because it will encourage girls to have premarital sex.

    Of course this is nonsense -- if a girl PLANS on having sex, she doesn't need Plan B since she has already arranged for Plan A.

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  3. Even when a patient can get a prescription, many pharmacies will refuse to fill it. They will recommend another pharmacy that will provide the drug but that can result in delays and make it hard to get. Maybe we should start a boycott(girlcott?) of pharmacies that won't provide Plan B.

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  4. The amount of progesterone for The Morning After pill is way less (1.5 mg) than what is given to pregnant women who are older and have trouble miscarrying (25 mg.), for which it is routinely prescribed. In fact, doctors treating women over 35 who become pregnant and do not prescribe it are taking a risk that the woman will lose the baby. Progesterone is also prescribed in very high dosages to women who suffer from exaggerated PMS, medically called PMDD (PreMenstrual Dysphoric Disorder). That dose can be as high as 800 mg. a day. Hormone Replacement Therapy (HRT) is best taken with progesterone, usually a 2.5 mg. dose, but it need not be taken daily with estrogen.

    While any hormone carries the possibility of an unwanted side effect, the three major medical associations who deal with pregnancy would not have approved progesterone being available so easily if the risk was more than miniscule. And it is worth noting that you can die from an overdose of aspirin or acetaminophen.

    Ill side effects from progesterone are extremely rare. The effect of an unwanted pregnancy is pretty drastic.

    What makes me so informed about this? I used to be a health and medical writer and wrote extensively about progesterone. I became interested because it so completely treated the symptoms of my own PMDD, and for that reason, I have been very aware of its other uses.

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  5. Thank you for writing about this. I did a 2 hour presentation in my Populations at Risk class for my BSW on rape victims who are often denied EC by ER doctors invoking contentious objection, which is sickening. So much is misunderstood about EC and I'm sick of politicians determining what's right for me and my family (and everyone else) regarding reproduction. My sister-in-law is a PA at Planned Parenthood and she is startled by how many people actually believe EC is the abortion pill. Very, very important topic and I'm glad you're addressing it.

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  6. Jane you statement about encourage premarital sex is so very accurate. They just do not understand that reality is reality - having a solution to avoid a potential pregnancy does not encourage sex - hormones and that warm fuzzy feeling do. It really isn't rocket science.

    What really bothers me about all the rhetoric is, that it is aimed solely at the woman and the man - well they sluff that off with "you know boys will be boys, sowing the wild oats" - if they want to go on a crusade, they need to crusade about the attitudes they themselves hold about how one of the two is seen as bad (fill in the blank), and the other is just doing what comes naturally.

    ***

    Whenever I get a new med to take the pharmacist sits down with me and goes over all the known risk factors. I am also given a print out of risks and signs and symptoms to be aware of and what my first step should be if anything listed happens. I have been on so many different drugs and combinations since I got sick and not once have I not been counselled about the new drug I am given.

    If a woman can sign away her legal rights to her child as a teenager then surely they must agree (not that I agree with the above), that she has the capability to listen, assess, and make her own educated decision to take something that may on a very rare occasion cause bleeding.

    ***

    It is crazy to me how many wish to go back in time to those "good old days". It disgusts me.

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  7. Actually, Anony 4:21 p.m. - you are incorrect. Those findings were for the abortion pill, which is not emergency contraception. That particular drug is still illegal in the US as far as I know.

    I know that kids start having sex the asap - all this nonsense about teaching them to be responsible is lovely and totally inaccurate. I have yet to meet a girl over the early parts of puberty (remember puberty often starts as early as 8 or 9 years old), that has not, at minimum, flirted with the idea of "going all the way" with a boy they like.

    Sigh.... definitely linking here....

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  8. I thought EC was the abortion pill-Well,learn something every day I wanted to be pregnant, so I wouldn't have taken either pill back when I had my son anyway. But for those not wanting to be pregnant, I guess it's better than having a surgical procedure Really don't know much about any of this I felt like everyone assumed that just because I was 'unmanned' I didn't want my baby or that it was an unintended pregnancy As far as EC I'm not sure I want all those hormone pills floating around over the counter Just more pills that will end up in the water/food supply

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  9. interestingly enough Margaret Sanger also targeted black women for abortions, and wanted to sterilize minorities, yes I am all for safe sex and measures for choice, but dont make a martyr out of a woman who obviously wasnt a saint

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  10. Oh wow, didn't know this Jenn, thanks for alerting us. Looks like the raciest mores of the era and her enthusiasm got the best of her. Often our saints have major sins.

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  11. but I do feel that she paved the way for a freedom that we enjoy now, or at least the start of a way. interesting piece, what was the last word on those brochures to pass out, because I would def. pass some out!

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  12. You were unaware that Sanger was a rather leading eugenicist, Lorraine? To me, living in another country, that is even the first association I have with that name.

    To quite some good people Satan is a name evoking just as much admiration as Sanger, though she wasn't quite as bad as some other eugenicists, granted, quoting her would rather give the wrong impression about your cause to some people.

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  13. Marie Stopes was Britain's equivalent to Margaret Sanger, and was influenced by her work.
    People sometimes get the two confused.
    Eugenics was broadly popular during the early decades of the 20th century when it was considered progressive and had not yet been discredited.
    Many famous names were included among its supporters, including Canada's father of medicare, Tommy Douglas, the title of whose master's thesis was "The problems of the subnormal family", (McMaster University, 1933).

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  14. I see not much daylight between eugenics and forced pregnancy/abortion for the under 17 (especially nice white girls who can produce for the market). That is exactly what Obama's stupid non birth control policy enforces.

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  15. RU-486 is what is known as the abortion pill. It was developed in France and is considered a medical alternative to surgical abortion. It is available in the U.S. through Planned Parenthood and probably other medical providers. It can only be used under close medical supervision as it does come with significant risks and side effects including hemorrhaging. I think this is what Anon 4:21 was referring to. There have also been some fatalities associated with the drug. It is a different combination of drugs than what is used in Plan B (or emergency contraception) and will never be approved for OTC use.

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  16. Plan B is nothing more than a high dose of oral contraceptives. I worked at Planned Parenthood during the 1980's and we gave Ovral in a two step dose at minimal cost. It is outrageous what the pharmaceutical companies charge for this drug! And as for the administration's paternalistic stance I am sooooo disappointed.

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  17. Thank you Mary!

    Someone said that Obama had to do this because he didn't want to anger the evangelical conservatives, but WTH, they aren't going to vote for him anyway. I countered with: But what about doing something to energize the base?

    It was my understanding that college infirmaries for years have given out emergency dosages of the pill to college students coming in need, and found out they worked to prevent pregnancy.

    And yes the cost is crazy! It is something like $35 when it should be no more than a few bucks (mostly for packaging and shipping) and still give Big Phrama enough profits. Keeping the cost high is like making condoms $20 apiece.

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