Over-the-Counter Sale of Morning-After Pill In US

On Aug. 24, the Food and Drug Administration approved the over-the-counter sale of the morning-after pill, known as Plan B, to women over 18. This decision was the culmination of a five-year battle to increase access to the drug, which can prevent pregnancy if taken within 72 hours of unprotected intercourse. The sooner it's taken, the more effective it is. The government's decision means that women under 18 will not be able to purchase Plan B without a prescription, despite the recommendation of two FDA advisory panels that it is safe for all ages.

The fight began in February 2001 when more than 60 medical and consumer groups filed a "citizen's petition" with the FDA to make emergency contraception available over the counter, asserting that the morning-after pill was safe enough to be sold without a doctor's supervision. Religious right and anti-abortion activists have opposed Plan B, calling it an abortefacient, but scientific opinion generally holds that it prevents conception and is thus a method of birth control, not abortion. Between the Lines' Melinda Tuhus spoke with Ted Miller, communications director for NARAL Pro Choice America, about his group's three-year effort to win FDA approval for over-the-counter access to Plan B. He discusses what the compromise decision means for women's health, and how anti-choice groups are likely to react.

TED MILLER: I think there are a couple of key people or organizations and others that Americans owe a debt of gratitude to: people like Susan Wood, who resigned last year from the Office of Women’s Health of the FDA over her objection of politics interfering with what was a medical decision that could improve women’s health. She was a true hero in this effort; her resignation heightened public awareness of what was going on at the FDA. In addition to Dr. Wood’s leadership, we also had Sens. Hillary Rodham Clinton and Patty Murray, who were absolutely stalwart in their support for over-the-counter access for EC (Emergency Contraception). What that did was catapult this issue up to the public consciousness in such a way that it was really the beginning of a slide for the Bush administration toward the inevitable position that they could no longer defend their political interference at the FDA.

BETWEEN THE LINES: But, despite much scientific and medical evidence that Plan B is absolutely safe for women under 18, the FDA’s decision does not allow them to access the morning after-pill, which NARAL and other groups fought for.

TED MILLER: The evidence on this drug’s safety is overwhelmingly positive. And you know, experts like the Academy of Pediatrics recommended the medication be available for women of all ages. I think what that age restriction does is it brings us to a broader issue about our country’s unacceptably high rate of teen pregnancy. This problem won’t be solved as long as the Bush administration refuses to support efforts to prevent teen pregnancy. So, I think the age restriction is an unfortunate and unnecessary restriction, but overall, we waited for so long for this decision to be made, and to push forward, that we take this initial step, make sure that women have the information necessary regarding Plan B, and to ensure that pharmacies are compliant in making sure that this safe, effective form of birth control is available to them.

BETWEEN THE LINES: Ted Miller, now, what about the role of pharmacists? Since a prescription is not even required according to the new FDA ruling, what role do they play?

TED MILLER: The far right – organizations like the Family Research Council, Concerned Women for America – groups that have launched a very hostile, aggressive effort against women’s access to birth control, are obviously upset at the FDA’s decision to side with science and women’s health. What we can expect to see is state-by-state effort by these groups to try to block women’s access to Plan B. I don’t know if the specifics will be clear yet, but we already know they have laid the groundwork in states to allow pharmacists to refuse to fill regular birth control prescriptions. In 2006, 18 states considered measures that would allow pharmacists to refuse to sell birth control prescriptions, so it is a very serious threat to women’s access to reproductive health care.

BETWEEN THE LINES: So, can pharmacies just decline to stock Plan B altogether?

TED MILLER: I think enforcement is a key part of this. This is an FDA decision; the FDA has clearly said women 18 and over should have unfettered access to this safe, effective form of birth control. We want to make sure that happens. I think right now the FDA is working with the manufacturer on the specifics, and so we’ll anxiously monitor those discussions to make sure that accessibility is addressed and that women have the access they need to Plan B. There are four states in the country where it’s legal for a pharmacist to refuse to fill women’s birth control prescriptions. Another high number of states have refusal clauses for medical conservatives that could be interpreted to extend to pharmacists. But what they’re doing at the state level is advancing legislation – and this happened in 18 states last year – where they are trying to pass legislation that would give pharmacists the explicit right to refuse to fill birth control prescriptions. Before the FDA’s decision on Plan B, part of that strategy was not only to block women’s access to the daily dosage of regular birth control pills, but also to allow pharmacists to block women’s prescriptions for Plan B as well.

It’s important to note there has been some positive progress as well. Before the FDA’s decision, nine states had passed bills that would allow pharmacists themselves to provide Plan B without a prescription.

BETWEEN THE LINES: Plan B costs between $20 and $40 for a two-pill dose. Why is it so expensive?

TED MILLER: We don’t deal, typically, with the cost of the prescription drugs, but we do support broader assistance for lower-income women to have access to birth control, and we certainly hope that states and the federal government would extend that coverage to women who want the access to the morning-after pill.

For more information on the fight for access to Plan B, call NARAL at (202) 973-3000 or visit the group's website at www.prochoiceamerica.org

Melinda Tuhus is a producer of Between The Lines, which can be heard on more than 40 radio stations and in RealAudio and MP3 on our website at http://www.btlonline.org. This interview excerpt was featured on the award-winning, syndicated weekly radio newsmagazine, Between The Lines for the week ending Sept. 1, 2006. This Between The Lines Q&A was compiled by Melinda Tuhus and Anna Manzo.

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