July 10, 2007

Plan B prevents pregnancy

Don Downing, Consultant to the South Carolina Emergency Contraception Campaign

As a pharmacist, college professor, and women’s health advocate, I spend a lot of my time educating pharmacists, pharmacy students and other medical providers on how to improve access to health care, especially health care that helps prevent avoidable problems, including unintended pregnancies.
Recently, I spent a week in South Carolina delivering seminars to pharmacists, nurses and physicians on emergency contraception. Last fall, the U.S. Food and Drug Administration (FDA) ruled that Plan B — also known as “morning after” pills, emergency contraception or emergency birth control pills — can be sold without a prescription to customers over the age of 18. (Women under the age of 18 still need a prescription from their doctor or clinic.) The FDA’s decision makes it much easier for women to obtain this method of contraception in a timely manner. And timing is everything. A woman can reduce her risk of pregnancy by up to 89% if she takes the medication within 72 hours (three days) after unprotected intercourse.
The health care professionals I met with repeatedly said that they had no idea that emergency contraception (Plan B) was not RU-486 – the abortion pill. They didn’t know that Plan B is a concentrated dose of the same medication as in regular birth control pills. Many believed, inaccurately, that Plan B only worked by preventing a fertilized egg from implanting in the womb. During the seminars, they learned that medical evidence does not support this belief. Plan B prevents pregnancy – it does not end a pregnancy. In fact, it has absolutely no effect if a woman is already pregnant when she takes it.
Providers, elected officials, and community leaders, among others, must make themselves aware of the unmet health care needs of the people they serve. They must understand and appreciate the factors that contribute to these health care needs, including becoming self-aware of things they themselves may be doing or believe that may contribute to health care problems. Unintended pregnancy is a national public health issue and access to contraception and objective sexual health information is critical to addressing this crisis. While women should take the lead in educating themselves about such matters, there must be additional support from physicians and pharmacists.
Recently, legislators in South Carolina have considered a bill that would allow pharmacists to refuse to fill prescriptions based on their moral beliefs. My major concern is that many providers have wanted to hide behind this type of “conscience clause” in order to not provide what they erroneously construed to be an abortifacient medication. What a shame if they denied a woman access to medication that actually has the potential to prevent an abortion! The number of women who have had to make the difficult decision to have an abortion because a provider failed to inform them about a legal and safe contraceptive method is a frightening thought.
While health care providers and pharmacists have constitutional protections of their religious freedoms and may elect to not provide a service that conflicts with their deeply held beliefs, this protection does not impart any right to refuse services they only thought were in conflict with their beliefs. I am concerned about how few people really know about the scientific evidence of how the contraceptive, Plan B, works. Before considering legislation that might allow unknowing pharmacists to deny contraceptive care, it would be prudent to make sure that enlightened choices by providers are being made.
Pharmacies must reasonably accommodate their employees’ rights but denial of a standard-of-care contraceptive service to a rape victim, incest victim or to a woman who, after-the-fact, discovers a hole in her condom or diaphragm, is a victimizing act in and of itself.
Rather than spending the time, money and energy it takes to pass laws that may increase women’s chances of having an unintended pregnancy, take a few moments to consider the evidence-based medical facts and consider supporting better contraceptive access and health education for everyone.
Don Downing, a licensed pharmacist in Seattle, Washington, is a faculty member at the University of Washington School of Pharmacy and serves as a consultant to the South Carolina Emergency Contraception Campaign. You may direct inquiries to him at info@morningafterinfo.org.