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Once again women’s health and autonomy is being compromised for politics.

In 2011 the FDA said that emergency contraception like Plan B and Next Choice should be available over the counter to all who seek it. But in an unprecedented move, then Health and Human Services secretary, Kathleen Sebelius, countermanded their recommendation, requiring that females under age 17 obtain a prescription. This meant that women of all ages had to ask for the medication from a pharmacist, who might lecture or even refuse outright as some disapproving conservative pharmacists have done.

On April 5, Federal JudgeEdward R. Korman called the restrictions “arbitrary, capricious and unreasonable” and said that “the secretary’s action was politically motivated, scientifically unjustified, and contrary to agency precedent.” He ordered the drug to be made available over the counter with no age restrictions by May 5. His ruling had support from the American Medical Association, the American Congress of Obstetricians and Gynecologists, and the American Academy of Pediatrics. It also fit the FDA’s scientific risk analysis.

But on Tuesday, April 30 the FDA recommended instead that the age be dropped to 15, that the drug be available with regular reproductive health products, and that cashiers rather than pharmacists verify the purchaser’s age.

On the surface this seems like a reasonable compromise. Pregnancies to teens under age 15 do happen, but they are so rare that the CDC and most states record teen pregnancy statistics just for girls age 15 and up, the age at which the public health problem becomes significant. Cashiers are in the habit already of verifying age on cigarette and alcohol purchases. And the pressure is on: Religious conservatives have been painting fantastical scenarios in which 11-year-olds walk into drugstores (apparently these are sexually active 11-year-olds with $50 in their pockets) and purchase the medication without being fully aware of the side effects (which in this scenario is somehow worse than an 11-year-old being pregnant or having a baby). So maybe, just maybe, the authors of these dire fables will be mollified and the women and teens who really need the medication will get it.

What’s wrong with a little compromise?

Two things.

First, the job of the FDA is to make rules based on uncorrupted science. Not politics. Not convenience or comfort. Science. Period. Drug companies may advocate on behalf of their profit margins. Politicians may advocate on behalf of political ideology or campaign donors or favorite lobbyists. But the job of the FDA is to make clean recommendations based on how foods and drugs actually affect people. In this case those people are women and teens, and the science is clear. Having the drug freely available results in better public health outcomes than does restricting it. Political compromise casts doubt on the whole regulatory enterprise, and the agency, and it should.

Second, the real effect of the compromise isn’t on 11-year-olds, who don’t actually have sex and then show up at drug stores with 50 dollars worth of allowance in their pockets asking for Plan B. The real effect is on females of all ages who are forced to produce ID to get emergency contraception. When a women or teen needs emergency contraception she typically is in a situation she would rather not publicize. A condom has broken. Or she screwed up her birth control. Or she had impulsive sex. Or she got raped.

For a teen, any of the above can be vastly more awkward or traumatic than for a more experienced woman. But either a teen or older woman who needs emergency contraception may not want to show her name to a cashier who has no professional code of confidentiality. Having to show ID to a cashier in order to get Plan B is not as humiliating as being subjected to an unwanted and politically motivated vaginal probe (aka probe rape) prior to an abortion, but it still is an indignity.

And that is exactly what religious conservatives are after. To make contraception more difficult in any way they can. To make sex scary. To make sex humiliating. To punish women and teens for failing to keep the aspirin bottles between our knees. Or daring to pursue dreams that aren’t about motherhood, or even daring to dream of motherhood that is planful and prepared. Mitt Romney, in a commencement speech at Southern Virginia University last Saturday advised graduating students to marry young and—in biblical language—to have a “quiver full of kids.” That’s what this is about, the fact that conservatives think they know when and how and why we should have sex. The Obama administration had the mandate and  information they needed to make a science-based decision that made women's health top priority, and once again they failed to do so. And that’s what’s wrong with the compromise.
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Read more:
The Big Lie about Plan B–What You Really Should Be Telling Your Friends.
Plan B Ruling: Fox and Family Research Council Seize Chance to Spread Misinformation
15 Things Old Boys like Rick Santorum Don’t Want You to Know About Your Body and Your Contraception
A Brief History of Your Period and Why You Don’t Have to Have It

Valerie Tarico is a psychologist and writer in Seattle, Washington. She is the author of Trusting Doubt: A Former Evangelical Looks at Old Beliefs in a New Light and Deas and Other Imaginings, and the founder of www.WisdomCommons.org. Her articles can be found at Awaypoint.Wordpress.com.

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Comment Preferences

  •  Tip Jar (8+ / 0-)

    Knowledge is an unending adventure at the edge of uncertainty.--Jacob Bronowski www.WisdomCommons.org

    by ValerieTarico on Wed May 01, 2013 at 10:33:08 AM PDT

  •  You can't split the deal on court rulings, either. (2+ / 0-)
    Recommended by:
    wilderness voice, david78209

    This doesn't bring them into compliance with the courts.

  •  This is ridiculous (3+ / 0-)
    Recommended by:
    Meteor Blades, splashy, david78209

    There is no danger to anyone taking this who isn't having sex.  If they are going to put an age on it, it should be no higher than 12.  I suppose a limit of 10 at least wouldn't do much harm.

    Moreover, they are under court orders to make it available to everyone, with no age limit, by Monday.  What is the point in announcing new rules that will only apply for 5 days?

    They say this is unrelated to the judge's ruling.  So it's not a compromise, I guess.  They say they were going to do this anyway.  But why not then  instead actually comply with the ruling, while they are at it?

     

  •  Evidence for this? (0+ / 0-)
    First, the job of the FDA is to make rules based on uncorrupted science. Not politics. Not convenience or comfort. Science. Period.
    Is that assertion supported by statute? Regulation?

    I ask because regulatory agencies commonly take into account nonscientific matters in their decision-making. EPA, for example, has calculated maximum contaminant levels in drinking water in part on science (i.e., dose-response considerations) as well as on economics and technical feasibility.

    •  you are referring to cost-benefit analysis (0+ / 0-)

      whereas this is a case of catering to the religious sensibilities of the fundamentalists

      •  I am referring to an absolute statement (0+ / 0-)

        that I suspect is not factual.

        But I'm open to being convinced otherwise.

        •  Pharmaceutical medications are (0+ / 0-)

          a very different area of regulation than that which the EPA oversees.  The pharmaceutical production and distribution system is highly controlled unlike environmental and ecosystems.

          In any case, in theory the FDA should be working from scientifically proven data to make their decisions.  Politicization at that agency, however, is not as rare as it should be.  There was a time when this country had the fewest drug recalls of any other nation.  But political meddling has infected the FDA in the past two decades under the premise that they were too slow at approving drugs and did not give enough latitude to researchers.  Some of that came out of the AIDS debacle of the 80s where between Reagan's denials of the dangers and realities of the disease and the slow progress on producing treatments for the disease created a coalition of people who pushed the FDA to be less conservative in their processes.

          This ruling by the FDA is pretty obviously a political response.  The Administration having lost cover with HHS has punted the issue over to FDA to get some ground back.  The next lawsuit that will be filed will be filed against the FDA.

          •  Understood (0+ / 0-)

            Again, I'm merely asking for substantiation for a claim made by the diarist.

            I would be surprised if such a limitation exists, but I'm willing to be convinced.

            •  I would guess that my statement (0+ / 0-)

              was overly simplistic.  

              Knowledge is an unending adventure at the edge of uncertainty.--Jacob Bronowski www.WisdomCommons.org

              by ValerieTarico on Wed May 01, 2013 at 01:37:54 PM PDT

              [ Parent ]

              •  That said, the other considerations I listed (0+ / 0-)

                appear to be off mission for the agency.  

                FDA is responsible for protecting the public health by assuring the safety, efficacy and security of human and veterinary drugs, biological products, medical devices, our nation’s food supply, cosmetics, and products that emit radiation.

                FDA is also responsible for advancing the public health by helping to speed innovations that make medicines more effective, safer, and more affordable and by helping the public get the accurate, science-based information they need to use medicines and foods to maintain and improve their health. FDA also has responsibility for regulating the manufacturing, marketing and distribution of tobacco products to protect the public health and to reduce tobacco use by minors.

                Finally, FDA plays a significant role in the Nation’s counterterrorism capability. FDA fulfills this responsibility by ensuring the security of the food supply and by fostering development of medical products to respond to deliberate and naturally emerging public health threats.

                Knowledge is an unending adventure at the edge of uncertainty.--Jacob Bronowski www.WisdomCommons.org

                by ValerieTarico on Wed May 01, 2013 at 01:45:21 PM PDT

                [ Parent ]

  •  this administration has a long standing habit of (2+ / 0-)
    Recommended by:
    david78209, Shahryar

    compromising with the RWNJ's.  They shoulda hit the ground running at the very outset, fired every single Bush appointee they could have, herded the rest into turkey farms, killed all the "faith based" funding, and prosecuted the Bushco torturers relentlessly.  The RWNJs were going to hate Obama you no matter what, so why do them any favors?  But that is just not Obama's style.

  •  I am still (4+ / 0-)

    of the opinion that having them available without having to go to a pharmacist is a good thing.

    "The next time everyone will pay for it equally, and there won't be any more Chosen Nations, or any Others. Poor bastards all." ~The Boomer Bible

    by just another vet on Wed May 01, 2013 at 11:51:45 AM PDT

  •  Since Plan B has been approved by OB/GYN's, (1+ / 0-)
    Recommended by:
    david78209

    I'm going to assume that no harm can be done. I'm always a little skeptical about drugs with hormones (I assume Plan B has hormones in it). My experience with hormones, both birth control pills and hormone replacement therapy, has been negative. I took neither for longer than a month or two, as they didn't agree with my body. If a girl under the age of 15 has bad side effects, will she turn to her parents or a doctor? All of what was said in this diary makes sense, and I'd be the last one to put any restrictions on women seeking to protect themselves. My concern is just as stated.

    •  Levonorgestrel, the drug in Plan B (1+ / 0-)
      Recommended by:
      david78209

      has been on the market in various forms for over 30 years. Most of the time it is used on a continuous basis, in contraceptive pills, or the micro-dose released by hormonal IUDs.

      There are acute side effects of taking an EC sized dose, like nausea, but there is not evidence of long term side effects from a single or scattered use. By contrast, an unintended pregnancy has a host of either short or long term side effects, depending on whether or not it is terminated. Of the three options, by far the one with the most morbidity and mortality is a pregnancy carried to term.

      Knowledge is an unending adventure at the edge of uncertainty.--Jacob Bronowski www.WisdomCommons.org

      by ValerieTarico on Wed May 01, 2013 at 01:42:28 PM PDT

      [ Parent ]

      •  So my question is, without some guidance (0+ / 0-)

        from a doctor or a pharmacist, will a 12 - 14 year old know what to do with the nausea? I imagine she will already be somewhat frightened by the thought of a possible pregnancy. If protecting these young girls from being left to their own devices means that older teens who look very young might have to be inconvenienced, I think I'm okay with that. We're not talking about something harmless. Plan B is medication that changes the natural workings of the body.

        Side note: I worked at the welfare office. One day there was an eleven year old girl sitting across from me with her newborn baby. I don't ever want to see something like that again. So, I have no problem offering women and girls what they need to protect themselves. I just think we need to concern ourselves with the effects on their bodies. Perhaps the government shouldn't get in the middle, or maybe that's the only place it's going to come from.

        •  The way FDA is supposed to make decisions (1+ / 0-)
          Recommended by:
          HappyinNM

          is by doing a risk/benefit analysis based on the scientific evidence.  So, even if you assume that there may be a 12 or 14 yo who doesn't know how to manage vomiting, the question is, is the alternative worse?  In this case the alternative is a slight (or not so slight) decrease in access to medications for all women and teens, but especially for teens who may not have ID or may be reluctant to show theirs.

          Knowledge is an unending adventure at the edge of uncertainty.--Jacob Bronowski www.WisdomCommons.org

          by ValerieTarico on Wed May 01, 2013 at 03:26:16 PM PDT

          [ Parent ]

          •  So, maybe the solution is to put a notice (0+ / 0-)

            where Plan B exists on the shelf saying that if you have any questions about the use and/or side effects of this medication, the pharmacist is available to answer your questions---It's not necessary for you to identify yourself. Maybe the same notice should appear on the shelf where any OTC drugs are sold.

            A pharmacist at Walgreens told me that many medications are no longer filled by the resident pharmacist. They are filled by machines in AZ and shipped to the individual stores. So it seems the pharmacists will have plenty of time to advise patients.

  •  Thank you very much for this diary. (0+ / 0-)

    I really hope the judge issues a bench warrant for Kathleen Sebelius if HHS doesn't comply with his order.  
    After learning that she's going to give Medicare "Advantage" plans a 2.2% raise a few days ago, and learning that hospices will get only 1.1% today, I'd like to see her in jail.  The worst thing about this little bit of fantasy schadenfreud is how unlikely it is to come true.

    We're all pretty strange one way or another; some of us just hide it better. "Normal" is a dryer setting.

    by david78209 on Wed May 01, 2013 at 02:23:55 PM PDT

  •  How many 15-year-olds have an ID? (0+ / 0-)

    Much less, one issued by a government (if that would be required).  At 15, I think I carried a library card.  Sometimes.

    We're all pretty strange one way or another; some of us just hide it better. "Normal" is a dryer setting.

    by david78209 on Wed May 01, 2013 at 02:33:00 PM PDT

    •  Kids who fly as unaccompanied minors. (1+ / 0-)
      Recommended by:
      david78209

      Kids who go on trips with groups that require them all to have government photo ID.

      Kids who have learner's permits - if they live in states where 15-year-olds are eligible AND if they or their families feel the need for them to be learning to.

      And considering how much a permit costs, and that the expiration period is much sooner than an adult license, I doubt many kids in poor urban neighborhoods have one, especially in carless families or places where walking or taking the bus will get you everywhere. Cheaper to wait until adulthood and get the full license after a short period on a permit, especially in states with graduated licensing systems for under-18s.

      Prayers and best wishes to those in Boston, in Texas, and for this week to be over without anything else happening.

      by Cassandra Waites on Wed May 01, 2013 at 03:05:05 PM PDT

      [ Parent ]

  •  Can we get the Israel lobby to help us here? (0+ / 0-)

    Plan B is produced by Teva phamaceuticals, an Israeli company. There is no reason that it should not be over the counter for everyone, other than politics. (There really is no reason why ANY oral contraceptive should not be over the counter.)

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