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The high price of birth control politics

By ROBYN E. BLUMNER
Published April 10, 2005

We're waiting. The women of America, or at least the 95 percent of us who will use some form of contraception during our childbearing years, are waiting for the Food and Drug Administration to stop putting ideology over science.

It has been nearly two years since the makers of Plan B, a morning-after emergency contraception pill, submitted an application to change the status of the two-tablet regimen from prescription-only to over-the-counter. There is only one reason the change has not been made: abortion politics.

At first it may seem odd that the antiabortion Bush administration would throw up unreasonable barriers to the approval of over-the-counter emergency contraception. It is estimated that allowing easy access to morning-after pills would prevent 1.7-million unintended pregnancies a year, including 800,000 abortions. Why wouldn't the administration jump at the chance to eliminate the need for thousands of abortions?

But dig a little deeper and a radical fringe agenda emerges. It has to do with the medical definition of pregnancy versus the theological one.

Emergency contraception pills are remarkably safe and highly effective at preventing pregnancy if taken within days of unprotected intercourse. The staff at the FDA and an advisory panel of experts strongly urged the agency to approve Plan B's over-the-counter availability. But last May, the FDA turned down that request on the grounds that girls under 16 might have difficulty understanding how to take the medication properly. (Funny, those concerns didn't stall the approval of over-the-counter sleeping aids and cough syrups.) The agency is now more than two months past a deadline for deciding on a revised submission that would limit over-the-counter access to those 16 and over.

The pills work primarily by delaying or preventing ovulation and by inhibiting fertilization - in both these cases, there is no fertilized egg.

But there is also an unproven theory known as the "postfertilization effect" that says emergency contraception and birth control pills alike change the uterine lining in a way that prevents the egg from implanting.

This is what all the fuss is about. To a tiny minority of doctors and pharmacists and to virtually the entire Bush administration, emergency contraception is an abortifacient.

Established medical science, however, has come to a different conclusion. The American College of Obstetricians and Gynecologists defines pregnancy as starting after a fertilized egg implants in the wall of the uterus, not the moment the egg is fertilized. Pregnancy tests won't even indicate a positive result before implantation; and it is worth noting that between 40 and 60 percent of fertilized eggs will, on their own, fail to implant. I guess that's viewed as nature's holocaust to some.

To see just how freighted the terms of the debate are, here is an exchange last month between Sen. Hillary Rodham Clinton, D-N.Y., and Dr. Lester Crawford, acting FDA commissioner, during his confirmation hearing: "Would you clarify for the committee that emergency contraception is a method for prevention of pregnancy, not the termination of pregnancy?" Clinton asked.

Crawford responded: "I may need to confer with the experts in the FDA about exactly what the physiology of it is." He then suggested that any label would say "prevention," and then backtracked from that.

Clinton tried again to get a straight answer. She read from the FDA's own release of May 2004: " "Emergency contraception is a method of preventing pregnancy.' That is the FDA position, is that correct Dr. Crawford?"

Crawford again dissembled and obfuscated, saying he needed to "consult with the experts in the center."

He also refused, despite pointed questioning from a number of senators, to assure that Plan B would be approved as an over-the-counter drug or to say when a decision by his agency might be made.

This obsession with a postfertilization effect is driving many of those pharmacists who are refusing to fill birth control prescriptions. They say their faith doesn't allow them in good conscience to provide hormonal contraceptives, because it might lead to a "chemical abortion" of a fertilized egg.

Before implantation, a human embryo is typically between 50 and 150 cells. Compare that to the 250,000 cells that make up the brain of a fruit fly and we can begin to see just how extreme these views are. Millions of American women may need emergency contraception in the next few years. But their ability to obtain it will be unnecessarily complicated until some semblance of common sense returns to Washington.

[Last modified April 10, 2005, 00:40:18]