Tuesday, February 19, 2008

Should pharmacists be able to deny EC to women?

The Missouri state legislature is considering a bill that would reclassify emergency contraception as an abortion-inducing medication. This is a problem for two reasons. Firstly, emergency contraception (EC) does not cause an abortion -- it prevents pregnancy. Secondly, if the bill were passed, the new classification would allow pharmacists to refuse to dispense EC for reasons of "conscience."

Opponents attacked the proposal as an unconstitutional restraint on reproductive freedom and an unconscionable affront to sexual assault victims. They said the bill would enshrine an inaccurate medical description in Missouri law, lead to increased numbers of abortions and leave millions of rural Missouri women without access to a safe and reliable form of birth control.

Filling prescriptions “is an essential function of your job,” said Pamela Sumners, executive director of the Missouri affiliate of the National Abortion and Reproductive Rights Action League. “If you become a pharmacist, you should do your job.”

The bill applies specifically to two drugs: RU486, the early name for mifepristone, the drug administered in a doctor’s office to perform a nonsurgical abortion; and emergency contraception, which is marketed as Plan B.

Mifepristone, which is used from five to seven weeks after conception, works by blocking a hormone needed to maintain the pregnancy.

Plan B, which is effective up to about 100 hours after unprotected sexual intercourse, works primarily by preventing ovulation, the FDA says. If an egg has already been released, the drug also can prevent fertilization. And if fertilization has occurred, it can prevent the fertilized egg from implanting in the uterus.

Susan Klein, a lobbyist for Missouri Right to Life, noted that the bill does not attempt to make emergency contraception illegal. It only seeks to prevent family planning activists from exerting legal pressure against pharmacies that refuse to dispense it.

Klein said her group considers emergency contraception a form of abortion because her members believe that pregnancy begins the moment an egg is fertilized. Plan B, therefore, can lead to the death of “an already-created human being” by blocking implantation in the uterus, she said.

By the time of implantation, “the human is long past the stage of being a so-called fertilized egg,” Klein said in written testimony. “If denied the ability to implant, then the human cannot form a placenta and continue to live. This means that a drug that prevents implantation causes an abortion.”

Sumners said emergency contraception does not induce an abortion. As the FDA notes, it won’t work if the fertilized egg has already implanted in the uterus and pregnancy has begun. Under Klein’s definition of pregnancy, many standard forms of contraception, such as intrauterine devices, would be defined as abortion-inducing, Sumners said.

Sumners is absolutely right: Klein's definition of pregnancy is absolutely false and is not accepted by any reputable medical organization or by the U.S. government. In fact, the idea that EC could prevent a fertilized egg from implanting is nothing more than speculation and the drug has never been scientifically proven to act in this way. The suggestion that EC causes an abortion is entirely mistaken and misleading, though it is a claim regularly made by anti-choice groups.

Of course, everyone has a right to their personal and religious beliefs, including those that are not scientifically sound. But while they are privately employed, pharmacists do provide a necessary public service. Women have the right to receive prompt, safe and non-judgmental medical care, and being denied that right can cause very serious consequences -- including the possibility of an actual abortion at a later date.

EC, more than most drugs, requires a high level of accessibility. The drug has some level of effectiveness for up to 120 hours (five days) after unprotected intercourse, but is most effective when taken within 72 hours. The sooner a woman takes EC, the better her chances for avoiding an unwanted pregnancy. The last thing any state government should be doing is making an FDA-approved and time-sensitive form of birth control less accessible to women who need it.

As Sumners and a Planned Parenthood lobbyist argue, the impact that this bill could have on women is rather dire:

Michelle Trupiano, a lobbyist for Planned Parenthood, said the bill is an effort to limit the availability of Plan B. The references to mifepristone are disingenuous, she said, because pharmacists are not allowed to dispense mifepristone, which must be administered by a doctor.

Plan B is so safe that it is available without a prescription to women 18 years and older, she said. However, one pharmacy that refuses to carry Plan B can leave thousands of Missouri women without a backup method of birth control, Trupiano said.

Sumners said a study found that 26 percent of women in Missouri do not live within 30 miles of a pharmacy that sells Plan B. She acknowledged that no pharmacy could be required to keep emergency contraception in stock. But if it is in stock, pharmacists should not be allowed to refuse to dispense it, she said.

Those are some pretty shocking numbers. Thousands of women without access to EC due to the personal beliefs of one pharmacist! But it's not only reproductive rights advocates that are up in arms over the bill. Other groups that care about women's rights are also very concerned:

Colleen Coble, who heads a Columbia victims’ rights group, urged the panel to consider the bill’s effect on sexual assault victims. She emphasized that emergency contraception was not a form of abortion. The use of emergency contraception is standard care for rape victims, she said, even in Catholic hospitals.

“In a case where your body has become a crime scene, where you have undergone an incredibly invasive examination to gather evidence, (this bill) would make you travel four counties away to avoid becoming pregnant by the person who violently attacked you,” Coble said. “This is an issue of health care. It’s an issue of decency.”

No woman should be denied EC, regardless of why she needs it, but Coble is right to suggest that the situation is most urgent for those who are the victims of sexual assault. No pharmacist is capable of knowing a woman's reason for requesting EC. And even though the reason shouldn't matter, pharmacists who refuse to dispense the drug are always taking the risk of revictimizing a woman who has been raped.

If you're close to a Planned Parenthood center, you'll always have access to EC -- even if you're under the age of 18. Because you never know when you might need it, it's a good idea to keep some on hand.

Of course, not all women are lucky enough to be close to one of our health centers, and not every medicine cabinet is stocked with EC. That's precisely why potential laws like these are so dangerous, and why they ought to be rejected.

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