This paper reflects the research and thoughts of a student at the time the paper was written for a course at Bryn Mawr College. Like other materials on Serendip, it is not intended to be "authoritative" but rather to help others further develop their own explorations. Web links were active as of the time the paper was posted but are not updated.
Sex and Gender
2005 Final Web Papers
Emergency Contraception and Anti-sex Policy
Jane is a sixteen year old high school dropout. She has run away from home and is living with her drug dealer boyfriend. One night, the condom breaks while they are having sex. She decides to go to the free clinic to get the morning after pill. The doctor gives her a prescription for Plan B emergency contraception, but when she visits the only pharmacy open in her town on Sunday, the pharmacist on duty refuses to give her the drug, for moral reasons.
Amy is a thirty year old, married suburban mother of two. One night, while walking home from getting her nails done, she gets kidnapped and raped. Her husband takes her to her family doctor to get a prescription for Plan B. Amy visits the same pharmacy and is also told that the pharmacist will not give her the drug for moral reasons.
Which woman should be given the pill? Which woman should not? Should their social background affect their access to emergency contraception? What are the pharmacists moral reasons and should he be allowed to refuse treatment? These questions are at the heart of the debate over emergency contraception.
I invented the previous two scenarios but there are thousands like them happening every day. An anonymous woman wrote to the emergency contraception provider getthepill.com. "After calling every local clinic, hospital and doctors office that was open on Sundays, I was amazed by their reaction and refusal to supply emergency contraceptive. Apparently, being responsible enough to immediately follow up after my birth control failed, is taboo in this small town!" And the president of Pharmacists for Life International, Karen Brauer, wrote about EC that "I would not touch the pill where abortion is a significant mechanism. The big conflict is that some people don't recognize there is a second person in a pregnancy. I have to look out for both of them." How can these positions be resolved?
I argue that the pharmacist does not have the right to refuse women their prescription. One woman does not have more of a "right" to emergency contraception than another based on her lifestyle choices or victimization. If emergency contraception is a right for Amy, then it is a right for Jane as well. To refuse Jane her drug is to punish her for her choices. And refusing her her drug will send the message that the government has the right to control whether or not women are allowed to have sex without bearing children. Men have always had the right to sex without childbearing. With new reproductive technologies like Plan B Emergency Contraception, women can now have that right as well. Taking it away from them is forcing them into traditional gender roles. Policing emergency contraception is policing sex.
To unravel the relationships between women, Plan B and pharmacists, one must start at the beginning: with the drug. Emergency contraception is difficult to define. Its biochemical mechanism is not yet known. Unlike RU-486 or surgical abortion, there is no exact scientific explanation of how the pill works. The US Food and Drug Administration explains:
Plan B works like other birth control pills to prevent pregnancy. Plan B acts primarily by stopping the release of an egg from the ovary (ovulation). It may prevent the union of sperm and egg (fertilization). If fertilization does occur, Plan B may prevent a fertilized egg from attaching to the womb (implantation). If a fertilized egg is implanted prior to taking Plan B, Plan B will not work.
This definition causes problems. The primary mechanism of the drug is to stop ovulation. Only 40% of women trying to conceive without using birth control become pregnant (gain implanted embryos). This means that it is unlikely that an egg will even come near sperm let alone unite with one and implant on the womb. Still, the pill may prevent implantation of a few hours old, microscopic embryo. Many of the pill's opponents use this possibility to claim that the pill is an aborticant, like the controversial RU-486. The pill's association with abortion creates inaccurate implications.. It is possible that Plan B may prevent an embryo from implanting. However, a months old fetus and a few hours old, bundle of cells are not the same thing. Plan B cannot abort a fetus. It must be taken within 72 hours after intercourse and is most effective 12-24 hours after. Plan B is a contraceptive method that encourages a natural process in a woman's body. The aborticant definition is inaccurate.
What other arguments can opponents make? If the pill is not a true aborticant, why shouldn't women be allowed to take it? The United States Food and Drug Administration recently decided that Plan B emergency contraception cannot be sold over the counter in America because of health concerns, despite the fact that the advisory committee of health experts that reviewed the drug expressed its support. For now, in America, emergency contraception is in the control of pharmacists and pharmacies. Even if the FDA had approved Plan B for over the counter use, companies as big as Wal-Mart refuse to dispense it. Cashiers can claim civil rights just as much as pharmacists do and have less of a medical obligation to help patients.
Jane and Amy's reproductive future is currently in the hands of pharmacists. And the government cannot force an employees to work again his/her morals. As Lawyer Cantor and Dr. Baum wrote "Although we believe that the most ethical course is to treat patients compassionately—that is, to stock emergency contraception and fill prescriptions for it—the totality of the arguments makes us stop short of advocating a legal duty to do so as a first resort." (New England Journal of Medicine) But this legal loophole is dangerous. As they state in a different part of the article, "...because a pharmacist does not know a patient's history on the basis of a given prescription, judgements regarding the acceptability of a prescription may be medically inappropriate. To a woman with Eisenmenger's syndrome, for example, pregnancy may mean death." Just how much background does a pharmacist need to dispense a drug? Should it be medical or social?
The language of emergency contraception opponents is one of crime and punishment, victims and perpetrators, virgins and sluts. Louisiana State Representative Woody Jenkins said it best in 1995 "...He argued that it [the clause legalizing abortions only for rape victims] was unnecessary since a rape victim could go to a hospital within a few days of the crime to get a pill or injection that would prevent pregnancy. He stipulated, however, that he didn't support the use of such morning-after pills in cases other than rape." (William Saletan on Jenkins, brackets mine) Here, emergency contraception can only be given to the victims. The "cases other than rape" do not deserve the luxury of emergency contraception, since they committed the crime of sex.
Jenkins discovered the biggest issue in emergency contraception. Unlike surgical abortion, this issue is not about not a fetus' right to live or women's control of her body. Jenkins wants to let the government legitimize sexual intercourse.
If the emergency contraception concerns were purely in objection to the minimal chance that it may work as an aborticant, then the government and even the Catholic Church would not make exceptions for victims of rape or incest, because all abortions would be equally evil, regardless of the manner of conception, or, as pharmacist Erik McKlave cites Mark 9:42 "And if anyone causes one of these little ones who believe in me to sin, it would be better for him to be thrown into the sea with a large millstone tied around his neck." However, Jenkins and others have specifically stated that rape victims are "allowed" this drug.
Even liberal author Naomi Wolf parallels Jenkins' remarks "Once, I made the choice to take a morning- after pill. If what was going on in my mind had been mostly about the well-being of the possible baby, that pill would never have been swallowed...I was not so unlike those young louts who father children and run from the specter of responsibility." Here Wolf, having had irresponsible sex, does not deserve to take the drug for the sake of the embryo that could not yet be more than one hundred cells. She later discusses her emergency contraception as a "sin" that must be atoned for. So, rape makes emergency contraception ok and consensual sex makes emergency contraception as sin?
Viewed in this light, forbidding access to emergency contraception will create an anti-sex, pro-children society. If emergency contraception is a sin equated with murder of the unborn, it should be completely outlawed. And, if one believes anything else than all women should have it barring real health risks. There is not a gray area here. But with all of this moralizing, emergency contraception becomes very complicated very quickly. What's an activist to do?
Enter Harrison Hickman, a man who did not call himself a feminist, but spent most of his political career working for their cause as a pollster. Hickman was and is the definition of a pragmatist. He manipulated voters any way he could to swing them to his side, at times using racist and even misogynist themes to promote abortion and women's rights legislation. His methods were very effective. He would never hesitate to compromise (Saletan, 24-65). How would a man like Hickman approach the emergency contraception issue? He would approach it pragmatically; do whatever is necessary politically to secure EC access.
As a strong-willed feminist, my knee jerk reaction is to force pharmacists to do their job. I am frustrated Cantor and Baum's statement that the legality of forced dispensal of EC is legally questionable. The solution that Hickman would probably approve of is a two part strategy using economic pressures on pharmacies and government restrictions on pharmacists. The government could force pharmacies to choose between dispensing either both oral and emergency contraceptives or neither. Market demand will probably force them to stock both. Then, working under what is commonly called a referral clause, pharmacists or cashiers (if the drug is made available over the counter) who do not wish to dispense emergency contraceptives must notify their boss in writing and refer patients to other pharmacies or other sources to obtain the drug. This solution is not perfect. However, Hickman would argue that the end result is best. Pharmacists who refuse to help their patients will be breaking the law and Pharmacies that refuse to stock EC will be losing money.
If pharmacists are allowed to refuse to dispense the medication as long as they refer the patient to another pharmacy that will, women still suffer. The drug is time sensitive and pharmacies can be scarce or hard to travel to in some areas. This is not a permanent. I think the referral clause loses too much ground for women. And I'm not alone. The Plannned Parenthood family planning organization states that "Pharmacists, physicians, and other medical clinicians have professional and ethical responsibilities to their patients. Health-related decisions made between a provider and patient should be based on the personal welfare and health-care needs of the patient — not the morals or beliefs of the caregivers." Pharmacists should not have so much control over patients' lives. Pharmacist Peggy Page claims that in pharmacy school, "a patient's individual expectations, because they can be incorrect or unrealistic, was never held out as the model by which we practice. Now, however, it seems that this has become a new standard, and must include that we do whatever the patient wants."
Still, forcing companies and employees to act against their morals martyrs them. It is in thinking through the problem of finding a way to morally strike mack at self-martyred EC opponents that my feminist foremothers, Barbara Ehrenreich and Deirdre English and their work For Her Own Good: 150 Years of the Experts' Advice to Women have been immensely helpful. The book was published in 1978, but its summary of how society uses science to manipulate women still rings clear in today's world. "Science had once attacked entrenched authority but the new scientific expert himself became an authority himself. His business was not to seek out what is true, but to pronounce on what is appropriate." (Ehrenreich and English, 26) The opponents of emergency contraception have been trying to manipulate science in just such a way. If emergency contraception may cause abortion, than its use cannot be appropriate. Women need scientific experts to regulate their lives for them. The FDA wrote in its dismissal of Plan B as an over the counter drug that "adequate data were not provided to support a conclusion that young adolescent women can safely use Plan B for emergency contraception without the professional supervision of a licensed practitioner." Effectively, the FDA has stated that the choice is in the hands of the medical experts, like doctors and pharmacists, instead of the woman herself.
The problem with entrusting the choice of emergency contraception into the hands of medical experts is that the decision is not primarily medical. Ehrenreich and English state that today's society "...has nothing to offer a discarded wife but welfare..." (Ehrenreich and English, 288). Pharmacists can force a choice onto a woman without assuming any responsibility for the consequences.
The solution I propose to the emergency contraception question is as follows. Women must say no. Women must say that the government does not have the right to dictate their heterosex life or the consequences of sexual assault (The further references to women are used to describe women who choose to have sex with fertile men. I do not mean to exclude other women.). Without adequate contraception, women cannot be men's equals in the bedroom. The stakes are higher when one partner may bear children and the other cannot. And by controlling women's sexual choices, the government is regulating heterosexual women into traditional woman as mother roles. In order to fully equalize men and women in society, women must be given the same reproductive rights as men. Men cannot yet bear children. But advances in biology have given women the right to have sex without bearing children. Medicine has given women this right. All government has to do is enforce it.
2/22/2004 "Testimonials." www.getthepill.com/about/testimonials.htm
Cantor, Julie and Ken Baum. "The Limits of Conscientious Objection—May Pharmacists
Refuse to Fill Prescriptions for Emergency Contraception?" The New England Journal of Medicine. 351;19 pp2008-2012
Ehrenreich, Barbara and Deirdre English. For Her Own Good: 150 Years of the Experts' Advice to Women. Anchor Press. New York: 1978.
Food and Drug Administration. "FDA's Decision Regarding Plan B: Questions and Answers." Department of Health and Human Services.
Friedman, Deborah. Refusal Clauses: A Threat to Reproductive Rights. Planned
Parenthood Federation of America Website.
McClave, Erik A. A Catholic Pharmacist's Struggle.
Page, Peggy. June 2, 2005 Testimony.
"Pharmacist Promotes Freedom of Conscience" University of Cincinnati Horizons Online. August 2005. http://www.magazine.uc.edu/0805/quest4.htm
Saletan, William. Bearing Right: How Conservatives won the abortion war. University of
CA Press. Berkeley and Los Angelas, CA:2003
Wolf, Naomi. "Rethinking Pro-Choice Rhetoric: Our Bodies Our Souls." The New
Republic. October 16, 1990
| Course Home | Serendip Home |