Confused Complaints and the Availability of Plan B

Last week, HHS Secretary Kathleen Sebelius overruled the FDA and chose not to permit the over-the-counter sale of Plan B to girls under 17. The resulting media furor reminded me that it was high time to revisit the birth control section of Abort73.com. I set out to make some updates but ended up with two complete rewrites. The first page examines the claim that the best way to decrease our national reliance on abortion is to increase our national reliance on birth control. The second page looks at the mechanics of birth control (and the competing definitions of pregnancy) in an effort to ascertain whether hormone-based "contraceptives" have the potential to cause an abortion. Those updates being done, I can now respond specifically to last week's decision.

Almost all of the criticism I read boiled down to the same two complaints – namely that Plan B is perfectly safe for girls of all ages and requiring a prescription will unduly delay its usage, making it less effective at stopping pregnancy. Both arguments conveniently overlook one huge reality. The morning-after pill is already available without prescription to anyone who is 17 or older. A girl of any age can walk into a drug store and get Plan B without a prescription; she just has to have a parent with her to do it. And that's the rub. The real complaint here doesn't relate to safety or urgency. It relates to parental consent. They don't like the idea that a young girl would have to enlist the help of a parent to secure emergency contraception. And truthfully, she doesn't even need a parent.

Kathleen Sebelius rationalized her decision by expressing concern that it wasn't appropriate for 11-year-old girls to be able to buy and consume such high-dose hormones without proper assistance. Dr. Cora Breuner, a professor at the University of Washington, scoffed at such an assertion, saying, "I don't think 11-year-olds go into Rite Aid and buy anything, much less a single pill that costs about $50." She then appeals to the plight of  teen girls who are of "more sexually active ages," and argues that this ruling will force them to "suffer permanent consequences." Lost is the fact that under current laws, all these girls need is a 17-year-old friend or sibling to buy Plan B for them. How many sexually-active 15 or 16-year-old girls don't have friends that are 17 or older?

I say all this to point out that access to Plan B is already remarkably lax. What other drugs of this magnitude are available for children to walk in and buy off the shelf? By far, the best reaction I've read to all this was a reader response to an editorial published by The Atlantic Monthly. It references the author's assertion that the HHS decision was "anti-science:"

I'm a retired public health epidemiologist (and scientist.). I'd like to explain that the Plan B contraceptive is one whopping dose of hormone -- the same hormones that are used in birth control pills and the same hormones that are associated with some types of breast cancer. I'd remind you that a 10- or 11- year old girl is just developing in terms of reproductive organs. I can tell you that there is NO evidence that it is safe for girls that age -- whose reproductive organs are not mature -- to ingest a very large dose of estrogen and progesterone. It is not known scientifically whether there would be any long-term effects.

Remember DES -- a synthetic hormone given to pregnant women whose daughters, years and years later, suffered numerous vaginal and other cancers as a result of their mothers taking the drug during pregnancy? [JF answer: yes of course I do.] In fact, please read a little about DES here: (or another, more scholarly source, if you will.) Then please think about what is not known even now about unrestricted use of hormones.

And there is much concern around the idea of hormones given to cattle and other animals and how that affects our food safety.  There is much opposition to health providers giving young boys growth hormone ( a form of male hormone) and testosterone to small boys or boys with small penis size. The concern is well justified.

So I am baffled at the idea that, on the liberal side, there is no evident concern about very young adolescent girls having free access to large doses of progesterone and estrogen. I can certainly understand, and support, the urgent need to interrupt a pregnancy in a very young girl.  But what about repeated use? What about unrestricted use? What about overdose? What about long-term, regular use?

I think that accusing people who raise concerns about this "anti-science" is completely unwarranted. It's not unwarranted to raise concerns about hormones in beef, but it's "anti-science" to raise concerns about 10- and 11-year olds taking large doses of hormones? It's not anti-science to raise concerns about excessive estrogen in Beluga whales, but in pre- pubescent girls it's anti-science?

Are you really helping the debate here?

In the first story I read on the Sebelius decision, I was struck by the statement that her ruling had "shocked women's health advocates." Even before reading the excellent remarks above, it seemed absurd to me that anyone could regard emergency contraception as something that is good for women's health. It causes brutal, unnatural reactions–stopping and starting processes in the woman's body in ways that were never intended. Some of the published side effects include upset stomach, vomiting, lower stomach pain, fatigue, headache and dizziness, irregular bleeding, and breast tenderness. It overrides a woman's normal, natural bodily functions to prevent ovulation. It thickens cervical mucus to prevent fertilization and compromises the lining of her uterus to make it hostile to implantation.

And this brings us to an ethical concern that goes well beyond the issues of safety and parental consent. Planned Parenthood states that emergency contraception is 89% effective if used within 72 hours of intercourse. They also say it's ability to prevent implantation is only theoretical–just as they do about oral contraceptives in general. In light of the fact that fertilization can occur in as few as 30 minutes after intercourse, this seems a highly improbable and disingenuous assertion to make. How could the morning-after pill be 89% effective at "preventing" pregnancy when taken within three days, if it is not actively inhibiting the implantation of living human embryos who may already be 3-days old? The pill's first two methods of operation don't work if ovulation and fertilization have already occurred. Nevertheless, it is commonly asserted that "If a woman already is pregnant, the morning-after pill has no effect." The only way this can be true is if you define pregnancy to begin at implantation, which is exactly what birth-control advocates have been doing since 1965.