Continued restrictions on emergency contraception access for young women are unacceptable

Yesterday, the Department of Health and Human Services (HHS) Secretary Kathleen Sebelius rejected the decision made by the Federal Drug Administration (FDA) to make emergency contraception (EC)–often known as Plan B, after the drug brand name Plan B One-Step–available to women of all ages without a prescription. This decision will maintain a harsh status quo for young women, who were excluded when EC was made available to women aged 17+ without a prescription in 2009 and whose likelihood to be uninsured make it extremely burdensome, if not impossible, for them to obtain a prescription for EC within the limited timeframe after intercourse during which EC is effective.

Because of immigration status, lack of insurance, residence in rural areas, and other structural barriers to accessing health care and services, young Latinas will be particularly affected by failures to increase access to EC, which represents only the latest instance of mixed messages sent to women about their rights and place in society. Latina teens are pregnant at higher rates than their peers, and the pregnancy rate for young Latinas has fallen more slowly than for other teen populations. In 2005, over 230,000 women aged 15-17 became pregnant and over half of them gave birth; in the same year, 15,000 young women under the age of 15 became pregnant, over 40% of whom gave birth.

This is the case because not only can many young women not access Plan B, but also because they also are not presented with a Plan A. Empirical studies document higher pregnancy rates in schools with abstinence-only sex education, yet many states do not acknowledge this fact or are just starting to. For instance, Texas, a state in which Latinos comprise over one-third of the population, has long been a devotee of abstinence-only sex education. Recent gains, though small, in abstinence-plus education are cause for celebration, but are far from enough to reverse years of failing to ensure that young women have comprehensive evidence-based sex education.

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Rights of pharmacists versus the rights of women: Case study in Washington State

By Myra Guevara, Research Intern

According to the Guttmacher Institute only 17 states and the District of Columbia require hospitals emergency rooms to provide emergency contraception (EC) related services to sexual assault victims. In the state of Pennsylvania health service providers may refuse treatment based on religious or moral beliefs as long as they provide immediate transportation to the closest medical facility. In Texas the Medicaid Family Planning Expansion (Title X) explicitly excludes EC.

Washington State and the Board of Pharmacy are under pressure from one local pharmacy (Ralph’s Thriftway, Olympia) regarding a 2007 law put into place by Governor Chris Gregoire (WA). The law requires pharmacists to dispense all legal drugs, irrespective of moral or religious beliefs. This lawsuit is specific to the emergency contraceptive Plan B, but could have an impact on the dispensation of hundreds of legal drugs, such as HIV medication or birth control.

After the threat of a lengthy and costly lawsuit from Ralph’s Thriftway, the Board of Pharmacy fell to the pressure and has already voted 3-2 in favor of changing the statute. The pharmacy felt the rule infringed on their moral beliefs.

As the new law stands a pharmacist is allowed to deny distribution if they can “pass a patient to a co-worker.” The pharmacy is still under legal obligation to fill the prescription.

This new stipulation could limit access to not only emergency contraception, but birth control and HIV medication due to ‘conscientious reasons.’ The referral system, although a seemingly appropriate compromise in urban areas, becomes a challenge in rural areas where pharmacies are a long distance away or there is only one for miles. Not to mention women that may not have readily available access to transportation or the resources to cover transportation costs. The referral system becomes an additional challenge for time sensitive drugs, like Plan B which needs to be taken within the first 72 hours in order to be effective.

The public can comment on the proposed rule changes until November 30th.

To learn more about the facts of EC and find more about legislation in your state go here.

By Myra Guevara, Research Intern

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Gender, Health, and Immigration Detention

The folks over at Latinovations invited me, Senior Policy Analyst here at NLIRH, to write a guest blog for them.  The blog, where I wrote about the experiences with health care immigrant Latin@s have in detention, was posted at La Plaza today:

As a reproductive health organization, sometimes people are surprised to learn that the National Latina Institute for Reproductive Health does immigrants’ rights work.  The truth is that immigration and reproductive justice are inextricably tied, and the health and struggles of immigrant detainees is an area that is particularly ripe for action.

To read more about health care and the experiences of pregnant women and transgender persons in immigration detention, make sure to check out the rest of the piece here.

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Pentagon finally ensures access to emergency contraception

On February 4, the Department of Defense (DoD) published its decision to guarantee availability of emergency contraception (EC) to women in all military facilities. This decision adds Next Choice, the generic version of levonorgestrel (Plan B) to the basic list of medications that all military facilities are required to stock by law.

The availability in military facilities would follow U.S. laws, making the product available over the counter for women 17 or older and by prescription for younger women. EC can prevent pregnancy if it is taken with 72 hours following unprotected intercourse or contraceptive accident. Plan B was approved by the FDA in 1999 as a prescription medication. In 2002, it was approved for over the counter distribution for women 18 years or older. In 2009, over the counter access was extended to 17 year olds.

In 2002, the DoD Pharmacy and Therapeutics Committee recommended that EC be added to the list of medications, but the decision was rescinded for review and never carried out. In November of last year, the same committee renewed its recommendation.

Women are currently up to 20% of active military members. A 2003 report by the Pew Hispanic Center reports that Latinos make up 9.49% of the military, a number that has been growing since. Access to basic health care in the military is an important issue for women and Latinos.

Especially considering the high rates of sexual assault in the military, access to EC is absolutely crucial. BBC reported last week that sexual assault against women in the US military is a “widespread problem.” In 2009, the DoD estimated that 90% of rapes in the military are unreported. The DoD needs to take immediate action to prevent sexual assault and punish sexual offenders. However, access to EC is important not just for victims of sexual assault, but for all women. Contraceptive accidents can happen anytime, and EC is part of a comprehensive reproductive health care plan.

Ensuring access to EC a long overdue step towards reproductive justice in the military. Next might we will see some significant action in repealing the Don’t Ask, Don’t Tell policy?

By Zarah Iqbal, Policy Intern

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Survivors of domestic violence more likely to experience reproductive coercion

A recent study led by researchers at UC Davis explores the association between intimate partner violence and unintended pregnancy. The study shows that young women often face efforts by their partners to coerce pregnancy or destroy contraception, and that these attempts at reproductive control are associated with other forms of intimate partner violence, increasing the risk of unintended pregnancy.

In this study, “Pregnancy coercion, intimate partner violence and unintended pregnancy,” published in the January issue of Contraception, researchers surveyed over 1300 English and Spanish-speaking women ages 16-29 who were seeking care at five family planning clinics in California. Researchers divided “reproductive control” into two broad areas: pregnancy coercion and birth control sabotage. The results showed that an astounding number of surveyed women had experienced either pregnancy coercion or birth control sabotage.

Approximately a third (35%, 237/683) of women reporting partner violence also reported either pregnancy coercion or birth control sabotage, in contrast to only 15% (91/595) of those who never reported violence reporting reproductive control of either form….The combined effect of both partner violence and reproductive control increased the odds of unintended pregnancy almost two-fold.

While many pregnancy prevention efforts place the responsibility for unintended pregnancy on women, especially among teenagers, this study shows that these efforts are not only wrong, but dangerous. They ignore the possible role of of abusive partners in pregnancy.

It also contradicts the popular notion that men are the sole victims of contraceptive sabotage. We often hear stories of women deliberately missing their pill or lying about using contraception entirely to coerce their partner into a more serious relationship due to pregnancy. Less commonly known or discussed is the fact that men also participate in birth control sabotage to manipulate their partners.

The authors suggest a possible step forward: intervention programs provided by family planning clinics and harm reduction services for women affected by partner violence. Family planning clinics could be a great resource for women suffering domestic abuse if programs such as counseling services are offered.

This study shows how important it is for all women to have access to emergency contraception, and a choice of contraceptive methods. Some women need injectable or intrauterine methods so that their partners cannot see or tamper with their contraception. The study also stresses the importance of confidentiality in reproductive health care, so that women can exercise their right to reproductive health without fearing coercion from their partners.

By Zarah Iqbal, Policy Intern

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Step forward in access to Plan B might not be enough for all women

There is some good news on the emergency contraception (EC) commonly known as Plan B. This week, the Food and Drug Administration approved Plan B® One-Step, which consists of only one dose.  According to Jennifer Rogers, from the Reproductive Health Technologies Project, the approval of this contraceptive is important:

The option to take one pill instead of two gives women a more accessible, straightforward contraceptive. And that’s always important when it comes to helping a woman prevent unintended pregnancy.

In addition, the FDA has also approved Plan B® for over-the-counter (OTC) use by women and men age 17 and older, meaning that the age restriction was lowered by one year.

Even though it can be seen as a small step forward, this “expansion” in the access to emergency contraception, should not merely be celebrated by reproductive health access advocates. Women who are 16 years or younger will still be forced to face many barriers in order to get a prescription for a drug that research has confirmed to be very time sensitive.

Visiting a doctor within a short time frame can be very difficult for many reasons. For example, many physicians do not work in the evenings or the weekends, a woman 16 years-old or younger might have to depend on an older person for transportation, and it might be very hard or impossible for her to miss school or work in order to visit a doctor. 

In addition to those barriers, young Latinas have to face a greater economic barrier, for if they have no access to a free clinic, a Title X sponsored clinic, or a Planned Parenthood office, they will most likely have to pay the doctor for a consult before receiving the prescription. Even if she has health insurance, a young Latina might not be able to afford a co-payment

All these barriers only serve to affect Latinas right for privacy, pressure them to rely on others for an important reproductive health need, and build more stress and discomfort in a situation that is already unpleasant. The elimination of the age restriction on OTC use of Plan B is necessary to ensure that Latinas can make the decisions that they want—and need—to make.

By Paula Latortue-Albino

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New One Pill Emergency Contraceptive, Plan B® One-Step Approved by FDA

On July 13, 2009, the U.S. Food and Drug Administration (FDA) approved a one-dose version of the Plan B emergency-contraceptive pill, called Plan B® One-Step emergency contraception (levonorgestrel tablet, 1.5 mg).

The FDA is expanding over-the-counter (OTC) access to Plan B® One Step for consumers age 17 or older; women younger than age 17 will require a prescription. According to a press release by the drug’s producers, Teva Pharmaceuticals, Inc, the product will be available at licensed U.S. retail pharmacies within the next month.

When taken as directed, Plan B® One-Step is highly effective in reducing the chance of pregnancy — about seven out of eight women who would have gotten pregnant will not become pregnant after taking it.  Like other forms of emergency contraception, Plan B® One-Step will not work if a woman is already pregnant and it will not terminate an existing pregnancy.

With the introduction of Plan B® One-Step, women can help prevent an unintended pregnancy after unprotected sex or contraceptive failure with just one pill in one dose. The National Latina Institute for Reproductive Health (NLIRH) applauds these exciting and empowering developments in women’s reproductive health. Although it is a victory that EC is available in a one-dosage option as well as  OTC for women aged 17 and older, for Latinas, there still exist a disproportionate amount of barriers to EC access, including the age restriction, the requirement of government-issued personal identification, and high cost.

For more information about Latinas and emergency contraception access, click here.

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One year of Emergency Contraception Over The Counter

This week marks the one year anniversary of the FDA’s decision to approve emergency contraception for use over the counter. Check out NARAL Pro-Choice America’s blog, Bush v. Choice, for more reflections on the anniversary, including mine, here.

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Newsweek.com: Reassessing Sexual Politics

At the National Latina Institute, we work to ensure that access to abortion remains a major component of the reproductive justice movement.

We also realize that not all will agree with abortion. This is true for all the Republican presidential candidates, for the exception of Rudolph Giuliani who holds pro-choice views. So far, the primarily questions around reproductive health and rights has been “are you pro-choice or pro-life” and “will you try to overturn Roe V. Wade”? Automatically, the answers will tend to be “pro-life” and “yes,” respectively. But, what about other reproductive health and rights issues?

In this August 17th commentary at Newsweek.com, Eleanor Clift suggests that reporters and debate moderators should stop asking candidates about their views on abortion, and start asking questions about family planning. Since the candidates are targeting specific voters, their statements on abortion are unlikely to change.

However, what will happen if people start asking specific questions, such as “do you think it’s OK for a pharmacy to refuse to fill a woman’s prescription for birth-control pills based on the personal views of the pharmacist? Should hospital emergency rooms be allowed to withhold information from a rape victim about the morning-after pill, which can prevent a pregnancy if it’s taken soon enough after the assault? Do you support age-appropriate sex education[…]?” Questions like these can lead to more than just a “yes or no” answer and more genuine responses as to their position on women’s right to bodily autonomy and reproductive choice.

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AMA pushes for pharmacists to provide information on EC availability

The American Medical Association voted to adopt a new policy requesting that pharmacies use their website or other means to let patients know if they stock and dispense emergency contraception and whether or not a prescription is required. If a pharmacy doesn’t dispense emergency contraception, pharmacies should indicate where emergency contraception can be obtained in their region.

“FDA-approved Plan B emergency contraception can prevent unwanted pregnancies,” said AMA Board Member Rebecca J. Patchin, M.D. “Even if women are aware of emergency contraception as a way to prevent unwanted pregnancy, they may not know where or how to access it. It’s important that pharmacies let patients know whether they can access emergency contraception at their store and, if not, where they can go to get it.”

This is an important push from the AMA that will help women cross the barriers which exist for accessing EC in the current hostile environment.

Via Earthtimes.

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