Nine arrested at the FDA; Morning-After Pill decision pending

Sixty women gathered and nine were arrested Jan. 7 trying to get the FDA to make the Morning-After Pill an over-the-counter drug in the U.S.

The FDA’s decision, expected by Jan. 20, will be the culmination of a many-year application process for the pill, which carries the brand name Plan B. Similar pills have been prescribed since the mid-70s to prevent pregnancy after unprotected sex.

Currently, the pill is only available by prescription, a requirement that feminists charge is ludicrous because the drug is most effective to prevent pregnancy in the first 24 hours after unprotected sex. (It may be used, with declining effectiveness, up to 120 hours after sex.) At the FDA on Jan. 7th, women testified about trying to obtain a prescription and fill it in the narrow time window. “I had to brave game-day traffic to get to the infirmary, which it turned out was closed,” Gainesville Area NOW’s Stephanie Seguin recalled. “When I lived in France, they were passing it out in bars with condoms.”

At a December 2003 hearing by a combined FDA advisory panel, the FDA’s experts agreed. They voted 23 to 4 that the drug should go over the counter, and 27 to 0 that the drug was safe. Plan B is one-time a higher dose of birth control, equivalent to about 4 birth control pills, but because it is not taken on a sustained basis, the side-effects from regular birth-control pills are not present. Around 1 in 5 women experience nausea or jitteriness.

The FDA normally follows the recommendations of its advisory boards. But after political pressure from Republicans in Congress, the FDA waffled, and asked the drug company, Barr, to resubmit its application with a provision for blocking women under 16 from getting the pill without a prescription.

At the January press conference, feminists who formed the “Morning-After Pill Conspiracy” to push for the drug to be over the counter committed civil disobedience by passing the prescription drug to one another, and to two women who asked for it after the event. It is illegal for laypeople to give out a prescription drug. The Morning-After Pill Conspiracy says that over 2,000 women have signed pledges to defy the prescription requirement and give the Morning-After Pill to any friend who needs it. These pledges, MAP Conspiracy reported at the press conference, have been faxed to the FDA as part of the campaign.

The Morning-After Pill Conspiracy opposes any age limit or requirement of proof of age, stating, “If you’re old enough to get pregnant, you’re old enough to decide you don’t want to be pregnant.” Further, they say, the age requirement would effectively put the Morning-After Pill “behind the counter” for all women, requiring every woman who wants the pill to ask for it from a pharmacist and prove their age.

The nine were arrested when they asked to see the decision-maker in the case, Acting Director Steven Galson, but a meeting was offered with only 5 people with another official. The protesters demanded to see Galson, and sat down. They were arrested and charged with Disorderly Conduct. A court date has not yet been set.

Four Gainesville women were among the nine, who represented groups including Gainesville Area NOW and Campus NOW chapters, the Florida NOW Young Feminist Task Force, the New York Reproductive Rights Taskforce, and Redstockings Allies & Veterans, which is based in New York City.

More on MAP Conspiracy can be found at www.mapconspiracy.org or you can email mapconspiracy04@hotmail.com.

One million march for women’s reproductive rights

Between 800,000 and 1.15 million women, girls, and male allies rallied and marched in Washington, D.C.. on April 25. It was the largest women’s rights march in the history of the U.S., and it focused not just on abortion rights, contraceptives, and sex education, which have been repeatedly attacked by the Bush administration, but also on moving forward to health care, childcare, and full equality for women. “Feminists, we are calling you” read one sign, and they came from every state in the union.
“This historic march is sending an unmistakable message: women’s rights and women’s lives are non-negotiable,” stated Eleanor Smeal, president of the Feminist Majority. “We are building an expanded and inclusive movement that will make women’s reproductive rights-just like social security-a third rail of politics.”
Gloria Feldt, president of Planned Parenthood Federation of America said “They’re not just after abortion rights. This is a full-throttle war on your very health–on your access to real sex education, birth control, medical privacy, and life-saving research.”
“We envision a day… when every person has access to comprehensive and affordable health care,” said Silvia Henriquez, executive director of the National Latina Institute of Reproductive Health, a co-sponsor of the march. “That is reproductive justice!”
The march was noticeably larger than similar marches organized by feminists and reproductive rights groups in 1989 and 1992, which drew 3-500,000 and 6-800,000 respectively. Those marches were responding to pending Supreme Court decisions and their size, energy, and message are credited with saving the parts of the Roe vs. Wade decision which are still in effect.
March organizers used standard crowd estimate methods, march participants were counted in designated grids on the National Mall. They said they verified this count by assigning 2,500 volunteers to stand at key entry points and count people by placing stickers on participants as they entered these entry points. By their count, 1.15 million people participated.
This year the march was most immediately responding to Congress passing and Bush signing a ban on the mischaracterized ‘partial birth abortion,’ a political term whose definition in the law is so vague it could be applied to most abortions. The law is now being challenged in court. As part of the court case, Attorney General John Ashcroft demanded hospital records of women who had had the types of abortion apparently banned by the law. Outrage from feminists, resistance from the hospitals involved, and then the march, apparently led Ashcroft to drop this line of inquiry on April 30.
Bush adminstration attacks on abortion rights also included the passage of the Unborn Victims of Violence Act, defining federal crimes which harm a pregnant woman as harming two individuals. National Organization for Women president Kim Gandy said, “This is a deceptive ploy that does nothing to increase protections for pregnant women, who are at increased risk of domestic violence.” A similar law which would have increased the penalties but did not include a fetal ‘personhood’ clause was defeated, showing that the law is not aimed at protecting pregnant women or their pregnancies, but is laying the legal groundwork to claim that embryos and fetuses are separate legal entities apart from the women who bear them.
And Bush reinstated and then expanded the Reagan-era “Global Gag Rule” which prevents international agencies that receive any family planning funds from the U.S. even informing their patients that abortion exists, let alone providing them. The ban means that family planning organizations that refuse to buckle under are starved for funds.
Morning-After Pill blocked
Then on May 6 the Bush Administration took another swipe at U.S. women when the acting Food and Drug Administration chief, Lester Crawford, announced that he was going against the FDAs own experts and advisory panels to keep the Morning-After Pill from U.S. women. The FDA’s decision sent the makers of “Plan B” (levenogestrel) back to the drawing board. Barr pharmaceuticals and its predecessor, Women’s Capital Corporation, had spent several years in the application process to get this after-sex contraceptive approved for over-the-counter sale. It is currently available in the U.S. only by prescription.
Prospects had looked good in December, when a combined FDA advisory panel voted 23 to 4 to approve the drug, noting that it is ‘extraordinarily safe.’ Public testifiers at the December 16 FDA hearing, including many feminists from Gainesville, pointed out that the Morning After Pill is available without a prescription in 38 other countries, including Canada and England. By contrast, many women testified that here in the U.S. it was impossible or near-impossible to get the drug in a timely manner since the prescription requirement forced them to make a doctor’s appointment, see the doctor and pay for the appointment, obtain a prescription, find a pharmacist who will fill it, and pay for the drug, all while the clock is ticking. The Morning After Pill (also known as ‘emergency contraception’) is most effective if taken in the first 24 hours after unprotected sex. It can be used, with diminishing effectiveness, up to 120 hours after sex. (The Morning-After Pill is frequently confused with RU-486, the so-called “French Abortion Pill” but it is not the same medication. The Morning-After Pill prevents pregnancy, which is defined medically as the moment a fertilized egg implants in the womb. If a woman is already pregnant, the pill has no effect.)
The FDA told Barr that it needed to study and report on the effects of the pill on women under 16, or it could devise a regime whereby all women would be forced to present a proof-of-age in order to buy the drug, and those under 16 would be required to get a doctor’s prescription.

Feminists have responded that the question of young women is a red herring, which is being used to block access for all women. “If you’re old enough to get pregnant,” the “Morning After Pill Conspiracy” said in an April 25 press release, “you’re old enough to decide that you don’t want to be pregnant.” Doctors on the advisory panel rejected these arguments about younger women when they were broached at the hearings in December, saying that there is no evidence of different effects in younger women. It was pointed out by panelists that pregnancy among early teens is the alternative to young women having access to the Morning-After Pill.
At the March for Women’s Lives, organizations making up the “Morning-After Pill Conspiracy,” including Redstockings Allies and Veterans, two Gainesville NOW chapters, and Gainesville Women’s Liberation, held a mini-rally during the main rally. Hundreds gathered around as about a dozen women testified about rushing around trying to get the Morning-After Pill after a condom broke during sex, about the prohibitive costs associated with a doctor’s visit, and about the tragicomic idea that anyone can get a doctor’s appointment in 24 hours, especially starting on a Friday or Saturday night. Expressing their view that the Morning-After Pill should immediately be made over-the-counter, they defied the prescription law by passing pills to friends and finally by flinging boxes of “Plan B” into the waiting crowd.
They invited the crowd to join them in signing the Morning After Pill Conspiracy pledge to defy the prescription requirement (and break the law) by giving a friend the Morning-After Pill whenever she needs it. About 800 signed pledges, which the groups are now sending to the FDA in protest of the decision. (Pledges can be viewed and signed at www.mapconspiracy.org).
A group of physicians with the Access Project also brought their prescription pads and wrote prescriptions for any woman who wanted one. They scribbled furiously to keep up with a line of waiting women. The doctors were illustrating a point which was repeated over and over in the FDA’s advisory hearings–no physical evaluation or instruction from medical professionals is needed to safely and effectively use this medication.
Several states have passed laws to put the morning-after pill in a ‘behind the counter’ status, with women having to ask for it from a pharmacist, but not required to get a physician’s prescription. In December the FDA advisory panels heard that the program has been a flop in California, mostly because pharmacies find the process too cumbersome and 86% don’t participate.
Additionally, studies by Planned Parenthood in New York and an ACLU study in Pennsylvania showed that pharmacists are ill-informed about the Morning-After Pill and gave all kinds of wrong advice about it when asked in phone surveys. Additionally, pharmacists have refused to fill prescriptions for the drug on ‘moral’ grounds, as in a widely publicized case in Texas where a rape victim tried to get her prescription filled and was turned away by an Eckerd pharmacist. The pharmacist and two co-workers were later fired over the incident. At the University of Florida infirmary women have had problems since at least the early 90s getting their prescriptions filled, and a pharmacist at UF was fired after feminists exposed and protested his refusal to fill women’s morning-after pill prescriptions. Feminists say that a switch to over-the-counter status, like condoms and cold medicine, would remove these unnecessary obstacles.
The Morning-After Pill Conspiracy released the following after the FDA’s decision was announced:
“For the past 10 months, a coalition of feminist groups called the Morning-After Pill Conspiracy has been campaigning for over-the-counter access to this safe, effective form of birth control. Since February we have conducted civil disobedience in New York and Florida and Washington DC by giving out the Morning-After Pill in front of the public and press. On April 25, we defied the prescription requirement again by passing out the Morning-After Pill at the March for Women’s Lives in Washington D.C. Approximately 1,500 women all over the country have signed our pledge promising to break the law by giving their prescription-only Morning-After Pills to friends whenever they need it.
“We will hand-deliver our pledge signatures to the FDA from more than a thousand women who plan to blatantly disregard the prescription requirement for the Morning-After Pill. In the tradition of women like Margaret Sanger, who broke the law by passing out information on birth control when it was illegal to do so, the members of the MAP Conspiracy pledge to bring our civil disobedience directly to the FDA- to illegally pass out the Morning-After Pill on their doorstep- in protest of this unjust ruling.
“The Morning-After Pill is one tool that women can use to control our bodies and direct our lives, a tool which the FDA continues to keep from millions of women who can’t afford, don’t have time, or aren’t able to get MAP from their doctors. Women of all ages should have unrestricted, over-the-counter access to the Morning-After Pill; we will continue to fight for this right by whatever means necessary.”
The demonstration at the FDA is planned for July 2. Go to http://www.mapconspiracy.org for more information and updates, or call the Gainesville Area or Campus NOW chapters at 377-2301.

MORNING AFTER PILL: Over the Counter or Behind the Counter?

“Because no one else [except the Women’s Liberation Movement] is going to cry out against these restrictions, it is up to feminists to make the strongest and most precise demands upon the lawmakers—who ostensibly exist to serve us. We will not accept insults and call them “steps in the right direction.” —Lucinda Cisler, 1970.*

It is obvious to most people that the current prescription-only status of the Morning-After Pill must be changed. It requires women to get (and pay for) a doctor’s appointment, which is a joke for a drug most effective to prevent pregnancy when taken within 24 hours—and fairly effective up to 72 hours—after sex.

But some have argued that making the Morning-After Pill an over-the-counter drug, like aspirin and cold medicine, is going too far, and that although the Morning-After Pill is safe, women should be able to obtain it only through a “pharmacist prescription,” a status sometimes known as “behind the counter.”

We completely disagree. We believe the Morning-After Pill should be immediately made an over-the-counter drug, and that it should be affordable and accessible to women of any age and in all parts of the country. We believe that the U.S. should follow the lead of dozens of other countries which already provide women access to this safe backup birth control method without any restriction.

The Morning-After Pill is marketed under the brand names Preven® and Plan B® (levonorgestrel) and is also known as “post-coital contraception” or “emergency contraception.” Plan B®, the progesterone-only Morning-After Pill, consists of two pills to be taken within 72 hours of unprotected intercourse to prevent unintended pregnancy. The first pill is taken immediately and the second 12 hours later.

Why not pharmacist prescription “behind the counter” status?

1. Pharmacist prescriptions will force a woman to stand in the middle of a drug store, in front of other customers, and discuss the last time she had sex, when her last period was, and other private information. This will discourage a lot of women from getting it.

2. Pharmacists are not necessarily knowledgeable about the Morning-After Pill. In studies conducted in New York and Pennsylvania, pharmacists had alarmingly little knowledge of the Morning-After Pill, and many disseminated misinformation about it. In a 2003 survey of 315 Pennsylvania pharmacists:

•13 percent of the pharmacists incorrectly stated the time parameters for using emergency contraception.

•5 percent said it was not available in the United States.

•28 percent did not know a brand name.

•13 percent confused emergency contraception with the abortion pill or thought it caused an abortion.

(“Study: Pharmacists not informed on morning-after pill,” Marie McCullough Philadelphia Inquirer, Oct. 21, 2003.)

Among 100 New York City pharmacists surveyed by Planned Parenthood in August and September of 1998: “Thirty-seven pharmacists received poor ratings for their knowledge of emergency contraception. A poor rating means the pharmacist either knew nothing about emergency contraception or only provided incorrect information about the treatment. Two-thirds, or sixty pharmacists, provided some type of incorrect information about emergency contraception. Only 3 received an excellent rating, correctly providing all the key facts about emergency contraception.” (www.ppnyc.org/new/publications/executive.html)

3. Some pharmacists will counsel women that they don’t need the Morning-After Pill based on where they are in their menstrual cycle. We know pharmacists will do this because this is the experience we have now, with doctors and physicians assistants who tell us we do not need the Morning-After Pill for various reasons.

• Some women report being left alone in a room with a calendar by their medical practitioner, and told to try to figure out the date of their last menstrual period. If they can’t remember, they’re told, they can’t have the Morning-After Pill.

• Women have been told by medical professionals that they shouldn’t put “all those chemicals” (meaning the Morning-After Pill) in their bodies, and are then told they should get on daily birth control pills. (Daily oral contraceptives can have serious long-term side-effects not associated with the extremely short duration dose of hormones in the Morning-After Pill).

• In 1998 it was revealed that the infirmary at the University of Florida required women to fill out a form when giving them the Morning-After Pill. This form required women to agree to take a regular form of birth and asked women if they had been sexually assaulted. Because this was a medical form women did not feel they could opt out of certain questions and were coerced into revealing information not necessary for distribution of the Morning-After Pill.

5. Women should be able to have the Morning-After Pill around before a problem arises. But we don’t know whether pharmacists will be willing to give women the Morning-After Pill to have “just in case.” Based on our experience with other medical professional, we suspect that some will and some won’t, and again our wellbeing will be in the hands of someone else.

If the Morning-After Pill is over-the-counter, women will make sure they have a current dose in their medicine cabinets at home, for themselves and friends who need it.

Although some drugstores are open 24 hours a day, most do not have pharmacists on duty more than 10 or 12 hours a day. And when a pharmacist is there, there is frequently a long line for service. In consciousness-raising women talk about the difficulty of getting off time during work or school hours to obtain the Morning-After Pill as quickly as possible. The terrible squeeze for time can be explained by the fact that in U.S., we already work the longest hours in the industrialized world, and women are still burdened with extra unfair responsibilities at home. We should be able to send a man to pick up the Morning-After Pill for us. This is only feasible if the drug is over-the-counter.

6. In our experience, many pharmacists will refuse to dispense the Morning-After Pill because of personal religious beliefs.

In 1991, a pharmacist at the infirmary at the University of Florida in Gainesville was discovered to be refusing to fill women’s prescriptions for the Morning-After Pill. Feminists protested and the university was eventually forced to ask for his resignation. But there was evidently still a problem as the University of Florida then had to institute a system to call another pharmacist if the pharmacist on duty refused to fill these prescriptions.

How widespread is this problem? A phone survey of 315 Pennsylvania pharmacists reported in the October 2003 issue of the journal Contraception noted that of the 65% of “pharmacists surveyed who could not fill a same-day prescription, 7 percent cited personal beliefs as the reason, while 6 percent said it was against store policy.” (“Study: Pharmacists not informed on morning-after pill,” Marie McCullough Philadelphia Inquirer, Oct. 21, 2003.)

There is even an organization, Pharmacists for Life International, founded by pharmacists who refused to fill women’s prescriptions for oral contraceptives “because they believed they cause abortion,” according to a 2002 article by Patti Miller. “The organization… has been effective in expanding the right of health professionals to refuse to provide reproductive health services such as contraception and emergency contraception. The president of PFLI is Karen Brauer, a pharmacist who was fired by Kmart in 1996 after she lied to a patient that an oral contraceptive was out of stock to avoid filling a prescription.” (Patti Miller, “Do No Harm: Far-Right Medical Groups and Religion Don’t Mix,” full article available at: www.rcrc.org/news/commentary/do_no_harm.htm)

7. Some argue that women who are raped should be encouraged to seek counseling and medical help, and if the Morning-After Pill is available without talking to a pharmacist, women will be less likely to get this counseling.

We say no woman should have her right to control her body held hostage until she reveals a sexual assault. We must be allowed to assess all our options in these difficult situations, and women know that we are often blamed and punished when we come forward.

Conclusion

Women know that often when we reveal that we have had sex we are stigmatized as a “slut.” This is especially prevalent against young women and unmarried women. Men face no such stigma, although they often perpetuate it against women. Requiring women to reveal the details of sexual activity to a pharmacist—who may be a stranger, or worse, an acquaintance—is humiliating and unnecessary unless there is an overwhelming safety reason.

There isn’t, according to the 60 organizations, including the American Medical Association, that support over-the-counter status.

We learned from the Boston Women’s Health Collective (authors of Our Bodies, Ourselves) that those who are set up as experts often serve to keep information from us. Women are the experts on our situation, and we can quickly become experts on medical issues that affect our lives.

We learned from Redstockings**, the radical feminists who first spoke out about their then-illegal abortions in 1969, that women are the experts on our lives. Not men, not the church, not legislators, not doctors or hospital boards or pharmacists or counselors, no matter how well-meaning or well-educated.

December 4, 2003

Gainesville Women’s Liberation

P.O. Box 2625 Gainesville, FL 32602

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*The quote is from “Abortion Law Repeal (Sort of): A Warning to Women.” Lucinda Cisler was chair of the NOW Taskforce on Reproduction and Its Control (1969-1971) and founder and first secretary of the National Association for the Repeal of Abortion Laws (NARAL), now the National Abortion Rights Action League.

**For more on this history, visit the Redstockings Women’s Liberation Archives for Action, http://www.redstockings.org