On August 24, 2006, the Food and Drug Administration (FDA) issued its long-awaited decision to make the emergency contraception drug Plan B®, commonly known as “the morning-after pill,” available without a prescription. After all these years of the bait-and-switch games the FDA has played, reproductive health advocates are justifiably celebrating this incredible victory. Although we should congratulate those responsible for this hard-won accomplishment, let us take a moment to remember that our work has only begun. Unfortunately, winning the fight for nonprescription access to emergency contraception (EC) is only the first step in addressing the reproductive health needs of many women.
To begin with, a much larger war is being waged over the fate of contraception. Most women in America would be shocked to learn how the anti-choice movement tries to drum up support for a broader anti-contraception agenda. They argue that America is swimming in a sea of contraception and information about sexuality, which has allowed our morality to wane and our abortion rates to rise. In short, they contend that more contraception leads to more abortions. Emergency contraception plays a unique role in this paradoxical reasoning because it is viewed as an abortifacient by many anti-choice activists. The problem is that emergency contraception works in the same way as other hormonal birth control pills – for the most part, it prevents ovulation; but in some cases it may stop the implantation of a fertilized egg. Is the anti-choice movement’s position, then, that the millions of women who take birth control pills are potentially having an abortion every time they swallow a pill?
For Latinas and other women who are disproportionately uninsured and have limited access to providers, however, the war on contraception may not even be necessary. Many Latinas do not have basic information about contraceptive methods, especially EC, nor do they have an affordable way to obtain them.
Given this context, there are obvious reasons to celebrate the FDA’s recent decision. However, a closer look at the details reveals a host of new roadblocks. For starters, EC will be sold from behind the pharmacy counter, which means that women will only have access to the medication during pharmacy hours. Even more problematic is the fact that the FDA has made EC available without a prescription only for women 18 years of age or older. Young women under 18 still need a prescription for the pills. Young Latinas currently have the highest teen pregnancy birth rate of any racial or ethnic group, and a majority lack health insurance. Moreover, sexuality and pregnancy prevention are not widely discussed in Latino families or communities. Latina teens may not feel comfortable talking to their parents about contraception, let alone have access to a doctor who could prescribe it to them within 72 hours of unprotected sex. For young teens who do not want to be pregnant, nonprescription access to emergency contraception would have offered them a second chance to avoid becoming another statistic.
Immigrant Latinas may also face difficulties obtaining EC even if they meet the age minimum. Under the reported provisions of the approved Plan B application, pharmacists will be required to check valid photo identification for proof of age. While this requirement may sound harmless, for the thousands of immigrants who do not have government-issued identification, the barrier could make the product inaccessible even for adult immigrants (unless they were able to get a prescription from a doctor). Finally, there are concerns that low-income women on Medicaid will need a prescription before obtaining EC because most state Medicaid programs do not cover over-the-counter drugs, nor do they have a mechanism in place for handling dual-label products (Plan B may need a prescription label and a nonprescription label). The cost of the drug could also rise now that it is available without a prescription, which means that it may simply be unaffordable for women with limited means.
Nonprescription EC also has implications beyond preventing unintended pregnancies. When someone has unprotected sex, two things should come to mind: one, could I be pregnant; and two, did I contract a sexually transmitted infection? The HIV/AIDS rate has risen dramatically in communities of color in the last decade. Latinas now have an HIV rate six times that of white women. It is essential that women obtaining EC be provided information about the risks of unprotected intercourse and the availability of free testing. Latinas also suffer from higher rates of morbidity from cervical cancer, which can be prevented or treated with proper screening and care. According to studies, Latinas do not have pap tests as often as recommended, and many are not aware that a sexually transmitted infection known as HPV (the Human Papillomavirus) causes cervical cancer. In short, Latinas and other women must understand that nonprescription EC cannot be a substitute for visiting a provider on a regular basis.
Many of these potential barriers can be addressed with careful implementation and constant vigilance by reproductive health advocates. We must work to ensure that ALL women have unimpeded access to EC and the full range of reproductive health services. At the same time, we must not lose the forest for the trees, because if we let down our guard after this short-term victory, we could be left fighting for something even more basic than broader access to the morning-after pill.
Angela Hooton is the Director of Policy and Advocacy at the National Latina Institute for Reproductive Health.