The Washington Post today detailed the tragic history of Plan B (a.k.a. the morning after pill). It is crystal clear that right wing idealogy has been winning out over science for far too long. From Wikipedia:
Emergency contraception (EC) (also known as Emergency Birth Control (EBC), the morning-after pill, or postcoital contraception) refers to measures, that if taken after sex, may prevent a pregnancy.
Forms of EC include:
* Emergency contraceptive pill –referred to simply as “emergency contraception,” “ECPs,” or “ECs”, or “morning-after pill” –are hormones that act both to prevent ovulation or fertilisation, or perhaps the subsequent implantation of a fertilised egg (zygote). ECPs are not to be confused with chemical abortion methods that act after implantation has occurred.
* Intrauterine devices (IUDs) – usually used as a primary contraception method, but sometimes used as emergency contraception.
As opposed to regular methods of contraception, ECs are considered for use in occasional cases only, for example in the event of contraceptive failure. Since they act before implantation, they are considered medically and legally to be forms of contraception. However, some who are anti-abortion define pregnancy as beginning with fertilisation, so they consider EC to be a form of abortion. These claims remain controversial; see Controversy section for more detail. [Link]
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The key thing to understand here is that idealogically driven elements in this country, working with the Bush Administration, have tried to equate the use of the morning after pill with abortion. When the public is misled in this way many feel they too should work against allowing over-the-counter sales of such a pill. This analogy is simply untrue. The morning after pill is a form of contraception. It works to prevent conception in the first place in cases ranging from rape and insest to when a condom breaks. It was back in 2004 that an independent FDA review board made up of scientists and health professionals recommended that the pill be sold over-the-counter:
”By overruling a recommendation by an independent F.D.A. review board, the White House is putting its own political interests ahead of sound medical policies that have broad support,” said Phil Singer, a spokesman for Senator John Kerry’s presidential campaign. ”This White House is more interested in appealing to its electoral base than it is in protecting women’s health.”… [Link]
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p> Today the morning after pill is back in the news and there is finally a glimmer of hope for some progress:
Non-prescription sales of a “morning-after” contraceptive could be approved for women 18 and older within weeks, U.S. health officials said on Monday after years of weighing whether to make Barr Pharmaceuticals Inc.’s Plan B pills more easily available.
The Plan B decision has seen the Food and Drug Administration lobbied relentlessly by supporters and critics of the drug and has held up confirmation of an FDA chief.
“We would like to meet with you as soon as practicable,” the FDA said in a letter to Barr, adding in a statement that it hoped to wrap the process up “in a matter of weeks.”
Some conservatives say easy access to Plan B, which can prevent pregnancy if taken within 72 hours of sexual intercourse, will encourage promiscuity and sexual diseases.
Women’s groups say over-the-counter sales could reduce abortions because more women could get the pills in time. [Link]
Now for the punchline. While we backward Americans continue to be bogged down in this issue, India shows us how to be progressive [via Scott Carney’s (of Wired Magazine) interesting new blog]:
Sure India has a reputation for being a little squeamish when it comes to frank discussions of sex, but that’s not to say that the country can’t be pragmatic when it needs to be. Last year after only a half hearted attack by assorted Hindu fundamentalist segments, the Ministry of Health gave the go ahead order to allow emergency contraception to be sold over the counter. One year later generic pharmaceutical companies like Banglaore based Intra-Labs have upped the ante with a broad based ad campaign to market the drug. It’s a breath of fresh air after living in Madison, WI for three years where Christian fundamentalists have attempted to ban sales of the pill several times… [Link]
Despite the fact that the FDA chief is apparently sending positive signals, Senators Clinton and Murray aren’t buying the same old story:
U.S. Senators Patty Murray (D-WA) and Hillary Rodham Clinton (D-NY) have announced that they intend to place a hold on Dr. Andrew C. von Eschenbach’s nomination to head the Food and Drug Administration, RAW STORY has learned…<
p>”Today’s announcement,” the lawmakers said in a joint statement, “is nothing more than another delay tactic.”
“We will maintain our hold on Dr. von Eschenbach’s nomination until a decision is made…” [Link]
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p>Way to play hardball. I think if it fails this time the Dems should use this as a wedge issue.
Great post. Really glad i have blogs like this to keep me informed of the small details about india-usa relations. Its my own laziness and ignorance which bars me from finding about this stuff from the source 🙂
I’m always uncomfortable with the India/USA comparisions especially in something that alludes to social behavior. There are a lot of BCs available in India that are not sold in the US/Canada or majority of Europe, one example is Diane because of stricter FDA regulations.
Secondly there are still many many many options available for women in the United States in terms of birth control. Also over the counter option in India is NOT the same as over the counter option in the United States. The level of descretion & privacy I’m allowed at a Duane Reade for example is not the same as any I would get in India. Even a metropolis like Mumbai and Delhi the social stigma attached to getting any form of birth control for women is very high.
Also the pill IS expensive in India and not really afforded by the average Jane. The two scenarios are so complex and different from each other and affected by so many different social/political/legal/cultural factors it makes me cringe to compare them.
But Joat, all of these differences should point to why you would expect Plan B later in India and earlier in the United States, except for safety regulations, which are not at issue here, as noted by the vast majority of the relevant scientists.
Good post, Abhi! Mis-take may be the first OTC pill that’s availabe as an emergency contraception but the prescription pill(NorLevo{Levonorgestel}, for example) is available for quite a few years now. Janeofalltrades is right when she said the OTC option is different from OTC option here in the US. But she is wrong about the pill being expensive and the average Jane. Compared to the risky abortions that girls are willing to undergo in India this is far less expensive. It was about Rs.45, the last time I bought it. About the differences in the way this pill is perceived, the right wing in the US are hell bent on not having this pill over the counter. In Illinois where I live, the governor actually had to pass a law to force right wing pharmacists to fill the prescription because some of the religious pharmacists thought they could opt out of filling the prescriptions that they felt are not inline with their religious beliefs. People fail to understand that even between consenting adults and many times with couples being married — condoms have a tedency to fail. In my own experience, the first time it happened we were fortunately in California and they had this law where the pharmacist can advice you and then give you the pill. $50 for the pharmacist(completely useless because we knew how the pill worked) and about $20( I don’t remember exactly) for the pill. The same thing happened while we were in India and I simply had to walk into a drug store and buy it for Rs.45. As simple as that. Sometimes, you feel with all this enforcement we only make things complicated. Janeofalltrades has no idea how popular this pill is even before the OTC option is presented to the general public. Forget about the metropolis, all that the average Jane in a rural town is required to do is to ask John to get her the pill from the local drug store.
JoAT, I agree with you that there are tons of different social and economic factors that make it more difficult for women to have access to birth control in India, but there are so many groups working to help make the pill more available to women there. The fact that emergency contraception is available helps them by adding one more option they can use to help women. The problem isn’t that women are denied access in the same ways here as they are in India, but just the fact that it is available in India and has the potential to be used given the right social changes.
Here, it is a necessary aspect of birth control that isn’t being allowed onto the market because of politics and religious concerns that (I don’t think) are shared by the majority of those who would need access to it. I’m not saying it would be an easy task to make contraception a safe topic to discuss in India, but at least you’re discussing it on a personal level rather than constantly running into the same political walls over and over again. I don’t know if I’m making sense here, but it makes some vague sense in my head 🙂
me=medical student.
Quote from my Ob/Gyn textbook: “Emergency contraceptive pills are high doses of both estrogen and progestin or, progesterone alone to prevent pregnancy after intercourse has taken place.”
To the women who use Oral Contraceptives[OCP] or have friends who have OCPs read the quote above again…and once more….and what do you think you can do w/ those OCPs i.e. ECPs are just a high dose of your OCPs.
This post isn’t meant to advocate anything – just showing you the screwed up world we live in. Not only is it wrong to deny women these pills, it’s also wrong to not educate them that if they want they ALREADY HAVE THESE PILLS! No extra prescription necessary – if you got an assohole of a doc who isn’t willing to give you the ECPs – let him/her know you plan on doing this if he/she doesn’t provide. See what their response is then.
just my two cents
“if you got an assohole of a doc who isn’t willing to give you the ECPs – let him/her know you plan on doing this if he/she doesn’t provide. See what their response is then.”
If the doctor is enough of an asshole, he or she’ll probably scare the patient by talking about the horrible side effects of birth control pills. Especially with younger girls, the whole “you’ll gain tons of weight and grow a beard” thing works. I had a friend in high school who went to her family doc and he scared her off by saying things like that. Her parents supported her decision to get on the pill, but her doctor “persuaded” her not to use them. That’s why clearly labeled emergency contraception available over the counter is so necessary. People can believe in very stupid things when a doctor tells them so. Not that doctors make a habit of telling people stupid things, it happens is all 🙂
GauravM & the million other docs who (I’m sure) read SM: I’ve always been confused about this. I have heard that ECPs are just higher doses of OCPs, but I would never know what to do… How many OCPs equal an ECP? 2? 5? 10? Do you take them all at once?
Not that you should be dispensing free medical advice, but…
In my experience, physicians do say a good deal of crap. Much less here than in India.
Like most science, med. science is a lot of shooting in the dark and trial-and-error and not really well understood. Unlike most other sciences, though the practioners try to look like they know it all. Part of it is that the patients want it like that. They like an authoritative opinion….so the physicians can’t show any doubts at all.
I wonder if these pro-lifers think that children in Lebanon have a right to life. Bu I digress.Such comparative social commentary is great bit this was no social commentary at all, but really a good ppint that can be thrown at the face of people who care so much abt cells- 2 to 16. Some people put a theological angle to it…something like religion X doesnt allow contraception and abortion.Hinduism is clearlynot in the league with detailed medical treatises on abortion always being written and pratciced.There is no problem with contraception too.But some religions or denominations might have a problem.Then I think something like a communal award would be helpful.If you are religion X that hates abortion and contraception, then contraception and abortion is problematic for you.If you think thats a problem and a very basic problem at that, try to reform your religion/denomination or if that cant happen , just quit it.There shouldnt be any blanket view on such things which also means that people who belong to religions that dont have a problem with abortion shouldnt be meddled with by anti-contraception/abortion loonies.People should have control over their individual lives and shared communal ethos and no further. Looking at the comments: PEP price starts from Rs.40.PEP is not supposed to be a regular thing and hence the price is far from prohibitive.Also, the normal OCPs are available at government instituions free of cost and women ( from mainly lower economis strata) queue up for these.Also condoms are available for free.Hence the issues about access to contraception is unfounded as unfoinded is the idea of feeling odd about it….it may be a high society phenomenon…I wouldnt know.Also it could be a pure surmise like the way people sit in Illinois or Sussex and do research on Bombay slums.I heard about a ” a lot of BCs” that are sold in India which arent sold in US/Europe.Can the commenter chuck the lot and atleast name 5…surely 5 aint a lot!! There are differences in drug availability between Europe and US..what is that ascribed to?? Fortunatelt FDA still doesnt rule Europe…yea! As for another commenter who talks about Indian docs talking a lot of crap…well what can I say.Somebody talked in the 60s about some branches who hate the root.And worse, the hate is baseless in the least.
This hoopla created over a pill is just beyond me. It was on 60minutes like last week and they showed how some pharmacies are just refusing to give this medicine. WHAAAT? How can they just refuse? its their JOB to fill my prescription just like a lawyer has to get me a fair trial even if i am guilty.
Pretty soon masturbation is going to be considered murder. I hate those billboards that read “a baby’s right to live VS. a woman’s right to choose”. Its conveying the wrong message
ummmm… please speak to your family physician about this…. i really hope no one will be taking this advice in serious practice! playing with med doses and mixing meds is NOT a game and there can be severe drug-related complications when done incorrectly.
in a textbook, yes, ECPs have higher doses of hormones than OCPs. BUT in practice there are different kinds of birth control pills that have varying ratios of estrogen:progesterone. Drugs are made differently for different purposes, just having a higher dose does NOT work the same way. Drugs are released at different rates and have different molecular forms etc…
also (this is something that personally bothers me) one cannot give kids half an adult asprin thinking its the same dose as baby asprin… that is NOT the same as baby asprin at an equivalent dose… the drugs are MADE differently!
and in what expert opinion can you make these claims?!?! i am NOT a doctor, but i’m a medical scientist and study drug/vaccine development. there ARE real concerns about taking certain medications. there IS a very clear link between taking birth control pills and some of the side-effects, also between BC pills and the rising breast cancer incidence! making claims like this on a forum that is so widely read can be severely misleading and is very irresponsible!!
and there ARE valid reasons why certain drugs should not be sold OTC because when mixed with other prescriptions drugs their effects can be detrimental!… people out there don’t know the appropriate information or how to appraise info on the internet to make these decisions on their own!
the whole issue of OTC ECPs not being available in the states bc of right-winged agendas is a different issue/concern… but let’s not make casual claims that can misinform people about serious things!
sleepy and tamasha: first off let me apologize for that passionate rant at 1 am last nite – studying for these step 2’s can do a number on your emotions 😉
secondly: before I digress any further advice, being that the interesting thing is, no attending/teacher of mine has ever told us an exact number of OCP’s to take to use as ECP’s. I don’t think anyone has a definite idea and if no one still does when I will FINALLY have the MD after my name – I just intend to make a direct comparison between the mg content of an ECP to an OCP (which I am sure has it’s flaws somewhere but I can’t think of em right now.)
Anyhow, the few places I could find an exact number say this: At Planned Parenthood, they write: “Off-label administration of progestin-only oral contraceptives is also effective, but it requires taking 20 Ovrette® oral contraceptive pills, and then taking another dose of 20 pills 12 hours later (Stewart, et al., 2004).” link
At Population Council they have a table making a direct recommendation for the number of pills to use for each brand name OCP (not many are on the table but it’s something). pdf link to table notice however, that’s a pdf for bangladesh – so who knows if those brands are here in the US. [I certainly haven’t learned that yet 😉 ]
Sumiti: I was just asking for curiousity’s sake. Currently it’s like some urban myth, and women might be tempted – with disastrous results. Either way, it should be addressed on our OCP packaging, no? Am I the only one who still reads it?
Anyway, the info GauravM found re: 20 pills is scary – I would take 20 of anything w/o consulting a Doctor.
Would NOT is what I meant! Oops!
Sumiti, speaking of making irresponsible claims on a widely read forum, if you’re going to make such broad statements, please back it up with reliable research, so that people can make informed decisions for themselves.
Ravi / Sleepy thanx for some more info on the situation in India. My mother is a practicing Ob/Gyn from India and hence a lot of the information I have comes from her. And the stigma issue is perhaps a upper class thing.
The biggest drawback she said about having an OTC pill is that women will abuse it in the west. It is not the kind of pill to be popped on a weekly basis or even on a regular basis and her concern is that once it goes OTC it will spread. Abortion alone is abused (I hate to say it) by so many women who don’t think twice about having one more often that this would be out of control. Regulating it thru a doctor (lets leave the religious nuts aside) ensures that there aren’t problems with other health issues as well as excessive abuse of it.
The pharmacist is after all a pharmacist and may have a standard list of questions he/she is supposed to ask but does not ensure anything. I am conservative (not the religious kind) and I’m a big proponent of women’s rights but I sincerely don’t feel comfortable with having OTC EC available. I am all about making it available thru organizations like Planned Parenthood for women who don’t have access to a regular doctor but I would still prefer to see it regulated.
Sumiti, “and in what expert opinion can you make these claims?!?! i am NOT a doctor, but i’m a medical scientist and study drug/vaccine development. there ARE real concerns about taking certain medications. there IS a very clear link between taking birth control pills and some of the side-effects, also between BC pills and the rising breast cancer incidence! “
I apologize if I came across as being facetious, I was tired when I was writing that last night. I’m a med student and I’ve done some research on the correlation between breast cancer rates and use of OC’s [not much though]. The point I was trying to make was that given a personal/political agenda, a doctor may feel tempted to mislead a patient. I completely agree that any doctor should discuss side effects and the potential risk of developing breast cancer in later life but it IS unethical for a doctor to scare a 16 year old girl away from OTC’s by repeatedly telling her that she’ll gain weight. It’s unfortunate that that can be a significant deterrent to someone that age but honestly, it is. As far a as a cost-benefit analysis of the pill; I think the benefits of being on the pill outweigh potential risks of developing breast cancer, especially when there isn’t that much data to prove such a link. There haven’t been enough long term studies done on the issue and it’ll be a while before we have enough data just because the hormonal content of the pills has been changing so much since the pill first came out. I can’t provide references right now, I’m in the middle of exams so I apologize. Feel free to tear apart the argument 🙂
So yes, an honest conversation between doctors and patients would be best, but we can’t ignore the fact that sometimes honest conversations don’t happen. I’m not an expert though, not even close.
Tamasha, Here’s another website to look at, but yeah, it’s important to talk about it with a doctor. If one is being unhelpful, there are always others. I got a little carried away with the asshole thing last night, need to sleep 🙂
you are right… i just didn’t/don’t have the time to look up the appropriate scientific references… but i felt that something needed to be posted to balance the messages here so that people didn’t get wrongful impressions of the drugs…
sleepy: i reacted a bit harshly in my comment as well… it just bothered me that the issue of taking over the counter drugs was over-simplified and that the claim of popping multiple BC pills being similar to taking ECP was made so casually (although i understand the intent was different)… it gives off a very wrong impression to a lay reader… and as a med student you must be aware of the possible concerns this may cause…
anyway, i need to work!!
AWESOME link sleepy!…exactly what I was looking for. thanx for sharing
You guys are really tough on pro-lifers. I’m really apathetic when it comes to this abortion debate but I think there is merit to both sides.(So I guess I’m not apathetic… just ahhh timid here) That said, “loonies”, whatever… I’m a retired liberal and certainly not conservative but it seems for every sincerely biggoted conservative there is… there is a generalizing, universalizing, demonizing liberal to match… therefore I dislike ethics…. Do you ever wonder how us desi’s are so different from our parents… I suppose the same reason the issei are different from the nissei… it’s the American way.
Sorry– One more thing… I’m really confused about the “anti-secular” comments being deleted? What’s up with that? There’s always a few anti-religious comments on SM…. shouldn’t that be considered “intolerant” which is apparently covered under the “Dont’ feed the trolls section”… in the words of the 90s one hit wonders OMC– “How Bizzare”
Exactly what I was wondering.
Unfortunately, religious groups who oppose abortion in the US also oppose contraception. But of course you have an option. If you don’t want a baby, just give it up for adoption so it can be abused and grow up to be a maladjusted person instead, thereby perpetuating the problem.
Sex education in Illinois High Schools comprises talking about Abstinence and almost nothing else. This report by Guttmacher provides some eye-opening statistics.
And I thought the Indian government loved being an Ostrich. My primary source is my roommate who teaches in high school and her sister, a senior this year.
What’s even more surreal is that Bush’s government is attempting to cut off reproductive aid to countries that legalize abortion.
I apologize for going off tangent, but it makes me furious to see so many unwanted children around (I live in a ‘developing’ neighbourhood in Chicago) … and so many people who shouldn’t have babies at all (but that’s another dicussion).
I wonder if these pro-lifers think that children in Lebanon have a right to life
the roman catholic church has generally taken an anti-war and anti-death penalty stance.
I sincerely don’t feel comfortable with having OTC EC available.
But JoaT, how does this same philosophy not apply to Sudafed, Tylenol, Nicotine Gun or Insulin? These are all somewhat dangerous things that can be abused and every now and then result in an accident or death, but the benefits of having them available to people are considered—by scientists who have carefully weighed the relevant statistics, more so in this case even than the other examples–to far outweigh the risks. THe difference between this and other medications is the organ system targeted and the population needing it. And any special consideration of reproductive health and women versus liverhealth/brainhealth/pancreasehealth/cardiovascular health is political, not scientific or medical.
You can in fact have it be “over the counter” but still keep it behind the counter—necessitating a conversation with a professional who warns you of the dangers–like nicotine gum and insulin. This would prevent children from abusing it to a large extent but would still make it quickly available.
the roman catholic church has generally taken an anti-war and anti-death penalty stance.
the GLOBAL Roman Catholic church is quite admirably consistent in its stand against abortion, war, poverty, and the death penalty. I dislike their desire to impose their religious preferences about birth control ( as opposed to about abortion) on non-Catholics via the mechanism of the state, especially because such preferences are quite specifically grounded in Catholic theology and metaphysics and much less grounded in some kind of potentially universal moral philsophy. The rest of it makes sense to me, politically pro-choicethat I am. (And by the way plenty of Hindus are religiously/personally/politically pro-life, and it makes sense given notions of the soul and stories about interactions with unborn children–Abhimanyu, Prahlad, and the Maruts come to mind.) What does not make sense to me is how much of the hierarchy of the American Roman Catholic church has abandoned any interest in peace activism or anti-death penalty acitivism or anti-poverty activism, and singlemindedly goes for anti-abortion activism to simply follow in the wake of the Protestant evangelical churches. It seems like a wholesale abandomenent of both philosophy and culture for the sake of an alignment with the current power structure, and personally, I am watching it drive devout friends out of the Catholic Church.
I’m not a med student, but thus far all the quotes and links have been saying that Plan B is a CONTRAceptive. If that’s true, then isn’t there a chance that it wouldn’t work if you HAVE CONCEIVED by the time you get your hands on the pill? I thought that the whole point of taking the pill was that in the event that you had already conceived, the hormones would terminate your pregnancy. Doesn’t that make more sense? And isn’t that the real reason they’re saying that it’s like abortion: because it will terminate a pregnancy even if it’s in the first 78 hours?
the point is to take it after sex but hopefully before conception or at least before implantation. I believe most women are most fertile many hours before ovulation—i.e. it usually takes awhile for the sperm to meet a ready egg. Pharyngula has a good post explaining the biology of this, but I can’t look it up from this device.
Study published in JAMA, January 5, 2005:
and another in the BMJ [2005;331:271 (30 July)]:
JOAT, your mom can relax now.
it’s a common misconception (and a whole lot of propaganda) that if women are given choices like this they will abuse them. That’s what the oponents of BC said when the pill first hit the market. Margret Sanger could probably say a few things to that 😛
The truth of the matter is that women are pretty intelligent creatures on the whole. Will there be idiots who abuse the system? sure, but that doesn’t mean that there will be a wholesale abuse of the system.
And this is not just limited to urban, educated women either.
A study done in Nepal showed that rural women given misoprostol (a REAL abortive agent, but one with other uses as well) to be taken just after delivery before birthing the placenta so as to prevent post partum hemmorhage (#1 cause of maternal death in developing countries) could both follow instructions AND not abuse the system. (I will find link to research soon)
let’s face it giving women access to more reproductive choices can only empower them…in sub-saharan africa where most first sexual encounters are coerced, or in south asia where child marriage thrives etc, or in America where women are too often raped, women need to have options, and these options need to be made as unrestrictive as possible. Especially when it comes to EC because it is SO time sensitive.
one more thing:
something that’s not often discussed is that because of Viagra, etc, there has been a huge jump in rates of STIs including HIV, among the elderly.
I don’t see people beating up makers of those products saying that it is being abused and should be used responsibly etc…is it perhaps because it is men who use these products? hmmmmm
food for thought.
Point taken. I couldn’t agree more. At the end of the day even with any possible bad reactions/abuse etc etc it is important that women have more choices. It’s easier for me to voice my opinion considering I am educated and aware and has access to healthcare but there are scores of women out there without these choices.
for anyone who is interested the program brief I referenced in comment #31 can be found here
and I was mistaken, this was implemented in Indonesia not Nepal (although I think they are now working in Nepal)
I dislike their desire to impose their religious preferences about birth control ( as opposed to about abortion) on non-Catholics via the mechanism of the state, especially because such preferences are quite specifically grounded in Catholic theology and metaphysics and much less grounded in some kind of potentially universal moral philsophy
You may be right but I thought Christians and Catholics who believed that contraceptive was wrong was based is Kant’s whole deal— a person being an end in themselves and how they can never be used as a means– i.e. a means to satisfy your sexual desire. I think Catholics or at least maybe JPII in his “theology of the body” talked about sex being a self-gift and contraception goes against that notion… not that I necessarily agree(I’m agnostic and thoroughly enjoy being as a means to a beautiful woman’s desire) that said… it is a beautiful thought.
I’m in the mood for self-gift… simply because I’m near you!