Dana L., Blame Yourself, Not the FDA

In her June 4 Washington Post editorial, “What Happens When There Is No Plan B,” an attorney using the name Dana L. wrote about how she was “forced” to have an abortion because the “morning after” pill is not available over the counter, (OTC).  
 

She wrote regarding her arrival at a Planned Parenthood clinic, “All the while, I was thinking that if religion hadn’t been allowed to seep into American politics the way it has, I wouldn’t even be there.”  She fails to realize that there are medical reasons why Plan B isn’t an OTC drug.  Writing, “This could have been stopped way before this baby was conceived if they had just let me have that damn pill,” she demonstrates an incomplete understanding of how Plan B works.  According to the FDA website, it is regimen of two levonogestrol pills.  The first tablet is taken as soon as possible after unprotected sex within 72 hours.  The second pill is taken 12 hours after the first.   This synthetic progestin can stop ovulation if it hasn’t occurred yet or stop fertilization if that hasn’t occurred yet.  Fertilization, (conception), occurs within 12 to 48 hours of unprotected sex when a sperm cell penetrates the egg.  Therefore, Dana L. could have conceived before she started her quest for Plan B.  If she had conceived, Plan B also prevents implantation causing the abortion of an embryo that has 23 pairs of chromosomes.  In other words, a human being.  Since “that damn pill” is only 89% effective, Dana L. would have had an 11% chance of becoming pregnant if she used Plan B.
 

Earlier in her editorial, Dana L. wrote that she and her husband “managed to snag some rare couple time and, in a sudden rush of passion, I failed to insert my diaphragm.”  Its use most likely would have stopped “this” “way before this baby was conceived.”  If Dana L. had paid attention in high school biology, she would have been especially careful to remember it: Women are most likely to have strong sexual urges and most likely to become pregnant when they are ovulating.  The ideas of devotion and commitment may be religious, but the biological purpose of sex is reproduction. 
 

Dana L. was more conscientious about finding out why the FDA didn’t approve OTC sales of Plan B than she was about using birth control.  She discovered that an advisory committee recommended OTC sales in December 2003, but the FDA “top brass” overruled the recommendation.  The FDA Statement on their website indicates there was insufficient scientific data that women under the age of 17 could safely use Plan B without medical supervision.  It questioned the feasibility of requiring a prescription for one population while permitting OTC sales to another for the same drug for the same usage.  The first concern addressed safety.  The second seemed to focus on the potential legal issue of discrimination.
 

Dana L. interprets it differently: “Apparently, one of the concerns is that ready availability of Plan B could lead teenage girls to have premarital sex.  Yet this concern – valid or not – wound up penalizing an over-the-hill married woman for having sex with her husband.”  If Dana L. weren’t so self-centered, she would realize that the FDA concerns itself not with her convenience, but with the safety of all potential consumers.
 

While the possibility that teenagers are more likely to have unprotected sex if Plan B were easily available is a valid one, it wasn’t one of the FDA’s points.  Plan B’s safety has not been assessed in younger teenagers.  Plan B contains a high dosage of the drug used in contraceptive birth control pills.  Birth control pill use is associated with blood clots, strokes and heart attacks and is not recommended for women with certain medical conditions.  These risks may not occur with Plan B because it is not used on a regular basis.  However, studies have not been done regarding repeated use of Plan B.  It is not meant to be used as routine birth control, but one in seven women in the UK have used Plan B repeatedly in a one-year period.  Additionally, the active ingredient can increase the risk of ectopic pregnancy, a condition that requires immediate medical attention.   
 

There is a possibility that those under the age of 16 will be less likely to understand or follow the instructions.  Plan B requires two doses and the timing is critical.  When a prescription is required, a healthcare professional can make sure the user understands the directions and risks.  In November 2002, the FDA sent the manufacturer a warning letter regarding some of the Seattle area advertising for Plan B.  The FDA cited the ads for not making it clear that the drug is most effective the sooner it is taken, for not emphasizing that Plan B is not a substitute for regular contraception and for minimizing the risk of ectopic pregnancy.  Even when these facts are clear, how seriously will younger teenagers take them?  There is a possibility that teenagers may use OTC Plan B in place of contraceptives that require prescriptions.  Additionally, if Plan B were available OTC, a teenager may be unlikely to seek medical help in the case of an ectopic pregnancy if she was trying to keep a sexual encounter secret.
 

Those are issues of health and safety rather than religion, but morals can’t be completely separated from this issue.  Dana L. stated that she is over 40 and was taking a medication that shouldn’t be taken if one were pregnant or planning to conceive.  This implies that she wouldn’t risk having a baby that was less than perfect.  She did not mention asking a doctor about how high the risk of birth defects actually was, about alternatives to the medication or about anything she could do to increase the likelihood that her baby would be healthy.  Yet she asked more than one doctor for Plan B.  Dana L. also felt she couldn’t have a baby because she and her husband don’t spend enough time with their kids.   An adjustment of work schedules or lifestyle could give her husband or herself more time for the children if it were important to them.  She also “thought of the emotional upheavals that an unplanned pregnancy would cause our family.”  Life is full of “emotional upheavals.”  Some, such as disabling accidents or illness, are harder to deal with than the creation of a new life.  Abortion takes that life as does Plan B if taken after conception.  Having unprotected sex when unwilling to have a baby is wrong regardless of one’s age or marital status.
 

The FDA’s decision was based on medicine, not religion.  However, our laws are based on ethics derived from religion.  The Declaration of Independence states, “that all Men are created equal, that they are endowed by their Creator with certain inalienable Rights, that among these are Life, Liberty and Pursuit of Happiness.”  Newly created humans should also be endowed with that right to life.  The pursuit of happiness should not include killing them.
 

Copyright Eva Ellsworth, 06/10/06, all rights reserved