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Posted by on Sep 16, 2012 in Politics, Religion, Science & Technology | 31 comments

We’ve not come a long way, baby; Republicans willfully ignore science in opposing morning-after contraception

These abortion-causing drugs go against our faith… We simply cannot abandon our religious beliefs to comply with this mandate.

And thus David Green, founder and chief executive officer of privately-held Hobby Lobby, explained this week why his privately-held company is suing the federal government over mandated contraceptive coverage in health insurance. Green, with a net worth estimated at $2.6 billion in 2010, is an evangelical philanthropist. Like Chick-fil-A, the Hobby Lobby stores are closed on Sunday.

The problem is … his objection isn’t grounded in science or an understanding of how the morning-after pill works. Well, that’s not the only problem with his position, but it is a substantive one.

***

Plan B, photo by Lillian FurlongIn 1965, the Supreme Court (7-2) ruled as unconstitutional an 1897 Connecticut law that banned the use of “any drug, medicinal article or instrument for the purpose of preventing conception.” The birth control pill was five years old.

The lawsuit, Griswold v Connecticut, was brought by (wait for it) the Planned Parenthood League of Connecticut.

It’s almost 50 years later, and we are still engaged in a struggle over women’s use of and access to contraception. And we’ve been engaged in this struggle for 150 years. The Connecticut law was first cousins with the Comstock Act, a federal law passed in 1873 that prohibited mailing information about abortion or contraception. Anthony Comstock was a religious zealot. His efforts amended an 1865 act dealing with obscenity.

I think this is the right time to remind everyone of Susan B. Anthony, champion of women’s right to vote and opponent of slavery, who said:

The religious persecution of the ages has been done under what was claimed to be the command of God. I distrust those people who know so well what God wants them to do to their fellows, because it always coincides with their own desires.

***

Earlier this year, Republican presidential nominee Mitt Romney referenced the morning-after pill as “abortive pills.” In this example of rhetorical excess, Romney is being consistent in his willful ignorance. From a 2005 column in the Boston Globe, written to explain why as Governor he had vetoed a bill providing morning-after contraception for rape victims:

Though described by its sponsors as a measure relating to contraception, there is more to it than that. The bill does not involve only the prevention of conception: The drug it authorizes would also terminate life after conception.

Despite Romney and Green’s assertions, this is not how the morning after pill works.

It may be how you think it works. Heck, it’s how I thought it worked until this latest brouhaha.

But this explanation is wrong. It conflates the morning-after pill with RU-486.

From the New York Times, June 2012:

Studies have not established that emergency contraceptive pills prevent fertilized eggs from implanting in the womb, leading scientists say. Rather, the pills delay ovulation, the release of eggs from ovaries that occurs before eggs are fertilized; and some pills also thicken cervical mucus so sperm have trouble swimming.

It turns out that the politically charged debate over morning-after pills and abortion, a divisive issue in this election year, is probably rooted in outdated or incorrect scientific guesses about how the pills work. Because they block creation of fertilized eggs, they would not meet abortion opponents’ definition of abortion-inducing drugs. In contrast, RU-486, a medication prescribed for terminating pregnancies, destroys implanted embryos.

[…]

Scientists say the pills work up to five days after sex, primarily stalling an egg’s release until sperm can no longer fertilize it. Although many people think sperm and egg unite immediately after sex, sperm need time to position themselves.

Emergency contraception was approved in Great Britain in 1984, 15 years before approval here.

The New York Times article details the history of the drug approval and labeling process. In a nutshell, the Food and Drug Administration decided that the label for “Plan B” (approved in 1999) should say that the drug might work by preventing a fertilized egg from implanting in the uterine lining.

That was the Clinton FDA. And the FDA took this action even though the pharmaceutical company protested.

By 2002, research showed “that Plan B did not interrupt implantation.”

In 2006, the FDA made Plan B available over-the-counter for women age 18 and older.

The pharmaceutical company again asked that the label be changed to accurately reflect the science. The FDA refused.

That was the Bush FDA.

Addressing the issue in a 2005 memorandum, Dr. Steven Galson, director of the F.D.A.’s Center for Drug Evaluation and Research, wrote that studies “conclusively demonstrate” that Plan B’s ability to block ovulation, is “responsible for most, if not all, instances in which emergency contraception prevents pregnancy.” But he also said that studies at that time could not exclude the possibility the pills impeded implantation “in a small percentage of women.” He declined a request to be interviewed.

And then in 2010, Teva Pharmaceuticals once more asked that implantation be removed from the label. The FDA again declined.

This time, it was the Obama FDA.

By this year [2012], the International Federation of Gynecology and Obstetrics considered the research so strong that it issued a statement saying that pills with Plan B’s active ingredient “do not inhibit implantation.”

The American Medical Association explained the social benefits of easy access to contraception and the reason that government action is needed to exert countervailing power in a oligopolistic system:

The goal behind the ACA provision on preventive health care services is to eliminate financial disincentives to using effective preventive care, thereby improving health. Numerous studies have found that even modest cost-sharing requirements can dramatically reduce use of preventive health services, particularly among lower-income Americans [4].

[…]

The HHS decision builds on major changes in private-sector contraceptive coverage over the past two decades. Since the late 1990s, 28 states have required plans to cover contraception when other prescription drugs are covered [7]. And in December 2000, the U.S. Equal Employment Opportunity Commission first made it clear that an employer’s failure to cover contraception when it covers other prescription drugs and preventive care violates protections against sex discrimination under Title VII of the Civil Rights Act [8]. By 2002, the vast majority of private insurance plans were covering a comprehensive array of contraceptive services and supplies, a substantial shift from coverage practices in 1993, when the issue was first studied [9].

[…]

Despite the well-documented benefits of contraception, many women face problems using contraceptives consistently over several decades. The result is that nearly half of U.S. pregnancies—more than 3 million annually—are unintended, and unintended pregnancy rates increased by 50 percent among poor women between 1994 and 2006 [20, 21]. Although there are myriad reasons behind these statistics, cost is one important access barrier, particularly with respect to long-acting, reversible methods (such as the IUD and the implant) that are extremely effective and cost-effective in the long run, but have high up-front costs.

A vocal minority — only about 20 percent of Americans, based on polling data — insist that their worldview on abortion and personhood be the law of the land. Why are the 80 percent acquiescing?

The issue is bigger than contraception or abortion. This issue goes beyond the heart of Susan B. Anthony’s arguments for the franchise to human agency, which I define as an individual’s ability to act on goals that matter to her, to freely make a meaningful choice.

But that minority – the 1-in-5 – is hellbent on reducing or removing choices for the 4-in-5.

When you vote in November, keep this in mind.

Photo: Lillian Furlong in Klipsun Magazine, an independent student publication at Western Washington University, Bellingham.

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