What took so long? That is the only sensible response to the FDA's decision to finally permit nonprescription sales of emergency contraception, otherwise known as the morning-after pill.
While Americans grow increasingly incensed as they debate one another about the morality of abortion, a pill has been available for years that could have made a real difference in reducing the number of abortions. While they may forget this fact as they scream back and forth, pro-choicers and pro-lifers do in fact agree that lowering the number of abortions is a good thing.
So how could it be that even with the FDA’s top scientific advisory board recommending over-the-counter sale in 2003, the pill, sold as Plan B, remained hard to get and abortions that should not have happened did?
The answer: ignorance, implacability and impropriety on the part of critics of emergency contraception who have incessantly lobbied the White House not to approve it.
Some have long opposed emergency contraception because they see the pill as an "abortion" pill. Others worry that having a day-after pill around will contribute to sexual immorality and promiscuity. This is sheer ignorance.
Emergency contraception is not an abortion pill. It is basically a big dose of one of the key ingredients in an ordinary birth control pill. If a woman has had sex and is afraid she may become pregnant she can drastically reduce the chance that will happen. The sooner the pill is taken the better but even if the pill is taken three days after sexual intercourse the chance of getting pregnant drops to around 10 percent.
Pregnancy prevention, not abortion
The pill acts in two ways. Primarily, it prevents the ovaries from releasing an egg so no fertilization can occur. Then in the rare event that an egg has already been released by the ovaries, the pill also changes the chemistry of the lining of the uterus so that any fertilized egg cannot implant.
Is this an abortion pill? No. For the most part the pill simply stops an egg from being available to come in contact with sperm. And even if there happens to be an egg present when sex occurs there is no disruption of an implanted embryo. The only way the pill can be seen as inducing an abortion is if one holds the view that non-implanted, fertilized eggs are fetuses — a view which few doctors, pharmacists, scientists or Americans subscribe to.
Will having emergency contraception around lead women to promiscuity? Information is already available from Europe's experience with the pill. Large numbers of rape victims, couples who had a condom break and women who were lured into having sex while drunk or under the influence of drugs seem to be the key users. There's no reason to think this pill would somehow induce abstinent women into sexual activity. Those most likely to use it are couples who are trying to be sexually responsible but suffer a condom failure or women who are forced, tricked or coerced into non-consensual sex.
Who thinks reducing abortions is a bad thing?
Politics aside, shouldn't the shared goal be to reduce the number of surgical abortions that women have? Roughly 80 percent of teen pregnancies are unintended. About 1.3 million abortions are chosen out of the 6 million pregnancies that occur in the United States every year. It stands to reason that by making emergency contraception relatively easy to get at pharmacies, police stations, student health services and hospitals, some pregnancies that now end in elective abortions would simply not become pregnancies. Yet implacability on the part of those who see abstinence and surgical abortions as the only public-policy options has hamstrung emergency contraception.
Lastly and most importantly, impropriety is the culprit in keeping the option of emergency contraception from being readily available to women. The White House has improperly played politics with this pill. Despite strong evidence from other countries that the day-after pill is both safe and effective, despite the positive recommendations of the FDA's scientist advisers and despite the overwhelming support for making the pill widely available by the vast majority of experts in obstetrics, gynecology and medicine, the White House has let ignorance and implacability overwhelm science. Even now, the only reason emergency contraception is moving into our drug stores is the drive to get the current candidate for FDA chief confirmed by the Senate.
Ignorance, implacability and impropriety do not make for a sound foundation for public health or public policy. They should not have and should not ever be the basis for deciding what you can choose to use to protect your health or plan your family.
Arthur Caplan, Ph.D., is director of the Center for Bioethics at the University of Pennsylvania.