When I went to the clinic, I was surprised to see the clinician pull out a pack of regular birth control pills, pop four out of their seals and drop them into an envelope for me. She instructed me to take two pills right then and two more later that evening. I knew that emergency contraception pills were related to birth control pills, but I didn't know that they were virtually one and the same. Mercifully, I dodged that pregnancy bullet, but just a couple weeks later one of my girlfriends found herself in a similar scenario. She was so freaked out and embarrassed that she didn't want to go to the clinic (a daughter of conservative Catholics, naturally), so I pulled out a pack of my birth control pills and set her up with the same dosage my clinician had given me. Word quickly spread in my female peer group that we could take such DIY precautionary measures and I was frequently thanked for sharing my knowledge.
Nineteen years later, I'm wondering if today's teens may end up resorting to such undercover actions, given the unfortunate, rising trend of pharmacists refusing to dispense emergency contraception pills (ECPs) based on their personal religious beliefs and the false assumption that ECPs are just another form of abortion. (ECPs are not to be confused with RU-486, a medication that can induce abortion early in a pregnancy.)
The phenomenon first came to public attention in 1999 when Wal-Mart announced that it wouldn't be selling ECPs at any of its 2,400 pharmacies. In February of 2004, a pharmacist in Denton, Texas refused to provide ECPs to a rape victim. A study of 600 Catholic hospitals found that only 28 percent would dispense ECPs to rape victims. A recent survey of New York City pharmacies found that 25 percent wouldn't dispense ECPs to their female customers, and earlier this year, a pharmacist in Madison, Wisconsin not only wouldn't fill one woman's prescription, he refused to return it to her so she could have it filled elsewhere.
Is this actually legal? Is it ethical? Does it even make any sense? The answers are mixed, depending on whom you talk to and what state you're living in, but one thing's for sure: It's entirely misguided and illogical from a medical perspective, even if you're opposed to abortion.
Deborah Oyer, MD, a nationally respected doctor who owns Aurora Medical Services and serves as a board member for the National Abortion Federation, is a passionate and dry-witted pro-choice advocate. Oyer gets particularly riled when talking about the religious right's role in spreading misinformation about emergency contraception. "The initial thought [in the medical community] was that we didn't really know how ECPs worked," she explains. "There were two possibilities: It could have delayed ovulation and any sperm would be gone by the time [the woman did ovulate]. The other theory was that if an egg actually was fertilized, use of ECPs would cause the uterine lining to denude [slough off], leaving no place for the egg to implant…. What's interesting is that about 80 percent of fertilized eggs do that ANYWAY, so the whole theory that 'once an egg is fertilized, you're pregnant!' is ridiculous."
Today we know that it's the former: A study published in the Journal of Contraception this past December showed compelling evidence that the only way ECPs work is through prevention of ovulation.
Such scientific facts are apparently lost on anti-choice pharmacists operating under the delusion that ECPs have some sort of abortive qualities. Of course, even if they did, refusing to fill a legal prescription should be illegal, right? Unfortunately, 20 states (not Washington) have laws in place that allow pharmacists to refuse to fill prescriptions, so it is legal in many cases, if not ethical. That reality recently led pro-choice Illinois State Governor Rod R. Blagojevich to pass an emergency rule making it illegal to refuse to fill ECP prescriptions.
Christine Gregoire hasn't pushed for such a measure yet, but the pro-choice community is ready for the fight. Kelly Reese, a lawyer for Planned Parenthood of Western Washington, asserts that refusing to fill ECP prescriptions is both unethical and illegal in our state. "It's our position that it's a pharmacist's ethical obligation to fill these prescriptions," she says.
Northwest Women's Law Center Executive Director Lisa Stone backs this up. "Contraception, including emergency contraception, is NOT the termination of a pregnancy--it's the prevention of implantation," says Stone. "What the religious right is trying to do is [distort] the meaning of pregnancy and personhood. No reputable medical entity thinks that contraception is an abortifacient--that is political rhetoric. There is not a state law or regulation that permits pharmacists to refuse to dispense legal medication in this state."
Stone worries, however, that some pharmacists in Washington may be refusing to fill emergency contraception prescriptions. "The offices of Senator Patty Murray asked me [about this] two weeks ago," Stone says. "And I inferred from the way they asked the question that they might have received some complaints." Oyer, Reese, and a rep I spoke with for the local chapter of the National Abortion Rights Action League have all heard stories about local women being turned away by pharmacists, although no one has come forward to file a formal complaint yet.
Stone made it clear that her agency won't hesitate to file a lawsuit against any offenders. "We would consider taking on advocacy, administrative action, or something else," Stone says.
The religious right continues to push its anti-choice agenda--and they're making headway. This month, the American Academy of Family Physicians (AAFP) will be considering a policy that would endorse both a pharmacist's right of refusal and a patient's right to have a legal prescriptions filled, a move that could determine how individual states handle this issue.
Watching this issue play out I find myself contemplating a return to my Reagan-era habits. I'm prepared to start hoarding those extra packs of birth control pills and teaching my girlfriends how to take care of themselves, DIY style--just like it's 1986 all over again.
For a searchable database of local pharmacies that will not only happily dispense ECPs, but have made special arrangements to dispense them to women without a prescription, go to www.not-2-late.com.