July 11 issue - In theory, access to the drug called Plan B should be a no-brainer. It's safe, it's effective, it's easily available in dozens of countries. But Plan B is a drug used to prevent pregnancy, and nothing about preventing pregnancy in America is simple, except for the fact that so many women do it as a matter of course.
Plan B is an emergency contraceptive that works by inhibiting ovulation, fertilization or implantation. It won't work if you're already pregnant, but it will stop you from becoming pregnant if your everyday contraceptive failed or you've had unprotected sex. But because it must be taken within a few days—it's sometimes called the morning-after pill—it's important to have ready access. Canada, Britain, France and a host of other countries allow women to get emergency contraception without a prescription. It's even distributed at public clinics in Peru, where abortion is largely illegal—and an estimated 400,000 illegal abortions are performed annually.
More than a year ago, an advisory panel at the Food and Drug Administration voted 23-4 to allow Plan B to be sold over the counter in the United States. In a highly unusual move, the agency rejected the panel's recommendation. In an even more unusual move, federal guidelines sent to hospitals earlier this year on the treatment of rape victims did not mention Plan B, although one study suggests that the vast majority of women who become pregnant through sexual assault can avoid it by taking the drug.
In a smart and provocative new book titled "Marriage, a History," social scientist Stephanie Coontz quantifies what most of us know: "The relations between men and women have changed more in the past thirty years than they did in the previous three thousand." Education, access to the workplace, assumptions about ability, ambition and attachments: the division of male actor and female enabler has crumbled. And no wonder. As Coontz reports, a 1962 Gallup poll showed American women were satisfied with their lives, but only one in 10 said she wanted the same life for her daughter. There have been many changes in the lives of those daughters, but one of the greatest has been the ability to control when, and whether, they would bear children.
But as surely as the pill led to great freedom, change has produced great outrage. The rise and righteous indignation of the powerful religious right have been fueled by the transformation of women's lives. So many of the objections to legal abortion over the past 30 years have been objections to female sexual freedom. So many of the arguments have suggested that modern women are either licentious or blind, that they end pregnancies heedlessly or don't know what they're doing.Feminist advocates have always suspected that the anti-abortion movement is less motivated by the sanctity of life than by opposition to women's rights. The fate of Plan B could settle the issue. Emergency contraception is the ultimate middle ground in an issue in which the middle has often seemed to be a black hole. One study has estimated that if Plan B were easily available, it could cut the number of abortions by half.
Yet the American Life League, the far-right wing of the anti-abortion movement, has said the organization is opposed not only to emergency contraception, but to any oral contraceptives or IUDs because they constitute "early abortions." In Colorado, rape victims aren't even told about emergency contraception in the ER. The governor, Bill Owens, said that to require hospitals to do so would raise "serious concerns" for Roman Catholics like himself, concerns more important than those of a woman carrying a rapist's child.
By contrast, Sen. Harry Reid, who also opposes abortion, spearheaded a measure, recently defeated along partisan lines, promoting education about emergency contraception. And there's not a mention of Plan B on the home page of the National Right to Life Committee, perhaps because the nation's most influential anti-abortion group knows that Americans may have a hard time finding a profound moral dilemma in a pill taken just a day or two after unprotected sex.
A bill that would allow pharmacists to dispense Plan B without a prescription in New York sits on the desk of Gov. George Pataki, who is still deciding whether to sign. Also in limbo is the question of whether the FDA will eventually allow the drug to be sold over the counter nationwide. It would be nice to assume that both decisions are awaiting scientific evidence of efficacy and safety, but that has existed in abundance for some time. Instead they are awaiting political calculation: more clout in the middle ground, or at the fringes that seek to push women backward?
If easy access to a pill that has been shown to significantly decrease the number of abortions is not a welcome development, what is the real point of the anti-abortion exercise? Is it to safeguard life, or to safeguard an outdated status quo in which biology was destiny and motherhood was an obligation, not an avocation? America leads the industrialized world in its abortion rate. Perhaps that is because it leads in hypocrisy as well.