June 10, 2013 • 32 mins
A court decision to lift age restrictions on purchasing Plan B emergency contraception set off a firestorm of controversy. Cristen and Caroline talk about what Plan B does and its impacts on young women's sexual health.
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Speaker 1 (00:04):
Welcome to Stuff Mom Never Told You from House top
works dot com. Hello, and welcome to the podcast. I'm
Kristen and I'm Caroline and Caroline. A couple of years
ago on the podcast, we did an episode on the
Morning After pill and what it is uh, and we're
(00:26):
going to revisit the Morning After pill and specifically the
branded Plan B emergency contraception because it has made some
headlines of late, and we want to talk about the
legal debate surrounding access to Plan BE, specifically access for
younger girls UM. And also what emergency contraception is. Yeah,
(00:51):
because previously UM morning after pills the more appropriate name
being emergency contraception because you don't have to necessarily take
them the morning after. The whole rigamarole was that they
were only available to girls seventeen and up with an
I D and a prescription. So the evolution becomes that
the FDA basically says it's okay for everybody. They study
(01:11):
the safety and efficacy, they say it's okay. The administration
kind of freaks out. The Obama administration kind of freaks out,
that's it's not okay for everybody. It's oh my god,
we have so many things to worry about. We can't
just be handing out drugs like candy. The f d
A in response kind of tucks their tail, and then
we get a whole bunch of lawsuits. That's that's kind
of glossing over how everything's evolved. Now. What we're dealing
(01:34):
with is this push to get rid of age restrictions
versus the push to maintain the older age limit with
I D. And what's interesting about this fight that we'll
get into is that both sides, for instance, groups like
the Family Research Council and groups like Planned Parenthood are
both saying that this is an argument of politics versus science,
(01:57):
and they're both both sides are accusing each other of
putting policy X before what is best for our children. Yeah,
and that's the Family Research Council obviously representing more of
the conservative side of things, whereas Planned Parenthood is arguing
more on the the liberal side of stuff. Not just
to boil it down to black and white, but the
(02:17):
drug in question that we're talking about is called leave
on a gestural and we hear about it under the
brand name Plan B. And just for a little bit
of historical context, emergency contraception is nothing new to medicine.
It's not like doctors recently figured out, oh, you know what,
(02:37):
we can actually give women a drug that could halt
the egg from being fertilized after they have unprotected sex
or in the case of sexual assault. And this brief
timeline is coming from the paper Emergency Contraception Underutilized Resource
out of the University of Wisconsin School of Medicine and
Public Health, and it talks about how hormonal emergency contraception
(03:02):
was first studied in the nineteen twenties when researchers figured
out that estrogenic ovarian extracts interfered with pregnancy in animals,
and so it started out as a high dose estrogen
only formula, and vets were the first ones to use
it on dogs and horses who had made it when
(03:22):
the owner didn't intend to not with each other. Right.
I had to read that twice. I'm not, I'm not, okay,
it's like dogs and horror. Okay, So dogs and dogs
and horses were the first the first animals to receive
this kind of emergency contraception. And let's not forget though,
about how women took emergency contraception into their own hands
(03:47):
even before the f d A had a drug approved
with douching, as we talked about in one of our
favorite stuff I've Never Told You episodes, Down with the Douche.
Apparently not only that we talked about in the podcast
about how women would douche with lysol and a lysol competitor, Zonight,
and apparently also with Coca cola. It is abrasive. Yes,
(04:15):
we are in no way endorsing any of that. Don't
do that. We're just saying that it happened. Yeah, keep
coke on ice, not in your vagina. Yeah, and that's
a quote we can read it. Yeah, Okay. So moving
on through the sixties and seventies, there was a lot
of research done on different combinations of drugs to prevent
(04:37):
UH pregnancy, and in the mid sixties we have the
first documented human clinical cases of post quoital estrogens, and
this is when doctors in the Netherlands use that veterinarian
proved method on a thirteen year old girl who had
been raped in order to prevent pregnancy. But by the
late nineteen sixties in the US, high dose estrogen regiments
(04:57):
became the standard, and then going to the seventies, we
have the development of regiments that are a combination of
estrogen and progestine. In nineteen seventy four, some of our
older listeners might be familiar with the youth Pay method.
This was named for Canadian Dr Albert use Pay, which
was an estrogen progestine combination and it replaced for a
(05:19):
while the high dose estrogen treatments because it had fewer
side effects. And now Plan B is a progestin only
formula and it has greater efficacy in terms of blocking
that pregnancy as well as fewer side effects. And in
the US Food and Drug Administration approved Plan B with
(05:44):
a prescription and since two thousand nine, the FDA has
approved it for over the counter sales for women seventeen
years old and over. And in two thousand eleven, this
is when the legalities start to get really dicey. In
two thou eleven, and Health and Human Services Director Kathleen
Sibelius blocks Plan B slash one step from being available
(06:07):
to all women of all ages over the counter. And
this happened in response to an application from drug maker Tiva,
who makes Plan b UM. When the FDA went back
and looked at it and recommended that it be made
available to all women saying that it's very safe, and
so Sibelia says, you know what, I'm going to overrule that,
(06:29):
and in response, reproductive rights groups such as Planned Parenthood
sued the Health and Human Services Department for that. And
so in the middle of all of this, we have
Judge Edward Corman of the District Court of Eastern New York,
who was the one who in April five, two thousand
thirteen this year overturned the US Health and Services ruling
(06:52):
to put an age limit on obtaining Plan B. So
it's just been it's it's almost like watching a ping
pong match between the courts and the f d A.
And then also you have Health and Human Services stepping
in and so people are kind of on the one
hand flipping out, saying, you know what, we need to
put some kind of age restriction on it. But the
(07:12):
interesting thing is Judge Edward Corman, who has been presiding
over this whole Plan B legality since two thousand five
in terms of overseeing whether or not it should be
made available to everyone, he is basically at the end
of his rope with all of this. Uh. There is
an NPR story about this, and it cites from the
(07:35):
legal brief that he wrote. The effort to convert these
leave on adjustural based contraceptives from prescription to over the
counter status has gone on for over twelve years, even
though they would be among the safest drugs available to
children and adults on any drug store shelf. And and
then he signed it with a giant snap. No really,
(07:57):
I mean I read the entire brief, his some brief,
and it was not only fascinating and enlightening, uh kind
of get a better understanding of what's going on politically
and in the courts about this whole issue right now,
But it was just the most entertaining thing I may
have ever read outside of a David Sadari's book, because
(08:17):
I mean, this is like the most intelligent snark in
the world. Judge Corman basically calls Sibelius's decision to overrule
the strike of the age limit as politically motivated, scientifically unjustified,
and contrary to agency precedent. He goes on to say that, look,
(08:38):
it's really only the f d A that has the
necessary information and expertise to make these decisions about the
safety and efficacy of drugs. A principle, he says that
Sibelius flagrantly violated, and so in response to the defendants,
who are you know, Sibelius and the Commissioner of Food
and Drugs seeking a stay of the a the strike
(09:01):
of the age rules to pursue an appeal, he says
it's something out of an alternate reality and says that
one of their arguments that if you let it go
over the counter now and then reverse it later without
a stay, it's largely an insult to the intelligence of women,
because he's like, dudes, you're the ones who have made
this process for obtaining Plan B so freaking confusing. And
(09:24):
some abroad the fact that it's telling that Corman is
having such an intense response against the Obama administration's wish
for that fifteen year old age limit on it because
Corman was appointed by President Reagan, so he was part of,
you know, a more politically conservative administration's appointments, and so
(09:48):
they're saying, well, you know, if he if he's freaking
out over this, maybe also for me, thinking about being
on the same case since two thousand five, maybe he
just needs a vacation. Good, Perhaps he's just tired, but hey,
frustration leads to some of the beautiful things that he wrote,
I'm okay with it. I highly recommend you search out
this brief and read it now. Of course, in April,
(10:10):
when Judge Corman said, you know what, enough of all this,
you need to make Plan B available over the counter
to all women of all ages. Also side note men,
you can buy Plan B as well. Um. But of
course when he said you know, the age limit should
be removed, Q freak out because not only do you
(10:33):
have well you have that in then the Obama administration
coming back and saying nope, we're gonna have a fifteen
year old cap for that, and you're gonna need an
I D. So Planned Parenthood said in response basically like thanks,
but you know what, you need to lift all restrictions
to this. And then on the more conservative side you
have Concerned Women for America saying, well, if Plan B
(10:56):
is so safe, then why do we need prescriptions for
birth control? Huh? Yeah, they they get a little snarky. Also,
this is like a big theme among this this debate
is some snark. The Concerned Women for America wrote that
the same quote women's rights advocates who want every decision
to be between quote a woman and her doctor are
now eliminating the doctor and putting politics ahead of our kids.
(11:19):
To see, there's that debate of like everybody's accusing everybody
else of being too political in this discussion, right, and
then the more liberal National Women's Law Center said, hey,
you know, with this whole I D issue, women who
don't have I d s are going to be denied access.
That could create problems. How many fifteen year olds do
we know who already have I D s. And even
(11:40):
if you you know, if if one of us, for
instance Carolina, older women who are plenty above the age
limit to get planned B if we go to the
drug store and all of a sudden, oh you know what,
actually we've forgot our I D, then we can't get it.
The whole timing issue with the access to emergency contraception
is important, even if it means oh, well you gotta
(12:01):
leave and then you might have to come back the
next day. Well, in the time that has passed, that
low worse the efficacy rates of emergency contraception. So this
timing issue is very important. Um and then we have
people from the Family Research Council saying, well, you know what,
what about what this hormone is gonna do to the
pre pubescent female body, because really a lot of this
(12:23):
ties into fear of whether or not access to emergency
contraception over the counter without an idea two girls of
all ages is somehow going to set off as domino
effect in younger girls brains that oh, you know what,
I can start having sex whenever, because if something happens,
(12:47):
then I can just go to Walgreens the next day
and take care of it. So the Family Research Council
points out that plan be distances the girls who are
at high risk of sexual abuse and at t I
S from the medical supervision they need. And I think
that's an important question of access because are these girls
(13:08):
who the Family Research Council is so concerned about, are
they even getting medical intervention? Do they even have access
to it? Are they able to go to the doctor
and ask questions and get a prescription for this stuff? Um?
I mean what group of people are we talking about?
Not everybody, not every Uh young girls parents are involved
(13:30):
in her life and can drive her to a pharmacy.
You know. Well, And when I was I was listening
to dance, I was talking about this not too long ago,
and he brought up a pretty distressing but relevant point
of Let's say, okay, a girl is raped by her
father and then she has to turn around and ask
him to drive her to the drug store to go
(13:51):
get planned beat, you know what I mean, Like it's
it's pretty telling to that. In November of two thousand twelve,
the American Academy of Pediatrics recommended that advanced emergency contraception
prescriptions be allowed because kids are more likely to use
it when that's the case, like it basically, if if
(14:12):
it's already there, if they have it, then if something happens,
then they're more likely to use it, which is one
reason why New York Times parenting blogger kJ del Antonia
suggested that maybe you know what, as parents, maybe we
need to go ahead and just stock up on Plan
B at home. And she advised that it be kind
of as hard as it would to maintain this, it'd
being no questions, ask policy like, just come come to
(14:34):
me and come get it if you need it, and
we'll deal with it. Then just tell her, you know,
tell your daughter that you that you have it and
why you hope she'll never need it. Yeah, And I
mean one thing to to point out with with these
understandable concerns about opening up a gateway to young girls,
girls who you know, it might not be a good
(14:56):
idea for them to be sexually active at such young
ages when we're thinking about girls under fifteen possibly needing
emergency contraception. But the Goodmaker Institute also highlights that very
few young girls are sexually active. Only point three percent
of ten year olds, point six percent of eleven year olds,
(15:17):
one point three percent of twelve year olds, and three
point four percent of thirteen year olds are sexually active.
But something happens between thirteen and fourteen where that percentage
jumps from three point four percent of thirteen year olds
to eight point six percent of fourteen year olds. And
in two thousand and eight there were over ten thousand
(15:38):
pregnancies among fourteen year old girls in the United States.
But among all that, there is no evidence that that
jump has anything to do with the availability of emergency
contraception exactly. But at the same time, it says, you
know what, putting this fifteen year old age restriction does
leave out a population that could be in me. Now,
(16:00):
before we get into some of the reasons why Plan
B is really just part of a broader discussion that
we need to be having if we really do want
to address lowering unintended pregnancy rates and specifically team pregnancy
in the United States. Let's take a quick detour, though,
to talk about what exactly emergency contraception is. This is
(16:24):
something that we covered in our two thousand ten episode
What Is the Morning After Pill? But it's worth going
over right now as well. Right So, Plan B, like
we said, contained the progestin hormone called leave an adjusterrial,
and you should take it as soon as possible, typically
less than seventy two hours after unprotected sex. But it
(16:47):
is worth noting that if you're already pregnant, it will
not harm the embryo. You will experience some side effects, though,
the most common of which are nausea and vomiting. You
might also experience abdominal pain, breath tender, dizziness, fatigue, headaches,
and irregular bleeding. Yes, emergency contraception is not, I repeat,
(17:07):
not the same thing as a medicated abortion um and
most women are satisfied with the results of Plan B.
There's a nineteen nine study which found that of emergency
contraceptive users would recommend it actually to friends and family,
but it is not cheap though. That's another thing with
(17:27):
this whole you know question about access. We're all freaking out, well,
you know what, Uh, fifteen year olds or fourteen year
olds might not even be able to afford it if
they were even allowed to buy it, because it ranges
from fifty to sixty dollars. And one thing too that
Judge Corman is concerned about is the fact that this
over the counter stuff is only affecting one brand and
not a generic, and that is going to do absolutely
(17:49):
nothing to possibly lower the price of emergency contraceptives and
may in fact have the market effect of increasing the
price because Tiva, that drug maker, can say, oh, well,
you know what, we're the only OTC brand, so you're
gonna have to pay what we say, which is awful. Yeah.
But other methods include the Paraguard copper i u D,
(18:12):
which must be inserted five days after unprotected sex, and
it's one of the best emergency contraception methods. Uh. They're
also combination birth control pills estro with estrogen and progestine,
which you have to take less than five days after
unprotected sex. And these methods typically prevent pregnancy by preventing
or delaying ovulation, blocking fertilization, and preventing a fertilized egg
(18:37):
from implanting in the uterus. Again, it's not terminating a
pre existing pregnancy. And in terms of the success rate,
it depends on that time factor that we talked about. Generally,
one to two out of women who use emergency contraception
will still get pregnant. Um It may also delay their
(18:59):
period for a week. But then if your period doesn't
come around four three to four weeks, you have a
dominant pain, you have spotting, doctors say, you know what
you need to go ahead and take a pregnancy test.
But those success rates will diminish the longer that you
wait to take emergency contraception. Get the paraguard I U
D used a combination birth control pills, whatever your doctor,
(19:23):
nurse practitioner recommends in that case. Okay, so we've told
you a little bit about the fight that's going on
over Plan B, and we've looked at other methods of
emergency contraception, but we haven't talked about maybe the downside
of Plan B and how it's not just a cure
all for all that ails us. Um it doesn't. It's
(19:44):
not a panacea for lowering unintended pregnancy and team pregnancy rates, because,
as we talked about, there are a lot of barriers
to access not just the I D and prescription, but
also the costs. And this is coming from New York
Times writer Rony Karen Raven who wrote that a lot
of studies suggests that many women don't even know the
morning after pill exists, or if they do know it exists,
(20:08):
they literally think it only works the morning after, right,
And these studies also point out that the patterns of
use generally don't really do much at all to diminish
unintended pregnancy rates, because emergency contraceptive use is highest among
women with the lowest risk of pregnancy. Because usually the
(20:29):
women who go and get the morning after pill and
take it are the ones who are already practicing safe
sex and maybe the condom broke or something happened, they
forgot to take their birth control pill and had sex,
and you know, they're women who are already mindful of
preventing unintended pregnancy, and so they then go and get
(20:50):
emergency contraception, so their actual risk of pregnancy is very low.
The issue is about getting it into women's hands sooner.
Also these women feeling that education gap among girls and
women who you know, think that it either only has
that twenty four hour window or don't really know that
(21:10):
it exists. Yeah, and a lot of the argument against
UH granting access to Plan B two younger girls, a
lot of that fear has to do with kind of
culturally ingrained fears about casual sex, team pregnancy, single motherhood,
taking parents and doctors out of the decision to take
(21:32):
this medicine. And all of that is summed up in
one quote in The New York Times from Dr Mary Davenport,
the recent president of the American Association of Pro Life
Obstetricians and Gynecologists, who said, fear of pregnancy is a
deterrent to sexual activity. When you introduce something like this,
it changes people's behaviors and they have more risky sex.
(21:53):
Teams will be counting on this morning after pill to
bail them out, and they'll have more casual encounters. And
I'm sorry, that's just unlikely because of everything we just
talked about, not only the lack of awareness that it
even exists, but so many barriers to access well. And
also the fact of the matter is studies have looked
into the connection between access to emergency contraception and quote
(22:16):
unquote risky sexual behavior, and the correlation does not stand.
I mean, I feel like, like I get a little
frustrated when people seem to assume that women, some women
just think of abortion, medicated abortion, emergency contraception, all of
(22:37):
these things that are not pleasant processes for our bodies.
It's just pleasant parachutes that we have just used. You know, hey,
we wanna just have some risk of sexual behavior, but
it doesn't matter. I'm just gonna have ab cramps and
abnormal bleeding for a little while, but it's fine, Like, yeah,
small price to pick. I don't know that that many
(22:57):
women are thinking like that, but my personal thoughts aside.
The American College of Obstetricians and Gynecologists have said point
blank that making emergency contraception more readily available does not
promote risky sexual behavior or increase the rate of unintended
(23:18):
pregnancy among adolescents. Ready access of emergency contraception among adolescents
is not associated with lower hormonal contraceptive use, lower condom use,
or more unprotected sex. It seems like, in fact, like
we said with that study finding that it's the women
who have the lowest risk of pregnancy who are actually
(23:41):
the highest users of EC emergency contraception. That that would
probably extend down to team populations as well. It's more
about providing comprehensive sex ad because really the fact of
the matter is this is I mean, it's emergency contraus.
It's called emergency contraception for a reason because the focus
(24:04):
really should be on consistent use of reliable forms of contraception. Right,
and and you talked about, um, you know, the groups
of women who are getting easy access to this are
maybe not the ones who need it the most. Philip
Levine and Melissa Kearney, for an article in The Atlantic,
talked about how this issue is really bigger than just contraception.
(24:27):
The team pregnancy rate issue is so much bigger than
just having access to contraception like emergency contraception. For instance,
they wrote that policies like access to plan be family planning,
abstinence only, education, and sex said don't really address the
(24:47):
fundamental economic and social issues that drive team pregnancy. Um.
They argue that we have to improve educational attainment for
young girls, show them valid reasons to delay motherhood, and
prove to them that they have a reason to invest
in their future and not just say well, I'm never
going to get out of this small town, I'm never
(25:07):
gonna have money, I'm never going to find a man
worthy of marrying. Why not have a baby now, right?
And they're saying this because the fact of the matter
is that girls from disadvantaged backgrounds, from lower socioeconomic groups
who live in places with a larger gap between the
poor and middle class are much more likely to give
birth as teens than girls who have similar backgrounds but
(25:30):
face less inequality. Yea, So income inequality leads to lower
economic mobility, which results in girls who don't see a
chance to better their lives, so they are the ones
who are more likely to have a child. So it's
not just that they're like going out and having risky sex,
you know, for whatever, They're not necessarily being so cavalier
(25:51):
about it. But it's like, well, you know what, what else?
You know, what else is there? Right? And I mean,
with all of this, it's no one is arguing that,
you know, kids should be having sex at younger ages,
or that we should be a cavalier at all in
our approach to sex or having received sexual behavior. One
(26:12):
thing that we have not mentioned about emergency contraception is that, hello,
it does not protect against STDs and s t I
s um. So it's but it's just part of this
broader contraceptive education that it's not just team girls who
need it, it's all of us. And also gets at
a massive fear and discomfort over team sexuality, which as
(26:36):
much as as adults, I'm sure you know, there's a
lot of refreshing going on. You don't want to think
about kids having sex, but it's like, what are we
gonna do do You either pretend that it's not there
and just hope to put the fear of you might
get pregnant and end up in a terrible situation, and
hope to god they just never have sex, which is
(26:58):
unrealistic because form and exist, or you educate them and
you grant access and you hopefully are you know, a
wise and brave parent. I save it on an up
end because it is such a huge challenge. But the
answer isn't fear. And I feel like a lot of
(27:20):
the combat against this kind of stuff of access to
Plan B is very fear motivated. Yeah, because kids are
gonna do what kids are gonna do, you know, and
again I think, you know, to tie all of this up. Uh,
it's sort of like when we talked about the topic
of abortion a long time ago on the podcast. It's like,
(27:41):
that's not the ideal situation. You know, that's never an emergency.
Contraception is not the ideal situation. That's why it's the emergency,
like we said. But you know, I'm now I'm just
repeating myself there. Well, I mean people aren't popping it
like candy. I mean, you know, like young girls aren't
just going out and having sex like you said and
being like that's okay, I'll just go get an abortion tomorrow,
(28:01):
or I'll just go get at emergency contraception at the
at the drug store. It's fine. You know, I think
that's far less common than than something accidental has happened
or something terrible has happened. And you know, like we
saw with that huge jump in sexual activity and pregnancy
rates with fourteen year olds, we are by by setting
(28:23):
what seems to me to be an arbitrary age limit
of fifteen, we're shutting out a huge group of girls
who need access. Yeah, access and and just education all around. Um.
So we're recording this episode in may you are listening
(28:44):
to it right now in June, so I'll be curious
to see it between now and when this podcast publishes,
if there will be any movement legally. But I have
a suspicion that the age limit will be lifted. I
think at some point that will go away. But I
want to hear from listeners about this access. I mean,
(29:04):
is is it too is it too young? You know
it should fifteen? Is it fine to leave that age
limit at fifteen? Parents? What do you do? Would you
do as that in Why Times parenting blogger advice and
say maybe we should just stock it for them? Hey?
Why not? Um? Let us sell your thoughts on this
more political than we usually go issue. Mom Stuff at
(29:27):
Discovery dot com is where you can send your letters.
We'd also love to hear from you on Facebook, where
you can tweet us at moms Stuff podcast. And before
we get to a couple of messages y'all have sent us,
let's take just a quick break and we'll be right back.
And now back to our letters. Well, it got a
couple of letters here, and the first one I have
(29:50):
is in response to an episode we did quite a
while ago on a sexuality and This is from Victory,
who wrote in saying I just wanted to thank you
for your excellent podcasts and helping me understand my a sexuality.
They've seen me through many a Monday morning and taught
me so much about myself in the world from a
feminist perspective. When you released your podcast on a sexuality,
(30:12):
that was actually when I figured out that I was
a sexual and everything that you described was what I
had been experiencing. That was quite an eye opening experience
for me because I finally realized where all of the
confusion involving my sexuality came from. I came out to
my friends when I was fifteen and had been openly
a sexual ever since. Thanks again for everything, and thank
(30:33):
you for writing in. Okay, I have an letter here
from Ashley. She says, I'm a biologist living in Baltimore,
and I have an interesting topic that I hear from
men now that I'm married. I call it the wedding
ring phenomenon. I first heard about it right before we
moved to Baltimore. We were having a goodbye dinner with
a couple of friends when the guy let Colin John
(30:54):
told us about how he will wear a wedding ring
while trying to pick up women. John I thought it
is appalling and completely ludicrous, but my husband thought it
made sense. The next time I heard about it, it
was from my husband's old boss, and more recently from
his current boss. Apparently, they think that men wearing rings
are considered ideal mates and that women will be attracted
to them and hit on them. I don't agree with
(31:16):
this at all. Back when I was single, when I
saw a ring, I immediately thought that property has taken
and moved on. My husband thinks that is more of
a male view and believes that most other women think differently.
He believes that when the average females he's a male
with a wedding ring, that she thinks that he must
have desirable traits and then immediately wants the desirable man
(31:36):
and acts on that desire. I was curious if you
know of any research backing this wedding ring phenomenon, or
if the men in my life are just full of themselves.
If you do find any research, she says, then I
have some questions. Does it work both ways? Does it
only happen between straight people? And to that, I say,
we do have some answers. And if you want to
(31:57):
read them, you should go to stuff Mom Never told
you that humbler dot com, and you know, check out
some cool stuff while you're there, including answers to wedding
ring phenomenon yeah and um. While you're at it, if
you want to drop us a line about what whether
or not you have ever witnessed this wedding ring phenomenon
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(32:18):
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(32:43):
more on this and thousands of other topics. Is how
Stuff Works dot com
Welcome to Stuff Mom Never Told You from House top
works dot com. Hello, and welcome to the podcast. I'm
Kristen and I'm Caroline and Caroline. A couple of years
ago on the podcast, we did an episode on the
Morning After pill and what it is uh, and we're
(00:26):
going to revisit the Morning After pill and specifically the
branded Plan B emergency contraception because it has made some
headlines of late, and we want to talk about the
legal debate surrounding access to Plan BE, specifically access for
younger girls UM. And also what emergency contraception is. Yeah,
(00:51):
because previously UM morning after pills the more appropriate name
being emergency contraception because you don't have to necessarily take
them the morning after. The whole rigamarole was that they
were only available to girls seventeen and up with an
I D and a prescription. So the evolution becomes that
the FDA basically says it's okay for everybody. They study
(01:11):
the safety and efficacy, they say it's okay. The administration
kind of freaks out. The Obama administration kind of freaks out,
that's it's not okay for everybody. It's oh my god,
we have so many things to worry about. We can't
just be handing out drugs like candy. The f d
A in response kind of tucks their tail, and then
we get a whole bunch of lawsuits. That's that's kind
of glossing over how everything's evolved. Now. What we're dealing
(01:34):
with is this push to get rid of age restrictions
versus the push to maintain the older age limit with
I D. And what's interesting about this fight that we'll
get into is that both sides, for instance, groups like
the Family Research Council and groups like Planned Parenthood are
both saying that this is an argument of politics versus science,
(01:57):
and they're both both sides are accusing each other of
putting policy X before what is best for our children. Yeah,
and that's the Family Research Council obviously representing more of
the conservative side of things, whereas Planned Parenthood is arguing
more on the the liberal side of stuff. Not just
to boil it down to black and white, but the
(02:17):
drug in question that we're talking about is called leave
on a gestural and we hear about it under the
brand name Plan B. And just for a little bit
of historical context, emergency contraception is nothing new to medicine.
It's not like doctors recently figured out, oh, you know what,
(02:37):
we can actually give women a drug that could halt
the egg from being fertilized after they have unprotected sex
or in the case of sexual assault. And this brief
timeline is coming from the paper Emergency Contraception Underutilized Resource
out of the University of Wisconsin School of Medicine and
Public Health, and it talks about how hormonal emergency contraception
(03:02):
was first studied in the nineteen twenties when researchers figured
out that estrogenic ovarian extracts interfered with pregnancy in animals,
and so it started out as a high dose estrogen
only formula, and vets were the first ones to use
it on dogs and horses who had made it when
(03:22):
the owner didn't intend to not with each other. Right.
I had to read that twice. I'm not, I'm not, okay,
it's like dogs and horror. Okay, So dogs and dogs
and horses were the first the first animals to receive
this kind of emergency contraception. And let's not forget though,
about how women took emergency contraception into their own hands
(03:47):
even before the f d A had a drug approved
with douching, as we talked about in one of our
favorite stuff I've Never Told You episodes, Down with the Douche.
Apparently not only that we talked about in the podcast
about how women would douche with lysol and a lysol competitor, Zonight,
and apparently also with Coca cola. It is abrasive. Yes,
(04:15):
we are in no way endorsing any of that. Don't
do that. We're just saying that it happened. Yeah, keep
coke on ice, not in your vagina. Yeah, and that's
a quote we can read it. Yeah, Okay. So moving
on through the sixties and seventies, there was a lot
of research done on different combinations of drugs to prevent
(04:37):
UH pregnancy, and in the mid sixties we have the
first documented human clinical cases of post quoital estrogens, and
this is when doctors in the Netherlands use that veterinarian
proved method on a thirteen year old girl who had
been raped in order to prevent pregnancy. But by the
late nineteen sixties in the US, high dose estrogen regiments
(04:57):
became the standard, and then going to the seventies, we
have the development of regiments that are a combination of
estrogen and progestine. In nineteen seventy four, some of our
older listeners might be familiar with the youth Pay method.
This was named for Canadian Dr Albert use Pay, which
was an estrogen progestine combination and it replaced for a
(05:19):
while the high dose estrogen treatments because it had fewer
side effects. And now Plan B is a progestin only
formula and it has greater efficacy in terms of blocking
that pregnancy as well as fewer side effects. And in
the US Food and Drug Administration approved Plan B with
(05:44):
a prescription and since two thousand nine, the FDA has
approved it for over the counter sales for women seventeen
years old and over. And in two thousand eleven, this
is when the legalities start to get really dicey. In
two thou eleven, and Health and Human Services Director Kathleen
Sibelius blocks Plan B slash one step from being available
(06:07):
to all women of all ages over the counter. And
this happened in response to an application from drug maker Tiva,
who makes Plan b UM. When the FDA went back
and looked at it and recommended that it be made
available to all women saying that it's very safe, and
so Sibelia says, you know what, I'm going to overrule that,
(06:29):
and in response, reproductive rights groups such as Planned Parenthood
sued the Health and Human Services Department for that. And
so in the middle of all of this, we have
Judge Edward Corman of the District Court of Eastern New York,
who was the one who in April five, two thousand
thirteen this year overturned the US Health and Services ruling
(06:52):
to put an age limit on obtaining Plan B. So
it's just been it's it's almost like watching a ping
pong match between the courts and the f d A.
And then also you have Health and Human Services stepping
in and so people are kind of on the one
hand flipping out, saying, you know what, we need to
put some kind of age restriction on it. But the
(07:12):
interesting thing is Judge Edward Corman, who has been presiding
over this whole Plan B legality since two thousand five
in terms of overseeing whether or not it should be
made available to everyone, he is basically at the end
of his rope with all of this. Uh. There is
an NPR story about this, and it cites from the
(07:35):
legal brief that he wrote. The effort to convert these
leave on adjustural based contraceptives from prescription to over the
counter status has gone on for over twelve years, even
though they would be among the safest drugs available to
children and adults on any drug store shelf. And and
then he signed it with a giant snap. No really,
(07:57):
I mean I read the entire brief, his some brief,
and it was not only fascinating and enlightening, uh kind
of get a better understanding of what's going on politically
and in the courts about this whole issue right now,
But it was just the most entertaining thing I may
have ever read outside of a David Sadari's book, because
(08:17):
I mean, this is like the most intelligent snark in
the world. Judge Corman basically calls Sibelius's decision to overrule
the strike of the age limit as politically motivated, scientifically unjustified,
and contrary to agency precedent. He goes on to say that, look,
(08:38):
it's really only the f d A that has the
necessary information and expertise to make these decisions about the
safety and efficacy of drugs. A principle, he says that
Sibelius flagrantly violated, and so in response to the defendants,
who are you know, Sibelius and the Commissioner of Food
and Drugs seeking a stay of the a the strike
(09:01):
of the age rules to pursue an appeal, he says
it's something out of an alternate reality and says that
one of their arguments that if you let it go
over the counter now and then reverse it later without
a stay, it's largely an insult to the intelligence of women,
because he's like, dudes, you're the ones who have made
this process for obtaining Plan B so freaking confusing. And
(09:24):
some abroad the fact that it's telling that Corman is
having such an intense response against the Obama administration's wish
for that fifteen year old age limit on it because
Corman was appointed by President Reagan, so he was part of,
you know, a more politically conservative administration's appointments, and so
(09:48):
they're saying, well, you know, if he if he's freaking
out over this, maybe also for me, thinking about being
on the same case since two thousand five, maybe he
just needs a vacation. Good, Perhaps he's just tired, but hey,
frustration leads to some of the beautiful things that he wrote,
I'm okay with it. I highly recommend you search out
this brief and read it now. Of course, in April,
(10:10):
when Judge Corman said, you know what, enough of all this,
you need to make Plan B available over the counter
to all women of all ages. Also side note men,
you can buy Plan B as well. Um. But of
course when he said you know, the age limit should
be removed, Q freak out because not only do you
(10:33):
have well you have that in then the Obama administration
coming back and saying nope, we're gonna have a fifteen
year old cap for that, and you're gonna need an
I D. So Planned Parenthood said in response basically like thanks,
but you know what, you need to lift all restrictions
to this. And then on the more conservative side you
have Concerned Women for America saying, well, if Plan B
(10:56):
is so safe, then why do we need prescriptions for
birth control? Huh? Yeah, they they get a little snarky. Also,
this is like a big theme among this this debate
is some snark. The Concerned Women for America wrote that
the same quote women's rights advocates who want every decision
to be between quote a woman and her doctor are
now eliminating the doctor and putting politics ahead of our kids.
(11:19):
To see, there's that debate of like everybody's accusing everybody
else of being too political in this discussion, right, and
then the more liberal National Women's Law Center said, hey,
you know, with this whole I D issue, women who
don't have I d s are going to be denied access.
That could create problems. How many fifteen year olds do
we know who already have I D s. And even
(11:40):
if you you know, if if one of us, for
instance Carolina, older women who are plenty above the age
limit to get planned B if we go to the
drug store and all of a sudden, oh you know what,
actually we've forgot our I D, then we can't get it.
The whole timing issue with the access to emergency contraception
is important, even if it means oh, well you gotta
(12:01):
leave and then you might have to come back the
next day. Well, in the time that has passed, that
low worse the efficacy rates of emergency contraception. So this
timing issue is very important. Um and then we have
people from the Family Research Council saying, well, you know what,
what about what this hormone is gonna do to the
pre pubescent female body, because really a lot of this
(12:23):
ties into fear of whether or not access to emergency
contraception over the counter without an idea two girls of
all ages is somehow going to set off as domino
effect in younger girls brains that oh, you know what,
I can start having sex whenever, because if something happens,
(12:47):
then I can just go to Walgreens the next day
and take care of it. So the Family Research Council
points out that plan be distances the girls who are
at high risk of sexual abuse and at t I
S from the medical supervision they need. And I think
that's an important question of access because are these girls
(13:08):
who the Family Research Council is so concerned about, are
they even getting medical intervention? Do they even have access
to it? Are they able to go to the doctor
and ask questions and get a prescription for this stuff? Um?
I mean what group of people are we talking about?
Not everybody, not every Uh young girls parents are involved
(13:30):
in her life and can drive her to a pharmacy.
You know. Well, And when I was I was listening
to dance, I was talking about this not too long ago,
and he brought up a pretty distressing but relevant point
of Let's say, okay, a girl is raped by her
father and then she has to turn around and ask
him to drive her to the drug store to go
(13:51):
get planned beat, you know what I mean, Like it's
it's pretty telling to that. In November of two thousand twelve,
the American Academy of Pediatrics recommended that advanced emergency contraception
prescriptions be allowed because kids are more likely to use
it when that's the case, like it basically, if if
(14:12):
it's already there, if they have it, then if something happens,
then they're more likely to use it, which is one
reason why New York Times parenting blogger kJ del Antonia
suggested that maybe you know what, as parents, maybe we
need to go ahead and just stock up on Plan
B at home. And she advised that it be kind
of as hard as it would to maintain this, it'd
being no questions, ask policy like, just come come to
(14:34):
me and come get it if you need it, and
we'll deal with it. Then just tell her, you know,
tell your daughter that you that you have it and
why you hope she'll never need it. Yeah, And I
mean one thing to to point out with with these
understandable concerns about opening up a gateway to young girls,
girls who you know, it might not be a good
(14:56):
idea for them to be sexually active at such young
ages when we're thinking about girls under fifteen possibly needing
emergency contraception. But the Goodmaker Institute also highlights that very
few young girls are sexually active. Only point three percent
of ten year olds, point six percent of eleven year olds,
(15:17):
one point three percent of twelve year olds, and three
point four percent of thirteen year olds are sexually active.
But something happens between thirteen and fourteen where that percentage
jumps from three point four percent of thirteen year olds
to eight point six percent of fourteen year olds. And
in two thousand and eight there were over ten thousand
(15:38):
pregnancies among fourteen year old girls in the United States.
But among all that, there is no evidence that that
jump has anything to do with the availability of emergency
contraception exactly. But at the same time, it says, you
know what, putting this fifteen year old age restriction does
leave out a population that could be in me. Now,
(16:00):
before we get into some of the reasons why Plan
B is really just part of a broader discussion that
we need to be having if we really do want
to address lowering unintended pregnancy rates and specifically team pregnancy
in the United States. Let's take a quick detour, though,
to talk about what exactly emergency contraception is. This is
(16:24):
something that we covered in our two thousand ten episode
What Is the Morning After Pill? But it's worth going
over right now as well. Right So, Plan B, like
we said, contained the progestin hormone called leave an adjusterrial,
and you should take it as soon as possible, typically
less than seventy two hours after unprotected sex. But it
(16:47):
is worth noting that if you're already pregnant, it will
not harm the embryo. You will experience some side effects, though,
the most common of which are nausea and vomiting. You
might also experience abdominal pain, breath tender, dizziness, fatigue, headaches,
and irregular bleeding. Yes, emergency contraception is not, I repeat,
(17:07):
not the same thing as a medicated abortion um and
most women are satisfied with the results of Plan B.
There's a nineteen nine study which found that of emergency
contraceptive users would recommend it actually to friends and family,
but it is not cheap though. That's another thing with
(17:27):
this whole you know question about access. We're all freaking out, well,
you know what, Uh, fifteen year olds or fourteen year
olds might not even be able to afford it if
they were even allowed to buy it, because it ranges
from fifty to sixty dollars. And one thing too that
Judge Corman is concerned about is the fact that this
over the counter stuff is only affecting one brand and
not a generic, and that is going to do absolutely
(17:49):
nothing to possibly lower the price of emergency contraceptives and
may in fact have the market effect of increasing the
price because Tiva, that drug maker, can say, oh, well,
you know what, we're the only OTC brand, so you're
gonna have to pay what we say, which is awful. Yeah.
But other methods include the Paraguard copper i u D,
(18:12):
which must be inserted five days after unprotected sex, and
it's one of the best emergency contraception methods. Uh. They're
also combination birth control pills estro with estrogen and progestine,
which you have to take less than five days after
unprotected sex. And these methods typically prevent pregnancy by preventing
or delaying ovulation, blocking fertilization, and preventing a fertilized egg
(18:37):
from implanting in the uterus. Again, it's not terminating a
pre existing pregnancy. And in terms of the success rate,
it depends on that time factor that we talked about. Generally,
one to two out of women who use emergency contraception
will still get pregnant. Um It may also delay their
(18:59):
period for a week. But then if your period doesn't
come around four three to four weeks, you have a
dominant pain, you have spotting, doctors say, you know what
you need to go ahead and take a pregnancy test.
But those success rates will diminish the longer that you
wait to take emergency contraception. Get the paraguard I U
D used a combination birth control pills, whatever your doctor,
(19:23):
nurse practitioner recommends in that case. Okay, so we've told
you a little bit about the fight that's going on
over Plan B, and we've looked at other methods of
emergency contraception, but we haven't talked about maybe the downside
of Plan B and how it's not just a cure
all for all that ails us. Um it doesn't. It's
(19:44):
not a panacea for lowering unintended pregnancy and team pregnancy rates, because,
as we talked about, there are a lot of barriers
to access not just the I D and prescription, but
also the costs. And this is coming from New York
Times writer Rony Karen Raven who wrote that a lot
of studies suggests that many women don't even know the
morning after pill exists, or if they do know it exists,
(20:08):
they literally think it only works the morning after, right,
And these studies also point out that the patterns of
use generally don't really do much at all to diminish
unintended pregnancy rates, because emergency contraceptive use is highest among
women with the lowest risk of pregnancy. Because usually the
(20:29):
women who go and get the morning after pill and
take it are the ones who are already practicing safe
sex and maybe the condom broke or something happened, they
forgot to take their birth control pill and had sex,
and you know, they're women who are already mindful of
preventing unintended pregnancy, and so they then go and get
(20:50):
emergency contraception, so their actual risk of pregnancy is very low.
The issue is about getting it into women's hands sooner.
Also these women feeling that education gap among girls and
women who you know, think that it either only has
that twenty four hour window or don't really know that
(21:10):
it exists. Yeah, and a lot of the argument against
UH granting access to Plan B two younger girls, a
lot of that fear has to do with kind of
culturally ingrained fears about casual sex, team pregnancy, single motherhood,
taking parents and doctors out of the decision to take
(21:32):
this medicine. And all of that is summed up in
one quote in The New York Times from Dr Mary Davenport,
the recent president of the American Association of Pro Life
Obstetricians and Gynecologists, who said, fear of pregnancy is a
deterrent to sexual activity. When you introduce something like this,
it changes people's behaviors and they have more risky sex.
(21:53):
Teams will be counting on this morning after pill to
bail them out, and they'll have more casual encounters. And
I'm sorry, that's just unlikely because of everything we just
talked about, not only the lack of awareness that it
even exists, but so many barriers to access well. And
also the fact of the matter is studies have looked
into the connection between access to emergency contraception and quote
(22:16):
unquote risky sexual behavior, and the correlation does not stand.
I mean, I feel like, like I get a little
frustrated when people seem to assume that women, some women
just think of abortion, medicated abortion, emergency contraception, all of
(22:37):
these things that are not pleasant processes for our bodies.
It's just pleasant parachutes that we have just used. You know, hey,
we wanna just have some risk of sexual behavior, but
it doesn't matter. I'm just gonna have ab cramps and
abnormal bleeding for a little while, but it's fine, Like, yeah,
small price to pick. I don't know that that many
(22:57):
women are thinking like that, but my personal thoughts aside.
The American College of Obstetricians and Gynecologists have said point
blank that making emergency contraception more readily available does not
promote risky sexual behavior or increase the rate of unintended
(23:18):
pregnancy among adolescents. Ready access of emergency contraception among adolescents
is not associated with lower hormonal contraceptive use, lower condom use,
or more unprotected sex. It seems like, in fact, like
we said with that study finding that it's the women
who have the lowest risk of pregnancy who are actually
(23:41):
the highest users of EC emergency contraception. That that would
probably extend down to team populations as well. It's more
about providing comprehensive sex ad because really the fact of
the matter is this is I mean, it's emergency contraus.
It's called emergency contraception for a reason because the focus
(24:04):
really should be on consistent use of reliable forms of contraception. Right,
and and you talked about, um, you know, the groups
of women who are getting easy access to this are
maybe not the ones who need it the most. Philip
Levine and Melissa Kearney, for an article in The Atlantic,
talked about how this issue is really bigger than just contraception.
(24:27):
The team pregnancy rate issue is so much bigger than
just having access to contraception like emergency contraception. For instance,
they wrote that policies like access to plan be family planning,
abstinence only, education, and sex said don't really address the
(24:47):
fundamental economic and social issues that drive team pregnancy. Um.
They argue that we have to improve educational attainment for
young girls, show them valid reasons to delay motherhood, and
prove to them that they have a reason to invest
in their future and not just say well, I'm never
going to get out of this small town, I'm never
(25:07):
gonna have money, I'm never going to find a man
worthy of marrying. Why not have a baby now, right?
And they're saying this because the fact of the matter
is that girls from disadvantaged backgrounds, from lower socioeconomic groups
who live in places with a larger gap between the
poor and middle class are much more likely to give
birth as teens than girls who have similar backgrounds but
(25:30):
face less inequality. Yea, So income inequality leads to lower
economic mobility, which results in girls who don't see a
chance to better their lives, so they are the ones
who are more likely to have a child. So it's
not just that they're like going out and having risky sex,
you know, for whatever, They're not necessarily being so cavalier
(25:51):
about it. But it's like, well, you know what, what else?
You know, what else is there? Right? And I mean,
with all of this, it's no one is arguing that,
you know, kids should be having sex at younger ages,
or that we should be a cavalier at all in
our approach to sex or having received sexual behavior. One
(26:12):
thing that we have not mentioned about emergency contraception is that, hello,
it does not protect against STDs and s t I
s um. So it's but it's just part of this
broader contraceptive education that it's not just team girls who
need it, it's all of us. And also gets at
a massive fear and discomfort over team sexuality, which as
(26:36):
much as as adults, I'm sure you know, there's a
lot of refreshing going on. You don't want to think
about kids having sex, but it's like, what are we
gonna do do You either pretend that it's not there
and just hope to put the fear of you might
get pregnant and end up in a terrible situation, and
hope to god they just never have sex, which is
(26:58):
unrealistic because form and exist, or you educate them and
you grant access and you hopefully are you know, a
wise and brave parent. I save it on an up
end because it is such a huge challenge. But the
answer isn't fear. And I feel like a lot of
(27:20):
the combat against this kind of stuff of access to
Plan B is very fear motivated. Yeah, because kids are
gonna do what kids are gonna do, you know, and
again I think, you know, to tie all of this up. Uh,
it's sort of like when we talked about the topic
of abortion a long time ago on the podcast. It's like,
(27:41):
that's not the ideal situation. You know, that's never an emergency.
Contraception is not the ideal situation. That's why it's the emergency,
like we said. But you know, I'm now I'm just
repeating myself there. Well, I mean people aren't popping it
like candy. I mean, you know, like young girls aren't
just going out and having sex like you said and
being like that's okay, I'll just go get an abortion tomorrow,
(28:01):
or I'll just go get at emergency contraception at the
at the drug store. It's fine. You know, I think
that's far less common than than something accidental has happened
or something terrible has happened. And you know, like we
saw with that huge jump in sexual activity and pregnancy
rates with fourteen year olds, we are by by setting
(28:23):
what seems to me to be an arbitrary age limit
of fifteen, we're shutting out a huge group of girls
who need access. Yeah, access and and just education all around. Um.
So we're recording this episode in may you are listening
(28:44):
to it right now in June, so I'll be curious
to see it between now and when this podcast publishes,
if there will be any movement legally. But I have
a suspicion that the age limit will be lifted. I
think at some point that will go away. But I
want to hear from listeners about this access. I mean,
(29:04):
is is it too is it too young? You know
it should fifteen? Is it fine to leave that age
limit at fifteen? Parents? What do you do? Would you
do as that in Why Times parenting blogger advice and
say maybe we should just stock it for them? Hey?
Why not? Um? Let us sell your thoughts on this
more political than we usually go issue. Mom Stuff at
(29:27):
Discovery dot com is where you can send your letters.
We'd also love to hear from you on Facebook, where
you can tweet us at moms Stuff podcast. And before
we get to a couple of messages y'all have sent us,
let's take just a quick break and we'll be right back.
And now back to our letters. Well, it got a
couple of letters here, and the first one I have
(29:50):
is in response to an episode we did quite a
while ago on a sexuality and This is from Victory,
who wrote in saying I just wanted to thank you
for your excellent podcasts and helping me understand my a sexuality.
They've seen me through many a Monday morning and taught
me so much about myself in the world from a
feminist perspective. When you released your podcast on a sexuality,
(30:12):
that was actually when I figured out that I was
a sexual and everything that you described was what I
had been experiencing. That was quite an eye opening experience
for me because I finally realized where all of the
confusion involving my sexuality came from. I came out to
my friends when I was fifteen and had been openly
a sexual ever since. Thanks again for everything, and thank
(30:33):
you for writing in. Okay, I have an letter here
from Ashley. She says, I'm a biologist living in Baltimore,
and I have an interesting topic that I hear from
men now that I'm married. I call it the wedding
ring phenomenon. I first heard about it right before we
moved to Baltimore. We were having a goodbye dinner with
a couple of friends when the guy let Colin John
(30:54):
told us about how he will wear a wedding ring
while trying to pick up women. John I thought it
is appalling and completely ludicrous, but my husband thought it
made sense. The next time I heard about it, it
was from my husband's old boss, and more recently from
his current boss. Apparently, they think that men wearing rings
are considered ideal mates and that women will be attracted
to them and hit on them. I don't agree with
(31:16):
this at all. Back when I was single, when I
saw a ring, I immediately thought that property has taken
and moved on. My husband thinks that is more of
a male view and believes that most other women think differently.
He believes that when the average females he's a male
with a wedding ring, that she thinks that he must
have desirable traits and then immediately wants the desirable man
(31:36):
and acts on that desire. I was curious if you
know of any research backing this wedding ring phenomenon, or
if the men in my life are just full of themselves.
If you do find any research, she says, then I
have some questions. Does it work both ways? Does it
only happen between straight people? And to that, I say,
we do have some answers. And if you want to
(31:57):
read them, you should go to stuff Mom Never told
you that humbler dot com, and you know, check out
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