Emergency contraception (a.k.a. EC, ECP, "Morning After" Pill)

"Access to Birth Control" (ABC) Act

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Overview:

Regular birth control pills are prescribed by physicians and dispensed by pharmacists. Emergency Contraception (EC) is approved for "over the counter" sale to adults throughout the U.S. without a prescription. There are significant numbers of cases emerging in which pharmacists have refused to supply birth control pills, including EC, on religious or ethical grounds.

EC prevents the release of an ovum or inhibits its fertilization. However, it was once believed that under rare circumstances, EC would prevent a fertilized ovum -- properly called a blastocyst -- from implanting in the woman's uterus. This has since been shown to be a very remote possibility or impossible. However, most pro-life groups seem to still believe in this discredited opinion.

Most physicians, social liberals, and religious liberals and others define pregnancy as starting at implantation. But many social and religious conservatives define the start of pregnancy at conception. Thus, the latter believe that under some circumstances, the pill could terminate a pregnancy; that is, it will cause an abortion. Some conservative Christian groups simply refer to EC as an abortifacient. Some pharmacists refuse to prescribe EC because of this belief. The ABC act would require pharmacists to over-ride their moral reservations and both fill prescriptions for birth control and dispense EC to adults upon request.

On 2007-JUN-06, Representative Carolyn Maloney (D-NY) introduced the ABC bill in the House as H.R. 2596. ₄ If passed and signed into law by the president, it would have require pharmacists to fill prescriptions for contraceptives, and adult requests for emergency contraception. It was referred to the House Committee on Energy and Commerce on 2007-JUN-06,

Senator Frank Lautenberg (D-NJ) introduced the same bill on the same day to the Senate as S. 1555. ₅

Both bills were referred to committees, but did not proceed.

What the bill says:

The bills outline the responsibilities of pharmacies concerning contraceptives. The bill notes that:

"Reports of pharmacists refusing to fill prescriptions for contraceptives, including emergency contraceptives, have surfaced in States across the Nation, including Arizona, California, Georgia, Illinois, Louisiana, Massachusetts, Minnesota, Missouri, New Hampshire, New York, North Carolina, Ohio, Oregon, Rhode Island, Tennessee, Texas, Washington, West Virginia, and Wisconsin. Since emergency contraception has become available without a prescription for individuals 18 and over, reports of refusals to provide non-prescription emergency contraception have also been reported."

The law would require pharmacists to:

	If the contraceptive is in stock, they must provide birth control and EC without delay.
	Refer the customer to another pharmacy if they normally stock contraceptives but are currently out of stock. Alternately, the pharmacy is required to order the contraceptive on an expedited basis if that is the customer's preference. That would not be a useful option in the case of EC because its effectiveness decreases with time; it has to be taken within 72 hours to be effective.

The law would require that the pharmacy ensure that its employees do not:

	"intimidate, threaten, or harass customers in the delivery of services relating to a request for contraception;
	interfere with or obstruct the delivery of services relating to a request for contraception;
	intentionally misrepresent or deceive customers about the availability of contraception or its mechanism of action;
	breach medical confidentiality with respect to a request for contraception or threaten to breach such confidentiality; or
	refuse to return a valid, lawful prescription for contraception upon customer request."

The law defines "contraception" or "contraceptive" as: "any drug or device approved by the Food and Drug Administration to prevent pregnancy."

There is no exemption for pharmacies in hospitals run by the Roman Catholic church or other religious organizations.

Non-compliance could result in a fine of $5,000 fine per day of non-compliance to a maximum of $500,000. The bill would also authorize litigation in civil courts. _4,5

Deficiencies in the bill:

There appear to be two very serious deficiencies in the bills that might completely torpedo the aims of their authors:

As is so common with bills before Congress, the bill does not define what is perhaps the most important word in the bill. In this case, it is: "pregnancy." This is an inexplicable and serious oversight. It might allow a pharmacist to claim -- in accordance with his or her beliefs about the timing of the start of pregnancy -- that Plan B can act to terminate a pregnancy, not prevent one, and is thus an abortifacient, not a contraceptive.

The bill allows the pharmacist to refuse "to provide the contraceptive on the basis of a professional clinical judgment." 4,5 A pharmacist might decide that the woman requesting EC may have a fertilized ovum -- properly called a zygote -- descending towards her uterus. Due to his or her conservative religious beliefs, the pharmacist might regard a pregnancy as having already begun, and that a human person is present in her body. In his or her clinical judgment, the pill would probably cause the death of that person. So the pharmacist might be able to refuse to dispense the EC to prevent a homicide.

If the bill had been signed into law in its original form, it might have triggered some interesting legal battles.

Some comments by pro-life groups:

Karen Brauer of Pharmacists for Life International said:

"Planned Parenthood is out to increase its own business. They are going to trash the health of Americans."

It is difficult to understand this comment, because denial of access to EC would produce more unwanted pregnancies, and an increase in the number of abortions performed by Planned Parenthood. About half of all unintended pregnancies end in abortion. Assuring prompt delivery of EC would lower Planned Parenthood's revenue.

Wendy Wright, president of Concerned Women for America, opposes the bill. She said:

"It makes no sense to require that pharmacists have to hand over drugs without using their professional judgment. Pharmacists are respected professionals, they are not vending machines."

Columnist Joe Giganti, of Renew America said:

"The concept of forcing a pharmacy and a pharmacist to prescribe something that goes against their moral and scientific beliefs is as un-American as one can be." ₂

Some comments by pro-choice groups:

NARAL Pro-Choice America promoted the bill. Planned Parenthood also supported the bill, even though free access to EC would reduce the number of unwanted pregnancies and thus reduce their earnings from performing abortions. They claim that pharmacists who refuse to dispense EC jeopardize women's health and safety.

The National Organization of Women issued a statement saying:

"There is an all-out attack on birth control in this country. Religious and political extremists are trying to make it impossible for women to fill their birth control prescriptions or get the morning-after pill."

The measure requires pharmacists to not "intimidate, threaten, or harass customers in the delivery of services relating to a request for contraception" or "interfere with or obstruct the delivery of services relating to a request for contraception." ₂

Nancy Keenan, president of NARAL Pro-Choice America commented:

"I thank Reps. Maloney and Shays and Sen. Lautenberg, for addressing this very fundamental issue," Keenan said. "It should be as easy as ABC: a woman walks into a pharmacy to purchase birth control, she walks out with the medication--without intimidation, harassment or delay. Timely access to birth control is essential to preventing unintended pregnancies. Those who oppose abortion should be working to ensure women's access to birth control, not blocking their access. ... Pharmacies have an obligation not to endanger women's health by withholding basic health care. The ABC Act is vital to ensure that no other woman faces the frustration and embarrassment Carrie Baker faced when her pharmacist said 'No I object to birth control; therefore I will not sell it to you'." (Carrie Baker from Georgia was refused Plan B^® at her local Kroger pharmacy on moral grounds) ₃

Lack of availability of EC in one state:

On 2007-JUN-06, NARAL Pro-Choice North Carolina released the result of their study of 583 community pharmacies -- those not located in hospitals and rehabilitation centers. They tried to include at least one pharmacy in each of the state's ZIP codes. The results showed both widespread ignorance on the part of pharmacists and a lack of women's access to EC:

	Only 57% of pharmacies in rural areas stocked EC.
	Only 64.3% of pharmacies in urban areas stocked EC.
	30% of pharmacies that did not stock EC refused to order it.
	Among those pharmacies who would order EC, a two day delay was normal.
	11% only dispense EC if the client has a prescription even though EC is supposed to be an "over the counter" drug.
	Nearly one-third of the pharmacists surveyed said they did not know EC was effective up to 72 hours after intercourse.
	Prices for EC ranged from $20 to $500; the median price was $40.46.
	Almost a quarter of pharmacists surveyed stated that EC was the same as the abortion pill RU-486.

Jay Campbell, executive director of the North Carolina Board of Pharmacy, said that the board's policy states that pharmacists:

"... do not have a right to obstruct otherwise legitimate prescription dispensing or delivery solely on the basis of conscientious objection. ... [As a "practical matter, I don't know why [pharmacies] would not carry a product that customers need."

Fred Eckel, executive director of the North Carolina Association of Pharmacists, said,

"The owner of the store decides what they are going to stock. There's an inventory investment and a space investment, and I think people should be able to make business choices."

References used:

The following information sources were used to prepare and update the above essay. The hyperlinks are not necessarily still active today.

1. "Bill would force pharmacists to dispense Plan B," CitizenLink.com, Focus on the Family, 2007-JUN-07, at: http://www.citizenlink.org/
2. "Pharmacists Could Pay 500K for Not Dispensing Plan B Under Natl Bill," LifeNews, 2007-JUN-07, at: http://www.lifenews.com/
3. "NARAL Pro-Choice America Endorses Bill to Protect Women's Access to Birth Control," NARAL, 2007-JUN-06, at: http://www.prochoiceamerica.org/
4. Text of H.R. 2596 is at: http://thomas.loc.gov/
5. Text of S. 1555 is at: http://thomas.loc.gov/
6. "Access to Emergency Contraception in North Carolina Pharmacies," NARAL-NC, 2007-JUN-06, at:  http://www.prochoicenorthcarolina.org/

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Copyright © 2007 by Ontario Consultants on Religious Tolerance
Created: 2007-JUN-09
Latest update: 2007-JUN-22
Author: B.A. Robinson

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