Obama Appeal?

Morning-After Pill Age Lowered, but Obama Will Appeal FDA Decision

Michelle Cottle says public health may still prove victorious over fears about libidinous teens.

The FDA’s decision this week to lower from 17 to 15 the age at which young women may purchase Plan B emergency contraception without a prescription was not exactly a bold move by the Obama administration.

It was, at most, the halfhearted removal of the thumb Health and Human Services Secretary Kathleen Sebelius had jammed into the FDA’s eyeball in December 2011, when Sebelius overruled Commissioner Margaret Hamburg’s recommendation that all age and point-of-sale restrictions—such as limiting its sale to clinics and pharmacies, keeping it behind the counter, and requiring ID—be removed from the so-called morning-after pill. Hamburg’s recommendation flowed from research indicating that the pills are safe and easy to use. Sebelius’s rejection was widely slammed as based on politics—specifically, the fear that conservatives would accuse President Obama of greasing the path to hot tween orgies.

Indeed, Sebelius’s intervention smelled so political that just last month a federal judge smacked down her smackdown. Over the course of 59 snippy pages, U.S. District Judge Edward Korman of New York dismantled Sebelius’s stated objections to expanding access; declared her actions “arbitrary, capricious, and unreasonable”; and ordered the FDA to remove all age and point-of-sale restrictions within 30 days.

As for Obama’s public hand-wringing about the potential risks of 10- and 11-year olds having access to Plan B, Korman was unconvinced:

“This case is not about the potential misuse of Plan B by 11-year-olds. These emergency contraceptives would be among the safest drugs sold over-the-counter, the number of 11-year-olds using these drugs is likely to be miniscule, the FDA permits drugs that it has found to be unsafe for the pediatric population to be sold over-the-counter subject only to labeling restrictions, and its point-of-sale restriction on this safe drug is likewise inconsistent with its policy and the Food, Drug, and Cosmetic Act as it has been construed. Instead, the invocation of the adverse effect of Plan B on 11-year-olds is an excuse to deprive the overwhelming majority of women of their right to obtain contraceptives without unjustified and burdensome restrictions.”

Far from chastened, the Obama Justice Department will appeal the ruling—a decision announced late Wednesday, just a day after the FDA trumpeted its half-a-loaf plan. While the administration insists that the two decisions are not related, a political cynic might suspect otherwise.

Still, no matter how long and twisted the path, this issue appears to be inching in a sensible direction, toward a victory of science and public health over whatever squeamishness many people may feel at the idea of libidinous teenagers. Unlike the sticky issue of abortion, in which a million shades of gray and questions of fetal viability can trouble even ardent supporters of women’s rights, most Americans agree that contraception is a good thing. Not Rick Santorum, maybe. But most Americans. Many of us, indeed, believe that a desire to reduce the number of abortions performed in this country jibes perfectly with the energetic support of making contraception as cheap and easy to access as possible.

Do I like the idea of a 14-year-old sashaying into her local CVS for some Plan B after a wild night with her boyfriend—or with some random skeezeball? God, no. But I like it a damn sight better than the idea of that same 14-year-old winding up in the stirrups at an abortion clinic several weeks later. Or, for that matter, in labor and delivery several months later.

As for concerns about young girls misusing the drug or, worse still, sexual predators exploiting it, such objections would pack more punch if they weren’t delivered so dishonestly. In response to last month’s court ruling, the president of the conservative Susan B. Anthony List, Marjorie Dannenfelser, grumped: “Teen girls need parents, not unfettered access to abortion-inducing drugs. Judge Korman’s decision is reckless and denies girls the protection that comes along with the involvement of parents and doctors.”

Even setting aside the false choice being presented—parents versus abortions!—Dannenfelser is wrong on the science: Plan B is not an abortifacient à la mifepristone, a.k.a. RU-486. A high dose of the synthetic hormone levonorgestrel, Plan B works by either preventing ovulation or by slowing the movement of the sperm via cervical mucus. As for the widely held belief, even echoed on the drug’s labeling, that Plan B may in some cases prevent implantation of a fertilized egg, a source of distress to strict life-begins-at-conception folks, the science increasingly does not support even that claim. (For more on the need for greater honesty and clarity from Plan B opponents, see this National Catholic Reporter piece from last year.)

Are there likely to be cases of immature girls misusing this drug? Yes. Even so, the inherent safety of Plan B is not in question—only the number of hoops that women and girls should have to jump through to acquire it. And, as with everything in the ongoing war over sex and reproductive rights, the risks must be weighed against the alternatives often confronting young women rather than against some fluffy-bunny version of connubial paradise that exists largely inside Rick Santorum’s head.