In 2005, Susan Wood resigned her job as the top women’s-health official at the FDA, claiming that the agency’s refusal to allow over-the-counter sale of emergency contraception was the result of political pressure by the Bush administration. “The decision, which left women of all ages without appropriate and timely access to emergency contraception, was a clear rejection of recommendations that had been based on extensive review and evaluation of the pertinent data,” she wrote in the New England Journal of Medicine.
This controversy was constantly cited in feminist indictments of the previous president. It was usually mentioned in critiques of Bush’s ideological, anti-empirical approach to science. That’s why women’s-health advocates and other progressives were so shocked yesterday when the Obama administration overruled an FDA recommendation to expand over-the-counter access to Plan B One-Step, a type of morning-after pill.
“I think everyone was taken by surprise and is deeply disturbed,” says Wood, now the executive director of the Jacobs Center for Women’s Health at George Washington University. “I certainly am. There’s no rationale that I can come up with that makes any sense whatsoever.”
Taken 72 hours after sex, Plan B greatly reduces the chance of pregnancy. Since 2009, it has been available without prescription for those 17 and over—an improvement over the previous policy, but one that’s still problematic, and not just for teenagers. “Adult women were encountering numerous barriers to accessing Plan B in a timely way because of the age restriction,” says Jessica Arons, director of the Women’s Health and Rights Program at the Center for American Progress. Because the pill is kept behind the pharmacy counter, it’s not available when the pharmacy window is closed. Some pharmacists refuse to dispense it on religious grounds even when their stores have it in stock. Even when pharmacists are cooperative, forcing women to ask for the pill is an unnecessary invasion of privacy. Because the pill is more effective the sooner it’s used, any delays in accessing it have serious health consequences, leading to more unintended pregnancies and more abortions.
Reviewing the evidence, the Center for Drug Evaluation and Research at the FDA found no reason to maintain the age restriction. In a statement put out Wednesday, FDA Commissioner Margaret Hamburg wrote that the agency “determined that the product was safe and effective in adolescent females, that adolescent females understood the product was not for routine use, and that the product would not protect them against sexually transmitted diseases. Additionally, the data supported a finding that adolescent females could use Plan B One-Step properly without the intervention of a healthcare provider.”
Nevertheless, Health and Human Services Secretary Kathleen Sebelius overruled the FDA, something Wood says is unprecedented. Explaining her decision, Sebelius cited the pill’s possible use by very young girls: “ten percent of girls are physically capable of bearing children by 11.1 years of age,” she wrote.
Experts dismissed this rationale. “We strongly believe this focus is completely unfounded,” says Sneha Baro, senior public-policy associate at the Guttmacher Institute. “Less than 1 percent of 11-year-old girls are sexually active, but almost half have had sex by their 17th birthday. What we’re really talking about here is 15- and 16-year-olds.” Besides, as Wood points out, while it’s awful that a rare 11- or 12-year-old may need Plan B, such a girl is hardly helped by being forced to risk a pregnancy. “This is safer than Tylenol, and yet we’re going to put extra barriers to keep that young teen from preventing an unintended pregnancy when she’s already in that circumstance,” says Wood.
If Sebelius’s justification was thin, it’s probably because her decision was nakedly political. The administration is already under fire from the Catholic Church over the mandate that health insurance fully cover birth control. Further, conservatives have been apoplectic about the Department of Health and Human Services’ refusal to renew an anti-sex-trafficking grant to the U.S. Conference of Catholic Bishops, a decision made because the conference won’t refer clients to reproductive health care. As Sarah Posner pointed out in Religion Dispatches, just last week Rep. Darrell Issa held a hearing to investigate whether Health and Human Services is biased against Catholics. It seems obvious that someone is trying to placate the administration’s religious critics.
What’s confusing, though, is why the White House thinks it’s a smart strategy to try and appease its foes while infuriating its friends. After all, the administration was just starting to rekindle liberal love with the president’s fiercely populist speech in Kansas, and with Hillary Clinton’s historic declaration that the oppression of gays and lesbians worldwide is “one of the remaining human-rights challenges of our time.” Now feminists, a crucial constituency, feel betrayed and furious. “I am trying to understand the political calculus here,” says Arons. “I’m flabbergasted. If I close my eyes for a minute, I might think I was in the Bush era.”