Plan B Confusion

The brouhaha over the current legal standard for non-prescription access to the Plan B “emergency contraception” pill involves a blizzard of cross-talk and hyperbole, and likely a futile or even counter-productive effort by the Obama administration to “compromise” between irreconcilable positions. But some interesting fault lines are emerging among antichoicers, who aren’t as united on the issue as they used to be.

To most reproductive rights advocates, scientists, and health care professionals, this is a bit of a no-brainer: Plan B is a reasonably safe medication for any post-pubescent woman that is far from 100% effective, but is a far superior alternative to an unwanted pregnancy that could lead to a clinical abortion or an abandoned child, not to mention terrible choices and consequences for the woman involved. The pill isn’t any more dangerous–and is probably far less dangerous–for teenagers. So setting age limits on non-prescription access to this drug, as opposed to others (as the Obama administration continues to seek to do in defiance of both FDA recommendations and a federal district court ruling) makes no sense, particularly since the consequences for young women of an unwanted pregnancy tend to be relatively dire.

But to many, perhaps most, antichoice activists, and to the U.S. Catholic Church (at least in its official positions), Plan B does not represent “emergency contraception,” but (at least “potentially”) an abortifacient, which means a baby-killing pharmaceutical that not only physically destroys a human being but involves the “pregnant” woman in a soul-destroying sin.

What’s interesting is that this isn’t a universal position among Catholic or evangelical (or presumably, other) antichoichers any more. Germany’s Catholic bishops recently dropped their opposition to the administration of Plan B to rape victims in Catholic hospitals on grounds that research shows the medication operates by inhibiting fertilization rather than implantation of a fertilized ovum in the uterine wall. Some opponents of legalized abortion, moreover, probably accept the medical profession’s standard definition of pregnancy as beginning with implantation, not fertilization, which moots the “abortifacient” argument for banning Plan B and IUDs altogether (and also heads off the even more radical idea, which some “personhood initiative” supporters semi-covertly support, of banning the estrogen “pills” that many millions of women take every day).

But even as anti-choicers argue with each other as to whether Plan B is a murder machine or ethically neutral, conservatives generally are retreating to the common ground of regarding the issue as one primarily involving the sexual behavior of young women and “parental control.”

Dr. Mary Davenport, recent president of the American Association of Pro-Life Obstetricians and Gynecologists, acknowledged that her group’s opposition to Plan B is rooted in broader concerns about casual sexual activity, teenage pregnancy and single motherhood.

“Fear of pregnancy is a deterrent to sexual activity,” Dr. Davenport said. “When you introduce something like this, it changes people’s behaviors, and they have more risky sex. Teens will be counting on this morning-after pill to bail them out, and they’ll have more casual encounters.”

There is zero empirical evidence for this widely-held proposition, and a lot pointing in the exact opposite direction. What we do know is that teenaged women are disproportionately likely to be forced into nonconsensual sex (whether or not it fits the legal definition of rape), and to rely on unreliable condoms for birth control, for the obvious reason that other methods aren’t available without prescriptions. Besides, the “common-sense” belief that pregnancy is an effective deterrent to teen sex should be balanced against the common-sense experience of most adults that teenagers won’t base the decision to have or not have sex on mathematical probabilities based on the availability of a less-than-totally effective pill taken later.

In any event, the “reasonable” or “compromise” approach of the Obama administration won’t cut any ice among antichoicers who think we’re talking about pharmaceutical homicide; among cultural conservatives in a panic about the sexuality of young women; or among health professionals and pro-choice advocates who regard this is a simple matter of letting people take a simple available step to protect themselves from the devastating consequences of an accident or mistake–or in far too many cases, of an unreported crime.

UPDATE: Well, things get even more complicated on the antichoicers’ treatment of Plan B. Turns out the position of the German Bishops I touted above as a significant change actually reflects the standing policy of the U.S. Bishops–and the Vatican–with this wrinkle: a rape victim in a Catholic hospital who asks for Plan B has to be tested to calculate if it’s likely she hasn’t ovulated recently before it is administered, so to avoid the possibility that the medication will interfere with uterine implantation of a fertilized ovum. Wow. I can’t imagine a system more cruelly designed to make it clear to the rape victim that she is nothing more than the vessel for reproduction.

Ed Kilgore

Ed Kilgore, a Monthly contributing editor, is a columnist for the Daily Intelligencer, New York magazine’s politics blog, and the managing editor for the Democratic Strategist.