Obama’s Plan B Controversy

09 Dec

Yesterday, I participated in an interesting online discussion on Facebook.  The Obama administration decided not to raise restrictions on Plan B (emergency contraceptive, which I have written about before) to make it available to minors without a prescription.  This is generating a lot of static from certain groups.

A friend posted a link to this article from the Washington Post and subsequently a conversation developed over the outrage of requiring a prescription for emergency contraception for girls under 17.

I decided to continue the topic here rather than further hijack my friend’s Facebook page.  For reference, here are the applicable pieces of the conversation:

ME: I don’t understand the controversy about this. Plan B is just like any other birth control pill, except it’s a more concentrated dose. So why would they make THAT available to anyone, when you have to have a prescription to get any other kind of oral contraceptive?

N: I thought about that too Amy, but I came to the conclusion that it must have to do with the effects of long-term use rather than short term use.

ME: But if Plan B were available over the counter, I have no doubt that a lot of people would use it on a consistent basis, long term (based on conversations my friend the Pharmacist has with her customers), which seems like it would be even more potentially dangerous than normal long-term birth control. So it still seems like access to it should be limited just like regular birth control.

S: Amy, I doubt that would make economic sense: a regular bc prescription is almost certainly cheaper than Plan B every time you have sex. In which case, it does make sense that it’s available without a prescription, both because of the time window in which it needs to be taken, and because the prescription for regular bc, as I understand it, is to make people aware of the potential health risks of long-term, continued usage.

N: Perhaps it could be restricted like sudafed or other drugs that can be used inappropriately but don’t need a prescription.

L: You’re ignoring the political benefits of banning this pill. Mis/Underinformed parents who don’t want their children to be able to do anything that they do not understand will find this comforting. Republicans cannot out-right this move (since there’s nowhere else to go from “no”), and they certainly won’t move left. And of course, children don’t vote. The future is never a priority in election cycles, for if it were, deficit spending, the environment, and education would be actual issues, instead of defense and present-tense economics. At no point in time was the science of this considered by the gov’t; the scientific process was already done, reviewed, discussed, and recommended. The political process then occurred.

ME: I guess I still don’t understand why it’s such a big deal. You can get it without a prescription if you’re 17. So the only people affected by this decision are children – who can still get it through any adult over the counter, or a doctor via prescription. So this falls into the same class as cold and allergy drugs, spray paint, lottery tickets, getting a tattoo, buying things from infomercials or getting married. I don’t hear anybody complaining about any of those things. And this is directly connected to health and wellbeing, even if it’s deemed “safe” by science. So in what scenario should a child who needs adult intervention to get a tattoo NOT need to involve an adult to use birth control?

P: Wow, I go off to have student conferences, and come back to a big discussion.

Amy: you *can’t* get Plan B without a prescription if you’re under 17 — that’s the ruling that’s being reversed. And I have a problem with that specifically because Plan B is an important emergency form of birth control, and there are numerous unpleasant situations where teens might need it, but might *not* have had the opportunity to get non-emergency birth control in advance.

If anything, making Plan B available without a prescription is *less* risky than the alternative, because it lessens the possibility that a young woman would try to recreate its effects by taking a large number of birth control pills at once — which *has* been shown to be dangerous.

ME: All a 16 year old kid needs is an adult to buy it for her – that’s what I meant by without a prescription. Just like I can buy cough medicine for my kid, I can buy Plan B for her too. It doesn’t appear that that’s being reversed. Plus, I suspect that any kid that has access to large amounts of birth control pills is also likely to have access to Plan B if needed.

P: Right — but if the adult in question is the abuser, or the spouse of the abuser; or if the kid was raped, and fears that the parents would blame her for being raped — where does that 16yo go for help? (I wish that weren’t necessary — I really do — but to keep Plan B prescription-regulated is to suggest that kids in these situations are “not capable of understanding its use” — but are somehow *more* capable of actually bearing children.

I can’t get behind that.

ME: This is a sticky area. Relaxing restrictions on Plan B would not have helped Jaycee Dugard. So you’re really only talking about kids that are 1) sexually abused by parents or guardians who would rather have the child publicly carry a baby to full term than any of the alternatives, and 2) still allowed enough freedom to go to a store unsupervised, and have enough cash to purchase something as expensive as Plan B. In which case, there are still problematic health issues. Because incest rape is never a one-time thing. So these kids are going to be needing the Plan B again and again and again and again – all the while not getting the help they REALLY need.

R: No, they’ll just be forced to get surgical abortions when their abusers realize they’re pregnant.

Anyway, hypothetical abuse scenarios aside, one known effect of restricting Plan B in this way is that, like cough syrup, it means that pharmacies have to control access to it, and that affects women over 17, not just young teens. Given the way that pharmacists in conservative areas have been refusing to give women prescription birth control, I don’t trust them to honestly deal with women who want to just walk in and buy Plan B without getting hasselled or being told that they are “out.”

J: I read this whole thing. Thanks for all the great info. For the record, I’m also against rape and incest and human selective breeding, and this product (and abortion) does far more to promote than prevent those things. I wouldn’t have even thought of it if P hadn’t mentioned it, but wouldn’t an abuser be the one to go out and buy this to cover up their crime, or perhaps the victim would go out and get it to hide the crime and so free herself to being abused again? I can’t support that at all.

R: J, you’re assuming that allowing teens access to this pill would create that scenario – but it already exists; given that the pill is available to adults, there’s nothing to stop them from obtaining it already… or, as I said, forcing an underage girl to have a surgical abortion. Making Plan B off-limits to teens doesn’t solve that problem – which is abusive adults hiding the results of their abuse through force – and, moreover, does deprive those abused teens of a relatively easy way to control their own bodies (something otherwise denied them).

What it will do is enable teens – including those in consensual relationships (the far more typical scenario) to avoid becoming pregnant if a condom breaks or they have unprotected sex.

I have to say, I’m rather disturbed that hypothetical scenarios about adults controlling teen-agers’ bodies are being used to deny teen-agers the tools they need to control their own bodies.

ME: ‎”What it will do is enable teens – including those in consensual relationships (the far more typical scenario) to avoid becoming pregnant if a condom breaks or they have unprotected sex.”

This is true – but I don’t understand why it’s so important for these same teens to have access to this pill without any adult involvement. They can control their own bodies by not having sex to begin with if they’re not ready to deal with the natural consequences. But oral birth control reaches into the medical realm and in every other medical scenario that exists, adults are involved in the treatment and care of children.

R: But the science shows it WON’T be a problem. That’s the point. They investigated it, studied the likely complications and usage problems, and concluded that it was safe to release it to a larger population, including minors… but were overruled for no more reason than “ew, icky.”

There are a lot of medications that minors can buy – such as pain killers, or vitamins, for example – that can potentially do a lot of damage, but they’re not restricted because the science doesn’t support a more stringent set of restrictions. The same applies here: worst case scenarios aside (and they will exist for _everything_ – even water can kill you if you drink too much) the people who make a living weighing the risks of such products have concluded it’s safe for the vast majority to have access to this medicine, even minors.

If the Obama administration wants to justify the restriction they need to provide more than just “ew, icky,” and they haven’t.

I have to say, I’m reminded of the shitstorm over Jocelyn Elders suggesting masturbation as an alternative to teen-age sex. Teens have sexual urges, like any physically mature human. Expecting them to pretend they don’t simply because it makes adults uncomfortable to contemplate it is unfair to them.

In other words, they need access to these pills _because_ their sexuality makes judgmental adults uncomfortable… but, really, it’s not the adults who have to live with the consequences of an unwanted pregnancy. Making it hard to prevent such pregnancies won’t stop teens from having sex – the evidence is amply clear on that point. All it will do is increase the numbers of teen-aged women who have to decide between an abortion or carrying an unwanted pregnancy to term.

P: What R said. And J, I know you mean well — but if a teen is worried about being pregnant, whether the circumstances are consensual or non, I would rather that she have maximum ability to control that possibility of pregnancy, rather than less. If you want to look at this in terms of abortions, then I would rather have teens have the possibility to insure that no pregnancy will occur even before the sperm and egg have contact.

A couple of side notes before I continue:

  • This is, one of very few political conversations of this nature I’ve ever had that remained amicable and peaceful for that long.  And for that, I thank the participants for their maturity.  Most of the time, discussions like this turn sour when somebody gets offended that their thoughts are being questioned, and then the conversation degrades to petty cheap shots – at which point I abandon the discussion and move on.
  • Written discussions are difficult for me because rather than a clear linear progression, they too easily start to look like a very old tree, with each branch sprouting more and more branches.  This tends to happen because each time someone contributes, they make multiple points – and while it is very tempting to try to address each of those points, it usually only serves to muddle the issue, which then digresses into other petty things.  So I have tried my best during this discussion to weed out a lot of the peripheral points and stick to the real issues that people were raising.  In keeping with that attempted focus, I’m going to narrow down all possible responses to the following two points:

Thing, the First

The science doesn’t necessarily show that it won’t be a problem.  The OTC acceptance was rejected for a very specific reason, more concrete than ew, icky:

In a statement and separate letter to Hamburg, Sebelius said she reversed the FDA’s decision because she had concluded that data submitted by the drug’s maker did not “conclusively establish” that Plan B could be used safely by the youngest girls.

Thing, the Second

Since the beginning of the discussion, I’ve been attempting to uncover the exact concrete demographic that is so negatively affected by this policy decision, and on whose behalf everyone else is so outraged.  Because clearly, it ISN’T:

  • Anyone over 16 (who can get the birth control by themselves already)
  • Anyone 16 or under who has a parent (or friend) 17 or older that would obtain the medication for them
  • Anyone 16 or under who sees a doctor and can therefore get a prescription
  • Child rape or incest victims (which is always the first hypothetical thrown out there, assumedly because it’s an extreme case with clear unarguable victims…yet it seems to fall flat or be abandoned when really examined)
  • Kids whose parents allow them to take oral contraceptives (and therefore wouldn’t need the less effective emergency contraception)
  • Kids whose parents do not allow them to take regular oral contraceptives, but who are aware they are having sex (so the kids would likely be able to obtain one-time contraceptives when the alternative is an increased risk of pregnancy)

So who’s left that would find it advantageous to avoid involving an adult in healthcare decisions affected by their sex life?  And after circling around a couple of times, I think the final statements of this Facebook conversation clear that up more directly.

The root of the backlash seems to be the ideology that a 15 year old kid should be able to have consensual sex against his/her parents’ wishes and keep it a secret from them.  Or, at least, 15 year old kids ARE GOING to have sex against their parents’ wishes and so they should be able to try to prevent the ramifications of such a decision without involving any adults.

If this is the real reason behind making Plan B available to minors without any adult involvement, then I simply cannot support that with any fiber of my being.

Kids’ sexuality is not what makes parents uncomfortable.  What makes parents uncomfortable (whether religious or not) is the NATURAL CONSEQUENCES of acting upon sexual urges.  And they are many.  Sex may be common, natural, innate – but it’s still a BIG DEAL.  It’s not like getting a headache, for which a minor can obtain Advil without a prescription.  There are physical and emotional consequences to sex, beyond pregnancy – for both genders but particularly girls.  And parents should not be blindsided by these consequences, or made unaware that they are a possibility, out of fear that they might be “judgmental.”  Kids who are clearly not ready to handle the effects of sex should not be left to their own devices to deal muddle through these consequences without adult guidance or supervision.  Say what you want about their “cognitive abilities” – they’re still KIDS.

“but, really, it’s not the adults who have to live with the consequences of an unwanted pregnancy.”

This is emphatically untrue.  Remember, we’re not talking about juniors and seniors about to embark on adulthood.  We’re talking about kids.  An unwanted pregnancy has a MAJOR effect on the lives of parents too – a new family member, childcare, a teen (or possibly pre-teen) that will be unable to finish school or move out when she turns 18 because there’s a baby to take care of.  Why should parents be kept in the dark about that possibility?

If my 15 year old is having sex, then there IS a possibility that she’s going to get pregnant (among other things), whether or not she has access to Plan B.

Fact:  Outside of abstinence, there is no such thing as a 100% effective form of birth control.  Those who take Plan B still have a 1 in 40 chance of getting pregnant.

If my 15 year old is making a choice that could change the rest of her life and mine, then I sure as hell have the right to know about it.  And if the medication is indeed safe for use without any worry of young kids “doing it wrong,” then that’s all the prescription does – it requires some kind of adult involvement so that some adult SOMEWHERE is aware that the kid is having sex and could suffer any number of health-related consequences.  And I don’t think that’s a bad thing.

But what about the science???

It’s probably safe, when used occasionally as directed.  But not for sure (see Thing, the First).  It probably doesn’t dislodge an already fertilized egg, causing what some would term an abortion, but again they admittedly still don’t know for sure.

But even if it’s totally medically safe under normal usage, that in and of itself is not a trump justification for making it freely available to kids.  See also: tattoos, lottery tickets, prescription shampoos, credit cards, consensual sex with an adult, gym memberships, and every other form of oral contraceptive.

But what about all those poor Catholic kids…

whose parents would never let them take any kind of birth control and who don’t have any friends old enough to get it for them?

So what do you do if you really want a tattoo (everyone else is getting one!) but your parents are big believers in Leviticus 19:28?  You wait until you’re of legal age when the choice is yours to make.

Look, no one is asking kids to pretend they don’t have sexual urges.  But it isn’t too much to ask them to control those urges – in the same way we ask them to control the urge to sleep in and miss all their high school classes every day.  Kids are notorious for making stupid decisions, it’s part of growing up.  But they are not animals.  They are certainly capable of controlling their bodies and it is not unreasonable for us to teach and expect them to do so.  (Consensual) sex is a choice.  It doesn’t just happen to you.

But what about all those poor Catholic kids whose parents would never let them take any kind of birth control and who don’t have any friends old enough to get it for them and who are just gonna do it anyway?  Shouldn’t we reverse the prescription requirement for them???

Let’s weigh the choices.  Doing so would come at the expense of allowing kids (KIDS.) of a very young age to engage in sexual activity with many obvious and unhealthy consequences including but not limited to the VERY REAL RISK of getting pregnant (pill or no pill), likely under the faulty assumption that they can just take the Morning After Pill to prevent pregnancy – AND all without any parental or adult knowledge whatsoever.

And that is my sticking point – the fact that the ONLY purpose of relaxing the prescription requirement is to exclude adults from this particular (and hugely important) piece of adolescent healthcare.  I can’t find any other benefit.

As a parent (and someone who identifies with both liberals and conservatives on various issues) when I weigh those two options, I can not support the repeal of the current prescription requirement.


 
  1. R

    December 9, 2011 at 1:20 pm

    “And that is my sticking point – the fact that the ONLY purpose of relaxing the prescription requirement is to exclude adults from this particular (and hugely important) piece of adolescent healthcare. I can’t find any other benefit.”

    And that, precisely, is why I am for it. No where in your description of who might be affected do you seem to have room for teens who do not have responsible adults in their lives. Kids who have adults that they trust will ask them for help whether Plan B is available or not. Kids who don’t have such adults in their lives are screwed if they’re forced to depend on those non-existent adults for their health and safety. And it’s pretty cruel to hold up your own desire to manage your children’s sexuality as a reason to deny other young adults the meager control available to them in a world where there is all too little control.

    Put another way, it’s too simplistic to boil it down to “kids shouldn’t have sex” and “if kids have sex they need to have adult supervision” as if all kids have choice in these matters, and as if all adults can be trusted to do what’s best by them.

    The world is not perfect, and eliminating one tool at-risk teens can use to control their own reproduction in an imperfect world does nothing but make adults feel comfortable – comfortable that their child would never need that medication (so no child should have access to it), comfortable that all children have responsible adults looking out for them (so no child should have a problem asking an adult for help), comfortable that only naughty teens will face these problems (so no good kids will be affected by this restriction), comfortable that the _reality_ that kids will have sex – even responsible, thoughtful kids – will never be an issue for them (so this medicine won’t ever be needed by responsible kids, only sluts, who clearly need more supervision and control over their lives), that no one will ever mess up, or be raped, or be so afraid and alone that they won’t or can’t ask for help… and while these teens are struggling with their difficult situation, one that could be slightly less difficult because of one pill (which isn’t cheap – no one’s buying a $50 pill on a whim, let alone a kid), the “responsible” adults get to talk about responsibility and good parenting while doing nothing at all.

    *shakes head*

    Yes, it IS about the “icky.” It’s about pretending that real live people do not need this sort of option, merely because they are underage, because then you have to think about why they do need it, and why they don’t have it, and why your privilege leads you to think that what’s true for your family must be true for all children, even though even a little thought shows it to not be the case.

    In your desire for a perfect world in which children are mentored and cared for by thoughtful adults, in which sexuality is approached in a mature and responsible fashion by everyone, in which all kids get the help they need when they need it… you’re ensuring that the teens who do not live in that world – that is, young adults who actually exist at this very moment – are going to suffer more than they otherwise might. I’m sure they’ll appreciate your consideration.

    I’ll stop now. Any more debate with you, and the civility you admired in the original thread is going to be too hard for me to sustain.

     
    • Amy

      December 9, 2011 at 8:19 pm

      So… my first response was, “Wow. That took an ugly, personal turn really fast.”

      Here’s a point to consider – and I’m not really talking to R because I don’t imagine she’ll be back, as evidently I hit a big enough nerve to impair her ability to be civil to me henceforth – so this is more of a generalization for anyone else who decides to participate in a discussion with me here or elsewhere.

      I’m usually open to changing my mind (or having it changed) about issues if a strong case is presented with facts for me to examine. If I initiate a discussion, it’s usually because I’m actually looking for other viewpoints – not just to spread my own ideas around. I actually thought a lot about this post before writing it. I am willing to admit that I don’t know everything, so if you have some valuable information to add that I might be unaware of or haven’t though about, then by all means have at it. I value your input.

      But catty statements that are only intended to be mean don’t change my mind. Attempts at villainizing me by twisting my words or inventing motives for my actions might make you feel better if you need to believe that I disagree with you because I’m a terrible person. But they don’t change my mind. In fact, they do the opposite. Not as much because they are useless and tactless in and of themselves, but because they undermine any valid points you might make by making me fight the gut reaction that I don’t want to think like you because I don’t want to act like you.

      “YOU’RE WRONG AND YOU’RE A STUPIDHEAD” has never won anybody over. Even in the 4th grade.

      But enough of that. I’m going to go back to the actual issue, because I think it’s important and even though I’m only talking to my self (apparently) this kind of writing helps makes things clearer in my head.

      Between the head shaking and wishing she could throw things at me, R did raise an interesting point that I have not previously addressed:

      No where in your description of who might be affected do you seem to have room for teens who do not have responsible adults in their lives. … Kids who don’t have such adults in their lives are screwed if they’re forced to depend on those non-existent adults for their health and safety.

      For one thing, that is not a birth control issue. Kids have to depend on adults for ALL health and safety issues. If there are kids who do not have adults capable of meeting those basic needs, then it’s rather short sighted to get riled up about birth control instead of the bigger problem at hand.

      But still, she makes a point. Kids without responsible guardians, such as kids who are either in foster care or have slipped through the social services system – that was not one of the demographics I listed.

      Honestly, I have no idea what the “rules” are surrounding foster kids and birth control, so I’m going to do some reading on that. I also don’t know how difficult it is for a foster child to see a doctor, should she need a prescription – particularly if she is not currently living with a long-term foster family.

      All I do know is that there are a lot of kids in the system, so it’s definitely worth looking at.

      The options have to be weighed, because I don’t believe there’s a freebie here. Which ever choice you make (to keep or remove the prescription requirement) someone’s benefit is going to be sacrificed. You might think it’s just the “comfort” of “judgmental parents,” but unless you’re seriously proposing that children are better off if parents/guardians are allowed no knowledge of or influence over children’s sexual behavior, then that simply doesn’t hold water.

      If:

      a) the only two options are allowing this pill for everyone everywhere with no regulation in any form vs. requiring a prescription or purchase by adult when neither option may be available to someone who truly needs it (someone remind me why those are the only two options?), and
      b) the best option removes the need for parental involvement in kids’ healthcare (sexual or otherwise),

      then:

      there had better be a damn good reason.

      And maybe there is. But I’m not yet at a point where I’m willing to make that definitive call.

       
      • John Kupitz

        December 10, 2011 at 11:50 pm

        Amy, I’m very impressed with this. Your research is well thought out. Thank you. I cannot contribute because you pretty much said it all and the only person left to discuss with has left the conversation.

         
        • Amy

          December 13, 2011 at 9:12 pm

          Thanks John, I appreciate you taking part in this conversation.