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Morning-After Sickness

It is no great secret that Democrats have been losing political fights over abortion for a while. And it's no great secret why. Although a majority of Americans agree with liberals that abortion should be legal, the right has succeeded in starting political debates that end up making liberals look like extremists. One method has been to focus on partial-birth abortion, a practice that most Americans oppose because it seems cruel. Another successful strategy, as William Saletan explains in the book Bearing Right, has been to push parental consent laws, turning the argument about abortion into a referendum on public attitudes toward sex and the rights of parents. But cultural conservatives have never ceded the more extreme elements of their agenda—something that will become apparent if a new controversy gets the scrutiny it deserves.

At issue is Plan B, a drug manufactured by Barr Laboratories and better known as the "morning-after pill." Plan B is a very high dosage of progesterone, the hormone that promotes pregnancy when produced naturally by a woman's body but prevents pregnancy when taken in a standard birth-control regimen. The problem with birth-control pills is that they only work when taken before intercourse, which is where Plan B comes in. It turns out that an elevated dose of progesterone taken soon after intercourse also prevents pregnancy, though its effectiveness diminishes quickly with time. Women can get this large quantity of progesterone simply by taking several birth-control pills together rather than over several days, as they would normally. Women's Capital Corporation, since bought by Barr, eventually got the idea of producing and marketing a single dose of progesterone designed specifically for use after intercourse, to be made available by prescription. In 1999, the Food and Drug Administration (FDA) approved the application.

The move got little attention amid the controversy over RU-486, the chemical compound that induces abortions even weeks into pregnancy (something Plan B can't do). But use of Plan B remains infrequent, partly because it can be difficult to obtain the drug quickly enough. As a result, women's health advocates have embraced a Barr proposal to make Plan B available "behind the counter"—meaning pharmacists could dispense it without a prescription—to women over 16 years of age.

This time, conservatives are making noise. A year ago, 49 Republican representatives wrote President Bush, urging him to block approval of Barr's FDA application. And, while the FDA's own scientific advisory panel endorsed the application by a vote of 23 to four, the Agency has withheld approval. Early this month, Senators Hillary Clinton and Patty Murray announced they would place an indefinite "hold" on the nomination of the FDA's acting director, Lester Crawford, to become its permanent director until the Agency issued a ruling. (Unrelated issues have since stalled Crawford's nomination.) Meanwhile, stories of pharmacists refusing to fill Plan B prescriptions are cropping up. Early this month, Illinois Governor Rod Blagojevich issued an emergency rule requiring pharmacies, as publicly licensed health care providers, to dispense the medications, even if employees object. Conservatives there are trying to overturn the order.

Plan B's most outspoken critic, the right-wing Concerned Women for America, insists it is actually worried about safety, given the lack of studies on the pill's long-term effects. But the vast majority of medical experts say Plan B is completely safe, in part because birth-control pills have such a well- established safety record themselves. According to the Guttmacher Institute, Plan B was available in 2002 without a prescription in 26 countries, including Switzerland, Israel, and Congo.

A less flimsy argument against Plan B is that it is tantamount to abortion. While science has demonstrated that Plan B works, it has not shown definitively how Plan B works. And, although most researchers believe that it acts by postponing ovulation or preventing fertilization, it could also prevent a fertilized egg from implanting in the uterus--which, according to some pro-life groups, is murder. That's a perfectly respectable, intellectually consistent position for people who believe life begins at the instant when sperm meets egg. But it's also a very severe standard, given that fertilized eggs naturally fail to implant 40 to 60 percent of the time. This is one reason that the medical establishment defines pregnancy as beginning only when a fertilized egg has implanted.

The other serious argument against Plan B is that it will increase risky sexual activity by young people. But peer-reviewed studies published in mainstream medical publications (like one just published in the Journal of the American Medical Association) have repeatedly found no such link. Of course, conservatives argue that making emergency contraception available sends a broader cultural message about the acceptability of premarital sex. But, even if that were true, there are the likely benefits of Plan B to consider. James Trussell, a professor of economics and public affairs at Princeton University, has estimated that, if emergency contraceptives were widely available in this country, they could reduce the approximately 1.3 million abortions that take place yearly in this country by half. If a culture of life is so sacrosanct, shouldn't that trump the issue of premarital sex?

When conservatives talk about Plan B, they conjure up images of lust-crazed college girls engaging in one-night stands, then reaching over empty beer bottles to grab their supersized Plan B jars. But the one group to whom emergency contraception would make the greatest difference is rape victims. According to Trussell, who studied statistics from 1998, about 22,000 of the 25, 000 women who became pregnant from rape could have prevented pregnancy with emergency contraception. Unfortunately, the new federal hospital guidelines for rape treatment released in January mysteriously omitted Plan B, even though a previous draft had included it. In Colorado, conservatives have fought efforts to impose a guideline that includes emergency contraceptives. Apparently, elements of the right are so committed to their stark definition of life and so concerned about hypothetical cultural signals that they would prefer rape victims become pregnant than inform them about emergency contraception. Who are the extremists now?

This article originally appeared in the May 5, 2005, issue of the magazine.