Emergency contraception has the potential to revolutionize women’s relationship to sex and birth control. How many women have wished to undo what throughout history could not be undone: a sexual encounter, driven by passion or fear or loneliness or too many margaritas, that leaves them at risk of an unwanted pregnancy? For two decades, the best-kept secret in America was postcoital contraception–two doses of certain oral contraceptives taken within seventy-two hours of sexual intercourse–which could have prevented some 1.2 million unplanned pregnancies and 800,000 abortions annually. While the pharmaceutical components of the method were widely available, the dosage and timing required were not well publicized.
All that changed in September, when the Food and Drug Administration approved Preven, the first prepackaged emergency contraception kit. The 1.3 million packages of Preven sold in its first three months on the market attest to the tremendous need for emergency contraception.
But Preven’s promise may not be realized. Wal-Mart, the nation’s second-largest drug retailer, has announced that it will not carry Preven–the first time the nation’s feel-good, big-box retailer has put any drug off-limits, and a likely preview of the boycott pressure that antiabortion groups will bring to bear once RU-486–“the abortion pill”–is approved as expected. In addition, some pharmacists, guided by their belief that the morning-after method is an abortifacient, have refused to fill Preven prescriptions and are demanding legal protection for their right to do so.
The usefulness of Preven rests on fast, no-hassle pharmacy access–it must be taken within seventy-two hours of intercourse and is far more effective if used within twelve hours. Pharmacists are so pivotal to emergency contraception that a promising pilot program in Washington State is allowing them to dispense it without a prescription. The same program also revealed that women often need emergency contraception because of imperfect contraceptive methods–just over half used it because their contraception failed.
Arthur Caplan, perhaps the nation’s pre-eminent health ethicist, says emergency contraception is a “tremendous ethical advance” that should be readily available to all fertile women. A study in the New England Journal of Medicine found that women would not rely on it as primary contraception, as its critics contend. Even the National Right to Life Committee signaled tacit approval, because unlike RU-486 Preven does not end a pregnancy. It prevents implantation of the fertilized egg, the generally accepted medical definition of the beginning of pregnancy.
Nonetheless, backed by the American Pharmaceutical Association and state pharmacy associations, pharmacists who label the method an abortifacient have invoked a right–not previously recognized by the profession–to refuse to fill a prescription they find “morally objectionable.” APhA and Wal-Mart both stipulate that a pharmacist who refuses to dispense a prescription must refer the patient to someone who will, but that doesn’t address either the unique time constraints of emergency contraception or the unfair burden imposed on women exercising basic reproductive rights.
Allowing pharmacists to refuse to prescribe one class of drugs sets a dangerous precedent. Already an antiabortion pharmacy group, Pharmacists for Life International, has seized on the publicity generated by Preven to push for state protections for pharmacists who refuse to prescribe other drugs they find morally objectionable–like ordinary birth control pills, which can sometimes prevent implantation. This is especially chilling given the consolidation of the drugstore industry. Women in rural areas (in which a Wal-Mart is frequently the only accessible pharmacy) or with a health plan that limits participating pharmacies may be forced to travel many miles to fill a simple prescription for birth control. Women without transportation could find themselves essentially denied chemical methods of fertility control.
Unlike its conservative cousin, K-Mart has said it will fire any pharmacist who refuses to dispense any FDA-approved medication. But other large chains have been silent on the issue, clearly fearful of the threat of a boycott by antiabortion groups–which is precisely what kept emergency contraception off the market for years. It’s up to state lawmakers and APhA, which sets the standards of behavior for the profession, to insure that all prescriptions are dispensed in an equitable manner consistent with good medical practice. Pharmacists and chain stores must not be allowed to wield arbitrary power over health decisions, to interfere with the doctor-patient relationship or to impose their moral standards on their customers’ lives.