In 1967 the world-renowned if somewhat Dickensianly named sexologist
John Money was offered a case he couldn't refuse.
Shannon O'Brien had advantages going into the campaign for the
Democratic gubernatorial nomination in Massachusetts. As the state
treasurer, she'd won a statewide race.
In some parts of China, local officials keep track of women's menstrual periods. We haven't come to that, but anyone who thinks women's reproductive and sexual privacy is secure in America wasn't following the news this summer.
Bush's counterterrorism efforts neglect women.
An antigay ballot initiative spurs some surprising political
The one thing that activists on every side of the abortion debate agree
on is that we should reduce the number of unwanted pregnancies.
America's rate of unwanted pregnancy is a huge public health scandal,
but five years after being approved by the FDA, emergency
contraception--the use of normal birth control pills to block pregnancy
within seventy-two hours of unprotected sex--has yet to fulfill its
potential. Part of the problem has to do with the difficulty of getting
EC in time; many doctors don't want the hassle of dealing with walk-in
patients, many clinics are closed on weekends and holidays (times of
peak demand) and some pharmacies, like Wal-Mart's, refuse to stock it.
That anti-choicers falsely liken EC to abortion and tar it as a
dangerous drug doesn't help.
The main barrier to EC use, though, is that most women don't know what
it is. To spread the word, Jennifer Baumgardner and I have written an
open letter explaining how EC works, how to get it and why women should
even consider acquiring it in advance. If every Nation
reader with access to the Internet forwards it to ten people and one
list, and those people do the same and on and on, it could reach
thousands, even millions of women. Like ads for Viagra, only not spam.
Activism doesn't get much easier than this!
An Open Letter About EC
The one thing that activists on every side of the abortion debate agree
on is that we should reduce the number of unwanted pregnancies. There
are 3 million unintended pregnancies each year in the United States;
around 1.4 million of them end in abortion. Yet the best tool for
reducing unwanted pregnancies has only been used by 2 percent of all
adult women in the United States, and only 11 percent of us know enough
about it to be able to use it. No, we aren't talking about
abstinence--we mean something that works!
The tool is EC, which stands for Emergency Contraception (and is also
known as the Morning After Pill). For more than twenty-five years,
doctors have dispensed EC "off label" in the form of a handful of daily
birth control pills. Meanwhile, many women have taken matters into their
own hands by popping a handful themselves after one of those nights--you
know, when the condom broke or the diaphragm slipped or for whatever
reason you had unprotected sex.
Preven (on the market since 1998) and Plan B (approved in 1999), the
dedicated forms of EC, operate essentially as a higher-dose version of
the Pill. The first dose is taken within seventy-two hours after
unprotected sex, and a second pill is taken twelve hours later. EC is at
least 75 percent effective in preventing an unwanted pregnancy after sex
by interrupting ovulation, fertilization and implantation of the egg.
If you are sexually active, or even if you're not right now, you should
keep a dose of EC on hand. It's less anxiety-producing than waiting
around to see if you miss your period; much easier, cheaper and more
pleasant than having to arrange for a surgical abortion. To find an EC
provider in your area, see www.backupyourbirthcontrol.org,
www.not-2-late.com or ec.princeton.edu/providers/index.html.
Pass this on to anyone you think may not know about backing up their
birth control (or do your own thing and let us know about it). Let's
make sure we have access to our own hard-won sexual and reproductive
The Things You Need to Know About EC
EC is easy. A woman takes a dose of EC within seventy-two hours of
unprotected sex, followed by a second dose twelve hours later.
EC is legal.
EC is safe. It is FDA-approved and supported by the American College
of Obstetricians and Gynecologists.
EC is not an abortion. Anti-choicers who call EC "the abortion
pill" or "chemical abortion" also believe contraceptive pills,
injections and IUDs are abortions. According to the FDA, EC pills "are
not effective if the woman is pregnant; they act primarily by delaying
or inhibiting ovulation, and/or by altering tubal transport of sperm
and/or ova (thereby inhibiting fertilization), and/or altering the
endometrium (thereby inhibiting implantation)."
EC has a long shelf life. You can keep your EC on hand for at least two
EC is for women who use birth control. You should back up your
birth control by keeping a dose of EC in your medicine cabinet or purse.
What You Can Do to Help
Forward this e-mail to everyone you know. Post it on lists, especially
those with lots of women and girls. Print out this information,
photocopy it to make instant leaflets and pass them around in your
community. Call your healthcare provider, clinic, or university health
service and ask if they provide EC. Spread the word if they do. Lobby
them (via petitions, meetings with the administrators, etc.) to offer EC
if they don't.
Make sure that your ER has EC on hand for rape victims and offers it to
them as a matter of policy. Many hospitals, including most Catholic
hospitals, do not dispense EC even to rape victims.
Get in touch with local organizations--Planned Parenthood, NOW, NARAL,
campus groups--and work with them to pressure hospitals to amend their
If you can't find a group, start your own. Submit an Op-Ed to your local
paper or send letters to the editor about EC.
Make sure your pharmacy fills EC prescriptions. Some states have
"conscience clauses" that exempt pharmacists from dispensing drugs that
have to do with women's reproductive freedom.
The recent news about the harmful effects of hormone replacement was
played in the media as a health story, but it is much more than that. In
fact, it may be the hot-flashiest corporate scandal to date: Let's call
If other corporate scandals have been about fudging figures, this one
is about fudging science--something that seems to have been surprisingly
easy to do. And such is the corporate culture that we have apparently
preferred to believe the drug companies rather than the women's health
advocates who have been lobbying for decades simply to get the
scientific evidence to back the companies' claims. The director of the
North American Menopause Society (NAMS), Dr. Wulf Utian, called the bad
news about hormones a bombshell, but it really isn't. Information has
been slowly accumulating about hormone replacement therapy's risks, even
as Wyeth and other manufacturers have been pushing their product as an
elixir for a widening group of symptoms. In recent years, this
potentially carcinogenic drug has been marketed with the nonchalance of
a vitamin pill: HRT advertising suggests that almost no woman over 50
couldn't benefit from it somehow.
Estron is the latest in a long line of scandals pitting women's health
against the interests of Big Pharma--scandals like the sale of faulty
Dalkon Shield contraceptives, which caused infertility, and medications
like DES, which caused severe illnesses in users and their children.
What all these cases have in common is that--like the manufacturers of
menopausal hormones--the drug companies, in their rush for profits,
insufficiently tested their wares before selling them to millions. What
these scandals suggest is that somewhere in the swampy landscape of
medical research funding, unhealthy relationships incubate between
medical practitioners and the drug-company reps who manage to dazzle
them with quasi science and quasi truths. The industry spends around $15
billion a year to promote its products--more than it spends to develop
them. Clearly, even those doctors who resisted the
luxury-cruise-lectures approach to sales found themselves suckered in.
The manipulation of HRT's scientific credentials began back in the
mid-1960s, when Wyeth paid gynecologist Dr. Robert Wilson to extol its
new wonder drug, estrogen replacement. In an evocatively named book,
Feminine Forever, Wilson declared that by replacing the estrogen
lost at menopause, women would remain attractive and easier to live
with. Over the decades since, Wyeth and other hormone manufacturers have
revised dosages and combinations to fit new medical revelations and
poured billions into sophisticated propaganda to get their message out.
The message is that menopause is not a natural life stage but a
disease--estrogen deficiency--and it will make you old. HRT is the cure,
and it will keep you young.
In recent years the manufacturers have claimed protective qualities for
HRT way beyond its original ambitions. First, it promised (and
delivered) relief from menopausal symptoms. Next came claims for
protection against heart disease in women already affected, and then in
healthy women. Then came its role as a treatment against osteoporosis,
which, manufacturers warned (falsely), becomes an instant risk at the
moment of menopause (it's a gradual risk over many years).
The truth is that the manufacturers didn't exactly know what HRT did or
didn't do, because they never ran a big, randomized national study
stringent enough to meet medical standards. For more than twenty years,
the companies used observational studies showing that women who took
hormones were healthier, but they didn't look at why: Was it that the
hormones themselves made women healthier, or that health-conscious women
were more likely to take hormones to begin with? There were many other
uncertainties. Yet calls to answer these questions, from women's health
groups and even from prominent politicians like Pat Schroeder and
Olympia Snowe, went unheeded.
For all the hype, there has been plenty of evidence, both scientific and
epidemiological, that estrogen, named a carcinogen by the FDA two years
ago, is not a wonder drug for everyone. Thirty percent of prescriptions
for estrogen remain unfilled, and the growing search for alternative
menopause products shows that increasing numbers of women are
uncomfortable with the prospect of a lifetime of swallowing synthesized
horse urine. And for all the spin, there has also been accumulating
evidence of serious side effects. As early as 1975 the FDA identified
links between estrogen and higher rates of uterine cancer. (Wyeth
responded by adding another product, progestin, to offset the risk.) In
1990 the Nurses Health Study reported that women on estrogen faced a 36
percent greater risk of breast cancer. That same year the FDA refused to
approve Premarin as a treatment to prevent heart disease, because the
company's evidence didn't convince them. The 2000 HERS study, actually
funded by Wyeth, found that hormone therapy increased risks in heart
disease patients in the first few years. (Wyeth countered that
long-term, it works.)
And people have been trying to warn us. As far back as the mid-1990s,
The Menopause Industry, by Australian reporter Sandra Coney,
presented heavily researched evidence of uterine bleeding, gallbladder
disease and increased cancer rates in hormone takers. In 1997 breast
cancer specialist Dr. Susan Love's Hormone Book returned to the
link between HRT and increased breast cancer risk and came under attack
for raising an alarm. Earlier this year Cindy Pearson, executive
director of the National Women's Health Network, published The Truth
About Hormone Replacement Therapy, outlining many other
discrepancies between hormone hype and science. The medical
establishment barely paid attention.
Finally, the scientific evidence that we have now, based on two large
randomized trials, is definitive, according to one of the study's
leaders, Dr. Deborah Grady. The trials have shown that not only does HRT
do more harm than good for women with existing heart disease, but it
doesn't protect healthy women either; in fact, during the trial it
increased incidence of heart attacks, breast cancer, strokes and blood
clots--enough to have caused the study to be abandoned three years
early. And yet belief in the hormone was so strong that researchers
feared it would be unethical to put women on placebos.
How is this possible? Dr. Utian of NAMS has admitted that many different
parties--from the drug companies to their paid researchers and
spokespeople to the prescribing gynecologists--have had a vested
interest in the success of hormone replacement, and for them, he told
the New York Times, the issue is about more than data. For them,
Utian said, truth is opinion. But that seems a risky precept for
physicians to work with. It sounds like something Arthur Andersen would
Hot media news: Women want hard-hitting reports on issues that affect them.
The Nation reported on Dr. Pendergraft's troubles in
"Abortion on Trial" by Hillary Frey and Miranda Kennedy, June 18, 2001.