Hawaii recently became the fifth state to make emergency contraception, also known as the morning-after pill, available directly from pharmacists. This is far from a small regulatory change. It means that next time it's 2 o'clock on a Friday night and the condom breaks, a woman there won't have to wait until the following Monday to find a doctor to write a prescription and then wait to get the prescription filled. She can go directly to her neighborhood pharmacist.
When taken within days after unprotected sex, emergency contraception–higher doses of birth control pills–can dramatically reduce the risk of pregnancy. But the pills should be used within seventy-two hours, and the sooner the better.
Pharmacies are located in every community, and many are open twenty-four hours a day. And cutting out a trip to the doctor means that the pills, at about $25 a dose, will be more accessible to the uninsured. In Washington State, pharmacies dispense more than 1,500 doses of emergency contraception a month. By contrast, very few gynecologists write more than five prescriptions for emergency contraception each year.
Studies show that most sexually active women use contraception, but no method is foolproof. Emergency contraception has the potential to transform women's lives by giving them a second chance to prevent an unwanted pregnancy. The pharmacy-access model has proven so successful in Washington and California that legislators in fourteen more states are now trying to replicate the program. These efforts have been gaining ground steadily in spite of the conservative political climate. Unlike RU-486, which triggers an abortion, the morning-after pill prevents conception and is opposed only by those antichoice groups that oppose all forms of birth control, including the pill. Experts estimate that emergency contraception averted 51,000 abortions in 2000 alone and that wider use of it in the United States could reduce the number of unintended pregnancies by almost half.
But emergency contraception is almost the story that wasn't. In 1996, more than twenty years after researchers discovered that higher doses of birth control pills could prevent conception after sex, women still had no dedicated product. So frustrated public-health advocates petitioned the FDA to require manufacturers to repackage their birth control pills for use as emergency contraception–or at least to enclose instructions about how to use the regular pills for this purpose. These efforts were steadfastly resisted.
Introducing products was left to the tiny startup Gynetics, whose Preven was approved in 1998, and Women's Capital Corporation, formed by women's health advocates, whose Plan B was approved in 1999. Lacking the resources of major drug companies, both outfits relied instead on activists to promote their products through grassroots education campaigns, hotlines that connect prescribers with clients and policy initiatives like those in Hawaii, Alaska, California, Washington and New Mexico.
The reluctance of pharmaceutical companies to embrace innovative products that could change women's lives is not limited to emergency contraception. Women make up an increasing majority of those who are HIV-infected. But twenty-two years into the epidemic, most women still must rely on men to use a condom or abstain from having sex to protect themselves. No major drug company is developing a product women can use on their own. Once again, it has fallen to the public sector and women's advocacy efforts to jump-start the R&D process for potential HIV microbicides–gels, creams or suppositories that women can apply without men ever having to know. Small university labs and biotech firms have produced some sixty microbicide candidates, but they're languishing in the pipeline for lack of a Big Pharma backer.
Giant drug companies are generally risk-averse, but much more so when there's even a whiff of political controversy, as is often the case with products linked to women's reproductive health. And the government, currently obsessed with abstinence, is not doing what it should to subsidize this R&D either.
Such political and commercial squeamishness is not only unwarranted, it endangers women's health. More than 60 million American women are in their childbearing years, and more than half want to avoid pregnancy. Worldwide, nearly 5,000 women a day become infected with HIV. All women deserve access to the safest, most effective technologies to protect their health and well-being. It's time for the government and the private sector to give women the prevention products they need and want.
