Wednesday, March 25 is Back Up Your Birth Control Day!
Back Up Your Birth Control (BUYBC) [11] is a national campaign to raise awareness of and expand access to emergency contraception (EC). As we celebrate the eighth annual BUYBC Day of Action, hundreds of advocates and health care providers across the country will help spread the message that EC is a safe and effective way for women to prevent pregnancy after unprotected sex. This is a crucial time to expand education about EC. In the current economic climate when women are losing jobs and health insurance [12] coverage, they need to know how to back up their birth control (or replace the regular birth control methods they can no longer afford) with EC more than ever. We hope you'll join us in raising awareness of what has often been called "the best kept secret in women's health" - emergency contraception.
On August 24, 2006, when the FDA approved Plan B for over-the-counter (OTC) sale without a prescription to women and men ages 18 and older, I was working to expand access to EC for low-income women and teens in Title X clinics. A colleague approached me that afternoon and said "well, I guess you'll be looking for a new job. Now that EC is available over-the-counter, the access problem is solved!" How I wish that were true.
From the first BUYBC Day in 2002 to today we can look proudly at Rosie the Riveter, our BUYBC "poster woman," and say, "You've come a long way, baby." Sales of Plan B have doubled since it became available OTC and surveys show most major pharmacy chains are now stocking it. Advocacy organizations, departments of health, campus groups, pharmacist's associations, and medical providers have created a wide variety of EC education and outreach campaigns. Yet despite these efforts and increased availability, myths about EC are still prevalent and very real barriers to access remain.
Results of annual surveys of BUYBC participants consistently rank lack of awareness of EC and of how to access EC as the primary barriers to EC access, ahead of other barriers like cost or age restrictions. Women can't be empowered to back up their birth control and prevent unintended pregnancy if they don't know about EC, and have the facts on how it works or where they can access it.
More education is needed to address the barriers to EC access by teens, low-income and immigrant women created by the FDA decision. The recent court ruling in the Center for Reproductive Rights case against the FDA will soon expand access to EC OTC to 17 year old women. The ruling also means that the FDA will need to reconsider the sale of Plan B OTC to women of all ages; however, no timeline is provided for how soon that might happen. In the meantime, teens must still obtain a prescription in order to access EC, despite a lack of any scientific evidence demonstrating EC is unsafe for them.
The high cost of EC OTC, usually $40-70, poses a significant barrier to low-income women, or to those whose budgets are tight right now. Only eight state Medicaid programs currently cover EC OTC, and efforts to expand this number are being severely challenged by state budget cuts. The need to show government issued ID as proof of age is a barrier for undocumented women and men. And the fact that Plan B is kept behind the pharmacy counter creates a barrier to access outside regular pharmacy hours, and the potential for pharmacists refusing to dispense EC. Since EC is most effective the sooner it is taken after unprotected sex, the delay caused by seeking a prescription, trying to get the money together, or finding a pharmacy that's open can significantly increase a woman's risk of unintended pregnancy. Education and outreach campaigns, like BUYBC, can help women identify sources of free or low-cost EC, raise awareness among teens of their right to access contraception including EC, and help undocumented people exercise their rights to reproductive healthcare.
We must also continue to dispel myths about EC, particularly the misinformation promoted by anti-choice forces categorizing EC as an abortifacient [13]. Despite solid scientific evidence which proves that EC works primarily by preventing ovulation and secondarily preventing fertilization and that EC will not interrupt or harm an established pregnancy, proposed state laws like the "fetal personhood [14]" amendment defeated in Colorado and a new law in Texas [15], and federal laws such as the Bush era HHS regulations [16] continue to attempt to classify EC as an abortifacient. Lawmakers continue to allow carve outs for emergency contraception in Family Planning Waivers, refusal laws, and by health insurance companies. Even the recent victory fixing the provision in the 2005 Deficit Reduction Act [17], which restored discount birth control pricing for college and safety net clinics and was a victory for women's access, doesn't impact EC prices since EC was never included in the birth control methods that qualify for nominal pricing. This means that while we wait to see whether the drug companies will restore the discounts and for lower cost birth control to come back to campus next school year, EC will remain an important but potentially expensive option.
Millions of young people in abstinence-only programs have also been receiving this misinformation about how EC works. A nationwide survey conducted by the Kaiser Family Foundation [18] found that over 25% of teens surveyed believed that EC causes abortion. This misconception must also be addressed in order to increase access to EC for rape survivors. Currently only 16 states require emergency rooms (ER) to provide EC to rape survivors even though timely access to EC is critical to reduce the additional trauma of a pregnancy due to rape. Women must know they have the right to request EC, or EC information, and lawmakers in the remaining states must be urged to stop putting politics before science and make EC in the ER available for all survivors.
Now is a crucial time to raise awareness of EC, not just because women need affordable access to birth control more than ever but also because there is hope for expanded access on the horizon. President Obama's stated commitment [19] to "ensuring that scientific data is never distorted or concealed to serve a political agenda and that we make scientific decisions based on facts, not ideology," seems to be a direct rebuff to the political machinations within the FDA that created the OTC barriers and the politics that have prevented women from having timely and affordable access to EC for too long. In addition to the win in the courts, new staff at FDA could be poised to remove some of these barriers. The possibility of a generic form of EC becoming available this fall when the patent on Plan B expires could also improve access for low-income women. Advocates across the country are continuing to fight for Medicaid coverage for EC OTC, and to ensure that universal health care plans include coverage for EC.
While advocates work for policy gains, we must continue to raise awareness about EC and empower women with a second chance to prevent unintended pregnancy. Please join the activists across the country who are participating in the Back Up Your Birth Control Day of Action. Visit this link [11] to learn how.