When Barack Obama was elected president of the United States at the end of 2008, many of his voters thought that they were going to change many things, among them issues related with women’s rights.

One of the areas where this expectation was highest was that of emergency contraception, i.e. in the use of the so-called “morning-after pill”, which as we know, can be used to prevented unwanted pregnancy after unprotected sexual intercourse.

The use of this pill was proposed in the United States in 1999, under the name Plan B. At that time, the pill could only be dispensed with a medical prescription. Essentially, Plan B consists of the administration of two 0.75 mg levonorgestrel pills, although later, in 2009, the go-ahead was given to administer it in a single 1.5 mg dose.

Its use is authorised for a period of up to 72 hours after sexual intercourse, although it is most effective the sooner the drug is taken, normally within the first 24 hours.

There has been intense controversy since then in American society regarding its effectiveness and safety, especially its mechanism of action, as many of the supporters of its use declared that it acted solely through a contraceptive mechanism, i.e. by impeding the production of a new living human being, while others, among whom we find ourselves, believe that together with this contraceptive mechanism, it can also act by an anti-implantation mechanism, i.e. by preventing the implantation of an already produced embryo in its mother’s womb. The ethical judgement that its use merits will depend largely by which of these mechanisms it acts, hence the controversy.

In 2001, at the request of the Center for Reproductive Rights, made up of a group of American lawyers and various civic associations (which brought together more than 70 medical and civil institutions), a petition was made to the Food and Drug Administration (FDA) for the morning-after pill to be issued freely in pharmacies without a prescription. The Bush administration opposed this petition, stating that it required further research on the safety and efficacy of the pill, which meant that being able to issue it freely in pharmacies was delayed for over three years. This decision sparked intense political controversy between the Bush administration and various senators, especially Democrats, among whom Hillary Rodham Clinton had a major role. Finally, in 2006, the FDA approved the distribution of the morning-after pill without prescription, but only for women aged 18 years old or over.

When President Obama took over the American government on 20th January 2009, the Democratic administration publically stated that it did not want to interfere with the scientific evidence that appeared to support the medical effectiveness and safety of the morning-after pill, which led many of the defenders of this pill to think that a favourable decision would be taken with respect to its distribution without a prescription for women under 16 years old as well. Nevertheless, the FDA took nearly 3 years to make a decision in this respect, since it was not until December 2011 that it authorised the free distribution of the pill in pharmacies to all women, based on the fact that, in its opinion, the pill was safe and effective.

However, the Minister for Health in the Obama Government, Kathleen Sebelius, did not follow the FDA recommendations, and defended the decision that the morning-after pill not be dispensed pharmacies without a prescription to women under 17 years, which unleashed intense controversy among various feminist institutions and other civic associations.

Recently, one of these associations, the Center for Reproductive Rights reopened the case; the result was that, 14 months later, on 12th April this year (2013), a federal judge ruled that the morning-after pill could be dispensed without a prescription to all women, irrespective of age.

Thus, since Plan B was launched in the United States until this latest decision (to make the morning-after pill available without prescription), 12 years have passed.

The long period of time that has been required to take, in our opinion, such a negative decision, has its foundation in the ethical issues arising from the use of a drug in which the mechanism of action is anti-implantation, i.e. abortive, in some circumstances; according to our estimates, this is approximately 50% of the time or more, which constitutes a serious ethical difficulty for many individuals and various groups in the United States.

To this underlying reason we must add another: the great confusion sown by the information furnished by various researchers and media, who categorically state that levonorgestrel acts solely by preventing ovulation, so therefore it would not have an abortive effect. This statement, which the Bioethics Observatory and also many in research have repeatedly refuted, is supported by manufacturers, various groups that advocate contraception, and even by some media calling themselves Catholic, such as the National Catholic Reporters (NCR, Kansas City, Missouri), which last 31 March published an article stating that Plan B does not cause abortions.

Thus, it seems that the long history of the legalisation of the use of the morning-after pill without a prescription in the United States has come to an end, in our opinion a sad end, unless President Obama’s Justice Department appeals against the decision taken by the judge last 13th April, which seems highly unlikely.

Finally, it should be remembered that the ability to dispense the morning-after pill without a prescription has failed to accomplish any of the proposed objectives with its use in Western countries, as it has not managed to reduce the number of teenage pregnancies or abortions, but it has increased, according to various studies, the incidence of sexually transmitted diseases. They will probably see this same trend in the US when they analyse the consequences of this liberalisation.

 

(Justo Aznar and Julio Tudela. Bioethics Observatory. Catholic University of Valencia)