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Plan B or not to B

Contraceptive flap underscores "conscience clause" trend

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After 29-year-old Eve had unprotected sex, she felt the responsible thing to do was seek pills known to dramatically reduce the chance of getting pregnant when taken after intercourse. She didn't think that a tense doctor's visit three days later would leave her frantic, indignant and demanding answers as the clock kept ticking. But that was before a Charlotte doctor, she claims, initially refused to grant the prescription, telling her a physician shouldn't have to if he's opposed to emergency contraception. A spokesman for the hospital that owns the clinic Eve visited denied her claim, saying medical concerns, not morals, led to a Presbyterian Urgent Care doctor's hesitance to prescribe emergency contraception. But Eve and supporters fear that her experience at the clinic on Randolph Road highlights what they say is a zealot-fueled trend in American medicine: Doctors and pharmacists refusing to fill prescriptions for emergency contraception — and even birth control — because of moral opposition.

"It would be one thing if they were concerned about a woman's health," said Cindy Thomson, president of the Charlotte chapter of the National Organization for Women. "But when they are trying to stop women from preventing a pregnancy, from getting an abortion, even from getting birth control, then it becomes a women's rights issue."

Thomson says she's worried more healthcare providers are bowing to pressure from anti-abortion activists by refusing to prescribe emergency contraception, and are "hiding behind their ethics when they're just trying to keep women from having their rights."

Such incidents are on the rise, according to Planned Parenthood. Emboldened by abortion opponents, some healthcare providers are "feeling they have a right to act out their personal views in their work," said Paige Johnson, spokeswoman for Planned Parenthood of Central North Carolina in Durham.

Reports of such refusals led Illinois Gov. Rod Blagojevich recently to order all pharmacies to dispense oral birth control, including emergency contraceptives. On the other side of the issue, Colorado Gov. Bill Owens last week vetoed a bill that would have required hospitals to inform rape victims about the availability of emergency contraception because of the possibility, he wrote, it "would prevent a fertilized egg from imbedding in the uterine wall. This raises serious concerns for those whose conscience tells them that a fertilized egg is a human life."

More states are adopting "conscience clauses" to protect doctors or pharmacists who won't prescribe or dispense birth control or emergency contraception. North Carolina, in fact, has taken steps toward joining those states. Although the state Medical Board hasn't adopted such a clause, spokeswoman Dena Marshall said "it's the opinion of the board's staff, which isn't the board itself, that the doctor does have the right to make a decision (based) on their (sic) moral or ethical values." And in December, the state Board of Pharmacy approved a clause that lets pharmacists refuse to dispense medicines if they morally object to them. However, David R. Work, the board's executive director, told Creative Loafing that while pharmacists may cite moral or ethical objections, they should refer to patients to another pharmacist who will fill the prescription "in a timely manner."

That may be difficult in rural communities, said Johnson, who calls such clauses "denial clauses." She points to the many decades a woman may spend trying to control her fertility and the 95 percent of women who use contraception at some point in their lives to explain why it's important women have access to hormonal birth control.

"Most women want to pace pregnancies, most women want to decide how many children they have," Johnson said. "To me it's unconscionable to deny women their form of birth control because someone doesn't believe they have a right to use it."

Groups that oppose abortion, however, say health providers have a right to opt out of treatment they find objectionable. Those who believe life begins when a sperm fertilizes an egg, like the more than 17,000-member Christian Medical & Dental Associations, say such pills may cause abortions by preventing fertilized eggs from implanting in the womb. A spokeswoman for the organization declined an interview request.

The American College of Obstetricians and Gynecologists, however, defines pregnancy as starting when the fertilized egg implants in the uterine lining, not when the egg is fertilized. Emergency contraception, such as Plan B and other birth control pills, works primarily by stopping ovulation, according to the FDA. They may prevent fertilization and possibly could prevent a fertilized egg from attaching to the womb, but they won't work once the egg is implanted. This differs from mifepristone (also known as Mifeprex or RU-486), which initiates a medical abortion by blocking hormones necessary to sustain a pregnancy.

Emergency contraception can reduce the risk of pregnancy within up to five days of unprotected sex, said Dr. David Grimes, clinical professor of obstetrics and gynecology at the University of North Carolina at Chapel Hill and vice president of biomedical affairs at Family Health International, a not-for-profit organization in Research Triangle Park. If taken within 72 hours, emergency contraception can reduce risk of pregnancy up to 89 percent. Although more effective the sooner it's taken, recent studies have indicated it can still be effective for up to five days.

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