"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.
Such deadlines worried Eve, who initially agreed to use her last name but decided against it two days later for fear of reprisals. After she had unprotected sex, she realized that Planned Parenthood, like most doctors' offices, was closed for the weekend, and she didn't think to disturb her regular gynecologist after hours. Nor did Eve know to call the statewide Planned Parenthood emergency contraception hotline (1-866-942-7762).
That's how she ended up at Presbyterian Urgent Care on Randolph Road, where she claims she met resistance in obtaining a prescription for emergency contraception. She said she left the clinic after a doctor told her he would prescribe it only for rape victims. He called her cell phone not long afterward, she said, and asked her to come back to the clinic: he'd give her the prescription if a pregnancy test came back negative. (Emergency contraception is not believed to interfere with a nascent pregnancy as defined by most medical groups, that is, a fertilized egg that's already implanted in the womb.)
She said once she returned to the clinic — it was after hours so she came in the back — he told her a doctor shouldn't be forced to prescribe medication if they have a moral issue with it. And, she said, he told her that she lives in a community with enough doctors that she should be able to find someone else to prescribe it.
"How many hoops do I have to go through?" she asked Creative Loafing.
The doctor Eve saw didn't return a call for comment. But Kevin McCarthy, manager of public relations for Presbyterian Healthcare, disputed Eve's story and said religious and moral considerations were not "part of the decision" involved in Eve's care. He wouldn't elaborate, citing privacy laws, unless Eve signed a confidentiality waiver. She told Creative Loafing she would not.
McCarthy said doctors are allowed to refuse to write prescriptions for emergency contraception and other birth control, though they would refer women to other physicians. But the hospital has no written policy, he said.
Presbyterian did indicate in a March survey of state emergency departments that it provides emergency contraception to rape victims and does not allow exceptions to the policy based on a provider's refusal to dispense medication.
Dr. Ophelia Garmon-Brown, medical director of the urgent care center, told Creative Loafing that the doctor Eve saw hesitated to prescribe emergency contraception because of the visit's timing.
"The pill is supposed to be given definitely before the 72 hours, most of the time before the first 24 hours. That's why they call it the morning-after pill," Garmon-Brown said.
But Grimes, a reproductive health expert who has testified before the FDA in favor of making emergency contraception available over-the-counter, said the passage of 72 hours shouldn't be a barrier.
"You should go ahead and give it anyway. Absolutely," said Grimes, once chief of the Centers for Disease Control and Prevention abortion surveillance branch. "Clinicians should be liberal (in prescribing the medication)."
Garmon-Brown said prescribing the medication after 72 hours could lead to an "incomplete" use. And only ob/gyn physicians — "never" an urgent care or emergency room doctor — should prescribe emergency contraception after 72 hours, she said.
Grimes, however, said, "Any physician should be comfortable prescribing it." He, like the AMA and Planned Parenthood, said emergency contraception won't harm an existing pregnancy
According to an analysis cited by the American Medical Association, emergency contraception helped avert more than 50,000 abortions in 2000-2001. The AMA, the largest US medical association, says the contraceptives are easy to use, non-addictive and have no known health hazards. Like the American Medical Women's Association and the American College of Obstetricians and Gynecologists, the AMA urges doctors to provide prescriptions for emergency contraception during routine office visits before the pills are needed.
The medical associations have opposed the Food and Drug Administration's move last year to keep Plan B, a two-pill emergency contraceptive, from being available over the counter. The FDA last summer went against two FDA advisory committees' recommendations that the regimen be available without a prescription. The regulatory agency said the proposal didn't provide enough evidence the pills could be used safely without guidance or that they wouldn't increase teenage promiscuity. It was a rare instance of the agency going against its advisors, according to the AMA, and one that led to charges of politics trumping medicine.
Last week, according to The New York Times, Senators Hillary Rodham Clinton of New York and Patty Murray of Washington, both Democrats, planned to block President Bush's nominee to lead the FDA until the agency agreed whether Plan B could be sold over the counter
In Charlotte, Thomson of NOW and other feminists hope emergency contraceptives become more accessible for women. They were among a handful of people who protested Saturday in front of the urgent care center to raise awareness.
For her part, the woman whose experience caught NOW's attention didn't attend the protest because of nervousness. She's no stranger to feminist organizing, having been a president of a NOW chapter at college in another state nearly a decade ago, but these days Eve just wants to be low key.
"This goes beyond Eve," Thomson said. "Any of us could be Eve."
North Carolina residents can call a Planned Parenthood hotline at 866-942-7762 for help obtaining emergency contraception. Nationwide, women can find the nearest Planned Parenthood for emergency contraception by calling 1-800-230-PLAN. For a list of other nearby providers, call the national Emergency Contraception Hotline at 1-888-NOT-2-LATE. Information is also available at http://www.not-2-late.com or http://ec.princeton.edu and may also be obtained in clinics, doctors' offices and hospital emergency rooms.
