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Step Up to the Counter

Plan B hitting drugstore shelves at last

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After years of political wrangling, the emergency contraceptive Plan B has been shipped to pharmacies nationwide for behind-the-counter access. Feminist and reproductive-rights groups are wary: Will the women who need it have access to this last-ditch birth control? Will pharmacists dispense the drug without judgment?

"I think [opponents will] continue to do what they can to put barriers up," says Cindy Thomson, coordinator of Charlotte's National Organization for Women chapter. "And I think that groups like mine and Planned Parenthood need to be vigilant and report those barriers."

Shipments began in mid-November of the two-pill regimen, which can reduce the risk of pregnancy by as much as 89 percent if taken within 72 hours of unprotected sex. As you're reading this, Plan B is likely on the shelves of a drugstore near you. And Planned Parenthood offices expect to have the non-prescription pills available by the first week of December, says Lindsay Siler, spokeswoman for Planned Parenthood Health Systems.

The Food and Drug Administration approved Plan B for non-prescription sales in August. Customers will have to be age 18 or older, and they'll have to provide photo ID. The pills will be stored behind pharmacy counters and for sale only during pharmacy hours.

Such a requirement may not be a huge hurdle in Charlotte, where large chains have all-night pharmacies. But in smaller communities, the process might leave women working against the clock. Planned Parenthood is currently surveying the availability of birth control in North Carolina pharmacies, and Siler says rural areas are of particular concern. "We recognize that pharmacist refusals can be particularly burdensome to rural or low-income patients," she says.

The FDA says Plan B works like typical birth control pills: by stopping ovulation, preventing fertilization or -- theoretically -- preventing a fertilized egg from attaching to the womb. Emergency contraceptives containing the same ingredient are available without a doctor's prescription in 43 countries, according to the Princeton University's Office of Population Research. Plan B is not mifepristone (also known as Mifeprex or RU-486), which initiates a medical abortion by blocking hormones necessary to sustain a pregnancy.

Reproductive rights groups have trumpeted its potential to lower rates of unintended pregnancies and abortions, but anti-abortion and anti-birth control groups have opposed any move to make Plan B more widely available. Anything that prevents a fertilized egg from attaching to a womb, they say, causes an abortion; anything that allows women to avoid pregnancy after the fact, they say, encourages promiscuity.

When FDA commissioner Dr. David Hager went against the agency's advisory panel recommendations and turned down requests to make Plan B more easily obtainable, feminists and some medical groups contended the decisions were politically motivated. In November 2005, the Government Accountability Office, the nonpartisan investigative arm of Congress, found that the decision process in considering Plan B's nonprescription application was "unusual." Hager said the denial decision was to protect young teens.

Plan B proponents are upset that the eventual approval hinged on an age requirement. "We need to reduce the number of teenage pregnancies, and I don't think preventing teenagers from getting (Plan B) is going to help them at all," Thomson says.

Reports of doctors unwilling to prescribe the drug, and pharmacists refusing to dispense it, have angered reproductive rights groups. In Charlotte, NOW protested outside an urgent care center in April 2005 after a 29-year-old woman said she was refused a prescription.

Walgreens spokeswoman Carol Hively points out that although the drugstore chain maintains its policy of allowing pharmacists to refuse to dispense the drug, the pharmacist will not control its sale -- other employees can ring up the sale as well and can't be ordered not to by the pharmacist, she says. (Wal-Mart and CVS, two other major Charlotte area pharmacies, also have "conscientious objection" policies.)

Planned Parenthood contends that wide access to EC could prevent up to 1.7 million unintended pregnancies -- and 800,000 abortions -- a year. Some studies, however, have found that Plan B has not reduced abortion rates in countries where it has been readily available.

Either way, emergency contraception isn't a panacea. Plan B does not provide protection against sexually transmitted diseases. Nor does it always prevent pregnancy -- and if the odds don't fall on your side, well, you likely won't view the pills with the same excitement as others.

For more information, see http://ec.princeton.edu/ or www.go2planb.com.

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