The Economist
So much for avoiding controversy
THE New York Times article on Kathleen Sebelius's decision to overrule the FDA and block over-the-counter distribution of emergency contraceptives gets it a bit wrong in the first paragraph.
For the first time ever, the Health and Human Services secretary publicly overruled the Food and Drug Administration, refusing Wednesday to allow emergency contraceptives to be sold over the counter, including to young teenagers. The decision avoided what could have been a bruising political battle over parental control and contraception during a presidential election season.
That was probably what Mrs Sebelius intended to do, but it seems to have had the opposite effect. The FDA's Center for Drug Evaluation and Research (CDER) had found that teenage girls understand what emergency contraception does and can use it correctly without a physician's help. Mrs Sebelius's move was a political reversal of a scientific review, and that has antagonised both the pro-choice left and the public-health community. Jodi Jacobsen at the reproductive health and rights blog RH Reality Check writes: "No amount of proof it seems can make up for the fact that, despite all the evidence, even President Obama and Secretary Sebelius appear to think young women are too stupid to make their own decisions or that they are just chum to be thrown to the religious right in an election year." Scott Lemieux calls it "an indefensible decision that wasn’t in any sense politically necessary, and indeed might be politically counterproductive." Amanda Marcotte says Mrs Sebelius "has just rejected all available scientific evidence, her traditional pro-choice politics, the advice of all the relevant medical academies, and basic common sense." Irin Carmon writes that there is "certainly no explanation based in science" for the decision. Brad DeLong says the administration is "making it really hard for its base to mobilise." Belle Waring says she "can't believe the Obama administration caved on this."
All in all, this doesn't seem to have avoided a bruising political battle.
So, what is this battle about, really? Several opponents of making Plan B available over the counter have...not argued, exactly, but made strange and confusing gestures in the direction of an argument that doing so would in some way promote sexual abuse of minors. (See Janet Crouse of Concerned Women of America, h/t Tedra Osell: “When anybody can buy an emergency contraceptive like this over the counter, you open the door for all sorts of abuse, and especially so when it comes to child abuse and child exploitation.”) This makes no sense; no mechanism can be imagined for this to happen, which is presumably why Ms Crouse is unable to say specifically what on earth she is talking about. Other opponents have argued that Plan B is an abortifacient. This is factually incorrect; it works by disrupting ovulation and fertilisation, and in any case, abortion is, you know, legal. Age and parental-notification restrictions on abortions are supposed to be handled at the state level, not through the HHS drug review process. Mrs Sebelius's own explanation for her decision is that "the label comprehension and actual use studies did not contain data for all ages for which this product would be available for use." This is obviously a weak excuse intended to justify a politically motivated decision; the CDER is the agency that reviews safety and comprehension, and as Ms Jacobsen writes, it ran its studies specifically focusing on these issues, and decided that over-the-counter distribution should be approved.
The most reasonable argument opponents make is that conservative or religious parents simply are not comfortable with having emergency contraception available to their children without a doctor's intervention, and that whether or not this objection is rational, they have a right to control their own family's approach to sexuality and to exercise a custodial position over their underage kids. Plan B poses no health risks and will be used correctly by girls under 17, but that's only partially relevant to this objection; this is an argument about parental control, even for parents whose beliefs are founded on scientific or behavioural misunderstandings. These parents want the federal government to help them shape their children's reproductive behaviour by preventing them from accessing emergency contraception without a prescription.
This argument is wrong because it demands that the federal government intercede in favour of the nebulous and poorly grounded interests of one faction of conservative or religious parents, and against two other groups whose interests should weigh more heavily. The first group is those parents who actively desire that their children be able to purchase emergency contraception without a prescription, in the well-grounded belief that their children may, despite their parents' best intentions and efforts, have unprotected sex—after which they may hesitate to admit this to their parents, wait too long to schedule an appointment with a physician, miss the 72-hour window of effectiveness, and wind up having an abortion. The second group is the one who has the strongest standing of all: the minors themselves who would want to purchase emergency contraception. The interests of the conservative parents are nebulous because there's no evidence that teenagers will be more likely to have (unprotected) sex if Plan B is available to them. In contrast, there's abundant evidence that teenagers do have unprotected sex, and that they would be well served if Plan B were available over the counter, as would those of their parents who would prefer that they prevent pregnancy, rather than undergo an abortion or have a baby.
There is, of course, one last subset of parents who do have a concrete, non-nebulous interest here: those who would prefer that, if their underage daughters have unprotected sex and risk becoming pregnant, they conceive and deliver the child, even if the girls themselves would rather have used Plan B. This is an incredibly thorny familial conflict; it is not at all clear that parents have the right to force their underage daughters to bear children against their will. But that's a values conflict for a different day. What I'm sure of is that such parents do not have a claim on federal government assistance to enforce their beliefs. The HHS and FDA drug review process is supposed to determine whether drugs are safe and effective. The federal government should not be barring over-the-counter access to Plan B specifically in order to help a subset of parents to impose their reproductive beliefs on teenage daughters who disagree with them.
http://www.economist.com/blogs/democracyinamerica/2011/12/reproductive-freedom
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