Posted on 6.13.2013 by Lily
So a lot's been going on with Plan B lately, yeah? Let's recap the events of the last few months:
In April, Judge Edward Korman raked the Obama administration over the coals for playing politics with emergency contraception and ordered them to grant the 2001 (yes, really) Citizen's Petition to make Plan B over-the-counter with no age or point-of-sale restrictions whatsoever.
In May, the Obama administration appealed his order because why not drag this endless saga on for as long as humanly possible? Why not maximize the number of days in which women's lives are changed forever because they can't access EC? Meanwhile, the FDA was off making a sweetheart deal with Teva (the company that manufactures one brand of EC) to lower the OTC age to 15+, but give Teva's brand OTC market exclusivity. I explained a few weeks ago why this policy, despite the lowered age from 17 to 15, would actually make the situation more harmful to girls and women than the current 17+ behind-the-counter status.
Last week, the Obama administration was ordered to make the two-pill version of EC immediately available over-the-counter. A few days ago, they responded by announcing that they would drop their efforts to restrict sales of the one-pill version (also known as Plan B One-Step). The two-pill version, however, they still want restricted since young girls might be flummoxed over having to take so very many pills! I mean, two pills versus one, that's tricky - math is hard, amirite girls? Good thing we have the Justice Department protecting us from straining our pretty little brains over figuring out how on earth you take two pills that come together.*
Anyway, all the different policy proposals and rulings and orders are convoluted and confusing and pretty emblematic of this decade-plus long struggle to get emergency contraception, arguably the safest medication in existence and one of the most critical for women's health, to be sold simply like Tylenol and condoms so that everyone who needs it can just… go ahead and buy it.
Pro-choice advocates like Cecile Richards, president of Planned Parenthood Federation of America, and Nancy Northup, president of the Center for Reproductive Rights, are hailing these most recent events as "huge victories" and "historic moments" for women's health and rights. "Finally, after more than a decade of politically motivated delays, women will no longer have to endure intrusive, onerous, and medically unnecessary restrictions to get emergency contraception," said Northup after the Second Circuit Court of Appeals ordered the administration to make the two-pill version available OTC.
Really, Nancy Northup? Really, Cecile Richards?
I recognize these are good steps forward, but I see them as that: baby steps forward. And not baby steps over the finish line, either. I think maybe I can see the finish line from here, but it's still a ways off.
It's either overly optimistic, naïve, or politically calculated to say that women are no longer going to face unnecessary restrictions to getting emergency contraception. We don't know exactly what the details of the policy will look like; the Obama administration submitted their retraction of appeal to Judge Korman, who still has to approve it. (And he doesn't take any shit, so we'll see if what they proposed is good enough for him!) Then, perhaps most importantly, we'll see what happens with brand names versus generic EC and market exclusivity. Plan B can run pretty expensive – over $50 is not uncommon for a pack, and a generic can be about $35, which is still fairly pricey for a one-time medication. If Teva has market exclusivity on Plan B One-Step on store shelves, as I delved into previously, it was estimated that the pill would cost over $60. Obviously the difference between brands and generics matters. If Plan B is now available OTC without age or point-of-sale restrictions, but the only OTC option costs over $60, are we really better off? Are the women and girls who are most disadvantaged – the ones who stand to benefit the most from a policy change – really going to be better served when they can get the pill without a prescription and without having to show ID, but they have to cough up more than $60 to do so?
I can't celebrate this news yet. Not until I know exactly how it's going to be put into place: what's going to happen with generics, will Teva have market exclusivity, what will prices be, whether they'll ever stop this ridiculous game of distinguishing between the one-pill/two-pill versions as though they're not the same exact damn thing, will EC actually be more accessible and affordable to everyone who needs it. Time will tell. All I can say now is that while we're seeing some cautiously good news, it's just the next agonizing slow step in the right direction in our country's sordid history around this life-changing medication. It's really not a historic moment, so let's not get out the champagne just yet.
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*I do admit that there is a disadvantage to the two-pill version in that the instructions still in many cases say to take the two pills twelve hours apart. This is unnecessary; taking the two pills together, as if they were one pill, is just as effective as taking them twelve hours apart, and much simpler. Women following the twelve-hour instruction are more likely to forget the second dose, which renders the regimen useless. But this is a problem of the packaging instructions, which should be changed to reflect the two-pills-together guideline; moreover, paternalism is not a good reason to keep the pills behind the counter – especially when there are generic two-pill versions that could be a lot cheaper than the one-pill OTC version.
Posted on 5.31.2013 by Lily
Note: This post is part of our collective blog remembrance for Dr. Tiller on the 4th anniversary of his murder.
About ten months ago, a 16-year-old girl in the Dominican Republic died of complications from leukemia after doctors spent three weeks withholding chemotherapy because she was pregnant.
About six months ago, Savita Halappanavar, a 31-year-old woman who was 17 weeks pregnant with a non-viable and dying fetus, died of blood poisoning when the hospital she went to in Ireland refused her a life-saving pregnancy termination.
Today, Beatriz, a 22-year-old mother with lupus and a high-risk, non-viable pregnancy lingers in an El Salvador hospital as her 26-week pregnancy endangers her life a little more every day. The Salvadorean Supreme Court decided that she would not be permitted a life-saving abortion, which essentially amounts to a death sentence, as Beatriz's doctors have assessed that continuing the pregnancy will likely kill her. They did decide she could be allowed a premature delivery by C-section - despite that the C-section is far riskier to Beatriz and, y'know, the fetus still won't survive. (You can support Beatriz's cause here.)
These are only a few stories. No doubt there are countless other women like Beatriz, Savita, and the anonymous 16-year-old who do not come into the grip of the world's attention, inspiring international frenzies and calls for justice.
Now another story. Four years ago today, Dr. George Tiller, perhaps the most well-known provider of second and third trimester abortions in the United States, was gunned down in his church in Wichita, Kansas, by a radical anti-abortion domestic terrorist.
What do these stories have in common? They are all about killing under the guise of "pro-life." None of these stories support life in any way that I understand it.
Dr. Tiller specialized in helping women no one else would. People flew to see him in Kansas from all over the country. They never expected to need his services. But pregnancies and life circumstances take unexpected twists and turns, and Dr. Tiller helped those in devastating circumstances who often found themselves needing to terminate desperately wanted pregnancies.
I imagine all but the most ardent anti-abortion folks believe that Beatriz should be "allowed" an abortion. After all, without one, both mother and fetus will likely die, which is surely a worse outcome than only the fetus dying. And they might think such a situation as is playing out in El Salvador today would never come to pass in the U.S. Of course, we would always do what needed to be done to save the patient, under circumstances so cut-and-dry.
But here's the thing. It's never cut-and-dry. There's no line dividing Beatriz from Dr. Tiller's patients. You may have your own guidelines for when an abortion is acceptable; when the patient has a 95% chance of dying, perhaps. 75%, 50%. If the fetus has this condition, or that one. If it definitely won't survive outside the womb. If it probably won't. If the woman was raped.
Who decides? Who decides how bad it has to be, how dire a woman's situation, how heart-wrenching her story, how sympathetic her character or the circumstances surrounding the conception? Who decides?
In El Salvador, a few judges decided - and took their sweet time, too, which is why Beatriz is now 26 weeks pregnant. Because that is what happens when abortion is illegal. Yes, there are varying degrees of legality, and few countries' laws are quite so harsh. But when you take the ability to handle a pregnancy out of the hands of the pregnant person and her medical team, well, a woman might very well end up wasting away as her pregnancy kills her a little more each day, waiting for some powerful people far away who don't know her to decide her fate.
Another woman might quietly languish at home, her physical health okay while she agonizes over how this child will fare when her three others already go to bed hungry. Maybe she thinks it would be more merciful to not bring this child into the suffering.
Maybe another woman's pregnancy is viable - so far - but when her husband beats her up, she fears for both her own and the baby's safety - and fears the child being born into that home even more.
Maybe another woman's physical health is okay, and she isn't being abused, and the pregnancy is healthy. But her depression grows by the day, and she may well become suicidal if the pregnancy continues.
Dr. Tiller famously wore a pin that said "Trust Women". With him gone, fewer women are trusted with their own bodies and lives.
It seems like every day there's another restriction on abortion in this country. Another TRAP law, another 20-week ban, a parental consent law. There are no sensationalized stories about the woman who goes bankrupt to pay for an out-of-state and later abortion because her local clinic closed for not having wide enough hallways. The pregnant teenager living in such fear and denial, unable to tell her parents as her pregnancy progresses past the point of decision, doesn't make the headlines. The patient weeping at the clinic where she found out she is two days past the 20-week cutoff, and now bewildered and lost with no idea where to go, doesn't inspire an international outcry.
All of them should.
Dr. Tiller's death left a gaping hole in American women's health care. Today, four years after his brutal assassination, it's even more crucial that we honor his memory and trust women - here and everywhere.
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Posted on 5.31.2013 by Lily
May 31, 2013 marks the fourth year since Dr. Tiller, an abortion provider in Wichita, Kansas, was brutally murdered while serving as an usher in his church. Dr. Tiller was known worldwide as a provider of compassionate, kind, respectful later abortion services that focused on preserving the dignity and integrity of his patients.
To honor his legacy, the Abortion Gang and the Provider Project asked folks to reflect on later abortions. Below is a list of posts taking on this topic and thinking about Dr. Tiller. This list will be updated as the day goes on:
Dr. Tiller, Beatriz, Savita, and all the others
Dr. Tiller Remembered
The Legacy of Dr. George Tiller
In Memory of Dr. Tiller, on the Fourth Anniversary of his Death
Remembering Dr. Tiller
Dr. Tiller was my abortion provider and he changed my life
On Anniversary of Dr. Tiller's Murder, Anti-Abortion Harassment is Still Hurting Women and Doctors
To Honor George Tiller's Legacy, Give to an Abortion Fund
Four Years After Murder of Dr. George Tiller, His Wichita Abortion Clinic Reopens Despite Threats
If you've written a post in honor of Dr. Tiller and don't see it above, please email the URL to email@example.com, tweet the link to @ProviderProject, or leave it in the comments.
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Posted on 5.29.2013 by Lily
This Friday, May 31, 2013 marks the 4th anniversary of Dr. George Tiller's murder. One year ago, we at the Provider Project and the Abortion Gang hosted a collective blog call for remembrance in his honor, and we'd like to make this an annual tradition. Unfortunately, threats against abortion providers are still all too real and we are fighting an ongoing battle against abortion restrictions across the United States. This year has seen a surge particularly in laws banning abortion after certain points in pregnancy, from a 12-week ban in Arkansas to the recent proposal to ban abortion nationwide after 20 weeks. Dr. Tiller was widely known for his 2nd and 3rd trimester abortion care, and it was ultimately his unwavering commitment to providing these services that was the reason for his assassination four years ago.
In light of that, we'd like for posts this year to address the question of those abortions performed in the 2nd and 3rd trimester that are most threatened legally right now. Your post could use some of the following questions as jumping-off points:
Why are there so few 2nd and 3rd trimester abortion providers in this country? How can we improve the situation so that more doctors provide this care?
Why is it so important that abortion remain legal past 20 weeks?
How would a nationwide 20-week ban affect the country, or your community? How might it affect your personal reproductive health decisions?
In your post, please link back to this blog post so that folks can come here and find links to other reflections on Dr. Tiller.
The Abortion Gang and The Provider Project will post links to pieces written answering this question, starting Friday, May 31through the following Friday, June 7. Please feel free to forward this call for posts to anyone who you think would be interested in honoring Dr. Tiller’s legacy. Send the links to your posts to firstname.lastname@example.org and email@example.com, tweet them to @AbortionGang and @Provider Project, or leave them in the comments.
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Posted on 5.16.2013 by Lily
Official Plan B One-Step and FDA guidelines still say that the levonorgestrel emergency contraceptive must be taken within 72 hours (3 days) after unprotected sex. Working in reproductive health, it's easy to forget that the standard 120-hour guideline is still technically off-label, since every single other health authority cites it. But even if the 120-hour guideline is the one most often followed in clinics and by sexual health experts, pharmacists dispensing the medication won't instruct off-label use, and patients could figure it's not worth it after reading the drug labeling.
Yes, it's always better to take EC as soon as possible. But a patient should not be discouraged from taking EC after 72 hours because it CAN still be effective for two more days, and it's time that the official FDA instructions reflect that.
Why exactly has the FDA not caught up with standard medical practice on this? Oh right, possibly because they're corrupt, overtly politicized, incompetent drug company panderers who put women's health last.
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