The Morning After: A History of Emergency Contraception in the United States

Conclusion

In an editorial for the journal Contraception in 2009, Francine Coeytaux, Elisa Wells, and Elizabeth Westley summarized the success of a twenty-year battle by women’s health advocates to bring emergency contraception “from secret to shelf.” Accomplishments included the creation of dedicated products, an increase in women’s awareness and use of this contraceptive method, and increased access through over-the-counter sales for women seventeen and older. Yet, despite this progress, the authors observed that advocates of emergency contraception had “encountered a curve ball that has us circling back where we started.” Analyses of the impact of growing availability of emergency contraception indicated that this technology had not fulfilled the promise of substantially reducing unwanted pregnancy on the population level. Rather than blaming this on user error, the editorial suggested that the population model aimed at reducing the epidemic of unwanted pregnancies and abortions was outdated and insulting to women. They and other reproductive health professionals needed to acknowledge “that individual women have a right to use the contraceptive method that best suits them, not the one that best contributes to overall demographic indicators.” The editorial observed that “women’s health advocates have fought long and hard to make ‘choice,’ not demographic indicators, the foundation of reproductive health services.” Emergency contraception was an excellent example of expanding choice, not only because it gave women a second chance to prevent pregnancy, but also because women could obtain this drug themselves with minimal intervention by the medical profession. The editorial urged other reproductive health and donor communities to not give up on emergency contraception just because it was not Conclusion 125 126 The Morning After proving to be as effective on a population level as originally expected. Instead, professionals in the field should protect women’s access to this contraceptive choice so they could “decide for themselves how EC [emergency contraception] fits into their plans to avoid an unintended pregnancy.”1 The editorial correctly observed that emergency contraception had come “full circle” in the sense that it had failed to fulfill the promise of “curing” the “disease” of unwanted pregnancy. It has not even filled the hopes of feminist activists that all women could access this product without any interference from health professionals. Emergency contraceptives are not literally available over the counter but are kept behind the counter, and customers must show identification proving they are old enough to purchase them. This is not the only OTC drug product sold this way. A number of states have recently passed laws or regulations requiring cold medicines containing the decongestant pseudoephedrine to be placed behind the pharmacy counter to prevent the bulk purchase of the drug to manufacture crystal methamphetamine. These developments have in effect created a third class of drugs whose restricted market is no longer defined in terms of the prescription but by the nature of the “counter.” This means that pharmacists have replaced physicians and nurse practitioners as the gatekeepers for certain classes of drugs. It also has allowed some pharmacists to create new barriers to medication access by asserting that they have a right to conscientiously refuse to sell emergency contraception on religious grounds.2 Yet, by endorsing the language of choice and women’s rights used by feminist health activists, the editorial illustrated how the attitudes of some reproductive health professionals had changed considerably over the past half century. During the 1960s, the “morning-after pill” was touted as a solution to the worldwide population crisis and the “epidemic” of unwed pregnancy in the United States. This shift in perspective reflected the professionalization of the women’s health movement. Since the 1970s, feminist health activists had gradually become insiders in reproductive health by earning professional credentials, which gave them the ability to reform organized medicine and healthcare policy from within. Although some of their contemporaries accused these newly minted professionals of “selling-out,” the corresponding radicalization of the medical establishment had a profound affect on reproductive healthcare for women. This transformation led health professionals to reevaluate the older disease-based argument that drove innovation in contraceptive technology. An emphasis on rights also gave advocates a way to prevent opponents from co-opting messages about risk and safety used by earlier feminist critics of 127 Conclusion hormonal contraception. In her testimony at the over-the-counter hearings for Plan B, thirty-five-year-old Amanda Leader, co-chair of Red Stockings...