Last week, another one of Bush’s politicized appointments favored ideology over reality, as the Food and Drug Administration (FDA) rejected over-the-counter availability of emergency contraception (E.C.).
The decision, condemned by the American Academy of Pediatrics, the American College of Obstetricians and Gynecologists, and the American Public Health Association, bears the mark of David Hager, chairman of the FDA’s Reproductive Health Drugs Advisory Committee. Hager is “scantily credentialed,” in the charitable words of Time Magazine; prior to his appointment, Hager served part-time in a voluntary position with Lexington’s Central Baptist Hospital. He’s well qualified in substituting opinion for science, however, in his private practice, Hager refuses to prescribe contraceptives for unmarried women, and advises prayer for women experiencing menstrual pain. It’s on his authority that women’s access to E.C.—available over the counter in 33 countries—is being hampered, counter to the advice of two of the FDA’s own expert advisory panels on the subject.
Opponents of over-the-counter access argue that E.C. poses greater risk to women, especially young women, than the average over-the-counter drug. Wendy Wright of Concerned Women for America, for example, asserts, “The FDA is right to be cautious about having a potent drug that can harm women next to candy bars and toothpaste.” Yet if E.C. opponents are genuinely motivated by concern for young teenagers, it’s unclear why they fail to consider age-restricted over-the-counter sale as an interim option, as possible dangers to young women are clinically assessed.
The issue of young teenagers’ response to E.C., though legitimate, is being cynically employed as a smokescreen for the Concerned Women’s real objection: the medically unsound belief that E.C. is an abortion procedure. Ironically, lack of access to E.C.—an increased dose of hormonal contraception, which prevents the attachment of the unfertilized egg to the uterine wall—is closely linked to teen abortion rates. Abortion opponents such as Concerned Women should recognize that E.C. poses a highly effective method of lowering teen abortion rates, and is not itself an abortive process. Instead, by misconstruing E.C. as abortion, and lobbying against it as such, Concerned Women and groups like it are effectively promoting higher abortion rates, whether or not they care to recognize it.
Jeffrey M. Drazen, M.D., editor of the New England Journal of Medicine, argues that “treatment for any other condition, from hangnail to headache to heart disease, with a similar record of safety and efficacy would be approved quickly,” and that the FDA’s refusal to approve over-the-counter E.C. availability “suggests that the FDA’s decision-making process is being influenced by political considerations.” Foremost among these is the concern, cited by 49 Congressional Republicans in a letter to President Bush last January, that over-the-counter E.C. would encourage teen promiscuity. Scientific studies have failed to bear out that claim. Vivian Dickerson, president of the American College of Obstetricians and Gynecologists, reaffirmed in a recent press conference that E.C. “does not increase promiscuity among teenaged women,” and that “over-the-counter status would not encourage young people to have unprotected sex.” To pander to uninformed constituencies, however, E.C. opponents are denying medical evidence in favor of common nonsense: that contraception makes for frisky teenagers. The results are pleased, voting parents; meanwhile, youth are put at risk.
The FDA’s decision is especially frustrating in light of the time-sensitivity of E.C. If taken within 72 hours of intercourse, the pills reduce the chance of pregnancy by as much as 89 percent; the sooner the pills are taken, the greater their efficacy. In situations of rape, particularly involving young victims, the process of finding a doctor and coming forth with the experience can pose a barrier to E.C. access. Even with older women, or in cases of contraceptive failure, getting a doctor to write a prescription in time can be difficult. With the decision to bar over-the-counter access to E.C., Hager has seriously compromised the safety of American women, placing his personal aversion to contraception before their health and welfare. Hager has every right to his opinions, but insofar as they detract from his ability to protect Americans’ reproductive health, he has failed his position on the FDA, and American women with it.
