The Morning After the Morning-After Pill
by Joseph C. Krupnick

As debates rage at the Supreme Court over the right to life, a related issue has provoked equally vitriolic political discussion. At stake is the dispensing of Plan B, the popular morning-after pill that reduces the risk of pregnancy by at least 85 percent if taken within 72 hours of unprotected sex and by 95 percent if taken within 24 hours. The current debate is over so-called "conscience clause" bills — introduced in 12 states and already passed in four (Arkansas, Mississippi, Georgia and South Dakota) — that would grant individual pharmacists decision-making power over whether to dispense the drug to women holding prescriptions. Pharmacists with moral objections to the morning-after pill would therefore be able to opt-out of providing the medication on a patient-by-patient basis.

As with the larger abortion debate, the "conscience clause" debate is primarily undergirded by political and moral predilections. Moral objections to the morning-after pill have already been so virulent that in many states rape victims are not offered the drug in the treatment kits they receive at hospitals. Still, moral arguments overlook the practical nuances that, in the long run, should trump even the most severe ethics.

Supporters of the bills make two distinct but related arguments; both are specious and pragmatically dangerous. The most common argument is that Plan B provides incentive to use the pill as an irresponsible form of contraception. Robert Meyer presented precisely this fear in the conservative journal Renew America: "Once we offer our approval to certain behaviors, we only increase the likelihood that they will grow in frequency of practice even without the safeguards that permissive folks claim will be the solution to the problem."

This argument is both illogical and unlikely, given the facts. Despite conservative admonitions, women do not perceive Plan B as a form of contraception equivalent to condoms or birth control. This is true almost by definition: consumers of Plan B did not plan to consume an emergency drug. What's more, the high concentration of levonorgestrel, the pill’s active ingredient, discourages frequent use. Its considerably unpleasant side-effects include nausea, menstrual changes and headaches. A recent study by the University of Pittsburgh showed that only 5 percent of women who use Plan B come back to use it again. The study also showed that women are no more likely to increase sexual activity and no less likely to use condoms after taking the morning-after pill.

Moral supporters of the "conscience clause" also argue that the morning-after pill is no different from doctor-performed abortion procedures. Under the assumption that fertilization is the earliest stage of human life, they argue that if the pill is consumed after ovulation, Plan B can in fact be abortifacient. So conservatives like Matt Sande of Pro-Life Wisconsin argue, "It just recognizes that pharmacists should not be forced to choose between their consciences and their livelihoods. They should not be compelled to become parties to abortion."

Here again the argument holds little water. There is consensus among physicians that life does not begin with fertilization, but with implantation, when the fertilized egg attaches itself to the lining of the uterus. Implantation generally occurs five to seven days after fertilization, long after the morning-after pill is consumed. Even assuming life does begin with fertilization, studies show that less than 5 percent of women take the pill after fertilization has occurred. And that rate drops dramatically the earlier the pill is consumed.

More importantly, abortion is precisely what the morning-after pill prevents. When pharmacists deny women the right to the drug for moral reasons, women are demonstrably more likely to pursue abortions later. A recent study found that Plan B reduced the number of performed abortions by 51,000 in 2000 and that the drug decreased the number of abortions by 43 percent between 1994 and 2000. Even if we grant the argument that an abortifacient Plan B constitutes a full-fledged abortion, the statistics still dramatically support the drug: in 2000, Plan B would have reduced the number of abortions by 45,000. Thus, if conservatives really aim to reduce abortions, it would be more pragmatic to support dispensing of the morning-after pill.

The more pernicious problems with the "conscience clause" bills, though, are the socioeconomic issues at stake. Pharmacists are ill-equipped to make such important decisions for patients. A pharmacist is no more a moral authority than the average person, and certainly less of a scientific authority than the doctor who prescribed the drug. In fact, a recent survey showed that 78 percent of physicians — and fully 52 percent of conservative physicians — feel that pharmacists should be required to fill a doctor's prescription for the pill.

The financial interests of convenience stores and pharmacies would also create an intractable disconnect between commercially driven owners and morally minded pharmacists. Pharmacies and convenience stores are driven by economic need to meet the demands of their consumers. Women who can't fill their prescriptions at one store because of a pharmacist's moral objections will take their business elsewhere. In the long run, morally minded pharmacists will just be replaced by those who have fewer qualms about dispensing the drug. This has already happened in Texas at Eckerd, in Ohio and Wisconsin at Kmart, and in California at The Riverside Neighborhood Hospital Center. In fact, Kmart has stated it will fire any pharmacist who refuses to fill Plan B prescription.

Delegating the morning-after decision to pharmacists is dangerously counterproductive. The "conscience clause" falls apart underneath its own flimsy foundations. If supporters of these bills possessed more foresight about their pragmatic implications, they should retain the current mandate rather than relying on self-righteous moralizing. Politics, Machiavelli taught us, should be an exercise in pragmatism and expediency, not a setting for personal ethical biases. If only today's politicians recognized this, it would save us all a lot of trouble and heartbreak down the road.

E-mail Joseph C. Krupnick at joekrupnick at gmail dot com.

— graphic by Dan Worthing