Immaculate Contraception

Medicine and theology face off in the pharmacy


It can be hard to be a God-fearing pharmacist in America. Just ask Neil Noesen, a Roman Catholic pharmacist who refused to dole out the birth control pill and was ordered to take ethics classes by a Wisconsin judge. Or the unnamed, now famous Illinois pharmacist who refused emergency contraception to two Chicago women. He was treated to a tongue-lashing by Illinois Gov. Rod Blagojevich, who then spread the anti-pharmacist wrath state-wide by declaring an "emergency rule" and ordering anti-contraception objectors to cut it out and hand it over.

Emergency contraception (EC), or the morning-after pill, is not the fetus-ending abortifacient that such uproar would suggest. When taken within 72 hours, EC prevents pregnancy by keeping fertilized eggs from implanting in the uterus wall. But it's still controversial, both because some insist that it is a form of abortion, and because others oppose contraception altogether. The FDA has kept it prescription-only because many in congress are uncomfortable with the concept, and increasing numbers of pharmacists have refused to deal in what they see as a moral liability masked as medicine.

The issue has grabbed headlines because it appears to be a rousing clash between stumpers for reproductive freedom and stalwarts of the Christian right—two groups not known for holding back in the midst of a good fight. Pharmacists' objections are likely to have greater implications because EC may change the way Americans get all kinds of drugs. The FDA insists that the morning-after pill is a prescription-only affair, so Washington, California, Alaska, New Mexico, Hawaii, and Maine have redefined prescription-only. Certain pharmacists are authorized to prescribe specific drugs, which has created a third class of pharmaceuticals that are neither prescription-only nor over-the-counter, but behind-the-counter. Some pharmacists can now ask a few questions and hand over the goods. They're being asked to make decision once reserved for doctors.

EC refusals in New Hampshire, New York, Texas, and Wisconsin have prompted a sea of state legislation country-wide, some seeking, like Blagojevich, to protect the needs of women who want contraception, others promoting "conscience clauses" giving pharmacists the right to refuse those women. The likes of Planned Parenthood and Pharmacists for Life would have us believe we're at the apex of some moral mountain with slippery slopes on all sides. After all, "Only Communist China forces people to do things against their conscience," explains Tennessee state Rep. Glen Casada (R-College Grove), who is sponsoring conscience-clause legislation. Planned Parenthood and the National Women's Law Center say pharmacists have a responsibility to restrain their beliefs and fill prescriptions. But asking them to check their faith at the pharmacy door is dehumanizing. Equally implausibly, pro-life pharmacists say women should just go somewhere else for their contraception fix. The morning-after pill becomes less effective after a day has passed, and just getting a prescription can take that long. Add wrangling one's way out of work, and the clock starts ticking. Being forced to shop around in rural America can mean the difference between getting EC in time or getting an abortion later.

Something is off when access to contraception depends on who is working the late shift at Walgreen's. The real scandal is not that women are being denied birth control, but that they have to ask for it. There is no reason why a woman's access to contraception should depend on a single Roman Catholic with a conscience, or why a pharmacist should have to weigh the decision between denying a woman her prescription and violating deeply held moral beliefs.

Contraception doesn't belong behind the counter; it belongs over-the-counter. A woman's access shouldn't hinge on whether she has health insurance, whether she has a doctor she can call at 5 a.m., or how her neighbors feel about the culture of life. Women should be able to order stacks of the stuff off of the internet to keep in their medicine cabinets, and pharmacists should be free to keep their drugstores clear of anything they find morally questionable. Pharmacy owners should be equally free to work out their own individual policies—and employ workers who agree to abide by them.

The FDA will probably let EC out of its moralistic grip any day now, and much of this unnecessary debate will whither away. But EC is just a high dose of the birth control pill, which is still prescription-only despite meeting all FDA criteria for over-the-counter status. The pill has been liberating American women for over four decades. It's time to liberate the pill from the web of legal requirements and moral bickering keeping it under wraps.