Day of Action on Emergency Contraception #ECOTC

Last year, I wrote of my disappointment that HHS Secretary Kathleen Sibelius overruled the FDA’s decision to make emergency contraception available over-the-counter with no age restrictions.

The Reproductive Health Technologies Project has started a campaign to convince Secretary Sibelius to reconsider her decision.  Their goal is to deliver a petition with at least 50,000 signatures to Secretary Sibelius on December 7th.  The petition reads:

“Women’s health, including the ability to determine the timing and spacing of pregnancies, should not be subject to politics. After more than a decade of medical research, the Food and Drug Administration (FDA) determined emergency contraception (EC) is effective and safe enough for access without restriction. Doctors recognize EC as an important component of reproductive health care, allowing women a second chance to prevent pregnancy when a primary contraceptive method fails. In December 2011, Health and Human Services (HHS) Secretary Kathleen Sebelius overruled the FDA and restricted access to EC. We urge Secretary Sebelius to revisit the evidence and remove the restrictions, placing women’s reproductive health above politics.”

If you agree, sign the petition.

Connecticut Senate Race and Emergency Contraception

via Talking Points Mem0

As many of you have heard, Republican Senate candidate Linda McMahon has tried to fudge her pro-choice position by stating that Catholic hospitals should not have to give out emergency contraception as mandated by a state law passed in 2007.   (In a related  Akin-esque moment, she also introduced the bizarre term “emergency rape“).
So, in this sense, she’s no different than the Senator she aims to replace, Joe Lieberman, who when the emergency contraception bill was being discussed in 2006, said that rape victims could just “talk a short ride” to another hospital.

Prochoice groups in the state are getting out the word that Linda is no friend of reproductive rights.  “Pro-choice candidates don’t compromise the health and safety of rape victims especially when receiving time sensitive medication,” said Christian Miron, executive director of NARAL Pro-Choice Connecticut. “There is no shortage of evidence proving that Linda McMahon is neither pro-choice nor independent,” said Murphy campaign spokesman Ben Marter. “McMahon’s extreme policy for rape victims and her support for the Blunt Amendment makes it clear that she would vote in lockstep with Washington Republicans that want to erase decades of progress for women.”

I’m hoping that this will earn a win for Chris Murphy.  (oh if you out-of-staters would like to help, please give to his campaign).

My historical detective work on #Emergency Contraception coverage in New York Times

Over the past two weeks there has been a robust discussion on the International Consortium for Emergency Contraception listserv about reporting in the New York Times discussing recent findings on how emergency contraception works.  According to this article, “an examination by The New York Times has found that the federally approved labels and medical Web sites do not reflect what the science shows. Studies have not established that emergency contraceptive pills prevent fertilized eggs from implanting in the womb, leading scientists say. Rather, the pills delay ovulation, the release of eggs from ovaries that occurs before eggs are fertilized, and some pills also thicken cervical mucus so sperm have trouble swimming.

It turns out that the politically charged debate over morning-after pills and abortion, a divisive issue in this election year, is probably rooted in outdated or incorrect scientific guesses about how the pills work. Because they block creation of fertilized eggs, they would not meet abortion opponents’ definition of abortion-inducing drugs. In contrast, RU-486, a medication prescribed for terminating pregnancies, destroys implanted embryos.

The notion that morning-after pills prevent eggs from implanting stems from the Food and Drug Administration’s decision during the drug-approval process to mention that possibility on the label — despite lack of scientific proof, scientists say, and objections by the manufacturer of Plan B, the pill on the market the longest.”

I’ll let scientists comment on the emerging scientific consensus on this and comment on what this says about historical research. While researching my book, I’ve spent countless hours reading and re-reading FDA transcripts and I have no recollection of any such objections from the manufacturer of Plan B, which at that time was Women’s Capital Corporation.  Shortly after this article appeared,  Newsweek Senior Editor Sarah Blustain contacted me to find out more about the FDA’s decision. She asked whether this was a political compromise imposed on the manufacturers of Plan B by FDA.  I told her that I didn’t recall any of this so went back and looked at the transcripts available on the FDA website.  I couldn’t find anything in the original New Drug Application for Plan B filed by Women’s Capital Corporation.  After some further digging, I found the relevant discussion in a transcript from a joint meeting of the FDA Non-prescription Drug Advisory Committee (NDAC) and the Advisory Committee for Reproductive Health Drugs (ACRHD) held on December 16, 2003. However, I didn’t find any objections from scientists who presented on behalf of the manufacturer of Plan B.  The relevant section starts on page 288 of the PDF version.  First, Dr. Joseph Stanford, a member of the ACHRD asks:

“I understand, again, that the data that we have on mechanism of action for Plan B is imperfect, incomplete, but I think it’s a
critical issue for those women who want to understand how it works and have informed consent for use. So along those lines I have a question from Appendix 6 from the sponsor’s book. They list all of the answers to Question 7 about — after they
showed the women the package, they said, “Without looking at the label, tell me what Plan B is used for,” and then classified answers as either correct and acceptable or correct but not acceptable or not correct and not acceptable, and they list them
verbatim. And among the ones that are listed as correct and acceptable are a number of women who said that — one of them is, for example, an abortion type  thing for the day after. One was them was to kill a fertilized egg, and basically showing that some women had that understanding, and it was classified by the company as a correct and acceptable understanding of
what the product is for. And so I’m just wondering for the FDA did they also classify those particular answers as correct
and acceptable for what the product is for.”

NDAC chairman Louis Cantilena  then called Karen Lechter from FDA Dr. Leonard Segal answered, “Dr. Lechter unfortunately had to leave, and I don’t know that I can actually specifically address how she did hercalculation in her review on that particular issue. My assumption is though that she probably followed the sponsor’s categorization.” Chairman Cantilena answers, “There were a few tables that she showed in her presentation where she had asterisks where there was, you know, a difference between her, you know, assessment and the sponsors. But I don’t recall if that specific issue was asterisked or not.”

Dr. Valerie Montgomery Rice from ACRHD says, “I think that one of the things that Dr. Stanford is getting to — and you can tell me if I’m wrong — is a matter of informed consent such that the patient is as fully informed as possible based on all of the information that we know about how this product works.

So I guess I would ask the sponsor first.  When you’ve done surveys, if you have — and you may not have this information — in women who have taken emergency contraception and then you’ve asked them the question of how they  perceive, first of all, the medication worked, besides one of these studies because during that time, I think when you are dealing with that immediate issue of needing emergency contraception or even within the first couple of weeks while you’re waiting for that cycle to come, your perception of how it works may be different than when you sit down and really think about it.  So I think that’s one point.

And then, you know, even with my background, having a lot of experience with infertility and giving a lot progesterone, et cetera, and I’ve reviewed the literature, there is some data out there that really does suggest at very high dosages that there may be the possibility that you’re interfering with the implantation.

And so I guess my comfort level would definitely — I would definitely be a lot more comfortable making sure that the patient or the woman who makes that decision is as informed as possible that there potentially is a possibility that still gives that woman enough information to make an informed decision and not dilute any of her rights in deciding to proceed with this medication.”

Dr. Carole Ben-Maimon, one of the physicians presenting on behalf of Women’s Capital Corporation, answered:

“We are very sensitive to the fact that there are differing views not only of how this could potentially work, but also when pregnancy begins.  And so there are actually statements in the labeling with regard to the implantation issue in order to provide women information so that they understand and that they know that this could potentially prevent implantation.

Again, we believe the data is overwhelming.  We believe the medical definition, which is that pregnancy starts at implantation, is a critical point to keep in mind, but we are sensitive to the issues that others — the opinions of others.”

In other words, not only was there no objection from those representing Women’s Capital Corporation, they actually provided the information about possible effects on implantation that went into the label for Plan B. Now, this doesn’t meant that there weren’t objections from someone either from WCC or elsewhere — but I can’t find this in the official record.

So what’s the point here?  Well, what bugs me about the New York Times coverage is that it grossly oversimplifies the FDA approval process and assumes that anyone who worked for FDA or served on its advisory committees were only there to enforce the political will of the Bush administration.  In fact, the committee members mentioned above are respected members of the reproductive health community who were asking important, nuanced scientific and ethical questions that had nothing to do with the culture wars over reproductive rights.  (Dr. Montgomery Rice, for example, is Dean of Morehouse School of Medicine who has worked extensively on health issues affecting women of color — and we historians of women’s health all know how poorly women of color were and sometimes still are treated by medical researchers — e.g. the field trials for the original contraceptive pills in Puerto Rico and Haiti).  So, naturally informed consent would be a critical concern for her.

I would be interested to find out whom the NYT reporter interviewed for this story. I don’t think anyone is purposely trying to rewrite history but they may have selective memories.


#EmergencyContraception Past, Present, and Future

Rutgers University Press book exhibit at 2012 American Association for the History of Medicine annual meeting

via RH Reality Check and my book pictured at left. Actually, the title of the RHRC post has the name of a specific emergency contraceptive product and shows a video produced by NARAL ProChoice NY for their Champions of Choice 2012 awards luncheon. The organization, “honored the visionaries behind Plan B. From Sharon Camp, who pioneered this emergency contraceptive product and even founded a pharmaceutical company to bring it to market, to Teva Women’s Health, which not only stands behind the current product but has pushed the FDA to increase access by making it available over-the-counter for all ages.”

This is an excellent video but because it celebrates a particular product it has its limits.  First, it’s not true that no pharmaceutical company was interested in creating an emergency contraceptive for the U.S. market — Roderick Mackenzie created the now defunct company Gynetics specifically for that purpose and got the no longer produced drug Preven approved by FDA first.  Second, the story is framed rather narrowly by the ongoing culture wars over contraception and reproductive rights — e.g. in the repeated use of the phrase “politics trumping science.”  Although important, this framework ignores the ways in which the public shapes what “counts” as scientific knowledge. It also overlooks the specific historical circumstances that lead to the production of new knowledge, especially when this involves a politically controversial health topic such as birth control. Most importantly, this claim treats “the public” as though it were a homogenous entity, ignoring the multiple constituencies who have contributed to reproductive health policy in the United States and the ways in which their positions have changed over time.

Okay, now that I’ve addressed the past and the present (sort of), what about the future?  Well, historians aren’t in that business but I’ll offer some thoughts based on my book’s conclusions. Since the early 1990s, emergency contraception has served as a bridge issue that brought together former adversaries, including feminist health organizations, population and family planning
people, and groups representing women of color who were the main targets of attempts to control the so-called “population crisis” in the United States. In order to bring more radical groups onboard, mainstream population organizations and reproductive health professionals had to overcome much bad faith generated by sexism in the medical profession and the often coercive policies of the population movement during the first half of the twentieth century. A narrow focus on purely technological solutions to
the complex social problem of pregnancy prevention tends to dissolve this fragile alliance. Therefore, as experts and activists develop policies on making new contraceptive options available to all women; it is imperative that the language of rights
and reproductive choice continue to remain at the forefront of these deliberations.

2012 National Back Up Your Birth Control Day of Action

via Back Up Your Birth Control and RH Reality Check

Today is the 11th annual Back Up Your Birth Control Day of Action sponsored by the the National Institute for Reproductive Health.  So, once again I’m helping them spread the word by blogging about emergency contraception.  This year the campaign has asked us to combat the misinformation about emergency contraception that misleadingly equates emergency contraception with mifepristone (aka RU-486) which is used to induce medical abortion.  To combat this misinformation, this year’s theme is EC=BC, “emphasizing that EC is a form of contraception that prevents pregnancy even though it’s taken after sex.”

Misinformation about the mechanism of action of EC dates back to the origins of this birth control technology in the 1960s.  Two of the researchers who developed the first oral contraceptive pill — Gregory Pincus and Min Chueh Chang — first described their work on what they called a postcoital contraceptive in 1966.  Yet the third “father” of the pill — physician John Rock, a devout Catholic — falsely claimed that this “morning-after pill” was an abortifacient.  This erroneous statement has stuck despite efforts by Pincus, Change, other scientists and activists to set the record straight.

[for more on this fascinating history, see my book,  The Morning After: A History of Emergency Contraception in the United States.  You can find out more about it at the Rutgers University Press  website,]

Here are other ways you can join the Day of Action:

  • Share the images on our EC = BC tumblr with your networks! We posted many more new images today. Follow and reblog on tumblr, post our images on Facebook, and tweet or mention them on Twitter!
  • Get creative and submit your own images to the EC = BC tumblr! We’ll circulate your images on social media throughout the day.
  • Get an EC coupon for Plan B One-Step® and ella® on the Back Up Your Birth Control website! Use them to purchase EC for yourself, send them to your friends, and let others know they can buy it in advance so that they are always prepared.
  • Blog for EC! Help us dispel the misinformation by clarifying that emergency contraception is a safe and effective form of birth control that prevents pregnancy after sex, but only works if you are not pregnant.
  • Follow us on Twitter at @NIRHealth and @ProChoiceNY, retweet our #ECfacts, and spread the word about EC using the #ECBC hashtag!
Visit the Back Up Your Birth Control website for more information. If you have questions about the campaign, contact Nicole Grafilo at ngrafilo@nirhealth.org.

Review of Leslie Reagan, Dangerous Pregnancies: Mothers, Disabilities, and Abortion in Modern America

via H-Disability

Leslie J. Reagan. Dangerous Pregnancies: Mothers, Disabilities, and Abortion in Modern America. Berkeley: University of California Press, 2010. xv + 372 pp. $27.50 (cloth), ISBN 978-0-520-25903-4.

Reviewed by Heather Munro Prescott (Central Connecticut State University)
Published on H-Disability (March, 2012)
Commissioned by Iain C. Hutchison

Prescott on Reagan

This book continues the compelling story of the history of abortion in the United States that Reagan began in her award-winning book, When Abortion Was a Crime (1998). The title Dangerous Pregnancies refers not to pregnancies that were dangerous to the lives or health of mothers, but to the “dangers” to home, family, and society posed by the birth of “defective” babies. Focusing on the responses to the German measles epidemic in the United States during the early 1960s, Reagan shows how fears of disability helped lend legitimacy to the abortion rights movement.

Reagan goes beyond her earlier work by linking the history of reproductive rights to two other fields of scholarship: the history of epidemics and infectious disease; and the history of representations of people with disabilities. She shows that in marked contrast to earlier epidemics, the German measles outbreak did not single out nonwhite or other stigmatized groups as sources of infection. Nevertheless, race was at the center of media representations of the disease. Responses to the epidemic highlighted how the birth of a disabled child wrecked havoc on the status of white, middle-class, heterosexual, nuclear families. The epidemic came closely after alarming reports about severe birth defects in infants born to women who had taken the sleeping pill thalidomide while pregnant. Although the U.S. Food and Drug Administration had not approved the drug, some American women were able to obtain the drug from overseas. The story of Sherri Finkbine’s efforts to obtain an abortion after she discovered she had taken thalidomide while pregnant with her fifth child, helped transform attitudes towards abortion in the United States. During the pronatalist 1940s and 1950s, media coverage emphasized the deviant nature of abortion and of the women who sought these procedures. Finkbine’s story, along with that of other white, middle-class mothers who had contracted German measles while pregnant, transformed the image of abortion “from a shameful, thoughtless, and sick action to an ethical and responsible one” that protected families from the “burden” of raising a severely disabled child (p. 104).

Despite these changing attitudes towards abortion, significant barriers remained even for those who sought to terminate “dangerous pregnancies.” Reagan contrasts the cases of Barbara Stewart and Sandra Gleitman, who with their husbands filed “wrongful birth” cases against the hospitals that refused to provide abortions after the women had been exposed to German measles while pregnant. Both cases showed that hospital abortion committees were fickle and arbitrary. For the Stewarts, an African American couple, race posed an additional hurdle. While they had private health insurance, racial discrimination denied them access to physicians who had connections to hospital abortion review committees. By demonstrating the central role that race played in these deliberations, Reagan answers Chris Bell’s suggestion that disability studies scholars need to pay more attention to the experiences of “people of color.”

Reagan is less successful in showing how the German measles epidemic contributed to the emerging disability rights movement. She describes the work of “rubella parents”–most of whom were white and middle class–who fought for and won the right to public education for children with physical, sensory, and intellectual impairments. These parents were successful largely because rubella and its effects were not confined to the poor or to “people of color,” and because their arguments focused on the core middle-class value of access to education. Reagan also periodically mentions persons with congenital rubella syndrome and other disabilities, including those who objected to the “humane” and “merciful” reforms that made it easier for women to abort fetuses with birth defects. Reagan claims that even the suits filed by the Stewarts and Gleitmans reflected an aspect of this rights movement, since their aim was to get resources for their children. Yet Reagan underestimates the countervailing power of terms like “therapeutic abortion” and “wrongful birth” to reinforce prevailing beliefs that disability is a fate worse than death. Rubella immunization campaigns weakened the disability rights perspective even further. They used sentimental images of “pathetic” rubella children and played into popular notions of disability as a “tragedy” that could be prevented through universal vaccination against German measles.

Reagan shows how the rhetoric about “dangerous pregnancies” backfired during the 1980s and 1990s. Opponents of vaccination have seized on these same fears by alleging that vaccines cause autism, and that by refusing to vaccinate their children, they are saving themselves from the “heartbreak” of raising a disabled child. The discovery of fetal alcohol syndrome and other defects caused by environmental factors “erased” the history of women fighting for accurate information about potential threats to their babies and the right to abort “defective babies.” Public health campaigns by the March of Dimes and other organizations recast pregnant women themselves as risks to the unborn. Reagan rightly concludes that German measles acted as a “crucible for change” by prompting dialogue about reproductive rights, civil rights, and disability rights, but this change was incomplete. Abortion rights are increasingly under assault, and stigmatizing language about disability and misconceptions about persons with disabilities remain with us today.

If there is additional discussion of this review, you may access it through the list discussion logs at: http://h-net.msu.edu/cgi-bin/logbrowse.pl.

Citation: Heather Munro Prescott. Review of Reagan, Leslie J., Dangerous Pregnancies: Mothers, Disabilities, and Abortion in Modern America. H-Disability, H-Net Reviews. March, 2012.
URL: http://www.h-net.org/reviews/showrev.php?id=33916

This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 United States License.