Last week I had the chance to hear some hardworking women’s advocates discuss emergency contraception—and the barriers to its access. As the first installment of NARAL Pro-Choice New York’s new speaker series “Choices,” the panel discussion brought together representatives from NARAL Pro-Choice New York, the National Institute for Reproductive Health (NIRH), the NYC Alliance Against Sexual Assault, and SAFER.
I’ve been thinking about access to emergency contraception a lot lately, as NARAL Pro-Choice NY gears up for the Back Up Your Birth Control campaign . (For all you New Yorkers, remember that the NYC Day of Action is at the end of the month. See the community events calendar if you haven’t already marked it down in your planner.) But I was still amazed and enraged all over again as I listened to the speakers talk through the laundry list of obstacles women—young women, low income women, immigrant women, survivors of sexual assault, etc—often face when trying to access EC. It’s incredible, but not entirely surprising, then that a whopping 60% of voters say they do not know about EC and only 6% report ever having used it. (To see my full report on the discussion, check out the NIRH’s blog, Repro Health Hub.)
The many barriers to EC access starkly highlight how various problems—reproductive rights, sex education, economic justice, health care access, and sexual violence—overlap and intertwine to prevent far too many women from having true access to reproductive choice. Listening to the panelists speak about their work, I was struck, for the millionth time, by that truth that is sometimes easy to forget: rights do not automatically equal access .
Access to reproductive health care is still a huge problem for many women in this country. And even as some (i.e. William “Personal Responsibility” Saletan ) attempt to deny its existence, others (i.e. Republicans in Congress ) are actively trying to make it even worse.
Do you all have any personal stories about accessing EC? Or other reproductive health services? In one survey, 40% of women cited cost as the biggest obstacle to getting EC. What are the biggest barriers in your opinion?
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1. COST, absolutely.
2. Varied information. The first time I took Plan B (high school), I went to Planned Parenthood and they didn't tell me anything about health risks or loss of effectiveness. Birth control pills flat-out don't work for me and while I'm careful with condoms, I've had to take it a few more times than most people I know.
It wasn't until after going to PP and 2 different drugstore pharmacies that a pharmacist on my campus told me that every time you take Plan B, it loses lots of effectiveness. All along, _many_ of my friends had told me that taking Plan B is bad for you, a statement the pharmacist said is untrue.
All in all, I'm hearing EC is effective...but then it's not, it's bad for you...but then it's not. My OB/GYN told me to find another source of birth control...but said there's no health risk to taking Plan B so besides cost, she couldn't come up with a real reason not to use it as birth control. It's so confusing and there are so many mixed messages.
Maybe someone in the health/reproductive field can give me the bottom line on safety and effectiveness of EC (not that I can afford it anymore anyway...)?
I've never heard of the effectiveness decreasing with repeated use. It doesn't really sound logical to me...it's just a higher dose of the same ingredients found in birth control pills. Time to go hunt down some reading material...
Public health person here...
1. EC DOES NOT become less effective each time you use it. It DOES become less effective the longer you wait to take it -- like, it's much more effective if you take it 5 hours after unprotected sex than if you wait 3 days.
2. EC is safe. As with nearly every medication, some people experience side effects, like nausea and headaches. But there's nothing dangerous about it.
3. The reason EC is not a great REGULAR method of birth control is that it's less effective than the pill, condoms, and most other forms of BC. Also, if you take it regularly, your periods can get irregular.
Hope that helps!
Oops, looks like AnatomyFightSong beat me to it :) Just driving the point home I guess...
Agreed. There's a lot of misinformation out there. Here are two good places to go for the facts:
www.not-2-late.com
www.backupyourbirthcontrol.org
Basically, EC loses effectiveness the longer you wait after having unprotected sex, but it does NOT lose effectiveness over time if you take it multiple times. And taking it more than once does not make you sterile--that's another myth I've heard was out there. thegecko is right, EC contains the same hormones as birth control pills and is very safe. The reason your OB/GYN maybe have discouraged you from using it as your primary form of birth control is simply that it is not as effective as regularly taking birth control pills. So the safest bet is to use it as a back-up.
I decided to be extra careful after a condom slipped off. At the time I was a college student from PA at a summer internship in NYC. From the Bronx, the closest place to get Plan B was the medical center affiliated with the school. I thought since I had insurance (a PPO) that it would be covered, but unfortunately the bill ended up being like $80 even with insurance. I was shocked! Obviously I'd have preferred not to go to an ER for something so simple, but it seemed I didn't have a choice.
I just walked right into the student health services at my college and asked for it. They gave me a pregnancy test and then gave me the EC for free (well, technically the health services fee I paid in my tuition paid for it). No problems at all; no reproving looks or lectures or anything - and I went to college in rural Georgia.
Just today, one of my PROFESSORS mistook RU-486 for "the morning-after pill," which just served as a personal highlight for the level of misinformation surrounding EC.
IMO, misinformation is pretty high up there as a barrier. Many people truly believe that Plan B is an abortion pill. Many don't know that it can be taken up to 72 hours after intercourse. During virtually every discussion on it I've had with a group, several people have mixed up the potential side effects with the considerably more severe side effects of RU-486.
Another barrier that's often shrugged off by non-feminists is the embarrassment many young people feel about needing EC. I've bought EC for several people who weren't comfortable asking a pharmacist for it - like there's something wrong with not wanting to be pregnant! But many young people do feel guilty or dirty about it, ESPECIALLY if they are recent victims of sexual assault. It's a very difficult and confusing thing to get through, and having to take pills afterward - because of what happened - can really compound it in ways that are hard to explain.
I've had two experiences with this due to a broken condom:
The first time I went to a womens clinic to get it. It took a grand total of THREE HOURS to get it and get out of there. I was stuck in the waiting room for ages. They made me take a pregnancy test in order to get it. I had to answer a billion and one questions. What if I'd had to work that day?
The second time I bought it from CVS. Thank god I'd just gotten paid because that was 60 bucks or so and I didn't/don't have a lot of money.
Oh, and distance. I had to drive thirty minutes from my town to the clinic and just as far to CVS. I'm really glad I'm able to have a car because there isn't public transit running between the two towns.
1. Misinformation/Propaganda
2. Cost
3. Red Tape
In Wisconsin, low income women can sign up for a free family planning services program...they even send you a debit card of sorts to use for payment services, such as pelvic exams or STD testing, etc..However, as I found out when I went to the pharmacy to get it, EC is only free if you have a prescription for it. So...if you are poor enough to need the program in the first place, how are you to afford a doctor appointment? Bus fare there and back? Perhaps childcare if you have children? Gas for your car, whatever? Time off from your crappy job?
Just saying. Red tape. I couldn't afford that appointment. I had to go to the nasty Health Department that I swear is designed solely to make all of us poor people, but most especially minorities, feel like crap for even exisiting. The doctor didn't give me a problem but I lost a day's worth of pay sitting in line like a bunch of cattle.
As previous posters have stated, the biggest barriers to EC seem to be misinformation and cost. I know plenty of people who are convinced it causes abortions.
Fortunately, I've yet to be in a situation where I need to take Plan B, but I did pick up a pack from the student health clinic at my university about a month before my wedding. We were honeymooning out of the country, so I figured it would make good sense to bring some along just in case. I explained the situation to the OB nurse and asked if I could get a pack of Plan B along with my birth control refill (they keep all kinds of contraceptives on site, no pharmacy visit necessary) and she thought that was a great idea. It wound up costing me an extra $13 (mind you, this was 2004, the cost has probably gone up). But the folks who work at our university clinic are wonderful, progressive people who believe in freedom of choice. I've never had a problem asking them for anything, even when I was single and living in sin.
I use to live in a very wealthy area and my local Planned Parenthood would give you a FREE Plan B (along with condoms) after each visit. I now live in, well, a "less wealthy" area and Plan B does not give out anything. hmm
I live in California, by the way, and it is very easy to access EC as it does not require a prescription. It is $25 though. I remember listening to a radio station advice line and the "doctor" told the girl a cheap alternative to EC - three or four birth control pills taken at one. Yikes, not quite sure if I'd trust that!
Thats what our womens clinic does. They have you take a week or two worth of regular BC, then a couple hours later do it again.
I did this in college a couple of times. I could get BC through my parents' insurance, and I just got an extra pack from the free health clinic. Then I took extra doses because I read that it's esentially what EC is. Now I question the safety of that kind of thing, but it seemed like a good idea at the time.
The Planned Parenthood my mom used to run did the same thing before Plan B was approved - they gave women a pack of pills and while I don't remember the exact dose, it was similar to what you described. Since Plan B is just a high dose of the same hormones in BC pills, it really does work the same way - it's just not as convenient, and you need to know what the correct dosage is.
In my small city, there is a large number of teenage parents, as well as the rest of the county, so the Planned Parenthood here offers free EC to any girl, and free EC to any guy who is at least 18. I went to get it for my friend so I went in, showed ID, answered some questions, got my blood pressure taken, and came out with EC. Oh, and they just charged me 10$ for the "medical exam". The only negative was that the hours of the Planned Parenthoods here (there are two within 15 minutes of each other) are pretty damn inconvenient. Or, one day there won't be a physician at one place or something like that.
If people really hate abortion, I do wonder why they don't push contraception? After all, it would prevent pregnancies that would otherwise be terminated?
I hate it when people turn healthcare, a vital need, into something that allows them to get rich off of other people's problems.
A good number of people who oppose abortion completely also oppose birth control because they believe it works along the same principles. Because many BC methods prevent implantation, many people believe that you're killing a baby because the egg is fertilized and just can't implant.
Now, some of those people support certain methods, such as condoms, but oppose others.
I also know a good number of people who believe that we all should be open to as many babies as God gives us, so they oppose all BC from that perspective.
My experience with Plan B was terrible. I'm on BC pills, but had sex when I was on antibiotics. I couldn't find any information about whether it was actually appropriate for my situation. I was terrified when I walked in the pharmacy and shocked that it cost $50. If only there was some way to force the other responsible party (men) to help out. Beyond that, my mom noticed the large charge on my debit card. It could have been a lot worse, but it was still on the whole much more unpleasant than it needs to be.
I'm sick of pregnancy avoidance being a secret women's world that we even aren't supposed to tell each other about. So f'ed up.
Three things:
1) Have ECP handy.
If you're sexually active, don't wait until there's an emergency. Assume you'll needed it and have it near by. [The packs have a shelf life of up to 2 yrs.]
2) KISP[eople]
The sooner you take it, the better, Also, if you're using a dedicated product like Plan B, take both pills at the same time. [Take an OTC antiemetic if you've experienced N/V with past use.]
3) OCPs work, too.
In a pinch, if you're an OCP user, you can substitute OCPs for Plan B. This is a good reference.
Wow, that site is a great reference! Thank you for posting this.
I got EC in the emergency room after being sexually assaulted. When the nurse brought it up, they way she talked about it was almost like a sales pitch, as if she was expecting me to balk at it. Of course, I said HELL YES. Later she told me that a lot of victims are pretty wary of taking EC, even after being raped - probably because of the misinformation about it floating around out there. I think hearing that made me sadder that being raped in the first place...
I wish I had your nurse when I went into an ER after being raped. You feel so vulnerable and judged already, and the nurse I had did offer me EC, but then spent a long time telling me that I didn't need it because I was on birth control. However, as I told her, I was on antibiotics also (both are for my skin). I didn't even remember at the time that antibiotics decrease the effectiveness of bc - in the past I'd had pharmacists warn me, but had never thought much of it because I wasn't sexually active. So I went along with the nurse's reccomendation not to take EC. When I came out of shock a few days later and thought about the fact that antibiotics make birth control less effective, I was disgusted. I spent just over two weeks absolutely terrified I was pregnant from the rape.
In college I had no problem, the health clinic was more than willing to prescribe it and it was reasonably priced. However, I once needed it while I was at home and called my family doctor (keep in mind this is an all female, supposedly progressive women's center) and I was completely shamed for it. The physician's assistant reamed me out over the phone and told me this is the one and only time the doctor will ever prescribe this for me. It was horrific.
I'm actually really appalled at the cost that so many comments have referred to - $50, $60, $80??
I live in Canada, so some cost may be subsidized by government programs (EC is not covered by the health insurance I had at the time), but the two times during university that I needed to get it, it came out to $25. More than that, and I probably wouldn't have been able to afford it on a student's lack of income.
So medea in Canada is appalled at what EC costs in the US - well I'm appalled x1000. I'm European but live in China, where you simply walk into a pharmacy, literally any chemist's of a reasonable size, describe what you need (or just tell them the brand name of the most popular oral EC, basically the same as what's sold as Plan B in the States), and they give it to you over the counter, no fuss. It cost me 18 yuan, which at present is about $2.60.
You don't get funny looks, and you certainly don't get pregnancy-tested or any of that! I can't believe what you all had to go through! I was especially lucky because the boy I was having the wonderful sex with at the time was a medical student who not only knew what to look for, he also volunteered the $2.60 because he felt it was kind of his fault.
The day I took the pill I certainly felt the side-effects - bloating, wooziness, headache, all of that. But it was nothing compared to the sense of relief at being temporarily resident in a country where birth control isn't a matter for judgement or subject to obstruction by religious fanatics. Of course the Chinese One Child Policy, which is at the root of this great availability, is a whole other kettle of bad-for-women fish, but at least it has had favourable side-effects for women's contraceptive choices. Information available to women would be the next thing to improve in China on this front - I've heard of Chinese girls from less well-educated backgrounds having so many abortions that they genuinely damage their reproductive systems, and that kind of phenomenon could be greatly reduced if more girls were told about emergency contraception.
As for Ireland, my home country, the story is a bit similar to the US: available, but expensive, and you need to go through hoops there too. Teen pregnancy in Ireland is shockingly, unnecessarily high, and I would carelessly guess that it has something to do with the rather pathetic, Catholic-influenced sex education still prevalent in state schools (at one point we were shown a sex-ed video made by a nun - a NUN!). So funnily enough it's information that's the stumbling block in both of these countries.