Louder For the People in the Back

Birth Control is Still Legal, Even in Missouri

Last week the New York Post reported on a non-controversy regarding the availability of emergency contraception pills (ECPs) at a Duane Reade on Wall Street. Apparently, some of the customers thought it was backwards that the store would lock up the socks but leave contraception out where—gasp—a kid could see it or—double gasp and clutch pearls tightly—pick it up. While some say it’s “ridiculous” to lock up cosmetics but leave contraception in an easy-to-grab bowl, I say it’s brilliant. People need unfettered access to exactly this kind of product.   

For those who have never lived in Manhattan, Duane Reade is a classic pharmacy now owned by Walgreens. It’s famous mostly for its ubiquity in New York City—think Dunkin’ Donuts, Starbucks, or Au Bon Pan (Boston circa 1990s)—you can stand in one and see the sign for at least one if not two others. 

The Duane Reade in question is way downtown near the intersection of Water and Wall Street. Because shoplifting is so common, the store locks up many of its items including chocolate, ice cream, and energy drinks. Packages of Take Action emergency contraception, however, were available in a bowl near the checkout lane for $39.99. According to the New York Post, the situation was similar in two other Duanes Reade in the area.

We all know that that stores put impulse purchases—things we might have forgotten we needed (like band-aids and lip balm) or those we really don’t need but may buy if they’re in front of us (like Us Weekly and gum)—near the front so we get stuck on line staring at them. We’re used to this in supermarkets and drugstores, and it must be a great retail marketing strategy because other stores like Dick’s Sporting Goods and Old Navy have started doing it as well. (I just bought a travel-sized bottle of Tums there along with a new pair of mid-rise jeans.)

Some shoppers felt that emergency contraception was not an appropriate impulse purchase for all of the reasons you’d expect (“Won’t anybody think of the children!!!”). One man who grew up in Queens and was visiting from Florida with his tweens told the New York Post, “You would think it would be with the other birth control products, but it’s just out in the open next to the sunscreen.” He’d like to see the product locked up behind the counter. A local construction worker thought “it just doesn’t make sense” that he had to get a store worker to unlock the fridge so he could grab a Red Bull, but anyone could just take this. Emily, another tourist, also from Florida, asked, “What about the kids seeing that stuff? They start questioning, ‘What’s that?’”

I’m still trying to figure out if this was a story that someone approached the New York Post with because they were outraged or if the New York Post approached these shoppers and got the outrage they were seeking.

If the Post had asked me, I would have been pleased rather than scandalized. I might have pointed out that sexual health products can be embarrassing to shop for (and quickly added that they shouldn’t be, but we’ve been culturally conditioned to believe sex is a taboo). I could have explained that people, including young people, need easy access to products like condoms and emergency contraception pills and added that ECPs should be taken as soon as possible which makes quick access even more important. I probably would have also noted that putting these products behind lock-and-key can stop people from buying them, thereby leading to more unintended pregnancies.

If Emily had asked me, I would have suggested that the kid probably won’t notice/care about the pills especially since the display was right next to the candy. If they did care, I would suggest—as I always do—simple honesty: “Oh that’s medicine you can take if you don’t want to get pregnant.” 

Alas, nobody asked me.

The Post did ask Walgreens, but the company didn’t respond. While the pharmacy giant gets kudos for recognizing a non-story, it gets none for recognizing the need to make contraception easy-to-access. According to a manager at the Wall Street Duane Reade what gets put in the bins is “just random.”

Missourians Think Birth Control is Illegal

Birth control is legal in Missouri. I repeat birth control is legal in Missouri. I’m saying it loudly for the people in the back (let’s say Springfield, Joplin, or Branson) because a recently released survey found that more than half of Missourians did not believe that emergency contraception (EC) was legal in their state, and some were worried about the pill as well. These results should not be surprising given the nationwide confusion that followed last summer’s Dobbs decision and two very public fights about EC in the Show-Me state.

The survey of more than 1,000 residents was conducted as part of the The Right Time Initiative, a coordinated effort by health clinics across the state to provide free and low-cost birth control. It found that 53% of Missourians did not believe/know that emergency contraception is legal in the state, 40% did not believe/know that IUDs are legal, and 25% didn’t believe/know that birth control pills are legal in the state.

What all three of these birth control methods have in common is the misperception that they are abortifacients (drugs/devices that cause abortion). We’ve been over this half-a-zillion times, but I’ll say it again for the people in the back (let’s say Washington DC), that’s not how it f**king works.

Birth control pills block ovulation, thicken cervical mucus, and slow sperm progress toward the egg, but they don’t do anything after the sperm and egg have met, and they can’t end an established pregnancy. Same with emergency contraceptive pills: they thicken cervical mucus (hi, Cecily) and, depending on when in the menstrual cycle they’re taken, they also prevent ovulation. ECPs cannot end an established pregnancy, and research has shown that they don’t stop implantation if a woman takes it after ovulation/fertilization.  

In the early days of IUDs there were some questions about how they really worked and whether they simply prevented implantation of a fertilized egg in the uterus. Today, we know this isn’t the case. IUDs work primarily by slowing the progress of sperm through the uterus and fallopian tubes. Hormonal IUDs may also prevent ovulation, and copper IUDs are toxic to sperm.  

I feel the need to add that even if any of these methods did prevent implantation, that doesn’t make them abortifacients because medicine says that pregnancy starts at implantation. Of course, I know the forces spreading misinformation about contraceptives are not coming at this from a medical point of view. These are the same forces who want to prevent abortion as early as “conception” which is a religious concept that doesn’t exist in scientific literature.

These are also the same forces that have been at work in Missouri trying to blur the lines between contraception and abortion in an effort to prevent both. One MO lawmaker, Paul Weiland, started his fight in 2013 when he sued to stop the state health insurance plan from covering contraception saying that it violated his Catholic beliefs. He won and kept fighting.

In 2021, Weiland and his Republican colleagues held the state’s Medicaid funding hostage, saying they would only authorize the Federal Reimbursement Allowance if Democrats would agree to add a caveat that no state Medicaid funds would be used to cover “any drug approved by the federal Food and Drug Administration that may cause the destruction of, or prevent the implantation of, an unborn child.” Since Medicaid can’t fund the mifepristone/misoprostol combo that can actually cause an abortion, it was clear that this new definition was an attempt to make sure the state didn’t fund emergency contraception.

This confusion played out in the state again after the Dobbs decision. Missouri was one of the states that had a trigger law all passed and ready to go. The law banned abortion in all cases other than medical emergencies and criminalized the procedure meaning medical professionals who performed an abortion could get up to 15 years in prison.  

This scared the doctors and lawyers at St. Luke’s Health System which runs 16 hospitals in the state. St. Luke’s worried that EC might be forbidden under the new law because the packaging on EC pills at the time said that they might work after fertilization. (The packaging has since been changed to better reflect science.) St. Luke’s announced it would stop providing EC at any of its hospitals, even to victims of sexual assault. State officials, including the Governor and the Attorney General, rushed to say, “No, no, EC is not an abortion, and contraception isn’t banned even under our super strict laws.” That may have been enough for the hospital system which begrudgingly reversed course, but this survey says that it wasn’t enough to clear up the confusion among Missouri residents. 

The people of Missouri, however, are quite adamant in their views that birth control should be legal and easy to get. A majority (84%) of survey respondents (including 82% of Republicans, 90% of Democrats, and 85% of Independents) support adults having access to birth control. Moreover, 72% of respondents (including 74% of Republicans, 72% of Democrats, and 73% of Independents) think the Missouri legislature should pass policies that make birth control more affordable and accessible.

I don’t see that happening, but maybe with Weiland gone (he was term limited) we could convince the legislature to fund an education campaign promising people that their package of Yaz does not count as contraband, and asking for Mirena isn’t going to get them sent to the slammer.