No Condoms for You

Says John-the-Walgreens-Check-Out-Guy

The nation is still reeling from the Dobbs decision and this week the White House weighed in with an Executive Order designed to protect what remains of abortion rights. The truth is that there is nothing the President can do on his own to restore reproductive rights in those states that have been gleefully restricted them since the Supreme Court removed all guard rails last month. Biden has explained that the only way to bring back abortion rights nationwide would be for Congress to codify the right to choose in a federal law. He said he would support lifting the Senate filibuster rules to make this happen but Senators Manchin and Sinema are yet again refusing to let go of their grip on the party’s balls (or in this case the country’s uteri) to make that happen. Instead, we’re left with an executive order that is great on intent but short on specifics.

The order directs various departments within the government to protect access to medication abortion, ensure the availability emergency medical services, protect patient privacy, and address deceptive or fraudulent advertising/practices. (Crisis pregnancy centers anyone?) It also calls on the Attorney General to convene a volunteer cadre of lawyers who would provide pro bono legal services to anyone who lawfully sought reproductive care including those who traveled out of state to do so.

It's a great list of things we want to see happen, but it is left very vague as to how the various departments will make sure that they do. And there’s a reason for that. Each day it is feeling less like we live in a functioning democracy, but we still have separation of powers which means the Executive branch can’t do all that much on its own. 

Emergency Contraception is Not Illegal, Even in Missouri

When the Dobbs decision was handed down, Missouri Attorney General Eric Schmitt wasted no time informing the Revisors of Statutes that the state’s trigger law—referred to as “The Right to Life of the Unborn Child Act”—was now in effect. The act not only outlaws abortion in all cases other than a medical emergency, it makes inducing an abortion a class B felony. Under this law, women who have an abortion are protected from criminal prosecution, but the medical professionals who perform the procedures could receive up to 15 years in prison.

Many pundits suggested that the language in the law—which was passed in 2019 in the hopes that Roe would be overturned—is open to interpretation both as to what constitutes an abortion and what counts as a medical emergency. While some doctors in the state were wondering whether they had to wait to treat ectopic pregnancies until a woman’s life was truly in peril, St. Luke’s Health System decided that its 16 hospitals would stop providing Emergency Contraception (EC) even to victims of sexual assault. The hospital worried that because the packaging on EC suggests it might work after fertilization, the so-called “morning after pill” was no longer legal in the state.

As we have discussed many times before, EC acts much in the same way the birth control pill does; it prevents ovulation and thickens cervical mucus. EC does not terminate an already established pregnancy. The murky part is whether it could prevent a fertilized egg from implanting in the uterus (a scenario researchers believe is unlikely but hard to test for) and whether Missouri law would consider that a termination.

Missouri officials rushed to reassure the hospital that EC is not prohibited by the new law. A spokesperson for Attorney General Schmitt said, “Missouri law does not prohibit the use or provision of Plan B, or contraception.” Governor Mike Parson tweeted: “To address any misinformation: Missouri law has not changed the legality of contraceptives. Contraceptives are not abortions and are not affected by the Right to Life of the Unborn Child Act.” Even the director of Campaign Life Missouri got in on the reassurance telling the St. Louis Post-Dispatch that someone can’t intend to terminate a pregnancy if they don’t yet know they’re pregnant. (I’m pretty sure there is a logical fallacy in here. Couldn’t you intend to terminate any pregnancy that might exist?)

St. Luke’s Health System was not entirely convinced. While the hospital system did agree to start providing EC again, it said in a statement: “The ambiguity of the law, and the uncertainty even among state officials about what this law prohibits, continues to cause grave concern and will require careful monitoring.” Democratic lawmakers are not convinced either. In a letter sent Monday, they asked Governor Parson to call a special session of the legislature so they could pass bills clarifying the law.

One Step Closer to Over-The-Counter Birth Control Pills

On Monday, HRA Pharma became the first company to seek FDA approval for over-the-counter birth control pills. Oral contraceptives have been on the market since the 1960s and have been credited with helping women advance personally, professionally, and politically by being in control of whether and when they get pregnant. Though some states allow pharmacists to provide oral contraceptives, most people in the United States need a prescription from a doctor to get the pill.

For a drug to be made available without a prescription, a manufacturer must seek permission from the FDA and then prove that their drug can be safely and effectively used without professional supervision. While advocates have been pushing for over-the-counter (OTC) access to the pill for over a decade now, few pharmaceutical companies have been interested in spearheading the process which is expensive and time consuming and may not lead to huge profits. HRA has been preparing this application—and the research to back it up—for seven years.  

Kelly Blanchard, president of Ibis Reproductive Health, one of the groups that makes up the Oral Contraceptive Over-the-Counter Working Group, explained to the AP: “A lot of our research has been about making the case to help inspire and support a company to take this work on.” The working group funded some of HRA’s research and runs a media campaign called “Free the Pill.”

HRA is putting forth a pill called Opill which it bought from Pfizer in 2014. Opill is a POP—a progestin only pill. Most hormonal birth control (whether it is in pill form or comes as a patch, shot, or ring) contains both estrogen and progestin, but POPs, sometimes called the minipill, rely on progestin alone. Many of the side effects of hormonal birth control, including potentially dangerous side effects like blood clots, are caused by estrogen so the minipill is considered safer especially if we’re taking the doctor out of the equation.

That said, the minipill may be slightly less effective than combined oral contraception in preventing pregnancy. Like other hormonal methods, the minipill thickens cervical mucus (hi Cecily) and thins the lining of the uterus to prevent sperm from getting anywhere near the egg. It does prevent ovulation but less consistently than methods that also contain estrogen. Taking the minipill at the same time every day can maximize its effectiveness.

The hope is that having the pill available without a prescription will remove a barrier for some people and make birth control more accessible. Of course, this only works if it remains affordable. The Affordable Care Act requires most insurers to cover FDA-approved birth control methods at no cost to the consumer. For the most part, this has only covered prescription methods. If the OTC version of the pill is not covered, it could be more expensive than other options for some people. (Certain cynical sex educators who shall remain me have often wondered if Republican support for OTC birth control pills was just a cover for making women pay more and insurers pay less.) HRA says it is working to keep the price down and Ibis says it is working with insurance companies to ensure coverage.  

The FDA’s decision is expected early next year.

No Condoms for You (Says John-the-Walgreens-Check-Out-Guy)

Seinfeld’s soup Nazi has nothing on John from the Walgreens in Hayward, WI. John does not want you to have condoms. Not because you took too long to choose between the Minestrone and the Matzah Ball (or in this case the lubricated and the ribbed), but because his faith forbids him from selling prophylactics.

Here’s the story.

Nate and Jess Pentz were heading to a vacation home they recently purchased about 45 miles from Hayward when Jess realized she’d forgotten her birth control pills. They stopped at Walgreens to see if the pharmacy could provide a refill. (It’s called a vacation override and forgetful travelers like me have taken advantage of such a thing many times). Unfortunately, the store’s pharmacy had already closed.  

Jess had gone in by herself while Nate stayed in the car with George, their dog. She did exactly what someone who realized she was about to miss a few days of birth control pills should do—she picked up a box of condoms which are an excellent, easy to get, easy to use backup method.

When she got to the register, however, John said no. Citing his religious convictions, the cashier said he would ring up all of the other items Jess had grabbed but not the condoms. Eventually, John called a manager who checked out her entire order. Jess left the store upset and told Nate that she was embarrassed in front of the three or four men who were in line behind her.

Buying personal care items—be they condoms, tampons, or hemorrhoid cream—can be uncomfortable. We often look down, hope the person behind the counter doesn’t notice exactly what we’re purchasing, and let out a sigh of relief when the product has been safely hidden inside a brown paper bag. I once had someone describe buying condoms with a credit card as the pinnacle of manhood, by which he meant he was brave enough and confident enough not only to purchase the product but to let the cashier know his name.  

Jess is in her 40s and has been married for 17 years. She was buying condoms to have sex with her husband. There was nothing illicit or illegal going on and yet she was embarrassed. Imagine how a teenage girl or twenty-something boy or someone having sex for the first time would feel if they encountered John’s religious convictions as they attempted to exchange money for pregnancy and STI prevention.

Nate said something similar to the local paper and also questioned whether John acts the same toward male condom-purchasers. Jess filed an official complaint with the Walgreens corporate office in which she said that an employee refused to sell her condoms and “… proceeded to embarrass me in front of other customers for my reproductive choices.” The couple says they don’t necessarily want John fired but think the store should have a process in place for calling on a manager on another cashier without embarrassing the customer.

Apparently, as Jess left with the condoms that the manager finally rang up, John said: “I hope you have a nice day.” She replied, “I hope you have the day you deserve.” Well played, Jess. Well played.