The Politics of a Second Chance

Kirsten Moore is President and CEO of The Reproductive Health Technologies Project (RHTP).

This was the best Halloween ever. No tricks, just one big treat. After three long years of denial and delay, the new ‘dual label' packages of Plan B were shipped out last week. That means sometime this week, those of us who are 18 and over and have identification to prove our age should be able to walk into area pharmacies and buy Plan B without a prescription. There is a difference of opinion within the reproductive health and rights community about whether this current situation constitutes a victory. Recently I was involved in a lively email exchange with a colleague who takes strong issue with my use of the word "victory" to describe the Plan B decision. He rightly points out that "the FDA's approach [to Plan B] violates fundamental principles of bioethics, including beneficence, autonomy, and justice." That it does. And I will continue to fight to make sure that when the moment is right, the FDA and Barr roll back the unwarranted restrictions on access to Plan B. In the meantime, though I am celebrating the fact that Plan B will be easier to get for many and that we arrived here with the Administration's begrudging acquiescence. Why do I believe this?

The Reproductive Health Technologies Project has advocated for better awareness of and access to emergency contraception since 1992. We are not a membership organization, we do not provide services, and we do not take money from drug companies. We got involved simply because it made good sense and frankly, because at the time, few others in the women's health community, particularly pharmaceutical companies, were prepared to do so, so we set out to make easier access to EC a common sense, common ground issue in the overly heated abortion debate.

We knew an over-the-counter (OTC) switch – although the right thing to do from a public health perspective and one that was ultimately endorsed by groups like the American Academy of Pediatrics and the American Medical Association – was a high profile political gamble, but we thought "Bring it on. This is one we can win." We had confidence that with science, facts, and process on our side, we could navigate opposing beliefs and opinions, settle differences fairly and move forward in a diverse society.

And for one brief moment in December 2003 when experts went through the process of critically evaluating the science and the facts and hearing from interested parties, including those who opposed the switch, at the FDA's Advisory Committee meeting, we thought we had prevailed. Some of my colleagues (and I'm sure you remember who you are) were not shy about letting me know that my optimism was naïve. They were right – at least for a time.

Looking back, it shouldn't have been a surprise that our ‘common sense, common ground' strategy wasn't enough because ultimately this wasn't just a debate about abortion – the dispute over how EC works notwithstanding. As others have written it was also an early sign that our political opposition would start going after contraception and sex. But I think the debate over easier access to EC exposed a fundamental underlying difference in worldviews that helps explain different positions on issues of sex and contraception as well as abortion: whether and how much we, as a society, trust each other to do the right thing.

Those who oppose easier access to EC believe you can't trust women, you really can't trust men, and you certainly can't trust young people. In their world, Plan B gives everyone an excuse to behave irresponsibly and avoid consequences. In my world, Plan B simply gives people a second chance to avoid an unwanted pregnancy which is good because I believe people try to do the best they can and even when they don't – or when their best wasn't good enough – they can own up to their mistakes and try to do better next time.

The FDA's decision on August 24 to ease access to Plan B emergency contraception was long overdue and an important advancement for women's health. Of course much more has to be done to ensure any woman who needs EC can get it in a timely manner and in a way that does not insult her intelligence or autonomy. But the fact that we got a decision at all – not to mention one that had President Bush's blessing, albeit begrudgingly – make it a highly significant political victory.

Why did the political calculus at last tip in our favor? Well, probably not because the Administration believes in a second chance. After all, who needs a second chance when you're so damn sure you're right. More likely, the Administration didn't know what to do with the mess it had made. When it chose to ignore longstanding widely accepted processes for drug approval it found itself fighting not just women's groups but also scientists and physicians, and even disinterested politicians who don't like to see their colleagues dismissed out of hand. Scoring points with a political minority was not enough to outweigh the continual drip, drip of embarrassing detail provided in depositions of current and former FDA staff taken by the Center for Reproductive Rights as to how the FDA's decisions never matched its own review of the evidence.

So as OTC Plan B begins its journey to pharmacy shelves, I am celebrating. And waiting to see what this week will bring both with Plan B and in the larger picture of women's access to reproductive health care services across the country – undoubtedly a mix of bright spots and trouble spots. That's okay because the Plan B journey reminds me I am a glass half full kind of person. While my faith in science, facts, and process meant nothing to the Administration or political opponents in Congress, it turns out that the general public shared my faith. So whatever happens today, I will get up on Wednesday ready to keep working for a political world in which we try harder to understand and respect different points of view and, when necessary, prepared to give people a second chance to help others succeed.

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