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Plan B Battles Embroil States

The effort to expand use of emergency contraception began well before Barr Labs made its applications to the FDA. As early as 1998, pharmacists conducting a study in Washington state began giving double doses of traditional contraceptives to women who had just engaged in unprotected sex and were worried about becoming pregnant.

Study leader Donald F. Downing, a University of Washington pharmacy professor, said the druggists found a "huge unmet need." Downing, often called the "grandfather" of the pharmacy access movement, helped establish a protocol in his state that allows pharmacists to give women emergency contraception, in the same way that pharmacists in some states can distribute emergency drugs for bee stings.

"What we've consistently found is that there's enormous interest among pharmacists in doing this, and there are thousands and thousands of women who need this service," he said. The FDA has not interfered in the practice because while it alone can decide which drugs need a prescription, states have the right to determine what constitutes a valid prescription.

Other Plan B advocates have also pushed to require hospital emergency rooms to stock and dispense emergency contraceptives to sexual assault victims -- a proposal opposed by Catholic hospitals -- and to require pharmacies that carry traditional contraceptives to carry emergency contraceptives as well.

While proponents are achieving some success in the more Democratic blue states, their efforts have not been as well received in Republican-leaning red states -- and Barr's lobbyist said the company spends little time pushing legislation in those more conservative states. The director of the Kentucky Right to Life Association said that a Plan B pharmacy access bill introduced this year is not expected to succeed.

"We're confident that our legislature will not approve the bill because we are strongly pro-life here," said Margie Montgomery. "Doctors tell us that Plan B can cause a very early abortion, and we oppose that."

Wendy Wright, president of Concerned Women for America, has testified against Plan B before the FDA and in numerous states because, she said, easier access jeopardizes women's health and welfare. Women need a prescription to buy birth control pills, she said, and it makes no sense for them to buy Plan B, a stronger version of the pill, without one.

While the Plan B debates in the states often involve traditional culture-war antagonists, they are not the only players. In Maryland, for instance, state Sen. Sharon M. Grosfeld (D) initially introduced a bill that would set up a collaboration between doctors and pharmacists that would allow the druggists to dispense Plan B without a prescription. That bill, however, ran into opposition from the state medical society as well as those opposed on religious grounds.

The bill Grosfeld then proposed would have the pharmacists work with the state Department of Health and Mental Hygiene, and would avoid the organized doctors that way. Her bill was narrowly defeated last year, and has been reintroduced this year.

The primary opposition to Plan B, however, has come from groups that contend that it can lead to very early abortions -- though experts say it acts in the same way as regular contraceptives. Efforts by antiabortion groups led to the passage last year of a Texas bill that eliminated the drug from a demonstration family-planning program, and to an Arkansas bill that kept emergency contraception off a list of protected contraceptives.

Jackie Payne of Planned Parenthood accused Plan B opponents in the states of mounting "an active attempt to blur the line and confuse people about emergency contraception -- saying it's abortion when it's not. Our job is to explain how emergency contraception avoids later abortions, and is in fact a win-win for everyone."


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