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Outlook: No Plan-B

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Dana L.
Attorney
Monday, June 5, 2006; 12:00 PM

The controversial contraceptive pill Plan-B, which lowers the chance of pregnancy by preventing implantation of a fertilized egg in the uterus if taken within 72 hours of intercourse, was supposed to be available over-the-counter months ago, but conservative politics have held it up. And that turned out to be more than a problem for Virginia lawyer and writer Dana L. , who was unable to get the drug after an unexpected, unprotected tryst with her husband. It turned out to be a major misfortune. Because her doctors wouldn't prescribe the pill, either, the 42-year-old mother of two became pregnant and found herself confronting the decision to have an abortion.

Dana L. was online Monday, June 5, at noon ET to discuss her Sunday Outlook article, What Happens When There Is No Plan B? , ( Post, June 4, 2006 ), and the continuing political debate over the "morning-after" pill that has made Plan-B unavailable to American women.

The transcript follows.

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Burke, Va.: While I am pro-choice and I do support Plan B being on the market, I felt like your anger was misdirected in this instance. I too have a small child and since my husband and I are not sure if we will have anymore children, we use birth control even in the heat of the moment, even when we have a precious few moments by ourselves. I hope I never have to make a decision like you did, I would not wish that on anyone, but it just appears completely irresponsible to have CHOSEN not to use birth control, when you had it readily available, then be angered at the government for your lack of resources after the fact.

I completely agree that the government should not meddle with a women's right to choose, but I also know that there are consequences to having sex whether your 15 or 40 and 1 minute would have spared you the heartache and time it took you to resolve those consequences.

Dana L.: While you may feel my anger was misdirected, I feel angry not just for what happened to me and my family but at the whole situation. What about people who find themselves in this situation on a Thursday night after having been raped? Or if their diaphragms or condoms failed? Yes, my husband and I made a mistake--people do, sometimes, we're human--but, the medicine is out there--medicine that would have prevented an abortion--medicine that is available over the counter in many other countries.

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Arlington, Va.: I admire your courage with your difficult decision, but instead of just asking "why I shouldn't have this baby," which you listed in detail such as your career, your life, your time, baby's health concerns, etc., did you ever consider "why I should have this baby?"

Dana L.: Yes, of course, my husband and I considered keeping the baby, too. As I said, it was a very painful decision--both physically and emotionally, and not a choice one makes easily. For a multitude of reasons, some medical (some of which I have detailed in the article), and others not, which we would prefer to keep private, we decided it was best for all concerned not to keep the pregnancy.

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Myersville, Md.: Thanks for the honest article. Does Planned Parenthood distribute Plan B in Virginia or is it only available through MD offices? If not, is it because of Virginia's state laws regarding the distribution of birth control?

Dana L.: I believe Planned Parenthood distributes Plan B nationwide. Unfortunately for me, in my panic that Friday, I didn't even think of calling them.

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Washington, D.C.: Did any of those doctors have a problem with prescribing ordinary birth control pills? Based on my understanding, Plan-B and birth control pills work the same way, so why would a doctor allow BCP but not be willing to prescribe Plan-B?

Dana L.: That is a puzzle to me, too. I would love to quiz my [former] ob/gyn about it as well as my internist, but, frankly, I don't know how I would, now that the article has appeared.

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Arlington, Va.: I just wanted to thank you for sharing your story. It must have been incredibly painful to relive, but I (and many, many other people, I'm sure) very much appreciate that you told it. Your anger, sorrow, and pain come through loud and clear, and I can only hope that someone influential reads your piece and is as affected by it as I was and decides to finally do something to give women options. I'm very lucky in that my ob-gyn, without my even asking about it, offered me an undated prescription for Plan B so I could have it on hand whenever I needed it. I'd urge all women out there who think they might need emergency contraception to find a doctor who will prescribe it, then get one of these undated prescriptions so they don't have to scramble when they need it.

Dana L.: I am so glad to read your post. One of the main points I had in writing my piece was to encourage all women to have on hand a standby prescription for emergency contraception so they won't find themselves in a situation like mine. Bravo to you for your forethought, especially in view of the current situation we find ourselves in vis a vis reproductive rights.

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Alexandria, Va.: Isn't it a little too easy to blame "the administration" for an unwanted pregnancy that was your responsibility? And just why should it be easy to terminate a pregnancy? That's not the same thing as going into the dentist to have a cavity removed. You're terminating a nascent life -- shouldn't you have to go through a bit of trouble to achieve that? Does it surprise you that doctors who struggle to bring life into the world don't want to help you destroy a new life?

Dana L.: You are missing the entire point. I wanted my doctors to help me prevent a pregnancy through Plan-B so I wouldn't have to abort a pregnancy later. Yes, I made a stupid mistake with my husband--but the diaphragm could just as easily have failed, or I could have been raped by a stranger--and I still would have been in the same place--with the doctors refusing to prescribe me emergency contraception. My point is the Bush administration is unwittingly encouraging abortions through its misguided Plan-B policy!

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Washington, D.C.: "the medicine is out there--medicine that would have prevented an abortion"

I would argue that that the "medicine" wouldn't prevent an abortion, it would cause one. That is why this is such a difficult subject. Reasonable people (I think I am, I assume you are) can have a different set of "facts" that they are working with.

Dana L.: The scientists at FDA--presumably objective people--didn't agree with you--however.

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Washington, D.C.: I too was stunned by your decision not to use a condom or refrain from sex. Before I was married, I set my alarm at 6am on the weekends, just so I could take the pill at the same time I took it during the week to ensure I got 24 hour coverage. If I had sex during ovulation, my boyfriend wore a condom or we refrained. Inconvenient? Definitely, but worth it.

Dana L.: Yes, I agree it was a mistake, and a dumb one. But the same result would have obtained if the diaphragm had failed or I had been raped. So the policy issue for all of us remains the same, does it not, even if you don't like my particular set of facts?

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Washington, D.C.: Thanks for sharing your very personal story. I don't know why more attention hasn't been made of the FDA's handling of Plan B, including the huge loss of Susan Wood, but maybe this will finally help. Have you heard from any politicians or lobbyists who want to push this issue forward?

Dana L.: No, but I hope my article helps to galvanize action on the seemingly stalled issue.

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Crofton, Md.: Doctors are not required to perform abortions. Nor should they be required to prescribe Plan B, because Plan B kills human life. Don't be mad at your doctor.

Dana L.: Different people see things differently. I don't see Plan-B any differently than the Pill. Do you view the Pill as abortion?

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Upper Marlboro, Md.: Dana, the pill is an abortion. I have heard of girls who died trying to abort the baby by using that pill.

Dana L.: I think you are possibly confusing Plan-B with the mifesteprone or RU-486 drug.

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Germantown, Md.: To compare yourself to a rape victim is absurd and offensive. I am not suggesting you did not face a horrible dilemma, and I respect your right to keep certain things private. However, your need to put the responsibility for that choice on someone else's shoulders is astounding.

Dana L.: I am not in any way comparing myself to a rape victim; that is absurd. I am simply saying how a pregnancy occurs is irrelevant. If someone who had been raped had called my doctor and asked for Plan-B, she would not have been able to get it either. Presumably, you wouldn't be making the same value judgment about her that you are making about me, and you wouldn't force her to have go through with that unintended pregnancy . . .

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Arlington, Va.: Dana, I found your article interesting since I had a similar event, but mine happened in the wee hours of Saturday AM, so calling my OB/GYN wasn't even an option. I immediately called PP on Sat. morning and went in for Plan B, which was administered right away. After paying $65 for the visit, I made a note to talk to my doc.

I asked her for a prescription to have on hand 'just in case', which she provided, along with a pack of 'regular' because pills with instructions on how to use them for emergency contraception (EC).

All women who think they might need Plan B need to do this! Arm yourself with a Rx before the emergency arises.

Secondly, I discussed it with my husband and he decided to have a vasectomy in order to avoid a repeat of the incident, which I thought was mighty sweet of him.

I hope your story raises awareness.

Dana L.: Thanks for your post. I wrote the article precisely to raise awareness and to get women to arm themselves with backup prescriptions for emergency contraception just-in-case. You never know . . . I never knew my own doctors would refuse me! And you know this health care system. You just can't get a strange doctor you've never seen to write you a prescription. Too bad I didn't think of Planned Parenthood in my panic.

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Fairfax, Va.: Aren't doctors required to prescribe two forms of birth control for women taking Category X drugs? Are you taking Crestor? Are the doctors only supposed to warn you and leave it up to you? This was a real eye opener for me. Living in the possibly the most media saturated area in the country, having post graduate education, and (presumably)health insurance and regular health care, it didn't even occur to a lawyer (or her husband) to call Planned Parenthood or other pro-pill, abortion activists to find out more because she panicked? What can we expect from teenagers? I was never a big abstinence advocate for teens but maybe that is the what should be promoted if responsible contraception is this unlikely.

Dana L.: My doctor never talked to me about birth control or that my cholesterol drug was a Category X drug. I only found that out myself, after I found I was pregnant. And the point of my article is exactly this: if a highly educated, busy mom of 2 was so ill-informed about birth control and her rights and remedies that she found herself in this situation, can you imagine how difficult it is for people with fewer resources?

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Washington, D.C.: As someone who has followed the Plan B saga from almost the beginning, I am interested in what you think our next steps should be to make sure that women are able to get this drug in the short window they have available. Should we petition the government? Should we vote a certain way? How do we hold those people responsible who are putting politics ahead of a woman's health?

Dana L.: First, don't be complacent. Second, donate to Planned Parenthood; it's become almost invisible, I think! Three, raise awareness -- ask you practitioner whether he/she prescribes EC and switch if he/she doesn't.

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Washington, D.C.: Seems to me you blame everyone but yourself for your abortion. (Conservative policies of Bush, your doctor, your midwife, your internist, the FDA top Brass, even Religion). I am pro-choice - even more so than you - because I respect your choice to have unprotected sex with your husband - knowing the risks. What I don't respect is your reaction to the consequences. Basically you didn't care to be inconvenienced by your own unborn son or daughter - a child that could have found a loving home with your infertile college friend.

Dana L.: That is just so silly. Believe me, I thought about it. If society, and people like you weren't so judgmental, I would gladly have borne that child (assuming he/she could have been born healthy what with all the attendant Category X drug health risks) and given the baby to my friend to raise with all my heart.

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Washington, D.C.: I'm the former Assistant Commissioner for Women's Health at the FDA, and I want to thank you for sharing your story. What happened to you shouldn't have happened, because if FDA had been able to do it's job properly, making decisions based on the fact that Plan B is safe and effective and needs to be readily accessible to women when they need it, then Plan B would have been available over the counter more than 2 years and you would have been able to get it.

I share your frustration that all we are asking is that women should have access to a second chance to prevent an unintended pregnancy - and the need for an abortion. We should all be in agreement here, but for some reason, even contraception is now deemed controversial.

Thanks again.

Dana L.: Thanks so much for your post. Wish you were still at the agency!

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Washington, D.C.: I still am at a loss for your comparison of a rape victim and yourself. In the case of rape, any emergency room visited gives out this type of contraception as a general rule. It appears to me that you wanted Plan B for the easy way out of an error in judgment on your part. Now that all this has happened, are you going to re-evaluate your birth control method to something a little more reliable and easy for you to maintain? Or are you going to risk the same thing happening again?

Dana L.: Of course, I won't make the same error again. But, again, you miss the point of the article. Why should Plan B be so hard to obtain that it forced me into an untenable position, regardless of how I got pregnant? It is over-the-counter in most countries, and, regardless, my doctors should have prescribed it.

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Washington, D.C.: Was any fact-checking done for this article? Even though it is -- technically -- an opinion piece, it contains some factual information that frankly makes me very skeptical. I would like to know whether anyone on The Post's professional staff checked with the various pharmacies, doctor's staffs, et al to see whether the sequence of events in fact took place as the author described. Regardless of one's views on abortion and on Plan B, this story to me seems like it could have been written by Rigoberta Menchu (or more to the point, by Janet Cooke).

Dana L.: Unfortunately, it's all true. For my sake, I wish it weren't.

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Washington, D.C.: The Plan-B pill just lowers the chance of pregnancy, it is not 100 per cent effective at preventing the pregnancy. So, even if you had been able to get the pill, you may not have avoided having an abortion.

Let us not try to make the plan-B pill as a kind of a panacea for like - you can make a mistake by not having protection, but you are still okay as long as you have the plan-B pill.

Dana L.: I agree that it's not a panacea, but it should be an option. I am not advocating unprotected sex. We had one slip-up during a long marriage. And you must agree, that using it is more responsible than having an abortion.

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Reston, Va.: Are you surprised by the lack of empathy shown on the discussion or were you expecting it? I for one, totally get your point. It was a painful decision; one made so by a political agenda. It's that simple.

Dana L.: I am not surprised. People are very emotional about this issue. Apparently, people want government regulation out of every facet of their lives except the bedroom for some reason.

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Leesburg, Va.: As you just stated, "different people see things differently" - therefore, that is why physicians have a CHOICE whether to prescribe medications/treatment just as you have a CHOICE on abortion. One point I wanted to bring up that has not been yet is since you and your husband have been certain that you do not wish to have any more children- have you considered a more EFFECTIVE and permanent form of contraception, such as vasectomy, tubal ligation, or IUD's? I agree with the first submission, stating your anger seemed misguided. You are 42 years old, please take responsibility for your actions. Planning would have greatly benefited in preventing this painful decision for you. I understand there are a lot of "what if's" to other situations and the outcome of those, but you chose to share your personal experience requiring this outcome, therefore, people are going to REACT to YOUR experience.

Dana L.: Well, I can only write about my personal experience, of course, to illustrate a larger point about policy. And that point is, the policy on Plan-B is leading to unintended consequences--in this case, pro-abortion consequences.

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Alexandria, Va.: I'm sorry, but I'm supposed to feel sorry for you - an attorney with a comfortable life - because you couldn't terminate a pregnancy you accidentally conceived even though you didn't want more kids? If you didn't want to have to "resort" to an abortion, why didn't you and your husband take more permanent and affirmative steps to ensure that you wouldn't become pregnant? If your medicine would harm a fetus, why weren't you utilizing a more effective form of contraception? In your 40s, if your family is complete, one would have thought a vasectomy, tubal ligation, or even the pill would have been a better choice for you than a diaphragm and crossed fingers. You clearly don't have a moral issue with contraception. Don't try to blame George Bush, the responsibility here is all yours.

Dana L.: Can't take the pill. Tried other methods to no avail. Husband was considering vasectomy, hadn't gotten around to yet. Didn't know about Category Xness of cholesterol drug until pregnancy happened.

I'm glad you've never made a mistake in your life. Good for you. I'm not that lucky. I have flaws.

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Colorado: Just as you, morally, believe in abortion and Plan-B, physicians have the right to not believe in prescribing and performing.

Dana L.: Yes, but isn't it worse when their choice not to prescribe Plan-B ends up with a worse consequence--abortion--performed by another physician?

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Langley, Va.: Do you plan on telling your kids about your abortion when they're older?

Dana L.: That depends on the needs of each child.

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Front Royal, Va.: So, now you say it's not the fault of administration you had an abortion, it's really due to societal judgmentalism? Why would anyone have looked down on you for having a baby and giving it up for adoption? That would presumably have made a couple happy and given a child a chance for life. How is that a bad outcome?

Dana L.: Listen, the focus of the piece isn't the abortion; it's Plan-B and how it should be made more freely available and how sad I am that it wasn't available to me when I needed it.

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Anonymous: I am a man and this really isn't my issue. (It is a real issue for my wife and daughter) I believe the government should just stay out of this issue altogether.

However, if the moralists who want to stop abortion are serious and not just about control of women, why are they spending all this money on legal cases and not giving women a viable alternative to abortion?

If you had a place to go have the baby; if you had a viable way to keep your job and career; if there were serious medical studies that should how to counsel the birth mother, the adopting mother and the child when it gets older, and foundations to cover the expense, would you have considered having the baby and giving her/him up for adoption? (Medical expenses for birth defects should also be covered.)

Dana L.: That is a very thoughtful question. Again, the focus of my piece is Plan-B, and the idea that, ideally, I would have been able to have prevented the pregnancy from occurring altogether.

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Anonymous: Hello, I'm a Virginia pharmacist in hope for a new protocol in the dispensing of Plan B. As a pharmacist, I would like to be able to dispense Plan B contraceptive to patients who arrive at the pharmacy and need Plan B in an emergency situation. In this plan, I would counsel the patient on vital information about Plan B such as, how it works, how to take it and what to expect from the medication. Patients will have a chance to change their minds when all the information is given to them. Hopefully, this will lift the pressure off patients who do not want to follow through with the plan. I feel that in today's society, a pharmacist's role has broadened especially with a generation growing up to become more educated. We are not here to dispense medications alone but to counsel, make recommendations on optimal drug therapy and become part of the medical team for our patients. How do you feel if this protocol could be enacted giving a pharmacist the right to dispense Plan B?

Dana L.: I think this is a terrific idea, but I don't see how this could happen without special legislation?

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Dana L.: Thanks for all the thoughtful discussion. I've enjoyed the online chat. Goodbye.

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