What `girls' should know
Our National Pledge Of "Liberty and justice for all" has a habit of going wobbly when it comes to women's reproductive rights. Just look at the current firestorm over the "morning-after pill." Next month, the Food and Drug Administration is expected to rule on whether women can have over-the-counter access to this emergency contraceptive. Its scientific review committee has advised that they should; the drug has already been deemed safe and effective. But the outcome at the FDA is by no means clear.
It should be an easy call. After all, we're talking about simply a higher dose of a birth control pill taken as soon as possible after intercourse. It has been used worldwide since the 1970s. Though something of a medical secret in this country, many doctors have for years offered this option discreetly to women in the know, and it's routinely given to rape victims. Some 46 million abortions occur each year (close to 1 million in the United States), and the hope is that wider access and responsible use of this option will reduce those numbers significantly.
Blame and regret. We can blame the sexual revolution, women's lib, the Internet, or a society that grooves on Sex and the City for creating women's morning-after dilemma. But that will not help the individual woman waking up to a broken condom, a missed birth control pill, or a totally unplanned sexual encounter. Even abstinence has its contraceptive failures. But Mother Nature offers a time-sensitive reprieve--pregnancy does not occur overnight. Medically, it requires implantation. It takes almost six days for an egg to find its way to the uterus and no less to establish a pregnancy should it meet a sperm along the way. A pulse of high-dose progestin (that's what the morning-after pill is) will in a matter of hours slow sperm down, suppress ovulation, and make the uterus hostile to egg implantation. An existing pregnancy is not harmed; a possible pregnancy is intercepted, in the nick of time. Thus the imperative for placing these pills over the counter, right next to the condoms. Not a bad idea, since pills don't prevent sexually transmitted diseases and condoms do.
Right-to-life critics holler, "Whoa, not so fast." They insist that it's in essence an abortion drug because a fertilized egg would find an unwelcome womb. That's an assertion made about other contraceptives, including IUDs and Norplant. Opponents also argue that making female contraceptives as accessible as aspirin or hair spray will promote promiscuity. Any drug can be misused, but the categorical statement smacks of our Victorian past, in which fear of pregnancy was seen as a needed deterrent to women's loose living.
In the good old days of the early 20th century, women's reproductive liberty was often misconstrued as libertine. Pure women were kept ignorant, pregnant, and under control. Indeed, Margaret Sanger, the founder of Planned Parenthood, bitterly watched her Irish Catholic mother die young, after 11 children. Later, as an obstetrical nurse, she saw the horrors of botched abortions, an epidemic of infant and maternal death, and the nasty secrets of syphilis and gonorrhea.
Condoms were widely available back then, thanks to Goodyear's fine, inexpensive vulcanized rubber, but to men only. They were dispensed mainly as prophylactics against venereal disease for those who dallied with fallen women. Women suffered under the yoke of the antiobscenity Comstock laws, which outlawed distribution of diaphragms--or even instruction in birth control. Sanger became the nemesis of Anthony Comstock, the public obscenity censor, as she openly flaunted gag rules, dispensed pessaries, and distributed her books-- including What Every Girl Should Know --about venereal disease. For this, she happily bore ridicule, threats, legal indictments, and time in jail.
If long life is sweet revenge, Sanger had it. The last vestiges of the Comstock laws were overturned by the Supreme Court in 1965, one year before she died at age 87. Even sweeter, by then her dream of a magic pill as easy to take as aspirin had been realized: oral contraceptives, containing the same synthetic progestin at issue today. The morning-after pill is an old medical secret for today's women in today's world. It's an option that every "girl" should have, if you only imagine that you are in her shoes.
This story appears in the January 19, 2004 print edition of U.S. News & World Report.