Yale profs detail difficulties in getting morning-after pill

Cati Vanden Breul

The University’s Women’s Center of Excellence and the Center for Bioethics sponsored a lecture Friday in Moos Tower discussing the ethical issues and availability of emergency contraception.

The talk covered the refusal of pharmacists and doctors to provide patients with emergency contraception because of moral beliefs, a term called “conscientious objection.”

Yale University professors Kenneth Baum and his wife, Julie Cantor, co-authors of an article on conscientious objection in November’s New England Journal of Medicine, spoke to a packed auditorium of students, doctors and health professionals.

If emergency contraception, commonly known as the morning-after pill, is taken within 72 hours of unprotected sex, the chance of pregnancy is reduced by 85 percent, Baum said.

But it is not always easy for women to get the pill.

“Problems arise when a patient’s needs and a provider’s beliefs clash,” Baum said.

Baum and Cantor said they found reports of conscientious objection dating back to 1991 but that the total number of incidents is impossible to count.

Between May and November 2004, however, Planned Parenthood received 180 reports of conscientious objection, Cantor said.

In addition to pharmacists turning patients away, the reports included times when pharmacists berated patients or confiscated their prescriptions, she said.

Currently, emergency contraception is available only by prescription, which makes it hard for some women to get the pill within a 72-hour time period, Cantor said.

This can be especially difficult for those in rural areas, Cantor said, because they need to find doctors in their areas willing to write the prescription, as well as pharmacies willing to fulfill it, all within a three-day period.

Many of those against emergency contraception view it as abortion, Cantor said.

“But how can we speak of it in terms of abortion? It just isn’t,” she said.

When effective, the morning-after pill inhibits ovulation and fertilization, and prevents an egg from being implanted. But the pill will have no effect on an established pregnancy, Cantor said.

Baum and Cantor said they favor a happy medium. Both pharmacists and patients have rights, they said.

“We want to attempt to find a starting point for discussion,” Cantor said.

In their November article, the professors gave suggestions on how to adequately serve the interests of both groups.

First, pharmacies that do not wish to fulfill emergency contraception prescriptions should display prominent signs to direct patients elsewhere, the article said.

Second, pharmacists wishing to conscientiously object must transfer patients to another pharmacy and should never confiscate prescriptions.

And third, the article said, in areas outside the metro where patients might have only one place to go for emergency contraception, pharmacists might have no choice but to dispense the pill.

Many advocates of the morning-after pill think it should be available over the counter to increase its availability, Baum and Cantor said.

An advisory committee to the Food and Drug Administration voted 23-4 in December 2003 to provide emergency contraception over the counter.

But in May 2004, the FDA decided it was not yet ready to approve the measure.

Boynton Health Service offers the morning-after pill to University students, and no one at the clinic has ever been turned away, said Dave Golden, the clinic’s public health and marketing director.

In a 2004 Boynton survey, 5.1 percent of students reported they or their partners had used emergency contraception within 12 months before the survey.