Vagina Talk: Nobody Puts Plan B Behind the Counter!

Congratulations world! Plan B One Step is now available over the counter for people of all ages! That means no more asking a pharmacist for it - you'll now be able to find it on a shelf in the pharmacy like any other drug. YIPPEE!!

It's been a long time coming, a hard fight and there are a lot of people to thank. Emergency contraception has been around for decades, but the actual brand Plan B first became available in 1999 and required a prescription. Since 2003, there's been a long fight to get Plan B available over the counter. This debacle has been wrought with political ideologies and motives overriding proven science and evidence that shows that access to emergency contraception is safe and necessary in preventing unintended pregnancy. Finally in 2006, Plan B became available over the counter for people over the age of 18. That age restriction changed to 17 in 2009, and over the last few months there has been a flurry of court challenges, rulings and FDA guidelines that have paved the way for Plan B to finally become available over the counter for people of all ages. Hurrah! (Side note: it can get a little confusing since the terms emergency contraception and Plan B tend to be used interchangeably but it's important to remember that Plan B is only one brand of emergency contraception.)

So why are we celebrating that as of today, August 1st, Plan B is available over the counter for people of all ages? Because it's a big freaking deal. The reason why we have been fighting for this long is because access to emergency contraception is really important. In the United States half of all pregnancies are unintended. There are a multitude of social and systematic reasons why half of all pregnancies are unintended (which I promise to write more about one day), but apart from addressing those underlying issues of reproductive injustice and inequality, increasing access to better health care and services is one way to fix this problem. In an ideal world, everyone would have access to comprehensive reproductive and sexuality education, and birth control that was 100% effective. Sadly, that's not the world we live in. So instead, access to emergency contraception offers a viable alternative to prevent unintended pregnancy because it's a back up plan people can use when their Plan A fails. Because let's be honest, accidents happen no matter how prepared we are.

But there's a lot of misconception about Plan B and emergency contraception out there, so let's take a few moments to debunk some pretty common myths.

1. Plan B is NOT THE ABORTION PILL. Say it with me! Plan B is not the abortion pill! (If you remember one thing from this post, please please please let it be that). Why isn't it the abortion pill? Well first of all, it's a totally different type of drug. Plan B is a high dosage of levonorgestrel, or a synthetic version of the hormone progesterone found in birth control pills. The abortion pill is a different drug called mifepristone or RU-486. Plan B is also not the abortion pill because it works in a totally different way, so much so that it won't affect an existing pregnancy. It works to delay ovulation by basically giving your body a high dose of hormones to confuse your natural cycle in a way that makes your ovaries say, "heeeyyyy wait a minute, maybe we shouldn't release our precious egg just yet." That's why the timing of when you take emergency contraception is so important because the sooner you take it, the higher chance you have of delaying ovulation. This gives you a higher chance of not getting pregnant since you're giving the sperm in your uterus time to die before an egg is released and they can go pounce on it. Because of the way it works, emergency contraception WILL NOT affect an existing pregnancy. See, there's even studies to prove it. 
2. Plan B can be taken up to 72 hours after unprotected sex. Like I said above, the earlier the better but you do have a window period, with some practitioners even saying you can take it up to 120 hours (5 days) later.  
3. While Plan B is awesome, it shouldn't be used as a regular form of birth control.This isn't because it's going to do anything terrible to your body (because again, it's basically just a high dosage of birth control hormones) but because if you really want to prevent pregnancy, the best way to do this is to be on a more effective and reliable form of birth control. 
4. Emergency contraception comes in a lot of shapes and pill sizes. On the one hand you have the type of emergency contraception made from levonorgestrel, like Plan B, Next Choice and Levonorgestrel. While they're all the same drugs, the most recent court ruling has only allowed Plan B One Step to be available over the counter. The other generic versions will still be available but will require a prescription for those under 17. The other type of emergency contraception out there is called Ella. It's relatively new to the US market and always requires a prescription because it's an alternate drug and works a bit differently. 
5. It is safe to have Plan B available over the counter! The hormone in Plan B mimics progesterone, which unlike estrogen that's found in some birth control pills, doesn't have the same risk for blood clots or heart issues. Related to this, having emergency contraception available over the counter to all ages will not increase sexual behavior. Going back to the facts, while the teenage pregnancy rate in the US has been declining over recent years, we still have the highest teen pregnancy rates among developed countries so let's face it, teenagers are having sex. Having emergency contraception available over the counter will therefore hopefully give teenagers and adults access to more options to control their fertility and prevent unintended pregnancies. 

But while we celebrate today, remember the fight is far from over. Just because Plan B will now be available over the counter does not mean access is guaranteed. Plan B is still pretty pricey and cost is always going to be a factor. The good news is that theoretically the Affordable Care Act will cover Plan B through the women's preventative services requirements. I say theoretically because the thing about insurance is that if you want it to cover your medicine, you have to have a prescription for it. The name "emergency contraception" implies that for most people, when you need it, you don't have time to go to your doctor, get a prescription and then take your pill before the 72 hours are up (not to mention you really want to be taking it as soon as you can). So with that in mind, there's still a lot of work to do to try and work with clinics/doctors/practices to set up standing prescriptions that individuals with insurance can use when the need arises, as well as lead massive education campaigns to make sure that everyone knows what "coverage" means so they can access the care they need.

Either way, we have a lot to celebrate and be thankful for today! This is a huge step and I for one, am super excited to see Plan B One Step available over the counter at my local pharmacy.

Vagina Talk: Standing With Wendy!

**Update: In the end, Governor Perry called a second special session and HB2 was signed into law on July 18th. However the Center for Reproductive Rights, Planned Parenthood, ACLU and Whole Women's Health announced on September 27th that they are filing a lawsuit against the bill. Read all the details here! 

As part of my MPH program, all students have to complete a practicum and I am spending my summer working in Austin, Texas. This week I was lucky enough to be in the right place at the right time to witness a historic, inspirational and important event.

On Tuesday June 25th, Texas State Senator Wendy Davis started a 13 hour filibuster to prevent SB 5 from passing during the Texas Legislature's Special Session. SB 5 is one of the most restrictive pieces of anti-choice legislation in the country, and would have dramatic repercussions on the state of reproductive rights in Texas. If passed, SB 5 would have banned abortions after 20 weeks, placed numerous regulations on abortion clinics causing 42 out of the 47 abortion clinics in Texas to close, effectively banned telemedicine abortions, and had no exceptions for victims of rape and incest.   Friday, the threat of SB 5 resulted in an incredible "Citizens Filibuster" in the Texas State House, where over 700 Texans delayed the vote until 3:40 am with hours of moving and powerful testimony. With midnight on Tuesday marking the end of the Special Session, Texas Senator Wendy Davis continued this heroic attempt to prevent the passage of SB 5 by starting a 13 hour filibuster at 11:18 am.

The Senate Gallery

When I finished work on Tuesday, I headed down to the Capitol to stand with Wendy Davis and support the fight for reproductive rights in Texas. Sitting in the gallery and listening to Wendy Davis' testimony was inspiring. By that point it was 5:30 pm and Wendy Davis had been filibusterting for six hours, with just under seven to go. While I was there her filibuster included testimony from Texas women on how this law would effect them; discussion of the harmful impact SB 5 would have on seeking emergency medical care for ectopic pregnancies and evidence from Texas ACOG regarding their opposition to the bill. She clearly explained the terrible impacts SB 5 would have on Texas women and passionately argued against the supporters of this bill that sought to drastically infringe on the reproductive rights of Texans.

The filibuster was also pure political theater. It was appalling to see the lengths at which the opposition tried to end the filibuster. I was in the chamber when Wendy Davis received her first point of order for ungermaneness for talking about Roe v. Wade, as well as the debacle surrounding the back brace. Listening to the Senators describe other filibusters and the parliamentary rules, it was clear that the  opposition was grasping for any chance they could to undermine the filibuster and move forward with the bill. But there were also a lot of encouraging examples of camaraderie and support between the Senate Democrats as they worked to contest each point of order, and finally stall the filibuster when the third point of order was sustained.

Wendy Davis in action! 

Apart from Wendy Davis, my favorite thing about the filibuster was seeing the reproductive rights community in the halls of the Texas Capitol. There were hundreds of men and women in orange, mothers showing their children the importance of being politically engaged, and people of all ages standing with Wendy. And it wasn't only Texans. Over 160,000 people all over the nation were watching the live stream and organizations from across the country sent food to the Capitol that volunteers passed out to the people lining the halls.  By 8:30 pm the line to get into the gallery was four stories high, the energy was intense and the passion was palpable.

Thankfully, SB 5 did not pass during this Special Session. In response to this, Lieutenant Dewhurst blamed "an unruly mob," but really, it was anything but that. The people who went to the Capitol on Tuesday were a passionate, organized and inspiring community pushing back and showing the power of civic engagement, solidarity and togetherness. Yes, they were angry but they have a right to be. All across the country state laws are chipping away at our reproductive rights and yet these laws do nothing to prevent unintended pregnancies but only seek to jeopardize access to necessary health care.

Governor Perry has already called another Special Session and in many ways the passage of some sort of abortion restriction bill seems inevitable. However, Wendy Davis' filibuster is still an extremely successful and important occurrence. At first glance, it shows that in many ways one person, like Wendy Davis, can make a difference. But more importantly, it shows that when a community comes together to stand for the things they believe in great things can happen. It was a privilege to be in Texas to witness this on Tuesday, but I also know things like this are possible all over the country and because of that, I am extremely grateful and proud to be a part of this amazing reproductive justice community.

By 8:30 pm the line to get into the gallery was four stories high (fourth story not pictured)