Slouching Toward Compromise – The Access to Birth Control Act

In high school I was a member of the Speech Club and the debating team. One of our favorite topics, both in class and in competition, was abortion – partly because it was emotional and made for lively discussion, but mostly because it was a question that could never be resolved. Now, some 40 years later, abortion is still hotly debated in the U.S. Emotions run higher than ever; doctors who perform them have been murdered. Women who have them have been harassed. Politicians have attempted to make end-runs around the Roe v Wade decision, which made them legal in 1973. But despite all the arguments one thing is sure: the question of abortion is still has no definitive answer.

Enter Representative Carolyn Maloney of New York and Senator Frank Lautenberg of New Jersey. Last week they introduced the Access to Birth Control (ABC) Act to Congress following the release of an Institute of Medicine (IOM) report recommending that birth control be made available without co-pays because of its importance for women’s preventive health care. The Access to Birth Control Act would prevent pharmacies from denying the sale of contraceptives based on a pharmacy employee’s religious beliefs.

Pharmacist bloggers have had plenty to say about the pending legislation. One complained about the tone of the articles he had read about the bill, saying that the organizations supporting it had painted a negative picture of the pharmacy profession. “You would think,” wrote the Redheaded Pharmacist, “there were widespread refusals to fill prescriptions by an entire band of rogue pharmacists if you read these news reports. Painting the picture that pharmacists routinely judge patients or make moral decisions for them at work is simply misguided and wrong!” I’m sure that the Redheaded Pharmacist is right when he asserts that the vast majority of pharmacists don’t mix their personal ideologies with their professional ethics. But his characterization of the bill’s supporting organizations illustrates some of the high emotions surrounding this issue. Not all pharmacists may routinely judge patients, yet the problem of pharmacists refusing access to birth control products is widespread enough to warrant attention by lawmakers. According to the Guttmacher Institute, women in at least 24 states have reported being denied access to birth control and emergency contraception. “The issue of pharmacies refusing to fill prescriptions for contraceptives came to light in 1996,” says NorthJersey.com, “when a pharmacist was fired from a Cincinnati Kmart after refusing to fill a prescription due to her own religious beliefs. Refusals have been documented in 19 other circumstances in several states, including Texas, Wisconsin and Massachusetts.” The problem, while perhaps not routine, is no longer unusual. And the pharmacists involved , while perhaps not a rogue band, are certainly representative of the current political climate in this country – one in which the right of a woman to make decisions regarding her own health has come under attack.

When individual rights are threatened, what is the remedy? The Redheaded Pharmacist, for one, doesn’t believe the federal government should have a role: “I have two words for Rep. Carolyn Maloney and Sen. Frank Lautenberg: state’s rights! The regulation of pharmacies and the requirements of pharmacists to practice should be a state oversight and not a federal issue.” The Roe V Wade decision addresses the issue of state’s rights in this case directly – in 1973 the Supreme Court struck down state laws that made abortion illegal. Legal access to abortion is, in other words, the law of the land. Since some religious views equate contraception with abortion, six states have stepped in with laws that require pharmacies to fill women’s birth-control prescriptions, despite the beliefs of individual pharmacists. But in the end a piecemeal approach to defining the scope of Roe v Wade isn’t practical. Challenges to federal law, whether from individuals or state legislatures, must be met on the federal level.

“This bill is critical because it ensures that every woman will be able to leave her pharmacy with her medication in hand and her dignity intact,” said Marcia D. Greenberger, Co-President of the National Women’s Law Center. The concept is simple – women should be able to walk into a pharmacy and leave with the medication they need. Although the Centers for Disease Control and Prevention included family planning in its published list of the “Ten Great Public Health Achievements in the 20th Century”, the United States still has one of the highest rates of unintended pregnancies among industrialized nations. Each year, 3,000,000 pregnancies, nearly half of all pregnancies, in the United States are unintended, and nearly half of unintended pregnancies end in abortion. Contraception is one of the best ways to prevent unintended pregnancy and reduce the need for abortion.

The ABC Act would require pharmacies to help, not hinder a woman’s ability to access contraception. Should the Redheaded Pharmacist or anyone else believe that the federal government is overreaching, consider this: a report by the Guttmacher Institute reveals that in the first six months of 2011, states enacted 162 new provisions related to reproductive health and rights. Fully 49% of these new laws seek to restrict access to abortion services, a sharp increase from 2010, when 26% of new laws restricted abortion. The 80 abortion restrictions enacted this year are more than double the previous record of 34 abortion restrictions enacted in 2005—and more than triple the 23 enacted in 2010. All of these new provisions were enacted in just 19 states.

While some pharmacists’ kneejerk reaction to the bill may be one of unwanted government interference, the bill actually gives pharmacists something to be grateful for. According to Representative Maloney’s own website the ABC Act protects the right of an individual pharmacist to refuse to fill a prescription by ensuring that pharmacies will fill all prescriptions, even if a different pharmacist has to do it: “By placing the burden on the pharmacy, the ABC Act strikes a balance between the rights of individual pharmacists who might have personal objections to contraception and the rights of women to receive their medication.”

Despite the controversy, the ABC Act is a bright spot in an otherwise dark picture for women’s reproductive freedom. The nature of that freedom will always resist definition because it is highly personal in nature, but this legislation gives us the hope that effective compromises can be reached. It is a reminder from the federal level to pharmacies and patients alike that because we are a nation of laws, and not men, the gulf between diverse positions can be bridged to serve the interests of those on both sides of any issue. Hooray for us.

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One thought on “Slouching Toward Compromise – The Access to Birth Control Act

  1. Great post and a great discussion/debate. I personally separate the issues of access to birth control and abortion and little further than you might and consider them different issues entirely although I can see how one would make the parallel.

    I was trying to convey the idea that the majority of pharmacists do not refuse to fill prescriptions based on religious or personal beliefs. And compared to the overall enormous volume of birth control prescriptions filled each year by pharmacists all across the country the relative number of patients who encounter a problem from a pharmacist who has personal issues with the idea of birth control pills is quite small.

    I don’t feel this issue is worthy of a federal law. I’d rather see the individual employers handle the minority group of pharmacists that are creating this controversy or at the least leave the issue to the states to handle as they see fit individually instead of setting one federal standard.

    But the issues of abortion and access to birth control sinks to the core religious and personal beliefs of individuals and I’m sure this debate will go on. It will be interesting to see what happens with this bill and if it will be passed into law. But one thing is for sure: no matter what happens to the ABC bill, the debate will live on!

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