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Sebelius's Surprising Plan B Decision

Was the HHS secretary’s override of allowing emergency contraceptive to be sold over the counter politically motivated?


| Posted 12/9/11 at 5:10 PM

2006 photo by Joe Raedle/Getty Images News/Getty Images

WASHINGTON — Most observers figured the Food and Drug Administration would rubberstamp a pending application to allow minor girls to purchase Plan B without a prescription.

Plan B is the so-called “morning-after pill” that has abortifacient as well as contraceptive effects.

After all, the Obama administration has been willing to accommodate the vast majority of political demands made over the last three years from its constituency of “reproductive health” advocates.

But Health and Human Services Secretary Kathleen Sebelius sprung a major surprise Dec. 7, when she announced she was overruling FDA Commissioner Margaret Hamburg’s earlier approval and instead was denying the application for non-prescription sales of Plan B to girls younger than 17.

Abortion lobbyists immediately denounced the action.

“The Obama administration has broken a key promise to the American people that it would base its decisions on sound science and what’s in the best interest of women’s health,” said Nancy Keenan, president of NARAL Pro-Choice America.

In contrast, pro-life advocates greeted the decision with muted praise.

“We welcome the decision,” said Deirdre McQuade, spokeswoman for the U.S. bishops’ Office of Pro-Life Activities. “It will keep things from going from bad to worse.”

McQuade noted that while Sebelius’s intervention prevented an “extreme” FDA action that would have made Plan B even more easily accessible than it already is, as it stands the drug can be obtained without prescription by anyone aged 17 or older, including males. Thus an older 17-year-old boyfriend could purchase the powerful drug — each dose of which contains 40 times as much of the female hormone progesterone as regular birth-control pills — and give it to a 12-year-old girlfriend after engaging in sexual relations.

Negative Effects

The Plan B decision does nothing to limit the drug’s existing availability, but the ensuing controversy provides an opportunity for those who oppose the drug to underscore a variety of issues related to its usage. A substantial amount of information about Plan B is available at the U.S. bishops’ website.

With respect to arguments by Plan B advocates that restricting its wider availability to minor girls inevitably will lead to more teen pregnancies and abortions, McQuade said this claim has not been borne out by any scientific studies.

“Greater access to emergency contraception does not lower pregnancy rates or abortion rates,” she said. “But what does go up is the rate of sexually transmitted diseases. And so young people would be put at additional risks, not less.” 

Sebelius grounded her own decision to withhold permission for non-prescription sales to young girls on a different issue. The HHS secretary said that the application to the FDA had provided insufficient evidence that very young girls would be capable of properly understanding instructions about how to take Plan B.

Many analysts, however, challenged this explanation. Some suggest that the Obama administration was ducking away from an action that would alienate voters next November.

“The general consensus seems to be that the Obama team is sufficiently worried about the 2012 election to be willing to enrage an important segment of his loyal base over an issue everyone thought was squarely in the bag in order to avoid a culture-war controversy with the rest of the country,” Greg Pfundstein commented National Review Online’s blog, “The Corner.”

Other observers suggested threats by Republican congressmen to withhold FDA funding also might have influenced Sebelius.

‘Common Sense’

Speaking at a Dec. 8 White House press conference, President Obama denied any involvement in the Plan B decision, but supported Sebelius’s action.

Obama said Sebelius had decided 10- and 11-year-olds girls shouldn’t be able to buy Plan B in drugstores “alongside bubble gum or batteries.”

“Most parents would probably feel the same way,” said Obama, whose own daughters, Malia and Sasha, are aged 13 and 10, respectively. “It is important for us to make sure that we apply some common sense to various rules when it comes to over-the-counter medicine.”

If Sebelius did make the Plan B decision without consulting with Obama, one possibility is that she was influenced by a desire to avoid provoking any more Catholic hostility, on top of the intense criticism already directed at her department over its interim final rule mandating that private health insurance plans must cover contraception and sterilization.

HHS declined to comment to the Register about the complaints that Sebelius’s decision had been politically motivated. HHS also declined to respond to a question about whether Sebelius, who is Catholic, had taken into consideration the objections of the U.S. bishops to all use of Plan B.

McQuade noted that 20 prominent leaders of Catholic organizations and universities subsequently joined with the U.S. bishops in releasing an ad that highlights the breadth of Catholic opposition to this contraceptive mandate.

“Catholics have been very vocal in saying that the contraceptive mandate is an affront to, and a violation of, our conscience rights and our religious liberty,” she said. “This particular question in terms of the marketing of availability of Plan B didn’t speak to the conscience issue as such, but if they haven’t heard the Catholic voice and our concerns about this by now, something’s wrong with their hearing.”

Register correspondent Tom McFeely writes from Victoria, British Columbia.