Sexual Health Roundup: Court Says Illinois Pharmacists Don’t Have to Distribute EC, Just as NYC Schools Stock Up on It

An appellate court this week ruled that Illinois cannot force pharmacies or pharmacists to sell EC. The New York City Department of Education, meanwhile, is offering it to students. And ACOG recommends IUDs and Implants for teens.

Pharmacists in Illinois Don’t Have to Distribute Emergency Contraception, but Students in New York City Can Get It in School

Emergency Contraception (EC), also known as the “morning after pill,” is a method of birth control that can be taken after unprotected sex. Women who had intercourse without birth control or experienced the failure of their regular method of birth control can take EC within five days in order to prevent pregnancy. Emergency contraception is a hormonal method that works, like the birth control pill, to prevent ovulation. EC does not end prevent a fertilzed egg from implanting in the uterus, nor can it end an existing pregnancy once implantation occurs. Despite this, many people continue to confuse EC with the “abortion pill” (which can end an existing pregnancy), and anti-abortion proponents continue to misrepresent it as an abortifacient. 

Illinois’ Health Care Right of Conscience Act says that health-care providers do not have to participate in any care that violates their consciences or religious beliefs. To ensure that this law did not prevent women from accessing EC, in 2005, former Gov. Rod Blagojevich mandated that all pharmacists and pharmacies sell the drug. In 2011, a judge in the state placed the law under an injunction, arguing that the law was not neutral because it was designed to target religious objectors. The judge noted that there was no evidence that EC had ever been denied on religious grounds. On Friday, an Illinois appellate court agreed and said that the Health Care Right of Conscience Act protects pharmacists who decide not to dispense EC due to their beliefs.

The ACLU of Illinois spoke out against the decision, saying:

“We are dismayed that the court expressly refused to consider the interests of women who are seeking lawful prescription medication and essentially held that the religious practice of individuals trumps women’s health care.” 

If, indeed, it is true that pharmacists in the state have not been refusing EC on religious grounds, then this ruling should have little immediate impact. Unfortunately, it does set the stage for religious objections to all sorts of birth-control methods, such as, for example, the birth control pill and IUDs that have inaccurately been labeled abortifacients by anti-abortion proponents.

Despite the myths that remain around EC, the New York City Board of Education took the bold move this week of making this method available in the school nurse’s office. New York City schools already distribute condoms and are now adding EC as part of a city-wide program called “CATCH” (Connecting Adolescents To Comprehensive Health), which is aimed at stemming teen pregnancy. Thus far, the pills are available in 13 high schools. This is the first time that city schools have distributed hormonal contraception.

Parents have been notified of the CATCH program, and they’re able to “opt out” of it if they do not wish their children to have access to condoms or EC. Only about one-to-two percent of parents have chosen this option. Parents will not receive notice that their children have accessed EC. 

City Council Speaker Christine Quinn spoke highly of the program: “High school students are very sexually active and getting pregnant, so we don’t have that luxury to think that they are too young to be engaged in conversations about contraception and sexual education.” 

ACOG Report Tells Doctors to Recommend IUDs for Teens

Last week, the American College of Obstetrics and Gynecologists (ACOG) released a report suggesting that doctors discuss intrauterine devices (IUDs) and contraceptive implants with teens looking for long-term contraception. Termed Long-Acting Reversible Contraceptive (LARC) methods, these two options remove almost all possibility for user-error, making them more effective than other methods, such as condoms or the birth control pill. 

Because of its history, including the now-infamous Dalkon Shield—which caused infertility in many women in the 1970s—the IUD has a shaky reputation. For many years, it was recommended only for women who had already had children and did not desire more. In recent years, however, new brands have been introduced and have been proven to be safe and effective. 

In 2007, ACOG noted that these methods were safe for all women, including teenagers, but confusion still exists among women and health-care providers. ABC News, for example, reported that a physician told his teenage patient that she could use an IUD only if she was in a monogamous relationship. Since she was not, she had the device removed. She subsequently got pregnant and had an abortion.

With the new opinion, ACOG hopes to remove any confusion by using stronger language, stating that LARCs should be considered a “first line” birth control option for teenagers. The opinion also suggests that counseling on these options should be part of all health-care visits with sexually-active adolescents. The opinion concluded:

When choosing contraceptive methods, adolescents should be encouraged to consider LARC methods. Intrauterine devices and the contraceptive implant are the best reversible methods to prevent unintended pregnancy, rapid repeat pregnancy, and abortion in young women.

One remaining obstacle for teens, however, is the price of these methods. Though they  become very cost effective if they are used for their entire lifespan (three-to-ten years, depending on method), they do require a large up-front fee. Though many insurance providers cover this fee, teenagers on their parents’ health insurance policies may not want to use this payment option because of confidentiality issues.