If you're trying to make sense of the decision by Health and Humans
Services Secretary Kathleen Sebelius to keep a "morning after" birth
control pill off store shelves, focus on one simple fact: little girls
don't vote.On the other hand, grown-ups do. Some of those grown-ups have
trouble dealing with another simple fact, which is that adolescent girls
sometimes find themselves in need of after-the-fact birth control.And
then there is the third simple fact that voters will decide in less than
a year whether to keep Sebelius' boss, President Barack Obama, in the
White House. When you put these three facts together, you have the
motivation - the only motivation, despite an avalanche of dissembling on
the administration's part - for Sebelius' out-of-left-field, last-minute
decision last week to prevent the Food and Drug Administration from
allowing unrestricted over-the-counter sales of Plan B One-Step.Plan B is
already available without a prescription to purchasers 17 years old and
older. Girls 16 and under, however, must have a prescription. As a
result, the drug is sold only behind the counter at pharmacies, rather
than on open shelves in supermarkets, drug stores and other outlets. A
single dose of Plan B sells for about $50.Nothing prevents an underage
girl from buying a package of condoms, or a bottle of aspirin, or cold
medicine, or almost any other over-the-counter pharmaceutical. Yet
Sebelius, whose education features a political science degree and a
master's in public administration, overruled the FDA's science staff, as
well as its commissioner, Margaret Hamburg, a Harvard-trained medical
doctor who found Plan B safe enough to sell off the shelf.In her own
statement, Sebelius set up a rhetorical straw man, in the form of an 11-
year-old girl who, statistically, has about a 1 in 10 chance of being
physically capable of becoming pregnant. Because Plan B's manufacturer,
Teva Pharmaceuticals, did not study whether 11-year-old girls can
comprehend the label and use Plan B properly, the science is not good
enough to allow girls 16 and younger to buy it without a prescription,
Sebelius asserted. (1)My 9-year-old niece can walk into her neighborhood
mini-mart and buy a bottle of Tylenol big enough to put her in the
hospital if she decides to eat it as breakfast cereal. Should Tylenol be
pulled off the shelves until we study the ability of 9-year-olds to use
it safely? Tylenol costs a lot less than $50 a bottle, too, putting it
much more within the financial reach of my hypothetically (but not
actually) witless niece.Let's put this in public health terms. If a young
girl who has just had unprotected sex is unwilling to seek help from her
parents, or an older sibling, or a doctor, which is the bigger threat: an
unwanted pregnancy, or that she is somehow going to misuse enough $50
doses of progestin to hurt herself?Sebelius argues that young women can
still get Plan B with a prescription. They use this system in Canada's
Quebec province, the only place in Canada where a prescription is
required to purchase Plan B. (It is sold on open shelves in every other
province save Saskatchewan, where pharmacists will dispense it to buyers
of all ages.) According to a screening form provided by the Canadian
Pharmacists Association, the kindly physician may inquire whether, since
the last menstrual period, there have been any other incidents of
unprotected sex, and whether the woman is using another form of birth
control, and if so, which one.Adult women in Montreal must be prepared to
answer these questions to get their hands on Plan B, which is bad enough.
Does Sebelius really think it is better to force a 15-year-old in
Memphis, who may be seeing the doctor in the company of her parent or
boyfriend, to answer these questions than to just let her buy the
contraceptive on her own?I don't think so. But Sebelius knows that it is
better, politically, for the incumbent president, who insists that he
"did not get involved in the process." He sounds like a mob boss who
makes certain to have a capo order a hit in order to keep his own hands
clean. In politics, however, they use the more polite term "plausible
deniability." Just coincidentally, Obama and Sebelius spent time together
on Air Force One the day before she squelched the FDA, but somehow the
subject never came up.Consider, also, all the grown-up women who might
benefit from Plan B but who simply don't know or think to ask for it at
the pharmacy counter. Putting it on shelves could make it more useful to
them, too. This, in fact, is why Teva said it sought over-the-counter
status for minors in the first place.Obama, who has insisted that his
administration would not allow politics to trump science, sought to
justify his secretary's action on "common sense" grounds. "I will say
this, as the father of two daughters: I think 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," he said, according to The New York Times.
(2)I can match Obama daughter for daughter. I know how he feels - how any
sensible parent feels - about the prospect of young teens being sexually
active before they are ready. I find it incredibly sad to think of any
young girl having to tap her babysitting or birthday money to buy Plan B.
But I find the thought of that young girl dealing with an unwanted
pregnancy sadder still. The kind of sense that this trade-off makes is
not common; it is political.Obama does not like to hand Republicans
social issues with which to beat him up. Also, a significant part of
Obama's base is socially conservative itself, particularly African-
American churches. This president has shown from the earliest days of his
administration that he will back-burner civil rights for gays and
reproductive rights for women when it seems in his political interest to
do so.Republicans certainly do not come to this issue with clean hands.
They have politicized women's reproductive health and rights for decades.
The George W. Bush administration fought to keep Plan B available only by
prescription for adults as well as minors. Non-prescription sales were
finally authorized, after a political and legal battle, in 2006. Some
Obama supporters were dumbfounded when his administration continued the
policy. It took a court order in 2009 to get Obama's team to allow over-
the-counter sales to women 17 and over.But nobody should be surprised.
This president's kind of "common sense" means you don't do things in
election years that alienate more voters than they attract. And,
remember, little girls don't vote. Sources:1) U.S. Department of Health
and Human Services, "A Statement by U.S. Department of Health and Human
Services Secretary Kathleen Sebelius"2) The New York Times, "Obama
Endorses Decision to Limit Morning-After Pill"