What happened to Plan A, Obama?

As submitted to Daily Maverick.

The man who said “We will restore science to its rightful place, and wield technology’s wonders to raise health care’s quality and lower its cost” in his inaugural address seems to have left the building. The building in question is the White House, and the man is of course President Obama.

We can hope that his absence is temporary, intended merely to provide for potential excursions into the hearts and minds of some Republican or undecided voters. But his endorsement of the decision to overturn the Food and Drug Administration’s (FDA) decision to allow “Plan B” (also known as the “morning-after pill”) to be sold over the counter to young teenagers rather than by prescription seems little more than a violation of that pledge to respect science.

Instead, he’s kowtowing to moral conservatives, alarmed at the prospect of their teenage daughters having sex. Seeing as many of these conservatives are equally fond of taking life guidance from religious texts, this is also another step back from the reassuring name-checking of “non-believers” in that same inaugural address.

Plan B is not an abortion pill, nor is it related to RU-486. The 1.5 milligrams of progesterone it contains helps to prevent ovulation and makes the lining of the uterus less hospitable to a fertilised egg. As the New York Times rightly points out, “this latter effect — shared by all hormonal and intrauterine contraceptives — makes it anathema to anti-abortion activists”.

Anti-abortion activists are perhaps unlikely to be voting for Obama in large numbers in any case. This is, after all, the President who shortly after taking office lifted the Reagan, then the George W. Bush, ban on federal funding for international health groups who support abortion rights. (The ban was briefly reversed by president Clinton before being reinstated by Bush.)

Then again, the man who campaigned as a pro-choice candidate did later sign an executive order ensuring that the healthcare law of 2010 would maintain the ban on federal money being used to pay for abortions (except in cases of rape or incest). So while it’s perhaps the case that his stance on abortion ends up evening out in terms of effects at the ballot box, this particular decision nevertheless stands out for its sacrifice of principles for potential political gain.

I say this for two reasons: first, this is the only time that an American Secretary of Health and Human Services has overruled an FDA recommendation. While the Secretary, Kathleen Sebelius, is the one who made the decision to do so, it’s clear that the decision was endorsed by Obama himself. A White House statement last week said:

The reason Kathleen made this decision is that she could not be confident that a 10-year-old or an 11-year-old going to a drug store should be able — alongside bubble gum or batteries — be able to buy a medication that potentially, if not used properly, could have an adverse effect. And I think most parents would probably feel the same way.

With eleven months to go before the US Presidential elections, the unprecedented overturning of an FDA recommendation is difficult to understand as anything more than an attempt to reassure conservatives that Obama is sympathetic to that nebulous concept of “family values” (which, like the term “neo-liberal”, seems in cases like these to mean whatever you do or don’t like about what the other guy is doing).

Second, the FDA recommendation appears to be well thought-through, making a principled objection to allowing over the counter sales of Plan B difficult to sustain. The need for drugs like this is clear in that the US has the highest teen pregnancy rates of any industrialised nation. Plan B is already available without prescription for women over 17, and by prescription for younger females.

The FDA’s proposal was for the drug to be available without prescription for younger teenagers also. It should of course go without saying that Plan B does not induce teenagers to desire having sex – many or most of them have that desire in any case, and would already have acted on it if they were trying to get hold of the drug in question . Furthermore, while making the uterus less hospitable to a fertilised egg could induce an abortion, the pill only lowers your chances of becoming pregnant to one in 40 (compared to one in 20 for unprotected intercourse), making it implausible that teens will use Plan B as licence for spontaneous orgies.

Sibelius’s claim is that we can’t be sure whether Plan B has harmful effects on eleven-year-olds, who can of course also fall pregnant. And naturally there might be risks. But in this case, we’re speaking of a drug which the FDA’s panel of experts regards as safe, and of which the assistant dean at the University of Southern California School of Pharmacy says: “very few medications are this simple, convenient and safe”.

A double-standard, informed by a moral panic around teens having sex, is clearly at play. Former F.D.A. assistant commissioner Dr. Susan Wood points out that drugs like acetaminophen (an analgesic found in Tylenol and many other over-the-counter medicines) can be fatal, but had not been specifically studied for effects on 11-year-olds, despite being potentially far more dangerous to them. She asks “why are contraceptives singled out every single time when they’re actually far safer than what’s already out there?”

We can of course also ask whether pregnancy itself is riskier to an 11-year-old than Plan B is. We can ask whether any of the people who might be heartened by this overrule, and Obama’s endorsement of it, were ever likely to vote for him in any case. More pertinently, we can perhaps ask what happened to the man who promised to restore science to its rightful place, and how did he become the man who seems willing to play politics with the bodies of the next generation of voters, for the sake of hypothetical sympathies from the current generation?