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Monday, February 06, 2006

should wal mart be forced to sell emergency contraception?

Some of you who've been reading for a while probably know by now that I like Planned Parenthood, and that my affinity is at least partly connected to the fact that my mother works for the well-known non-profit. But despite my ardent admiration for its dedication to providing important health services to millions of women in the U.S. and beyond, I found myself cringing at a PPFA-related online poll that my mom forwarded to me a few days ago, asking me to submit my vote. This time, I thought, they've gone too far. (more in expanded post)

Those who follow news on reproductive choice are probably familiar with the recent controversies over whether individual pharmacists should be allowed to refuse to fill people's emergency contraception prescriptions on personal moral grounds. In addition to individual employees exercising discretion over which prescriptions to fill, some pharmacies have opted, for similar philosophical reasons, not to stock certain kinds of birth control at all. Notable among these pharmacies is Wal Mart. So while I wasn't surprised at the poll soliciting my vote on the Wal Mart contraceptive issue, I was dumbfounded by the specific question it posed, and the way the email summarized the issue at hand:
A lawsuit has been brought against Walmart for failure to stock and dispense emergency contraception.

Walmart pharmacies serve primarily mid-to-low-income people. In many communities, Walmart is the only pharmacy in the local area. Low-income women have few choices when it comes to accessing emergency contraception. Please indicate your support for requiring Walmart to stock emergency contraception.

Because of the publicity around the lawsuit, CNN is polling on whether WalMart should stock EC. The poll is now in the "QuickVote" box on: http://www.cnn.com/2006/LAW/02/01/walmart.contraception.ap/index.html

Here’s where the poll currently stands:

Should Wal-Mart be required to stock the "morning after pill"?

Yes -- 47% -- 51895 votes
No -- 53% -- 58999 votes
Total: 110894 votes

Hold on, back up a minute. Should Wal Mart be required, by the government, to stock a medicine to which it objects on moral principles?

Should Wal Mart be required to stock anything it doesn't want to stock? It it the government's job to tell private retailers what to sell?

This one really had me confused. That is, until I actually clicked on the link and read the corresponding article.

As it turns out, we're not just talking about any old merchandise here. The government can't butt its nose into Wal Mart's decision, for instance, not to sell Jon Stewart's book "America" (not that it would want to, I guess). But in Massachusetts, where the lawsuit was filed on behalf of three women plaintiffs, it comes down to a question of whether or not emergency contraception is legally considered a commonly prescribed medicine. If it is, then according to state law, all pharmacies must supply it. If it's not, then businesses can decide for themselves whether to stock it. From the CNN article:
A new state law that took effect late last year following heated debate among lawmakers requires all hospitals to provide the morning-after pill to rape victims. It also allows pharmacists to dispense the pill without a prescription, but does not require it.
The lawsuit, backed by abortion rights groups Planned Parenthood of Massachusetts, NARAL Pro-Choice Massachusetts and Jane Doe Inc., argues Wal-Mart is violating a state policy that requires pharmacies to provide all "commonly prescribed medicines." They are suing to force compliance with the regulation through the Massachusetts Consumer Protection Act.
In a letter to a lawyer for the three women plaintiffs, "Wal-Mart attorney John W. Delaney wrote that Wal-Mart has 'long had the corporate policy of declining to make available EC (emergency contraception) medication, based on, among other things, a view that EC medication is not 'commonly prescribed' and within the 'usual needs of the community,'" the article says.

If the poll question had asked me whether I think emergency contraception satisfies the criteria in question, I would have answered yes. The FDA's research committee has reccommended that EC be granted over-the-counter status, and many prominent physicians' groups support EC as an important option for preventing unplanned pregnancies. According to Planned Parenthood's website, "Widespread use of emergency contraception could potentially prevent an estimated 1.5 million unintended pregnancies and 800,000 abortions each year in the United States (Glasier & Baird, 1998; Stewart, et al., 2004). In 2000, an estimated 51,000 abortions were prevented through the use of emergency contraception; moreover, ECPs were responsible for approximately 43 percent of the decrease in total abortions between 1994 and 2000 (Boonstra, 2003)."

On January 19, the American Public Health Association adopted 19 new policies, including this one:
Access to contraceptive prescriptions: Supports many provisions to ensure women are able to have contraceptive prescriptions filled without interference or delay, including collaboration between pharmacist associations, pharmacies and schools of pharmacy to work with reproductive and public health professionals to conduct ongoing educational programs for pharmacists about the dispensing of contraception and emergency contraception. Continues to urge the U.S. Food and Drug Administration to make emergency contraception available over the counter.
It will certainly be interesting to see how this case plays out. Now that I understand what it was really trying to ask, I would vote yes on the initially baffling poll question ("should Wal Mart be required to stock 'morning after pills?'") since I think the availability of emergency contraception is very important for many people--including individuals, couples, and families--and thus for a community. How would you vote on CNN's question, and, if you see an important distinction between the two questions, how would you vote on EC's qualification as a commonly prescribed medicine that fills the usual needs of a community?


At 9:13 PM, Blogger narcissusfemme said...

Personally I think the issue with WalMart (as opposed to other pharmacies, such as Walgreens and Target) refusing to fill EC prescriptions is the fact that WalMart pharmacies are really the only ones available within a pretty large radius in a good number of rural (and often poor) areas throughout the country. If women are refused EC there, they often have nowhere else to realistically turn.

At 12:36 AM, Blogger katie loncke said...

Yeah, I definitely see the logic in that now, but when I first read it I couldn't wrap my head around how the government could oblige a private company to take on such a role--especially when it contradicts the company's principles--unless some sort of federal financial sponsorship were involved. But I guess there's a compelling interest for the government to ensure that citizens have access to the medicines they need, without having to set up a whole bunch of state-sponsored pharmacies.

It's going to be fascinating (and a little unnerving) to see how this issue develops. Even if the plaintiffs win this case and Wal Mart and all pharmacies are required to stock EC, the question of whether individual pharmacists are required to dispense it is still being hotly debated.

The linked ABC News article says,

"According to Planned Parenthood Federation of America, three states — Arkansas, Mississippi and South Dakota — already have laws that give pharmacists the right to refuse to fill prescriptions. Ten other states are considering similar laws.

Four states — California, New Jersey, West Virginia and Missouri — are evaluating laws that would require pharmacies to fill all legally prescribed medications. And Democratic lawmakers gathered in Washington recently to tout a plan for a federal law that would stop pharmacies from denying the sale of prescribed medications."

Some say that a compromise could be struck that would allow pharmacists to maintain their autonomy and refuse to fill EC prescriptions, but only if they refer the customer to another pharmacy. But as you point out, this could place a significant burden on poor people living in rural areas since Wal Mart may be the only place for miles; plus, lack of transportation access, not to mention the time to go on a wild goose chase, may pose a large problem for people of limited means.

At 2:33 PM, Anonymous reader again said...

This whole debate about pharmacist's having the right to administer or deny this medication is an interesting one. I'm wondering if this kind of rule is used for any other types of medication, or just birth control/the morning after pill? If so, what I find worrisome is that this rule targets women specifically, and subjugates their own health/safety/well-being to both the moral agenda of the pharmacist and the 'well-being' of the (as yet unknown whether it exists) fetus.

For my thesis, I've done some reading on pain treatment and attitudes in Western culture and medicine, and one of the main points that a lot of doctors and researchers make is how biased our culture is *against* people who suffer from ('complain of') chronic pain. In general, our culture tends to support stoicism, urging everyone to sort of 'buck up' and learn to transcend our physical ailments, and chronic pain patients seem, by this thinking, to be weak people, failures who are unable to gain control of their own attitudes and bodies. One of the problems that arises from this has to do with prescribing painkillers -- many doctors are hesitant to continue prescribing painkillers to people who complain of chronic pain, because they grow skeptical that the people really 'need' the medication for pain relief -- either they are becoming junkies who are addicted to their meds, and/or they just 'aren't trying hard enough' at recovery, and the drugs are acting as a crutch for this weakness.

So, my question is this: are pharmacists allowed to (or do they ever) deny a prescription for, say, painkillers, using similar 'moral' objections? If anyone knows of an instance of this occurring, can you comment on how people reacted? For my own part, I am ignorant, but I wonder whether people would find denial of this kind of medication as acceptable as the denial of birth control, or more or less so. Does anyone have thoughts on this? How would you feel if you were denied your pain medication, or if someone you knew or read about was?

If the prospect of denying someone some other kind of medication strikes some people as wrong, we should consider why. I'm guessnig that those who take this position would defend it by pointing to the relationship and relative power/status of the pharmacist and the patient as two individual people -- perhaps they might argue that the pharmacist should not have the right to sacrifice another's well-being to his own agenda, or that, as a person himself, it should not be up to him to determine the fate of another (I'm just guessing here; please someone feel free to give a more eloquent/thought-out defense).

If this is true, then the problem with denying birth control to women is that it seems to equivocate on the importance and nature of this relationship. For in the birth control case, the relationship that is given the most attention is NOT the relationship between the pharmacist and the patient (the potential parent) but rather between the pharmacist and the (potential) fetus; the potential parent's needs/well-being/intentions etc. are ignored. Is that fair/okay?

And on the other hand, if pharmacists generally have free reign to wantonly administer and deny prescriptions whenever they want to, how come it seems that they don't seem to exercise it much in cases other than abortion (or do they)?

At 10:03 PM, Anonymous Thelonious said...

this is definitely a topic well-worth discussing.

you make an interesting point when you mention federal financial sponsorship. many (like myself) would argue that the tremendous amount of federal subsidies WalMart has received over the years should count as more than enough incentive for the company to be held uniquely accountable to the needs of its consumers.

in an ideal market setting such an issue would never reach the table for discussion, as market forces would simply make other companies who offered EC more competitive, but when you consider that 1.) the market is not and never has been free, meaning that certain companies are regularly priviledged with government contracts and subsidies, and 2.) the disparity between the large companies and small companies is so enormous that the traditional rules of economics simply cannot apply, government intervention becomes the most democratic and just course of action.

as of the year 2000, out of the top 100 economies in the world, the bottom 49 are nations. the top 51 are corporations. it's almost impossible to fathom the implications of this, the fact that Israel, a nation with the 4 largest military on the planet, is not as powerful (financially) as WalMart. so this particular issue begins to strike at the heart of what concerns so many of us over here on the far left.

"These corporations are in essence private governments - exerting power and influence over products, wages, prices, political affairs, cultural images, fashions, and ideas. But this power is not constrained by Constitutional order. Corporations answer only to their stockholders, and the bottom line - concern for those they control is not necessarily in the mix."

this quote is from a random website that i don't necessarily endorse, but the sentiment is far-reaching and widely ignored when we see "anti-globalization" protesters in the media.

perhaps this issue could help to align women's issues with the greater global-economic justice movement.

i guess one can hope.


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