Legislators look at birth control issues

JEFFERSON CITY — In a legislative session dominated by parochial issues, some Missouri lawmakers are trying to move beyond restrictions on abortion rights to impeding access to certain types of birth control.

The focus of the efforts is to make it harder for women to obtain emergency contraception, commonly known as the morning-after pill. Legislation introduced in the House would classify emergency contraception as an abortion-inducing medication, contrary to the definition used by the Food and Drug Administration.

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Opponents have attacked the proposal as an unconstitutional restraint on reproductive freedom and an unconscionable affront to sexual assault victims. They said the bill would enshrine an inaccurate medical description in Missouri law, lead to increased numbers of abortions and leave thousands of rural Missouri women without access to a safe and reliable form of birth control.

Gerry Greiman, chairman of the church-state committee of the Jewish Community Relations Council, called such bills an end-run around constitutional rights. They are an effort to imbue a single pharmacist with the moral authority to deny health care they don’t like.

“Certain public services are health related and vital to the community,” Greiman said. “When someone needs and chooses to avail themselves of the full range of health services, he or she ought to get them and not have to drive from hospital to hospital or pharmacy to pharmacy to find them. You shouldn’t be denied services you need because one person’s personal order of things determines what is needed and what is not.”

The legislation seeks to protect pharmacies from lawsuits for refusing to sell or fill a prescription for any drug defined as triggering an abortion. It would block state regulators from punishing pharmacies for not filling such prescriptions. And it would assert that emergency contraception triggers an abortion.

Susan Klein, a lobbyist for Missouri Right to Life, emphasized that the bill does not attempt to make emergency contraception illegal. It seeks only to prevent family planning activists from exerting legal pressure against pharmacies that refuse to sell or stock an item that violates their conscience, she said.

Joan Denison, executive director of the St. Louis Chapter of Hadassah, said the issue involves balancing the rights of individuals to observe their religion in the workplace with the rights of the public to make health care decisions according to their own moral and religious beliefs.

Hadassah’s national position is that religious conviction should be accommodated whereever possible. But such accommodation cannot ignore the harm or burden placed on others.

Government and business should “put in place mechanisms that ensure patients’ access to medication without delay,” the Hadassah policy says. “Where access to medications cannot be provided without delay, the right to health care must supersede the right to religious accommodation.”

The Missouri Board of Pharmacy has taken no position on the whether pharmacists have a right to refuse to fill a prescription for moral reasons. Debra Ringgenberg, the board’s executive director, said no complaints have been filed against pharmacists in Missouri for refusing to fill prescriptions and the board has seen no reason to inject itself into the controversy.

The bill applies specifically to two drugs: RU486, the early name for mifepristone, the drug administered in a doctor’s office to perform a non-surgical abortion, and emergency contraception, which is marketed as Plan B.

Mifepristone, which is used from five-to-seven weeks after conception, works by blocking a hormone needed to maintain the pregnancy.

Plan B, which is effective up to about 100 hours after unprotected sex, works primarily by preventing ovulation, the FDA says. If an egg has already been released, the drug also can prevent fertilization. And if fertilization has occurred, it can prevent the fertilized egg from implanting in the uterus.

Klein said Missouri Right to Life considers emergency contraception a form of abortion because members believe that pregnancy begins the moment an egg is fertilized. Plan B, therefore, can lead to the death of “an already-created human being” by blocking implantation in the uterus, she said.

By the time of implantation, “the human is long past the stage of being a so-called fertilized egg,” Klein said in written testimony. “If denied the ability to implant, then the human cannot form a placenta and continue to live. This means that a drug that prevents implantation causes an abortion.”

Opponents of the bill say Klein’s definition attempts to blur the line between contraception and abortion. The references to mifepristone are disingenuous, they said, because pharmacists are not allowed to dispense mifepristone, which must be administered by a doctor.

Plan B won’t work if the fertilized egg has already implanted in the uterus and pregnancy has begun. Under Klein’s definition of pregnancy, many standard forms of contraception, such as intrauterine devices, would be defined as abortion-inducing.

Plan B is available to adults without a prescription. But one study found that 26 percent of women in Missouri do not live within 30 miles of a pharmacy that sells Plan B.

Therefore, one pharmacy that refuses to carry it can leave thousands of Missouri women without a backup method of birth control.

Greiman said the bill was clearly an effort to impose a narrow, religious aversion to birth control on all of society. Health care professionals, he said, have a duty to serve the public first.

“If you have a personal conviction against dispensing this, then find another line of work,” Greiman said. “Become a lawyer.”