Little Girls Don’t Vote

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.

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.

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.

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