Time for a Plan C

Originally published in The Washington Monthly on November 26, 2013.

After years of fighting to make Plan B available without a prescription to girls of any age, the discouraging announcement that Norlevo, a European drug identical to Plan B, loses effectiveness in women who weigh more than 165 pounds and is completely ineffective for women who weigh more than 176 pounds, casts a dark shadow on what was previously celebrated as a victory for women’s health and empowerment. The racial and economic disparities of those who can benefit from Plan B turn out to be much starker than previously understood.

Manufacturers of the European drug announced that they will be updating their packaging information to reflect the weight limits, but it’s unclear yet whether the U.S. will make similar changes to the American version.

When the Obama Administration decided this past June to allow a federal district judge’s ruling to stand—which said that girls younger than 17 should be allowed to purchase plan B over the counter—it seemed like hard-won triumph for the scientific community and women’s rights organizations.

Planned Parenthood Federation of America president Cecile Richards, called the government’s decision to drop the appeal “a huge breakthrough for access to birth control and a historic moment for women’s health and equity.”

Yet this turns out to be a far greater “breakthrough” for some women than for others.

People knew Plan B was hard for poor people to access before this announcement. It’s expensive! One package typically costs between $30 to $65, which can be hard to raise on very short notice. In an economy where nearly 2/3 of the 3.6 million minimum wage workers are women, the affordability of Plan B is already a difficult if not impossible expense.

And, as one might expect, American women often come in over this new weight range. According to the Centers for Disease Control and Prevention, the average weight of American women during the years of 2007-2010 was 166.2 pounds. The average weight of non-Hispanic black women aged 20-39 was 186 pounds, and among Mexican-American women, 78 percent were overweight or obese.

To sum up: Plan B is an ineffective and often unaffordable emergency contraceptive for many American women, particularly minorities.

According to the Guttmacher Institute, in 2006, black women had the highest unintended pregnancy rate of any racial or ethnic groups. At 91 per 1,000 women aged 15-44, it was more than double that of non-Hispanic white women.

Plan B is not an abortion pill, like RU-486, which must be administered in a doctor’s office. Instead, it prevents the fertilization of an egg—which is why it must be used within about 120 hours of intercourse. The drug has been available by prescription since 1999, and contains levonorgestrel, a synthetic version of the hormone progestin. Levonorgestrel has been used in birth control pills for more than 35 years; Plan B contains a higher dose and is taken as two separate doses 12 hours apart.

But drug makers say they’re unsure if increasing levonorgestrel levels further would boost its effectiveness for women over 165 pounds. A spokeswoman for the European drug said, “A dose increase of levonorgestrel is not proven to be a solution for this problem.”

The spokeswoman recommended women with higher weight consider intrauterine devices (IUDs) as an alternative. Yet IUDs are even more expensive, costing anywhere from $500-$1000.

As the abortion fight wages on around the country, with more and more states and cities looking for ways to limit access to abortions or ban them entirely, the fact that a safe and legal abortion alternative is ineffective for many women is rotten news.

At least under the Affordable Care Act, women do have more options than they did several years ago. Birth control and preventive services like mammograms are now covered (barring more legal challenges); insurance premiums are now equal across genders.

But unplanned pregnancy is still a problem—even birth control isn’t 100% effective.

The U.S. Department of Health and Human Services’ Healthy People 2020 campaign aims to reduce unintended pregnancy by 10%, from 49% of pregnancies to 44% of pregnancies, over the next 10 years. According to the Guttmacher Institute, about half of the 6.7 million pregnancies in the United States each year (3.2 million) are unintended.

An emergency contraceptive that disproportionately benefits wealthier and skinnier Americans cannot be the only (relatively) affordable option. If we truly want to help reduce unplanned pregnancy and improve all women’s health and equality, then we need a plan C.


FLOTUS Is More Than a Charming Wife and Mother

Originally published in the JHU Politik on March 4th, 2013.

Last week a video of Michelle Obama “mom dancing” on Late Night with Jimmy Fallon went viral on the Internet. She also made an appearance at the Academy Awards to present the award for Best Picture. These recent events reinforce what we know so well about her: Michelle is a classy, fit, and stylish woman. A devoted wife and a loving mother, she fills the First Lady position with grace.

And yet, when I think about her role in the White House, I can’t help but feel, on some level, real disappointment.

Michelle Obama attended Princeton University and Harvard Law School. She then worked in a Chicago law firm and on behalf of Chicago mayor, Richard M. Daley. Yet this side of Michelle—the impressive, ambitious intellectual—is too often concealed from the public. If it’s acknowledged at all, it’s merely to show that she appreciates first-hand the promise of the American Dream and how hard it can be for individuals to make ends meet. But really, that’s about the full extent.

We could say everyone behaves like that—we live in an anti-intellectual society and everyone minimizes his or her scholarly side. And to some extent, we do. One needn’t look further than a few years back to recall President George W. Bush publicly criticizing his Ivy League pedigree in an attempt to gain a more populist appeal. However it’s undeniable that President Obama portrays himself as a thoughtful, smart and reserved leader. This is his public image. He’s known for being a constitutional law professor, a reader of Philip Roth and Herman Melville, and the President of the Harvard Law Review.

Michelle, like her husband, is an eloquent speaker; we saw this with her moving remarks at the Democratic National Convention. But even that speech, like so many of her speeches, downplayed her professional achievements and emphasized her role as a wife and a mother. She concluded with, “You see, at the end of the day, my most important title is still mom-in-chief.” This is her public image.

Perhaps this is all strategic: have Michelle be the endearing figure to provide her husband the space to work on more difficult goals. But , even if this is so, it should not be accepted without scrutiny.

When I think about inspirational First Ladies I think of Hillary Clinton and Eleanor Roosevelt. Hillary Clinton took on one of the most politically challenging obstacles of the day—health care reform. Eleanor Roosevelt fought for racial equality and labor standards. Both women were vociferously attacked, but I admire them for their bravery. They worked hard to bring light to uncomfortable topics.

Michelle’s path has followed Laura Bush’s and Nancy Reagan’s. Laura Bush worked to promote literacy, while Nancy Reagan counseled children to “Just Say No” to drugs. Michelle is working to combat obesity and promote healthy nutrition. It’s not that these things are unimportant, but they aren’t particularly “brave” either.

I’d like to see the smart and accomplished Michelle speak out on some of the tougher issues we face. Low-income housing? Parental leave policy? Education reform? The list could be very long, and there is certainly room (and need) for her to tackle something else alongside her nutrition campaign. Besides, sociological determinants such as quality housing, income-level, and education contribute to the choices people make in nutrition. By taking on the battles of deeper disparities, Michelle could not only meet the goals of her nutrition campaign, but also address inequities that permeate society.

Michelle is darling, but I want her to be bold. She is arguably the most powerful woman in the country, and has a real opportunity to use her influence, intelligence, and popularity to bring some political attention to hard issues. She has the approval and good will of the public. She should use it.

We know she loves her husband. We know she loves her children. But we also know there is a whole lot more to her than that and her chic demeanor. I hope in the future to read fewer headlines about her bangs, cool dresses, and shades of nail polish.

Call me crazy, but I believe there is much more to Michelle Obama than we have been privileged to see.

photo credit: usmagazine.com

photo credit: usmagazine.com