A Big Win For Plan B

By Jyoti Thottam, Sean Scully/Philadelphia

Wal-Mart, usually a 10-ton target for activists ranging from union organizers to antiglobalization protesters, found itself wearing a new label from some liberals last week: ally. After months of pressure from both sides of the abortion debate, Wal-Mart decided to stock the controversial emergency contraceptive Plan B, also known as the morning-after pill, in all its more than 3,700 pharmacies nationwide beginning March 20. The company has never publicly objected to the drug and says it chose not to carry Plan B because of low demand. But after being forced by Massachusetts and Illinois to stock the pills in those states, Wal-Mart concluded that wasn't a battle worth waging anywhere else. "Rather than try to fight these [bouts] state by state, it just seemed like the right time to begin to sell emergency contraceptives," says Mona Williams, a Wal-Mart spokeswoman. The decision is the latest in a string of developments expanding access to emergency contraception, one of the few arenas in which abortion-rights groups seem to be gaining ground.

"In rural areas this means that a lot of women who would have had to drive for miles and miles to find Plan B will be able to find it at their local Wal-Mart," says Sharon Camp, founder of the company that developed Plan B and now president of the Alan Guttmacher Institute, a reproductive-health research group. Because the drug's effectiveness drops 50% every 12 hours and is limited to the first 72 hours after unprotected sex, proponents of Plan B say any obstacle--a doctor who is unavailable to write a prescription or a pharmacy that is out of stock--runs down the clock toward an unplanned pregnancy. The drug, a high-dose variant of ordinary birth-control pills, works in a similar way, by preventing ovulation and fertilization. It can also inhibit a fertilized egg from implanting itself on the wall of the uterus, resulting in what anti--abortion-rights advocates say is effectively an abortion. In any case, it can do nothing to end an existing pregnancy. About 1.3 million prescriptions for Plan B were filled last year, generating $30 million in revenue for its manufacturer, Barr Pharmaceuticals. Now that Wal-Mart has agreed to stock it, so will every major pharmacy chain in the country.

Anti--abortion-rights activists say they are deeply disappointed by the about-face. "It's a capitulation to the strong-arm tactics of the abortion lobby," says Wendy Wright, president of Concerned Women for America, a Christian public-policy group.

With the Food and Drug Administration (FDA) stalling on a decision to make Plan B available over the counter--as recommended by its scientists--abortion-rights groups have moved aggressively to expand access at the state level. Eight states allow specially trained pharmacists to dispense the drug without a prescription as long as they follow state guidelines, including informing patients of all contraindications for Plan B and supplying the drug only to those who need it immediately. Seven more states are considering similar legislation. Massachusetts and Illinois require pharmacies to carry Plan B, and Connecticut and New York are contemplating whether to follow suit.

"You have to give credit or blame to the Governor of Illinois," says Ed Martin, an attorney for Americans United for Life, a law firm specializing in antiabortion advocacy. Martin says Governor Rod Blagojevich's emergency order on Plan B, later made permanent by the Illinois legislature, mobilized support for Martin's efforts to pass rights-of-conscience laws, giving pharmacists the right to refuse to dispense Plan B or other drugs to which they are morally opposed. Four states have passed such laws, and eight more are considering them. Martin says the political momentum among his allies in the antiabortion movement is shifting toward laws passed in Mississippi and South Dakota that strictly limit access to abortion, and bills for expanded conscience clauses in those states are unlikely to pass. The higher-profile abortion fights, he says, "sometimes suck the oxygen out of the room."

Plan B's backers, despite their recent victories, say they have little hope of grabbing the real prize, over-the-counter access, anytime soon. An FDA ruling could make Plan B as easily available as condoms, but with the November midterm elections looming, a decision on such a politically charged issue looks unlikely before then.