E-Mail This Article to a Friend Pharm stand Anti-choice pharmacists opposed to all forms of artificial contraception are seeking the power to mess with women’s everyday lives BY DEIRDRE FULTON

THE MAJORITY of women, whether they’re pro-choice or not, are more familiar with the look and feel of their local drugstore than they are with the inside of an abortion clinic. An estimated 95 percent of women use some form of artificial contraception at some point during their child-bearing years, while statistics from the New York–based Alan Guttmacher Institute show that if current rates continue, about 35 percent of American women will have an abortion during their reproductive years. We certainly can do more to continue reducing the abortion rate, but the fact remains, many more women are preventing unwanted pregnancies than are terminating them.

So, when the religious right enters pharmacies and emergency rooms to undermine access to contraception — "a very important part of women’s basic health care," says Massachusetts ACLU lobbyist Norma Shapiro — the intrusion is not abstract. By expanding their opposition to reproductive rights beyond the context of abortion, a growing movement of anti-choice extremists in the pharmacy profession is messing with women’s everyday lives.

Some religiously conservative pharmacists affiliated with organizations such as Pharmacists for Life International have long objected to synthetic birth control, such as the Pill. In the past, many have quietly passed such prescriptions on to colleagues unfettered by such qualms. These days, however, technical refinements to the "morning-after pill," or emergency contraception (EC) — a highly concentrated form of birth control that works within five days after unprotected sex to prevent ovulation, fertilization, or, in very few cases, implantation of an egg in the uterus — along with efforts to expand access to and awareness of it have prompted conservative pharmacists to mount organized opposition to all forms of artificial birth control.

No doubt emboldened by right-wing political rhetoric and an increasingly anti-choice climate, these pharmacists are seeking protection through what are called "conscience clauses," which allow health-care providers to bow out of providing services that conflict with their moral or religious beliefs. That may sound reasonable enough. Trouble is, there is every indication that, in today’s political climate, activist pharmacists are unwilling to settle for conscience clauses alone.

Four states already have laws on the books that permit pharmacist refusals; now, 12 more are considering similar legislation. Only some require pharmacists to refer (to another pharmacist or a different drugstore entirely) a prescription they refuse to fill. Meanwhile, just four other states are considering legislation that would do the opposite by requiring pharmacists to fill prescriptions.

With several states, including Massachusetts, considering expanding EC access, and the federal Food and Drug Administration weighing the benefits of over-the-counter access to the drug, the drugstore battles are bound to heat up even further.

GEORGE W. BUSH’S re-election sounded a wake-up call to pro-choice advocates across the country (see "Last Choice," News and Features, November 26, 2004). With conservatives controlling two branches of government — and ready to pounce on a third as soon as a Supreme Court seat opens up — women’s-rights organizations prepared for an onslaught of federal and state legislative attacks on reproductive rights. Their concern was not misplaced. During Bush’s first four years, right-wingers launched a series of incursions into reproductive rights — passing anti-choice legislation; de-funding international health-care agencies that merely offer information about abortion; nominating extreme religious conservatives to key positions, such as the failed attempt to name David Hager head of the Food and Drug Administration’s Committee on Reproductive Health; and promoting abstinence-only rather than comprehensive sex education in public schools.

After November’s elections, the anti-choice movement gained momentum. Just last week, the US House passed a bill that would make it illegal for an adult other than a parent or guardian to transport a minor across state lines (presumably to a state with less-stringent parental-notification laws) to get an abortion. Women’s-rights groups say the measure places undue strain on young women and families, and argue that it’s just one more angle from which to chip away at abortion rights. The bill, and its US Senate counterpart, are on the GOP’s top-10 list of legislative priorities this session.

In Arkansas, Georgia, Mississippi, and South Dakota, state laws or pharmacy-board regulations already allow pharmacists to refuse to fill prescriptions, including those for birth-control, if doing so conflicts with their personal beliefs. (Mississippi’s statute passed in 2004; the others have been on the books for years.) As of April, legislators in 12 other states (including Rhode Island, Vermont, Texas, and West Virginia) had filed similar legislation for the current session. More legislation will likely lead to increased public acceptance, and then, more refusals.

The movement, meanwhile, is not content merely with pushing for conscience clauses. Reflecting the extreme social conservatism of its deceased founder, Sam Walton, Wal-Mart refuses even to stock EC (and given the behemoth super store’s market share, it’s sure to be the only pharmacy serving many rural areas). There are also reports of pharmacists flat-out refusing to transfer a prescription to a more-cooperative colleague. Even more disturbing are scattered accounts — including some in Massachusetts — of pharmacists offering lectures in lieu of prescriptions.

"If it’s about conscience, that’s one thing," says Judy Waxman, vice-president for health and reproductive rights at the Washington, DC–based National Women’s Law Center. However, she adds, the pharmacy isn’t a pulpit. "If it’s about extremists trying to get in the way of women’s health care, it’s inappropriate."

Especially since, like most other women’s-health issues, this one has the potential for a disproportionately harsh effect on women who are poor, young, or live in rural areas. These women will have more difficulty traveling to fill a referred prescription at a different pharmacy. In addition, studies show that poor women and minorities are less likely even to know about emergency contraception. Unaware of the drug, or of how and when to obtain it until the last minute, women seeking EC might arrive at a pharmacy later in the five-day window of the drug’s effectiveness — with less time to waste dealing with moralizers and bureaucracy.

In Massachusetts, pharmacists who refuse to fill a prescription are violating the state’s policy, which contains "no morals clauses or conscience clauses," says Donna Rheaume, spokesperson for the Massachusetts Department of Public Health. "The Board of Pharmacy expects that all prescriptions will be filled by pharmacists," unless there’s a medical reason (such as drug interactions) why one shouldn’t be.

Unfortunately, that doesn’t mean it can’t happen here. Planned Parenthood League of Massachusetts (PPLM) reports hearing of a handful of refusals; the organization is in the process of confirming the nine official complaints it has received in the past year and a half. "Sometimes it’s not even a refusal, it’s a lecture," says PPLM spokeswoman Erin Rowland. "It’s the same imposition of ideology on a patient who’s very vulnerable."

In one publicized case last year, a CVS pharmacist in Amherst refused to fill the regular birth-control prescription of a University of Massachusetts Amherst sophomore, the school’s Daily Collegian reported in December 2004.