E-Mail This Article to a Friend Not so EC after all The average woman knows next to nothing about emergency contraception, but it’s the medical profession’s best-kept secret in women’s reproductive health. Will Beacon Hill keep it locked away? BY KRISTEN LOMBARDI

AS LONG AS we live in a right-leaning culture that imposes conservative-Christian morality on anything concerning human sexuality and reproduction, we can expect sensible forms of birth control to become embroiled in controversy. The latest example? The battle brewing on Beacon Hill over emergency contraception (EC), otherwise known as the "morning-after" pill.

Last month, reproductive-rights advocates, physicians, and their legislative allies staged a well-attended State House press conference to draw attention to a bill that would make the morning-after pill more readily available to women — to rape victims at hospitals, and to others from pharmacists without a prescription. The measure, nicknamed the "EC bill," had passed the Senate by unanimous voice vote two weeks before. Yet it had seen no movement in the House, even though a majority of state representatives support it. On June 30, proponents ratcheted up the pressure: they called on House Speaker Tom Finneran to allow debate on the bill. And they released a June 29 letter addressed to Finneran, signed by 59 of his colleagues, which urged him to bring the EC bill "to the floor for House action before this [legislative] session ends" later this month.

The next day, July 1, proponents got a rather predictable response. Finneran — a staunch foe of women’s reproductive rights — seemed upset by the call to action, as though he were caught off guard. He told Jon Keller, of WB56 news, that legislators were trying to "stampede" him on the issue. As he told Keller: "I think the bill was just sent to us about two days ago, and so the notion that all of a sudden we have to drop everything ... strikes me as absurd."

Finneran has yet to take a public stance on the EC legislation. (Through his spokesperson, Charles Rasmussen, he declined to comment for this article.) But he has hinted that he sees EC as a moral issue, not a medical one; indeed, he told Keller that he would "give [the bill] a fair reading on both sides," but "I tend to be cautious, and I don’t like it when people try to stampede me — particularly on issues that involve human life."

And so the clash over what is widely regarded as the safest and most effective contraceptive methods has kicked into overdrive. The EC bill, "An Act To Provide Timely Access to Emergency Contraception," would improve access to the morning-after pill for women in two ways. First, it would mandate that all hospitals provide the pill to rape victims; second, it would allow pharmacists, guided by certain protocols, to dispense the pill without a physician’s prescription, as is now required. The measure is modeled after laws in states such as Maine, California, and Washington, and it boasts support from nearly every medical group, including the Massachusetts Medical Society, the American College of Obstetricians and Gynecologists, and the American College of Emergency Physicians. But anti-abortion activists — led by Massachusetts Citizens for Life and the Catholic Church — have come out strongly against the measure, going so far as to call EC a "chemical abortion."

Already, the current battle looks like a replay of past reproductive-rights clashes. Bills dealing with women’s reproductive health have always encountered problems, says Dianne Luby, of Planned Parenthood, "because of the large number of Catholic legislators, and the impact of the Catholic Church in state politics." The House, under Finneran’s leadership, tends to serve as the roadblock. For example, when reproductive-rights advocates pushed to pass the Massachusetts "buffer zone" law mandating an 18-foot radius around abortion clinics where demonstrators were not allowed, the Senate approved the measure twice in a row, in 1998 and 2000, only to watch it languish in the House. Only after proponents delivered a letter to Finneran signed by 82 legislators urging action did the House pass the buffer-zone law, in July 2000.

Meanwhile, it took six years to pass the state’s contraceptive-coverage law, which requires private health plans to pay for contraceptives as they do any other prescription drug. Signed into law in March 2002, the measure had soared through the Senate for two sessions straight, from 1997 to 2000, only to die in the House. When the Senate passed the bill again in the 2001-’02 session, the speaker finally relented and scheduled the legislation for a House vote after 92 House members signed a letter demanding that he do so.

So the recent June 29 letter to Finneran, delivered only a year after the EC bill was first filed, reflects a hard lesson learned by reproductive-rights advocates and their legislative allies. They know how much of a barrier abortion opponents — bolstered by the like-minded Finneran — can be. The current opposition, says Doug Petersen, the Marblehead representative sponsoring the EC measure, "is standing in a very black-and-white way on its view of reproductive issues, and that stand is getting in the way of women’s reproductive health."

BUT IF THE current opposition to the morning-after pill is nothing new, neither is the pill itself. Since the late 1960s, doctors have given women who have unprotected sex — who suffer, say, a condom break or a diaphragm malfunction — high doses of birth-control hormones within 72 hours to prevent unwanted pregnancy. Although the practice has existed in the medical field for decades, says Phillip Stubblefield, a professor of obstetrics and gynecology at Boston University, only recently has a pharmaceutical company thought to "repackage the idea into a product."

Hence the advent of EC, which Stubblefield calls "the best-kept secret in women’s reproductive health," and which the federal Food and Drug Administration (FDA) approved for packaging back in 1998. The EC pill works by delaying ovulation and stopping fertilization. Sometimes, it blocks a fertilized egg from implanting in the womb, which explains the objections to it among pro-lifers and the Catholic Church. But unlike another famous pill, RU-486, EC is classified as a contraceptive, not an abortifacient. It has virtually no side effects, save for mild nausea and headaches. It even meets FDA criteria for over-the-counter medication: it’s safe, effective, easy to use, and will not endanger the health of those with medical problems. Last year, in a 23-to-four vote, an FDA scientific-advisory panel actually recommended that the agency approve EC for sale without a doctor’s prescription. Last May, however, the FDA stunned medical experts and women’s advocates alike by rejecting the recommendation — a move widely criticized as a political nod to religious conservatives.

Stubblefield, who also heads the state’s Emergency Contraception Network, a coalition dedicated to improving access to EC, wryly notes, "You can go to the drugstore and buy enough aspirin and Tylenol to kill yourself 10 times over for $5. So what’s the big deal about approving EC?"

The politics of FDA policymaking aside, despite EC’s obvious benefits for women, the drug is hard to come by in Massachusetts. Just last month, the state chapter of NARAL Pro-Choice America (formerly the National Abortion and Reproductive Rights Action League) conducted a study on access to EC throughout the Bay State, and uncovered some startling trends. The group surveyed all 71 hospitals across Massachusetts. Each institution received two phone calls. The first came from an advocate posing as an average woman seeking EC for herself; the second from an advocate posing as a rape-crisis counselor seeking EC for a client. The study found that up to 38 percent of the state’s hospitals — 27 of them — refused to make EC available to women. Even for counselors calling on behalf of rape victims, who typically receive special treatment, the findings were pretty grim. One out of every six hospitals — 12 in total — did not provide EC to assault survivors. The numbers reflect a slight improvement over a similar 2001 survey, which found that 51 percent of hospitals refused to provide EC to women. Still, says Melissa Kogut, the director of Mass NARAL, "the reality is that if you go to the wrong hospital and ask for EC, you might be turned away."

Even with a doctor’s prescription in hand, women can bump into trouble. A 2002 Mass NARAL survey showed that as many as 42 percent of Massachusetts women are likely to face problems while trying to fill an EC scrip. "Pharmacists aren’t stocking the drug," Kogut explains, "or they’re questioning women’s right to have it at all." She adds, "The bottom line is we need to improve access to EC for all women."