Slate‘s new “Human Nature” column (on “Science, culture, and politics”) reports:
SEX
Item: Morning-after pills don’t lull women into risking unprotected sex.
Source: Center for Reproductive Health Research and Policy
Outlet: Washington Post, Jan. 5
Gist: Last year the Food and Drug Administration refused to allow nonprescription sales of Plan B, a morning-after pill, on the grounds that its easy availability might lull young women into having more unprotected sex. A study by CRHRP finds no such effect.
Liberal spin: This cuts the scientific legs out from under what was really a political decision. Now give us the pill.
Now of course this is a short item, which necessarily omits some of the story. Here’s an excerpt from the longer story, in the Washington Post:
Providing women with easy access to the emergency contraceptive Plan B [the “morning-after pill”] did not lead them to engage in more risky sexual behavior, a study of more than 2,000 California women has concluded.
The study did find that women given a supply to keep at home were more than 1 1/2 times as likely to use the drug after unprotected sex as those who had to pick it up at a clinic or pharmacy. The findings led the study authors to conclude that easy access to Plan B, also called the morning-after pill, could reduce the number of unwanted pregnancies while posing no apparent risk to women.
The study contradicts a key claim made by opponents of easier access to Plan B at a time when the Food and Drug Administration is preparing to decide on a second application to allow nonprescription sales of the drug. . . .
“Our findings were that women don’t change their sexual behavior when the drug is easily available, but rather that they’re more likely to use it if access is easier,” said lead author Tina R. Raine of the Center for Reproductive Health Research and Policy at the University of California at San Francisco.
The study looked at the experiences of 2,117 San Francisco-area women ages 15 to 24 who were randomly put into one of three groups — one was given the drug to take home, the second could pick it up without a prescription at a clinic, and the third could get it without a prescription at a pharmacy.
The study found that about the same percentage of each group had unprotected sex over a six-month period, that incidence of sexually transmitted disease was equal, and that about the same percentage became pregnant.
Nonetheless, about 37 percent of women in the group given Plan B to take home used it at least once during the six months, compared with 21 percent in the clinic-access group and 24 percent in the pharmacy-access group. . . .
The new study, being published today in the Journal of the American Medical Association, supports the position taken by much of the FDA review staff and 23 of 27 members of the FDA advisory panel that the drug could be safely and properly used without a prescription. . . .
So what’s missing from the Slate item, and buried in the Post story? While the study didn’t find an increase in unprotected sexual behavior when distribution constraints on the pill were relaxed (i.e., when the pill was just given to women, or was available without a clinic visit at a pharmacy), it also didn’t find a decrease in pregnancy. As the study abstract says, “compared with controls, women in the pharmacy access and advance provision groups did not experience a significant reduction in pregnancy rate (pharmacy access group: adjusted odds ratio [OR], 0.98; 95% confidence interval [CI], 0.58-1.64; P = .93; advance provision group: OR, 1.10; 95% CI, 0.66-1.84, P = .71).” The study’s text, which my library got for me, says the same.
The Post story, as I mentioned, does note this in the 8th paragraph — but the 2nd paragraph says “The findings led the study authors to conclude that easy access to Plan B, also called the morning-after pill, could reduce the number of unwanted pregnancies while posing no apparent risk to women.” Say, wouldn’t it have made sense to mention, in the same paragraph, that the study failed to find that easy access to plan B actually reduced the number of unwanted pregnancies?
Also, note that the research doesn’t precisely lead to the “conclu[sion]” that “Providing women with easy access to [the morning-after pill] did not lead them to engage in more risky sexual behavior.” Rather, it fails to support the contrary conclusion: It finds no statistically significant evidence that providing women with easy access does lead them to engage in more risky sexual behavior. As they say, absence of evidence (here, lack of a statistically significant correlation between access and risky behavior) isn’t evidence of absence (a statistically significant showing of no correlation). If enough studies fail to find a correlation, we may become fairly confident that the correlation, if there is one, is very weak. But when one study fails to find a statistically significant link, that’s hardly dispositive.
But that’s a fairly small quibble compared to the broader point — sure, easier distribution of the pill that aims to reduce unwanted pregnancies doesn’t seem to have some kinds of harmful side effects, but it doesn’t seem to have much of an effect in reducing unwanted pregnancies, either. Seems to me that both points should be noted prominently.
I should stress, by the way, that I have nothing against morning-after pills, and I think that women should have access to them. Even if easier access to the pills doesn’t do much good overall, it may help some women in some circumstances, and I think women should have convenient access to this choice. (I don’t take the view that a day-old unimplanted zygote has rights; and, no, I’m not going to take the time to debate this point, which is in any event tangential to the heart of this post.) I thus support the bottom-line policy conclusion that the Post article and the Slate item point to. I’m just not wild about how the study is being described.
As always, please correct me if I’m misreading either the study or the stories.
UPDATE: Just to be clear, the study wasn’t measure the side effects or effectiveness of the morning-after pill as such; it was measuring the side effects or effectiveness of easier distribution of the morning-after pill. My original post made this clear, but in some parts of it I used “pill” as shorthand for “easier distribution of the pill,” and that was confusing; I’ve updated the post to remove the confusion.
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