Being sexually assaulted was just the first part of 18-year-old Nicole's ordeal. The second was her frantic drive around New Orleans, trying to find a pharmacy that would fill her prescription for emergency contraception.
"My mother drove me around," says Nicole, a college student who chokes up at the memory two years later. "I was really hurt and really sick, and I should have been in bed, but we were driving all around looking for it. Every pharmacy we went to said it was not available; they did not have it. We went to a ton of them. I didn't think it was possible that none of them could have it."
After she was raped, Nicole (who asked Gambit Weekly not to reveal her full identity) had gone to the hospital and was treated for injuries sustained in the attack. There, hospital staff gave her one dose of emergency contraceptive pills, which are taken within 72 hours after unprotected sex to stop ovulation, fertilization or the implantation of a fertilized egg. Though insertion of an IUD can be used as emergency contraception, the vast majority of doctors prescribe it in pill form.
Nicole was responsible for getting the second required dose from an outside pharmacy. "I was terrified that I would be pregnant," she says. "I'm pro-choice, but have always said I wouldn't be able to [have an abortion] myself. But I realized then, when that happened, that that would be the one situation where I would have to abort."
She and her mother drove around for hours, with Nicole growing so anxious that she became violently ill. They returned to the hospital, where Nicole begged a nurse for a second dose from the hospital pharmacy. "I think she snuck it out of there," she recalls. "She didn't charge us for it."
Emergency contraception (sometimes referred to as the "morning-after pill") is often confused with the "abortion pill," mifepristone (formerly known as RU-486), which is taken in combination with a prostaglandin after a woman has tested positive for pregnancy. The latter blocks the creation of progesterone, a hormone required to sustain pregnancy. Mifepristone is not currently available in pharmacies, but is dispensed directly from the prescribing doctor.
Unlike the so-called abortion pill, "emergency contraception is birth control," says Julie Redman, executive director of Planned Parenthood of Louisiana and the Mississippi Delta. "It's just another form of contraception. Mifepristone is the abortion drug. There is a difference." She says that while only a handful of doctors in Louisiana provide mifepristone, many will prescribe emergency contraception.
But to abortion-rights opponents, there is little difference between the two: Many believe that interfering with the fertilization of an egg, or with the implantation of a fertilized egg, is a form of abortion. Some states have passed laws letting health-care professionals refuse to provide a service, such as abortion, if they have a religious or moral objection to it. Such "conscience clauses" or "refusal clauses" (depending on which side you ask) provide legal protections to the objecting party. Some extend to cover emergency contraception and even regular contraceptives. In Louisiana, the state Legislature considered a bill to create such a clause about five years ago, but it never passed.
Emergency contraceptives are legally available and hormonally similar to birth-control pills, which are widely available in most pharmacies. The Food and Drug Administration is considering a proposal to allow "EC" to be sold over-the-counter to those over the age of 16.
But many New Orleans-area pharmacies who carry birth-control pills and other contraceptives don't carry EC. Gambit Weekly took an informal survey of pharmacies in the metropolitan area and learned that most of the ones called at random -- mostly independent pharmacies, but national chains as well -- don't keep EC in stock. Even within the same chains, availability differs. Suburban pharmacies were less likely than their inner-city counterparts to carry widely prescribed brands of emergency contraceptives.
Some pharmacies said they could have it within a day or two. But EC is a time-sensitive prescription: The first dose must be administered within 72 hours, and the earlier it's taken, the more effective it is likely to be. Women seeking EC, therefore, have a short window of opportunity to obtain it.
"The question is: Why aren't they carrying it?" Redman asks. "It's hard to say -- are they refusing based upon moral or religious grounds, or are they refusing because they don't get any calls for it?" She says that given the number of requests Planned Parenthood's Uptown office regularly gets for emergency contraception from all over Louisiana and Mississippi, it's hard to believe the demand isn't there.
The American Pharmacists' Association's policy says pharmacists can refuse to fill a prescription if they have moral objections to it, but they must provide a referral so the person can get it elsewhere.
Lloyd Duplantis, owner of Lloyd's Remedies Apothecary in rural Gray, La., is among the pharmacists who put contraceptives in the same "harmful" category as medications such as mifepristone. "The question was: Is there any harm being done by these steroidal pills and contraceptives?" Duplantis says. "I started to study it as a scientist, and I came to the conclusion that [they posed] harm to a woman, and a substantial number of times there is the potential to abort a child that's been conceived. I came to the conclusion that I needed to avoid this type of practice."
Women who seek contraception in his pharmacy are steered to devices that can help them chart their ovulatory cycle, so they can abstain from sex during fertile periods. "What we recommend is natural fertility regulation," says Duplantis, a member of the national organization Pharmacists for Life. "[A woman] doesn't have to take something that compromises her life and compromises her health. It's not in your best interest to use those type of contraceptive things to plan your families."
Duplantis' pharmacy is located between Houma and Thibodaux. "The closest pharmacies are five miles from me; I'm the only pharmacy in this zip code," he says. Because most of his clients are elderly, he says, he doesn't have much of a problem with customers complaining about his refusal to carry most contraceptives, though some have. "We don't sell cigarettes either," he points out.
As a pharmacy owner, Duplantis has not encountered problems refusing to dispense certain products. In a case where an objector is a public employee, the waters are murkier. Two years ago, Marrero nurse Cynthia Day filed a complaint with the state, saying the state-funded clinic where she worked had threatened to fire her when she refused to provide EC to patients.
The Department of Health and Hospitals (DHH), which apologized to Day in writing for her "ordeal," offered her the option of working at other state-funded facilities, which she took. DHH spokeswoman Kristen Meyer says that DHH has no standing policy regarding "conscience" or "refusal" clauses among state employees. "We deal with this on a case-by-case basis," Meyer says. "If an employee has a legitimate concern with an aspect of their job -- such as distributing emergency contraception -- because of their moral beliefs, they should express that to us, and we will work to get them reassigned."
Redman, of Planned Parenthood, suggests that those who have trouble getting emergency contraception from a pharmacy should complain to its management. "Birth control is basic health care, and to not offer these products is discrimination."
Complaining about her inability to get EC was not something that Eve, a Louisiana State University student, was inclined to do. Her gynecologist in Baton Rouge had said that Eve could call her if she ever needed EC, and one morning, Eve did. "I had a birth control failure, and the doctor was not in," recalls Eve, who also agreed to speak on condition of anonymity. "They passed me around to different nurses, and I had to tell everybody the same thing."
She eventually spoke to another doctor in the practice. "It was very obvious to me that she didn't like the fact that I was asking for this," Eve says. "She was very cold and said, 'I don't do that.' She offered no explanation, not any sort of help, nothing. I had no idea what to do."
Eve called the New Orleans Planned Parenthood clinic, but couldn't afford its $75 charge for EC. "I was a college student, and I wasn't about to ask my parents for the money," she says. She waited anxiously for three weeks, when a pregnancy test came up negative.
Eve says her encounter with the clinic staff left her too embarrassed to call her doctor and report the problem. "I felt judged, embarrassed, mortified," she says. "I felt like a whore. That's how those people made me feel. I wasn't about to go back to them for anything."
The future of emergency contraception is in the hands of the FDA. "I think really what we're talking about with emergency contraception specifically underscores the need for it to go over-the-counter so it is as widely available as it can be," says Redman. "Or you could get it over the Internet if you needed to. At Planned Parenthood, we encourage everyone to take EC with them -- all persons who come to our clinic. We encourage them to have emergency contraception on hand for when they do have an emergency.
"The fact that some pharmacists would refuse to provide a medically prescribed contraceptive underscores our push to make EC available through over-the-counter access," she says. "The American College of Obstetrics and Gynecology is pushing for it; it's under study by the FDA."
In the spring, the FDA rejected an advisory panel's recommendation to make it available for over-the-counter use, saying it was concerned about EC's use among teens. The FDA did advise the petitioner, Barr Pharmaceuticals Inc., that it would consider a resubmitted application to make it available over-the-counter for women over the age of 16; that application is pending.