Many sexually active people have experienced a breakdown in contraception. Whether it's a forgotten pill, a broken condom, or the mistaken idea that marijuana functions as a contraceptive (true story), the thought of "what if...?" has crossed many a post-coital mind.
As most of our schoolchildren are dogmatically learning, abstinence is the only 100% sure method of avoiding pregnancy. Abstinence, however, is not right for everyone, and methods of birth control have existed for centuries. More recently, synthetic hormones have delivered the sexually active person a large degree of control over their child rearing or lack thereof.
Mistakes will be made, however, and emergency contraception (also known as Plan B or the morning-after pill) exists as a safety net for women who find themselves on the unhappy end of a "what if" moment. If taken within 72 hours (and the sooner the better), emergency contraception greatly reduces a woman's chance of becoming pregnant. Beginning January 1, 2007, emergency contraception will be sold around the country over the counter to women 18 years and older. But what happens until then?
I asked myself this question in response to a blog written by a woman in rural Ohio. A broken condom on a Friday night (and no access to her doctor over the weekend) forced her to rely on emergency rooms and clinics in her area for emergency contraception. She was repeatedly told that she could come in and "try," but would be interviewed by the doctor; if she met his "criteria" she would be granted a prescription for EC. Based on the nurses she spoke with, it appears that these criteria consisted of being a victim of rape or someone's wife. Denied care at a number of medical facilities, she was forced to go without emergency contraception for more than the recommended 72 hours.
"Could this happen to me?' was my immediate and selfish response to the horror of her situation. I decided to find out by calling a smattering of Chicago ERs with a similar story. Friday after 5pm, I called 10 Chicago hospitals to see what they will tell me if my doctor has gone home for the weekend. I opened each call with the same basic request: "Hi. I am looking for emergency contraception. My doctor is gone for the weekend, and I was told to call an emergency room."
I chose my hospitals based on a number of factors: the results of a Google search, which should bring up results common to anyone searching in the city; my familiarity with the institution; affiliation, especially important for Catholic hospitals; and population served, i.e., students, low income, etc. My aim was to get an idea of what obtaining emergency contraception is like for an average, young and unsure city resident.
Some caveats: My position as a young, white female from the North Side leaves me with a bias of familiarity to North Side hospitals. My mention of having a doctor in my query led at least one nurse to assume that I had medical insurance. Thirdly, I wasn't nearly as aggressive as I would have liked to have been with a couple hospitals. I feel a woman in my "situation" would be more demure in an attempt to get what she wanted, generalized submission being the easiest way to achieve goals as a woman in American culture. With that in mind, here's what I found.
Northwestern and Walgreens
Located in the affluent Streeterville neighborhood in downtown Chicago, Northwestern is widely regarded as a hospital of high repute. I am quickly connected to a nurse and relate my story.
"Emergency contraception? You mean like the morning-after pill?" he asks.
He puts me on hold for a moment and comes back to say that he believes it is available over the counter, that he'd seen a sign in Walgreens. He suggests that I check there first and then call him back if I am unable to obtain it.
I know that EC isn't available, but I call my local Walgreens and leave a message for the pharmacist. I stress in my message the obvious urgency of the situation.
After waiting 15 impatient minutes, I decide to go to the pharmacy in person. I speak with the young, male pharmacist at the window. It takes three names — EC, emergency contraception, and finally the morning-after pill — for him to understand what I'm looking for. He says that it is still unavailable without a prescription and is unsure what date it will be available over-the-counter. He tells me that my doctor can call the prescription in for me.
Checking my voicemail, I have a message from the pharmacy, which I must have missed en route. Based on the voice, I think it is the same pharmacist, which is interesting since he responded to my request for emergency contraception by that name over the phone, but not in person. The message says that "the medication [I] inquired about" will not be available until December due to the fact that the manufacturer needed to change the packaging. Again he tells me my doctor can phone in the prescription.
I return my call to Northwestern and speak with the same nurse. He seems surprised, but quite affably tells me to come into the emergency room. When I ask if I will have to have a pelvic exam, he says, "No, just a discussion with the doctor." He suggests that I come in quickly, as they are having a "slow period." He seems frustrated on my behalf for the hassle of having to come in and asks me no personal questions.
Illinois Masonic is located in Lakeview, near the Belmont and Clark area. The nurse I speak with is very straightforward, friendly, and efficient. She says I will have to come in. When I ask if I will need a pelvic exam, she says, "No, no. Just come in." Emboldened by my positive experiences thus far, I decide to call a Catholic hospital.
St. Joseph's Hospital
St. Joseph was my hospital until this summer. A number of years ago, it became affiliated with Resurrection Health Care, a Catholic health system. At that time, my friend who had a doctor at St. Joe's became unable to obtain birth control unless she had "extenuating circumstances." Her doctor asked her leadingly if she "got cramps." My friend replied that she did, and birth control was prescribed.
Calling St. Joe's takes the wind out of my sails. The attendant tells me, "This is a Catholic hospital, I don't think they're going to be able to help you," but connects me to a nurse. He tells me, with a slight edge to his voice, that the hospital does not "dispense contraception of any kind." I give my thanks and he quickly ends the call. He seemed annoyed either with my request or that I was unaware that it would be denied, it's unclear which.
University of Illinois at Chicago Hospital
I am slightly taken aback at the brusqueness of nurse at St. Joe's. Considering that my "situation" was rather traumatic, he seemed, at best, unconcerned. I decide to retreat a bit, and call what I assume will be a slam dunk. UIC is a major college in the city; they must surely be familiar with the EC routine.
It is not the encouraging call I'd been hoping for. The UIC attendant answers the phone with only her name, and I have to ask if I have reached the ER. When I ask for EC, she gruffly tells me, "We don't do refills," even though she seems to understand that I am asking for the morning-after pill. She tells me that I will have to come in, and that she does not know what the procedure will be once I get there. Though I am clearly concerned by what might await me, she does not offer to connect me with a nurse.
Weiss Memorial Hospital
Starting to feel somewhat discouraged, I call Weiss' ER. I give the now-familiar story to the attendant, who pauses, and then asks hostilely, "And how can I help you over the phone?" I explain in a small voice that I am unsure what to do, if the hospital could call in a prescription for me or if I would have to come in. In the same tone, he says I will "absolutely" have to come in. He does not offer to connect me with a nurse, and hangs up on me as I express my tepid thanks.
Our Lady of Resurrection
A glutton for punishment, I decide to call another Resurrection Health System hospital. After explaining my situation, the attendant puts me on hold. I wait for nearly three minutes before the nurse picks up. She explains, more kindly than the nurse at St. Joe's, that they will not provide emergency contraception for me.
"Where am I supposed to go if not my hospital?" I ask.
"You can get it at Walgreens," she replies.
"That's not until January; I called them."
"Oh. Well you can go to any hospital, but not a Catholic hospital because they don't believe in contraception."
I thank her and hang up, wondering if her use of the word "they" indicates frustration on her part.
Swedish Covenant Hospital
I decide to call my new hospital, Swedish Covenant. Unbeknownst to me, it is affiliated with the Evangelical Covenant Church. I will soon be given cause to look this fact up.
During my call, I speak with a nurse who sounds about my age. In response to my query, she says, "I don't know what happens with that," and puts me on hold. When she comes back on the line, she says that I can come in but that it's going to be "very expensive" and that "it's my decision."
"Well, what are my other options?" I say a bit incredulously.
"You have up to 72 hours to take it," she casually replies.
"But isn't it better to take it sooner?"
"Yes, but if you come into the ER, you'll have to wait to see the doctor." This is clearly viewed as a great inconvenience; I briefly ponder the inconvenience of becoming pregnant.
"What will the exam consist of?" I ask.
"You just have to come in," she says quickly. It sounds like evasion.
"Do I have to have a pelvic exam or anything?"
"No, you just tell the doctor your situation and he'll decide whether or not to give it to you."
"Can he choose to not give it to me?" I am becoming decidedly uncomfortable. "Is that an option?"
"It's his decision," she replies simply. She mentions again how expensive a trip to the ER is. Her unspoken suggestion is that I call my doctor on Monday. While this would have pushed the 72 hours to the max, I get the feeling that she is really trying to save me what she knows will be an unsuccessful trip. I resolve to call my HMO on Monday and switch to a different hospital.
Cook County Stroger
Frustrated with private health care, I decide to call the hospitals of Cook County, a sure source of additional aggravation. Plagued with finance and staffing problems, these facilities are notorious for their slow service, dooming those without health insurance to painfully long waits for appointments and prescriptions. A microcosm of the typical Stroger visit, my call to the ER elapses a total of 12 minutes, at least eight of which are spent waiting for someone to pick up the ringing phone.
When I speak to the attendant at Stroger, he actually laughs out loud and says, "I don't know anything about that. Let me get you to a nurse." The hilarity evades me as I listen to my first six minutes of ringing. Finally, a woman answers. I give my line, and she says only, "Hold on."
I again listen to several minutes of ringing before I am transferred back to my merry friend, the attendant. I recap, and he says good-naturedly, "How did you get back to me?" As I recount the eight minutes I can never have back, he says, "Lovely. Hang on." At least now he's as frustrated as I am. Another few minutes of ringing connects me with a nurse.
When I ask for emergency contraception, she says, "Oh, the morning-after pill thing?" She's friendly though, and says to "come on in." When I ask what the visit will consist of, she doesn't know, and neither does the other nurse she asks. I ask if I will be given a pelvic exam, and she says that would be "up to the doctor."
The majority of my time engaging Provident is actually spent with Google as I try to find the number for the emergency room. The top four hits for the hospital the day I searched are actually links to a website about its history that provide no useful information about how one might access the resources so dutifully enumerated.
When I talk to the nurse, she stresses that I'll be waiting a long time. Something, presumably my mention of having a doctor, leads her to assume that I have insurance, and she recommends that I go to my regular hospital. I tell her it's St. Joseph's and that they have refused me.
"So, wait, your hospital won't give you the pill, but your doctor will?" she asks.
"Yes," I say, remembering my friend's situation, "I think she'd give it to me." Even to me, my pause makes me sound cagey.
"Well that's more information than I need. I'm not trying to get information from you," she responds quickly.
I ask what will happen during my visit and whether or not I will have to have a pelvic exam. She allows it may happen. I ask why that would be necessary and she says, "Well, you can't just come in here and decide what medicine you want." I am left to wonder what a pelvic exam might tell a doctor about my desire not to become pregnant.
For the most part, however, this nurse is friendly and motherly. She encourages me again to visit "any other hospital" if I have insurance because the wait at Provident will be "hours." Her realism may be less for my benefit than the prospect having one less body in the ER, but it is appreciated.
St. Mary's Hospital
As I place my final call to another Catholic hospital, I wonder if a Resurrection employee will help direct me to a specific location to get care. My fears of utter rejection are unfounded at St. Mary's, however. One of the friendliest voices I've heard gives me the party line, but without prompting directs me to Northwestern or Illinois Masonic.
I was surprised by how nervous I became before each call. This was especially true if I'd just spoken with an attendant or nurse that seemed resistant to my request. The call to Weiss and the attendant's hostility shook me up, leaving me to wonder about the reactions of a woman who actually needed EC. I should have been fairly well insulated emotionally — my story was fake, whereas a woman seeking much-needed medication would have become more distraught over each discouraging call.
The call to Swedish Covenant was particularly disheartening, as I realized that my HMO-assigned hospital might provide me selective and, I would assert, substandard care. If I entered the emergency room with a broken arm, also the result of an accident, the doctor wouldn't decide to fix it. It wouldn't be the ER's prerogative to decide whether my accident should alter my life irrevocably, the possible result of an untreated break. I wouldn't be denied medication to alleviate the effects of my mistake.
So, then, isn't a judgment of worthiness the clear message of meeting with the doctor to discuss my "situation?" The merit of my request will be assessed, and, if I meet some undefined set of criteria, I will be granted the resources I seek. The Provident nurse's "you can't just come in here and decide what medicine you want" point is well taken, but why is emergency contraception considered a "want" any less important than other remedies? I mean, I don't technically need to get my broken arm fixed. I might not be able to use it for a while, it might hurt, and it might substantially alter the course of my life, but isn't getting it repaired really a "want?" Don't I simply "want" to regain the full use of my body as I know it as quickly and painlessly as possible? These are serious questions because women across the country are not getting equal care. Until January, they are being forced to persuade their doctors to provide medical attention for a "situation" that is neither illegal nor uncommon.
I know these arguments will be considered by some as part of the amoral, "sex without consequences" lifestyle currently destroying our culture. But where is the line between moral and immoral? Is it moral that access to legal medication functions for many women like a slot machine, their fates determined by which doctor happens to be on call? Is it moral that a woman without health insurance should be condemned to wait prohibitively long hours in a waiting room? Is it moral for my hospital to tacitly suggest that I visit my doctor on Monday, when every hour I wait increases my chances of unwanted conception? For the life-begins-at-conception crowd, is it moral to force me into an abortion, rather than give me a pill to prevent it? None of these scenarios seem particularly moral to me.
Emergency contraception will soon become legal for over-the-counter sale. Undoubtedly, numerous women across the country will be affected by "morality clauses," which will continue to inhibit their ability to obtain medicine with the same legal standing as Advil. Until that time, however, every woman must roll the dice, hoping for a doctor who understands that their morality should end where her rights begin.