A controversial and unreported move by the Board of Weld County Commissioners to stop dispensing emergency contraception has forced low-income county health department patients to seek the drugs at the scant number of non-profit clinics in the area.
The Independent has learned that, in the summer of 2010*, the commission’s five members decided that the so-called morning-after pill causes abortion and, for that reason, voted to stop providing it at the county’s two family-planning clinics.
“We debated long and hard,” said Commissioner Doug Rademacher. “We looked at website[s] — there are a lot of pros and cons out there — and we thought that, even though [emergency contraception] is still counted as birth control, it could abort a fetus. That’s what we decided. At that point, we said, ‘We can no longer dispense that pill.’ We didn’t want to be involved. We didn’t want to be in that arena.”
Minutes of the exchanges that led to the decision and that participants said likely took place in May don’t seem to be a part of the public record.* References to the decision appear in subsequent minutes but, at press time, neither the Weld County Board clerk nor the Independent could find them.
Asked for details, Rademacher said he remembered the vote against emergency contraception being unanimous, although the commission did decide to continue offering all of the other family planning services provided by the health department, including birth control pills. Rademacher also said the board meeting included no testimony from medical professionals about emergency contraception and how it works to prevent pregnancy.
The board, Rademacher acknowledged, had waded into deep waters.
As abortion politics have heated up in recent years, influencing debate at all levels of government, a battle to define emergency contraception has clouded the science behind popular morning-after drugs such as Plan B, Next Choice and Ella.
Last year, The New York Times examined the arguments being made against morning-after pills and concluded that much of the substance they rely on is “likely rooted in outdated or incorrect scientific guesses about how the pills work.”
Experts interviewed by the Times said that, since 1999, when the drugs first became available to Americans as prescription medicine, scientists have determined that they work by preventing ovulation, just like daily birth control pills do. In other words, the drugs prevent eggs from traveling down the fallopian tubes where they can be fertilized.
The scientific findings debunk material widely disseminated by anti-abortion groups who subscribe to the “personhood” theory that fertilized eggs are people and that emergency contraception is murder. The Times speculated that those groups are motivated in their attacks on the drugs in part because outdated warning labels still attached to morning-after products suggest they can prevent fertilized eggs from implanting on the uterus where they grow into fetuses.
In the years since the 2010 Affordable Care Act, or “Obamacare,” took effect, anti-abortion employers, such as the owners of the Hobby Lobby craft-store chain, have taken up the personhood position in regard to the pills and filed high-profile lawsuits seeking to avoid the law’s emergency contraceptive mandates, arguing that the drugs violate religious opposition to abortion.
Dr. Judith Shlay, a Colorado expert on reproductive and community health care, said scientific understanding that the pills prevent ovulation and do not affect fertilized eggs has moved far ahead of the popular debate on the issue.
“This is now well established, the literature supports this understanding,” she told the Independent. “The [emergency contraception] drugs the counties in Colorado offer to patients can not cause an abortion. If an egg is fertilized, these drugs will not prevent implantation.”
Shlay said she understands that abortion is an emotional topic. All the more reason, she suggested, to believe the board would have benefited from turning to experts.
“The Internet is not the source to go to for knowledgeable medical care,” Shlay said. “To make these decisions, it is my opinion, you need to bring medical experts in with information that is tested and correct. Our state has fine universities, medical libraries, on-site medical school libraries where you can access the literature and make informed decisions.”
As it turns out, Dr. Mark Wallace, director of Weld County’s Department of Public Health, was at the board meeting where the decision on whether to continue providing emergency contraception was made. Still, Rademacher said he didn’t remember that Wallace was ever asked to weigh in on whether or not the pills could cause abortions.
Wallace said he remembers telling the board members during the meeting that denying patients emergency contraception might put the federal grants supporting the county’s family planning clinics at risk.
“It was during a routine annual review,” he said. “The board directed us to discontinue dispensing emergency contraception and we are following the policy directive of the board, as we do in all matters.”
The county hasn’t lost federal family planning grant money as a result of the decision, but Wallace said county patients and care providers were at least initially confused. He said his department received calls from patients asking where they could go to get emergency contraception and that “a few county agencies” asked if the health department could begin again to offer the service.
“We directed these individuals and agencies to other providers,” he said.
Many patients in Weld County headed to the Planned Parenthood clinic in Greeley. Monica McCafferty, spokesperson for Planned Parenthood of the Rocky Mountains, said staffers at the group’s Greeley clinic noted an increase in requests for morning-after pills from county health department patients.
McCafferty said her organization, which operates 29 clinics in a four-state region, fulfilled more than 300,000 requests for birth control last year and that 13.4 percent of those requests were for emergency contraception.
Like Planned Parenthood, the Weld County Health Department’s two family-planning clinics mostly serve patients who struggle to pay for medical care — primarily young people and low-wage earners who have spotty insurance coverage or none at all.
Dr. Shlay said access to care is a top priority when it comes to public health and that county clinics are intended to serve “people “who fall through the cracks.”
“You can go to a pharmacy when you need to and emergency contraception will cost you $45 to $50. If you’re well off, you go to the pharmacy, and it’s done. If you aren’t well off or if you’re uninsured, you end up choosing between the contraception and food or paying bills.
“[The board’s decision] means it gets more complicated,” she said. “Now the county’s patients have two trips to make: they have to go to the clinic and then another clinic or to a pharmacy.”
According to the Colorado Department of Health, roughly 29 of every 1,000 girls in Weld County ages 10 to 19 will give birth this year. That number has dipped about 40 percent in the last twenty years, but it remains roughly 3 points higher than the state’s average pre-teen and teen birthrate.
*Edit note: The participants in the commission hearings interviewed for this story remembered the debate on Plan B taking place in 2011. But the minutes for the commission meetings, found after this story was published, show the debates took place in the summer of 2010. We have updated this story to reflect that information.[ Image via Flicr by danc3droll. ]