Army hospitals in Europe offering 'morning-after' pill
June 8, 2005
Two weeks ago, a proposed defense bill amendment to assure availability of the “morning-after” pill on all military bases died in the House rules committee.
But at U.S. Army bases in Europe, the pills used for emergency contraception are already available, and have been, in one form or another, for some time, doctors and pharmacists say.
“If people know to ask for it, I think there’ll be no problem with getting it,” said Col. Richard Jackson, chief of obstetrics and gynecology at Landstuhl Regional Medical Center in Germany and consultant to the European Regional Medical Command. “I just order it on the computer and the patient goes and picks it up.”
At Landstuhl, Jackson estimates, women come in seeking emergency contraception maybe twice a month. He said he personally sees about five such patients each year.
“It’s usually that ‘the condom broke,’ or ‘we didn’t have protection,’” he said. “It’s a walk-in thing to the emergency room or the family practice clinic.”
Jackson said emergency contraception is routinely offered to rape victims as part of the treatment protocol.
“It is always offered for any alleged sexual assault,” he said. ‘I say, ‘Ma’am, I can offer you some protection against pregnancy with this pill.’”
Jackson said he believed that’s been Defense Department policy for years.
“There was a little kit and there were instructions line by line,” he said.
But whether that level of care is consistent throughout the military remains an open question.
In April, when officials from Washington and the U.S. Army Medical Department visited Heidelberg, Germany, and other parts of Europe to train advocates for sexual assault victims, no mention was made of emergency contraception.
Col. Denise Anderson, an administrator with the U.S. Office of the Surgeon General, detailed the rape treatment protocol, even mentioning the number of hairs pulled from a victim’s head for DNA testing. But asked whether the victim would be offered emergency contraception, she said no.
“We don’t put it out there. If they ask about it, we’ll counsel with them,” she said.
Anderson said offering the pills to rape victims might be offensive or interfere with their religious views.
Women’s advocates say an overarching Department of Defense policy would make for consistent access to emergency contraception for military women.
Ted Miller, a spokesman for NARAL Pro-Choice America, said the DOD should act especially in light of numerous reports in the past few years of rapes in the military.
“In the context of the Defense Authorization Bill and what we’re learning about sexual assault in the military, this is one way to provide access to a certain population,” he said.
Pills’ complicated history
The pills — which are increased doses of the same hormones in birth control pills — are highly effective in preventing pregnancy if taken within 72 hours after sex. Although doctors say the pills act in the same manner as regular oral contraceptives and do no harm to an established pregnancy, the medication nonetheless has become a matter of national debate. Right-to-life and conservative groups oppose its use, saying it causes abortions and leads to sexual promiscuity.
Last year, the FDA, despite strong recommendation from its own expert committee, declined to make available a specially formulated and packaged emergency contraceptive, known as “Plan B,” without a prescription.
The American College of Obstetricians and Gynecologists, noting that the drug was safe, easy to use and was most effective if taken soon after sex, issued a highly critical response, saying the group found the FDA’s action “morally repugnant.”
But a similar situation within the Department of Defense went less noticed.
In February 2002, the DOD Pharmacy and Therapeutics Executive Council recommended Plan B be added to the Basic Core Formulary — a list of drugs available to all military care facilities.
The committee noted that its efficacy and reduced side effects — primarily less nausea and vomiting — made it the “drug of choice for emergency contraception,” and that doctors from three services supported the drug’s addition to the formulary.
But in May of that year, according to meeting notes, the council was informed that previous approval from Tricare, the military health-care program, had been rescinded, and that the matter was to be reviewed by the assistant defense secretary for health care.
Three years later, Plan B is still not on the Basic Core Formulary in the United States, and the emergency contraception debate has only grown louder.
Although at least seven U.S. states have joined Canada, Britain, Australia and other countries and made it available without a prescription, some pharmacists have refused to fill prescriptions or stock the drug, citing moral reasons.
Six months ago, the European Regional Medical Command decided to put Plan B on the command’s formulary, meaning it or an equivalent should be available at hospitals and clinics throughout the command.
Decisions about which of the thousands of drugs available to put on the list are made with a number of factors in mind, said Col. R. J. Weickum, pharmacy chief for ERMC. Among them are what doctors request, and which products might be easier for patients to take.
“We’ve said this might be useful,” Weickum said of Plan B. “In the military, we’re here to take care of the patients. If the product was harmful, we wouldn’t even consider it.”
A number of Army Europe pharmacies, including that at Landstuhl, are now stocking Plan B. Others, such as that at Heidelberg, provide the older regimen of birth control pills, which doctors have known to work for emergency contraception since the 1960s. An informal poll of five Army pharmacies indicated that all carried at least one of the two types.
Dr. Michelle Bergmann, a civilian doctor at Heidelberg Army hospital, said she believes morning-after pills are more readily available in Europe’s military community than her former workplace in Colorado. Sometimes, she said, doctors there would have to call five or six pharmacists to get a morning-after pill prescription filled.
But Col. Teresa Martinez, chief of pharmacy at Heidelberg, said she’s never heard any pharmacist object to filling a prescription.
“We don’t have any ethical issues with dispensing it,” she said.
One Army specialist who said she took the morning-after pill five years ago after having unexpected, unprotected sex, said that all the medical people she saw the morning she went to sick call were kind and helpful.
“They calmed my fears and they gave me a series [of pills] to do,” she said.