Imagining American sexuality

in debates over access to

emergency contraceptive pills

Lecture for ANTH106

Dr Lisa Wynn
 New reproductive health technologies
• stem cell research,
cloning, medical abortion,
in vitro fertilization,
preimplantation genetic
testing, erectile dysfunction
drugs, emergency
contraception, etc…
• Often produce intense social
debate. Why?
• Not just about health; about life itself: When
does life begin? What creates and ends life?
• Not just about life; also about sex; sex and
sexuality amongst most moralized areas of
private behavior.
An example of how new reproductive health technologies shape our images of
bodies and normality: discussion of erectile dysfunction drugs last week was very
heteronormative; Wentzell points out that this is a product of Viagra marketing.
Plan B – the brand of EC sold in the U.S.
Watch trailer for The Pill (2012): think critically about what stories about a
drug tell us about how we imagine sexual and romantic relationships.
https://www.youtube.com/watch?v=orlkEZZTnOM
 A preview of my theory
• Debate over EC in the
U.S.:
women’s bodies are a politics of
sexuality
site of control where the
politics of sexuality,
Women’s
discourses on public bodies
medical
health, and medical constructions
discourses
on public
constructions of of biological
health
processes
biological processes
intersect.
 What is emergency contraception?

• EC: methods of contraception used

after sex
• Reduce (but don’t eliminate) risk of pregnancy.
• EC methods include pills and copper IUD
• ECPs (=EC pills): contain same hormones in
“birth control pills,” but in higher doses
• Can be taken up to 5 days after sex.
• In Australia: available from pharmacist
• Brands in Australia:
– Postinor 1, Postinor-2
– Levonelle-2
– NorLevo
 Mechanism of action
There are 3 theorized mechanisms of action for emergency
contraception (i.e. ways that the drug works in the body
to prevent pregnancy):

1. By delaying ovulation
2. By blocking the transport of either sperm or egg
3. By preventing the implantation of a fertilized egg (zygote/
blastocyst)

The last mechanism of action is considered the least likely

by scientists. Yet it is also the most controversial.
 Mechanism of Action

This short film explains the mechanism of action of EC:

https://www.youtube.com/watch?v=7Vozr9vHeMo
 DIY emergency contraception in AU
• Can cut up a regular pack of birth control pills:
• Take 50 pills within 120 hours after unprotected
sex: Microlut, Microval

• Oral Contraceptives used for EC / Progestin-Estrogen

Combined (Note: in 28-day packs, only the first 21 pills
can be used) 
– Take 2 pills within 120 hours after
unprotected sex and take 2 more pills
12 hours later: Nordiol 
– Take 4 pills within 120 hours after
unprotected sex and take 4 more
pills 12 hours later: Levlen, Microgynon-30, 
Monofem, Nordette 
– Take 5 pills within 120 hours after unprotected sex and take 5
more pills 12 hours later: Loette, Microgynon 20, Microlevlen
 Dedicated ECPs:
• “Dedicated” means drugs that are
packaged and labeled for EC use (i.e. not
do-it-yourself cutting up pill packs in your
bathroom)

• Some common ECPs worldwide:

– Norlevo
– Postinor
– Optinor
FDA hearing
Plan B – theon Plan
brand B in the U.S.
of EC sold
 Structure of FDA hearing on Plan B

FDA
hearing

6 non-
Nonprescription Advisory
voting
Drugs Advisory Committee for 4 Voting
FDA
Committee Reproductive Consultants
participants
Health Drugs
 Statement from ACOG

• Vivian Dickerson MD, president of ACOG, the

American College of Obstetricians and
Gynecologists.
• Dickerson said:
“The college rarely presents product-specific
testimony. However, we are delighted to have
the opportunity to present today because we
strongly believe that Plan B meets the FDA
criteria for over-the-counter status, and because
there is a public health imperative to increase
access to emergency contraception.”
 Open Public Hearing

FOR expanded AGAINST expanded

EC access: EC access:

• Planned Parenthood • Concerned Women for

Federation of America America
(PPFA) • Catholic Medical
• National Family Planning Association
and Reproductive Health • American Life League
Association (NFPRHA) • Human Life International
• National Organization of
Women (NOW)
 John Bruchalski, MD, representative of
Catholic Medical Association

“We all know that two-thirds of twelfth

grade women have had sexual
intercourse. We also know that three to
four million of the new STD cases this
year will be teens… without medical
advice from a health professional, the use
of Plan B by teens will be disastrous. We
are passing up an opportunity to engage
our teen patients about the hazards of
sexual intercourse… It is in…conversation
and counseling that they will become
more open and honest with their medical
providers. Conversations lead to trust.
Trust leads to following advice. Over-the-
counter status decreases conversations.
Over-the-counter status for Plan B is bad
medicine”
 Judie Brown, president,
American Life League
“…Emergency contraception, first of all, is not
contraception. So-called emergency contraception
can by definition abort a child before the child
implants. A human being begins at conception,
not at implantation. Pregnancy begins at concep-
tion. It does not begin at implantation. If a human
zygote cannot implant, he or she will die. That
means that the pills act to prevent pregnancy by
abortion a child…

“Pills such as Plan B are designed with one

purpose in mind: to destroy the evidence that a
sexual encounter has occurred that could result in
the conception of a child. The emergency in this
case is a baby. If these pills are made available
over the counter, adolescents who might have
given such a result a second thought will not be
inclined to take pregnancy into consideration before engaging in risky sex –
”

CHAIRMAN CANTILENA: “I’m sorry ma’am, you’re out of time. Next speaker,
please.”
 Outcome of FDA hearing
• Voting at end of day:
– 3 Bush appointees voted against making Plan B
available OTC.
– 23 committee members voted yes to the
nonprescription switch
• With wide majority, most expected the FDA to approve
the Plan B application. BUT
• In May, 2004, the FDA issued a “not approvable” letter,
citing lack of data on teen use of Plan B.
• Medical authorities publicly condemned the FDA.
Dickerson, president of ACOG, called the decision
“morally repugnant.”
FDA hearing as key moment in the social life
of this pharmaceutical product
• Things, not just people, have social lives (Arjun
Appadurai)
• FDA hearing encapsulated activism of the main
players in the public opinion-making around
women’s reproductive health.
• Many of these same players have also been
vocal participants in debates over other new
reproductive technologies in the US (including
medication abortion, stem cell research, assisted
reproductive therapies, and cloning).
 FDA memo from Curtis Rosebraugh

In an internal FDA memo released in 2006, Curtis

Rosebraugh, a medical officer at the agency, reported on
deputy operations commissioner Janet Woodcock’s
concerns about making the emergency contraceptive
Plan B available over-the-counter. He wrote,

“As an example, [Dr. Woodcock] stated that we could not

anticipate, or prevent extreme promiscuous behaviors
such as the medication taking on an ‘urban legend’ status
that would lead adolescents to form sex-based cults
centered around the use of Plan B” ([i]).

[i] Kerr K. FDA faces more questions on Plan B. Long Island Newsday. April 24, 2006.
Available at
http://www.newsday.com/business/ny-bzfda244715237apr24,0,6813243.story?coll=n
y-business-print
. Retrieved May 15, 2006.
 EC as recreational drug?
• No one takes EC recreationally. It just makes you feel nauseous.
So why are people talking about it like a recreational drug?
• Association with sex? Adult fantasies about what teens get up to
secretly?
• Echoes 1980s fears of teens in Satanic cults.
 Imaginations of American sexuality in FDA
debate over nonprescription access to ECPs

2 poles of sexual behavior theorized:

1. An exploitative 2. A responsible,
male sexual condom-using
predator woman in a
– Women are cast in committed
the role of weak relationship with an
sexual gatekeeper equally responsible
man.
 What kinds of sexual encounters and
possibilities are absent in this debate?
• Non-heterosexual, non-penetrative sex [we’ll bracket that
off since this is a debate about contraception]
• Consensual sex under the influence of alcohol, or
• Getting “caught up in the heat of the moment” – i.e. no
contraceptive used in the first place

• Research strongly supports the idea that the two poles of

hypothetical sexuality portrayed in this debate (women
being exploited by male sexual predators vs
responsible, condom-using women in committed
relationships with equally responsible men) are NOT the
face of “typical” American sexuality or, especially, of
unintended pregnancy
 What kinds of sexual encounters and
possibilities are absent in this debate?
• The possibility that women might be the exploiters,
rather than men
• The highly gendered portrayal of sexual encounters in
the anti-EC position is revealed if we try a little thought
exercise: can we imagine an alternative scenario in
which the roles are switched?
• Imagine an older woman, hopping with STDs, trying to
seduce a younger man into having sex without a barrier
contraceptive by whispering into his ear, “Don’t worry,
baby, you won’t be stuck paying child support payments
for the next 20 years – I’ll take Plan B tomorrow mornin
g.” Sound improbable??
 EC vs Viagra
• The organizations that lobbied against EC did NOT lobby
against Viagra. Why not? Why do these groups portray
Plan B but not Viagra as facilitating the sexual
exploitation of women?

• The woman-as-gatekeeper of sexuality image.