When I took Plan B, I was over 176 pounds and I thought I was protecting myself with the best available option. How many millions of women have done the same?
On Monday, Mother Jones broke the news that the European manufacturer of a pill identical to Plan B (an over-the-counter emergency contraceptive sold in America) has revealed that the pill loses efficacy for women over 165 pounds and is completely ineffective for women over 176 pounds. As in, it does not work. As in, it does not quash pregnancy. As in, it might as well be a piece of delightful candy for all the good it does for your reproductive parts.
The European version of this drug, Norlevo, will have new packaging to reflect the new research on weight limits. The American versions of this drug (Plan B One-Step, Next Choice One Dose, My Way, and others) are chemically identical to Norlevo, but American drug companies have not yet committed to publishing this information on their packaging.
I don’t normally like to speak on behalf of any group (who am I, right?), but in this case, I’ll happily break my own rules: On behalf of all sexually active women over 176 pounds, what the fucking fuck?
The Plan B aisle of a 24-hour Walgreens is never a place you want to find yourself at 2am, but I was 20, the condom broke, and while the guy was sweet and kind, neither he nor I was looking to be a parent anytime soon. So there I was, with the other middle-of-the-night prowlers, pacing the drug store, hopping from one foot to the next, waiting to pay so I could race home and swallow a pill that I was told would make our mid-coital accident go away. And though I thought that gulping down the pill and two glasses of ice water was the most relieved I’d ever felt, true relief came three weeks later when my period arrived on schedule.
I guess I was just lucky?
Between 2006 and 2010, 11% of sexually active American women between the ages of 15 and 44 have used an emergency contraceptive pill at least once. That’s 5.8 million women. The average American woman is 166 pounds, so about half of them took a pill billed as an emergency contraceptive that had lost potency or didn’t work at all. Of course it should come as no surprise that Plan B is not 100% effective (no form of contraception is), and that much is printed on the packaging. But, there is no mention that, for approximately 20-25% of American women, an easily identifiable group no less, it’s a safe bet that it won’t work.
There are a few ways we could have arrived at this unfortunate (and in my opinion, outrageous) juncture. Either the drug companies knew that Plan B was not effective for women over 176 pounds and they declined to notify the public (and were not required to by the FDA), or they didn’t know that Plan B wasn’t effective for women over 176 pounds, which suggests some serious gaps in their testing (and again, where is the FDA on this?). Either way, we have a problem.
If Teva, which manufactures Plan B One Step, knew that their drug did not work for women over 176 pounds, and didn’t share it, they’ve got a lot of explaining to do. This is not cold medicine, with annoying but manageable consequences of failure. This is pregnancy we’re talking about. When I took Plan B, I was over 176 pounds and I thought I was protecting myself with the best available option. How many millions of women have done the same? If I had known it wasn’t effective for me, I would have called my doctor and sought additional counsel.
It’s in Plan B’s interest to be an efficacious drug for as many women as possible, but it’s also in Plan B’s interest to sell as many pills as they can. More warnings on the box mean fewer sales. If there had been a big “Not for women over 176 pounds” sticker on the package, I sure as shit wouldn’t have bought it five years ago. I don’t know what labels the FDA requires, but I assume that Teva is complying with the bare minimal regulations. Which leads me to…
What the hell are these regulations? If Teva didn’t know that their drug didn’t work for women over 176 pounds, then we have a whole new issue on our hands. How big was their sample group? How strong is the correlation between weight and failure? The language that Norlevo is including in their new packaging makes it seem pretty damn strong, “Studies suggest that Norlevo is less effective in women weighing [165 pounds] or more and not effective in women weighing [176 pounds] or more…Norlevo is not recommended…if you weigh [165 pounds] or more.”
So what happens now? What is legal may not, in this case, align with what is ethical. The legal requirements that the FDA compels drug companies to follow are, for better and worse, different than their European counterparts. Just because Norlevo will have a warning doesn’t mean Plan B will. How high a fail rate is acceptable for an emergency contraceptive? What about the fact that the average American black woman is 186 pounds, and that, if this research proves out, half of black women who take Plan B might as well be munching on altoids? Where’s that warning on the box? “Black? Above average weight? Don’t take this; call your doctor.” If Plan B didn’t work for blue-eyed women (1 in 6), do you think they’d tell us? (Side note: As of Tuesday afternoon, the FDA has responded to Mother Jones’ story and will be reviewing the relevant research.)
Legally, a 20-25% fail rate may reside in the gray area, but ethically, to my mind, it does not. We, the sexually active 176+ crowd (25% of American women!), have a right to know that the drug we’re relying on in times of extreme anxiety is not, in fact, designed for us. There’s enough fat-shaming floating around in the world already—just read the comments on the Mother Jones piece, “How many woman over 176 pounds get laid anyway?”—for a drug company to leave the reproductive health of overweight women to chance.
Role/Reboot regular contributor Emily Heist Moss is a New Englander in love with Chicago, where she works in a tech start-up. She blogs every day about gender, media, politics and sex at Rosie Says, and has written for Jezebel, The Frisky, The Huffington Post and The Good Men Project. Find her on Facebook and Twitter.