Editorial: The courage of contraceptive 'convictions': Griswold v Crawford

Many readers may be surprised to learn that in 1965, 30 states had laws prohibiting or restricting the sale and/or use of contraceptives. Connecticut, in fact, had some of the most extreme prohibitions. Distribution and possession of contraceptives were illegal in my state, even when the intent was to save a woman's life, and married couples could be arrested for using birth control in their own homes. To challenge this absurd statute, Planned Parenthood League of Connecticut (PPLC) opened a birth control clinic on November 1, 1961. On November 10, 1961, PPLC's Executive Director, Estelle Griswold, and its Medical Director, Dr. Charles L. Buxton, were arrested.

In the 9 days it was open, PPLC's clinic provided thousands of married couples with information, instruction, and medical advice on contraception. And both Griswold and Buxton subsequently were found guilty of doing just that. In a 7-2 ruling, however, the US Supreme Court overturned their convictions, declaring the Connecticut law unconstitutional based on the privacy provisions of the First, Third, Fourth, Fifth, and Ninth Amendments to the Constitution.¹ In the majority opinion, Justice William O. Douglas argued that married people's right to privacy predated the Bill of Rights, so laws obstructing that right, therefore, were unconstitutional on their face.

How dismayed would Dr. Buxton be to learn that the government is once again attempting to deny women access to contraception? The FDA's official position is that Barr Laboratories presented the agency with novel regulatory hurdles by submitting an application seeking OTC sales of Plan B for women aged 16 years and older but maintaining prescription status for those younger. Yet the FDA effectively placed itself in this conundrum by refusing to support its own advisers' earlier advice to grant OTC status for Plan B across the board.

Both the external advisory committee that considered Barr Laboratories' original application and the FDA's own internal reviewers overwhelmingly supported OTC status for Plan B.^2,3 But then pressure was brought to bear by conservative lawmakers and religious activists concerned that OTC availability would promote promiscuity and increase STI rates in young girls. And so, the FDA declined to approve OTC status and the manufacturer subsequently proposed a dual OTC/prescription compromise.

After more than a year of deliberation, the Commissioner still cannot reach a decision and has ordered a 60-day public comment period. And the fallout has been swift. Dr. Susan F. Wood, Director of the FDA Office of Women's Health, has resigned in protest. In an e-mail to advisory committee members, Dr. Wood said, the "recent decision announced by the Commissioner about emergency contraception, which continues to limit women's access to a product that would reduce unintended pregnancies and reduce abortions is contrary to my core commitment to improving and advancing women's health." Commenting further, she said she can "no longer serve as staff when scientific and clinical evidence, fully evaluated and recommended for approval by the professional staff here, has been overruled."

Drs. Buxton and Crawford are studies in contraceptive conviction and lack thereof, respectively. The former risked his career, reputation, and even personal liberty to prevent unwanted pregnancies and provide couples with reproductive freedom. The latter has eschewed making a simple decision that would further reduce unwanted pregnancies and enhance women's reproductive rights. On September 24, 2005, Dr. Crawford resigned following a scathing editorial in the New England Journal of Medicine about his handling of Plan B, and after his attempt to appoint a male veterinarian to replace Dr. Woods. His brief tenure at the helm of the FDA was associated with further erosion of public confidence in the agency.

REFERENCES

1. Griswold v. Connecticut. 381 U.S. 479; 85 S. Ct. 1678; 14 L. Ed. 2d 510; 1965 U.S. LEXIS 2282.

2. Lockwood C. Editorial: OTC emergency contraception: the right choice. Contemporary OB/GYN. 2004;49(1):12-15.

3. Lockwood C. Editorial: Playing politics with women's health: The FDA and Plan B. Contemporary OB/GYN. 2004;49(7):11-15.