The Nation has a disturbing investigative report about Dr. David Hager, who is probably the man responsible for putting the kaibosh on Plan B’s application for approval as over-the-counter medication last year. (We’ve chronicled the Plan B story here, here, here, here, and here.)

A leading voice among fundamentalist conservatives on women’s health care, Dr. Hager is accused by his ex-wife (also a fundamentalist conservative) of sexually abusing her repeatedly over many years. And the juxtaposition of these accusations of marital rape and Dr. Hager’s actions at the FDA point, in the end, to why over-the-counter access to Plan B is so essential.

  • To understand Dr. Hager’s role in the emergency contraception travesty, you must know that an FDA expert advisory committee reviewed all the evidence on Plan B more than a year ago and voted 23 to 4 to make it available over the counter. Dr. Hager was a member of the panel, appointed by the Bush administration; not surprisingly, he voted with the minority. One panel member in the majority, professor Julie Johnson of the University of Florida’s Colleges of Pharmacy and Medicine, said, “I’ve been on this committee…for almost four years, and I would take this to be the safest product that we have seen brought before us.”

    FDA, to the shock and dismay of expert observers, ignored the panel’s advice and asked for more information, specifically on whether over-the-counter access to Plan B would encourage young teens to have unprotected sex. That question was, according to panel members, thoroughly answered in the negative by studies they reviewed. A new study answers it again, even more emphatically: over-the-counter access does not encourage young teens to have risky sex.

    By January 2005, FDA was supposed to announce its final decision. Now, five months after the deadline, FDA hasn’t made a peep. Washington’s US Senator Patty Murray is pressing FDA for action: she’s placed a “hold” on confirmation of the Bush Administration’s nominee for FDA administrator (though he’s fulfilling the duties anyway, as acting administrator).

    Why FDA ignored the expert panel’s advice has always been a mystery, though the obvious presumption is political interference from the White House or its appointees on the panel, prominent among them, Dr. Hager. Reinforcing that hypothesis, here’s what Dr. Hager said in a speech recently, as reported by Ayelish McGarvey in The Nation:

    “I was asked to write a minority opinion that was sent to the commissioner of the FDA…. Now the opinion I wrote was not from an evangelical Christian perspective…. But I argued it from a scientific perspective, and God took that information, and He used it through this minority report to influence the decision.” [Emphasis added.]

    None of the four panel members I spoke with for this article were aware of Hager’s “minority opinion.” An FDA spokeswoman told me that “the FDA did not ask for a minority opinion from this advisory committee,” though she was unable to say whether any individual within the agency had requested such a document from Hager.

    The document, apparently, articulated the arguments and questions presented by FDA in its request for further information a year ago. This fills in one part of the mystery about FDA actions around Plan B-actions that the American College of Obstetricians and Gynecologists termed a “dark stain on the reputation of an evidence-based agency like the FDA.”

    What’s so profoundly and disturbingly hypocritical about Dr. Hager’s actions is that he has prevented over-the-counter access to Plan B for at least one year. And ready access to Plan B lowers both the abortion rate and the unwanted pregnancy rate. It’s one thing that pro-choice and anti-abortion forces ought to agree on. During that year, tens of thousands of American women who would have used Plan B were it readily available at their pharmacy instead took their chances after unprotected sex. A few thousand of them became pregnant and had abortions or gave birth to babies that they hadn’t intended to conceive.

    Even more poignant, the actions that Dr. Hager’s ex-wife accuses him of-raping and sodomizing her while she was, initially, in a deep sleep from narcolepsy medication-is a perfect example of the kind of case in which women most need over-the-counter, no-questions-asked access to Plan B. Dr. Hager’s ex-wife, like many women who are raped by their husbands, was mortified by the abuse. She spoke of it to almost no one.

    The article doesn’t say, but I’d surmise she would have been far too intimidated to speak with a doctor and ask for a prescription for Plan B, if pregnancy was a risk in these rapes. (That is, if she was not using the pill or an IUD and if neither she nor her husband had been sterilized.) After all, her husband was a leading Ob-Gyn in their community and the famous author of a Christian medical text called As Jesus Cared for Women.

    Rape inside of marriage is an ugly but shockingly common crime. Professor Vera Mouradian of the National Violence Against Women Prevention Research Center at Wellesley College in Wellesley, Massuchesetts, has summarized published research on its incidence. She concludes that, during their lifetimes, 10-14 percent of women are raped by their husbands or boyfriends on at least one occasion. And, overall, between 20 and 40 percent of all rapes are perpetrated by husbands and boyfriends.

    Roughly 9 percent of births in Washington State—and a much larger share of abortions—result from unwanted pregnancies, as we discussed here. The figures are similar in Idaho and Oregon, and a bit higher in the United States overall. What share of these unwanted pregnancies stem from rape, I do not know.

    But I do know that the last thing rape survivors need in those first terrifying hours after an attack is obstacles in their path when they realize they could become pregnant. The FDA’s stonewalling is unconscionable. Let’s hope that the The Nation’s investigation puts a national spotlight on the issue and forces action.

    UPDATE: WaPo has more (registration required) on this.