Planned Parenthood’s Ann Rahall

photo: Nina Lee

Last year, women in the United States benefited from two breakthroughs—one scientific, one political—in reproductive health. Gardisil, a vaccine that prevents most cases of cervical cancer, became available. And, for women ages 18 and over, the U.S. Food and Drug Administration approved over-the-counter access to Plan B, a brand of emergency contraception. Dr. Ann Rahall, medical director of Planned Parenthood of Hawai‘i, explains what these major changes mean for women in the Islands.

Q: How does Plan B work?
A: Plan B is emergency contraception that prevents pregnancy. A woman can take Plan B within 120 hours of unprotected intercourse to reduce the chances of getting pregnant by up to 89 percent. It prevents pregnancy primarily by stopping ovulation. If the pregnancy is already established and a woman takes Plan B, an abortion will not occur. A lot of people ask, “Does it cause abortion?” The answer to that is it prevents abortion, because fewer women are becoming pregnant who would then end up choosing abortion because they didn’t want to be pregnant.

Q: How did the FDA’s decision to make Plan B available over the counter for women 18 and over affect Hawai‘i?
A: Long before Plan B went over the counter, Hawai‘i had a system where pharmacists could have a collaborative agreement with physicians to dispense Plan B without a written prescription. Women could go into a pharmacy, fill out some medical paperwork and have a brief consultation with the pharmacist, who could then give it out. Now, it’s easier, because women ages 18 and over don’t have to fill out the forms or do a consultation, so the costs will be lower. Girls ages 14 to 17 still need a prescription or have to get it through a collaborative agreement with their pharmacist or doctor’s office.

Q: Is it a good idea for women to buy Plan B in advance?
A: Yes. In fact, any patient I see who’s chosen a barrier method like a condom or diaphragm as a primary method of contraception, I ask her, “Do you want to have some Plan B just in case you need it?” Because the sooner you take it, the better. If the condom broke, you go into your medicine cabinet, you take it. That’s your best chance right there.

Q: Another breakthrough this year was the introduction of Gardisil, a vaccine against the human papillomavirus (HPV), which causes cervical cancer. What does it do and how affordable is it?
A: It is amazing that this vaccine is available. Gardisil is a vaccine against the four major types of HPV, [including the two that] cause approximately 70 percent of cervical cancer. We know that 70 percent of sexually active women have been exposed to or carry HPV. Most will never get any kind of symptoms, but there’s no way to predict who will and who won’t. The vaccine is targeted primarily for girls and women ages 9 to 26. A course of three shots is given over six months, and each injection is about $130. Some insurance companies are starting to cover it. At Planned Parenthood, we’re working with a couple of different programs to help with funding for lower-income women and children.

Q: Some parents worry that a vaccine against a sexually transmitted disease will only encourage their daughters to have sex. What do you say to them?
A: I would say it’s not going to increase whether they’re going to choose to have sexual activity or not, but it may prevent them from getting a life-threatening disease. We need to make this a routine vaccination that doesn’t have the stigma related to sexual activity. We’re giving everybody Hepatitis B from the time of birth, when, in the past, that used to be for people who were at high risk—health providers, people with multiple sexual partners, IV-drug users. Now it’s routine.

Q: Should women over age 26 get vaccinated?
A: After 26, they should talk to their physician and do it on a case-by-case basis. A 45-year-old woman who’s been married to the same guy for 25 years and he’s her only lifetime partner probably doesn’t need it. But a 40-year-old who’s in a new relationship and wants to get it? Absolutely.