Under orders

When military pharmacist David Black received word that the Pentagon would require all military treatment facilities to stock emergency contraception-the Plan B drug that he considers abortion-inducing-he grew immediately anxious. Black, who asked that WORLD not use his real name in order to protect his job, told a supervisor that he would not dispense the pill and suggested they ship it to a local provider who was willing to dispense it. The supervisor said that was not an option.

Abortion currently is banned from all military treatment facilities, and so is the use of defense funds for abortion. But Plan B does not fall under the federal definition of abortion; instead it's classified as "emergency contraception" taken less than 72 hours after unprotected sex. It releases a high dose of the hormone levonorgestrel and sometimes works by inhibiting the implantation of an already fertilized egg-ending a life after conception.

Some-but not all-military facilities have stocked Plan B since 2007. In early February, the Obama administration made it a requirement: All U.S. military bases would offer Plan B. Since military facilities do not have co-pays for drugs, taxpayers will be footing the bill.

Black said he's concerned about more than Plan B, noting that this recent Pentagon decision comes along with a push to allow openly gay people to serve in the U.S. military. "They're starting to expand this type of thing," Black said. He is worried this is just the beginning: "People are afraid that this is going to lead to RU-486 and then abortions in military facilities." He is quick to add, "That's yet to be decided of course. That's speculation."

But Jeanne Monahan, director of the Center for Human Dignity at the Family Research Council, also sees the requirement as part of a broader administration push to move abortion from being merely legal and available to being funded and promoted. "In the same way," she said in a statement, "the fact that Plan B is optional for military facilities is not sufficient for the Obama Administration, so now military facilities will be compelled to carry and disseminate Plan B."

Plan B has always been politically contentious. In 2006, Senators Hillary Clinton, D-N.Y., and Patty Murray, D-Wash., blocked Andrew von Eschenbach's appointment as permanent head of the FDA until the FDA approved Plan B without a prescription. This time, Sen. Frank Lautenberg, D-N.J., sent a request to Defense Secretary Robert Gates, asking that the Pentagon make all of its facilities stock Plan B. Gates made the same request of the Pentagon's Pharmacy and Therapeutics Committee, and in November of last year the committee voted-with two opposed and one abstaining-to recommend the requirement.

Lautenberg has been pushing this issue for years. In 2007 he co-sponsored the "Access to Birth Control Act," which would have made pharmacies fill all emergency contraception requests. This bill stated that access to contraception "is a protected fundamental right in the United States and should not be impeded by an individual's personal beliefs" and said that pharmacies should make sure their employees do not "interfere with or obstruct" a request for contraception. In 2007 and in 2009, Lautenberg co-sponsored a bill that would have required the Pentagon to do just what this latest decision requires: force all of its facilities to dispense Plan B.

This latest decision means that if someone requests Plan B and the pharmacist has moral or ethical objections to dispensing the prescription, then the pharmacy must find a way to provide it anyway. According to Austin Comacho-spokesperson for TRICARE, the military's healthcare program-each branch of the service will set its own policies regarding the religious objections of pharmacists.

The Air Force did not respond to a query, but a spokesperson for the United States Army confirmed that if pharmacists have moral objections, supervisors must set policies to ensure that the prescription still gets filled. The Navy said the same in a 2007 memo. Black, a contract pharmacist, says that according to these provisions he will not have to dispense Plan B; someone else at the facility, a non-pharmacist, will do it. Taxpayers won't be given the same choice.