Robbinsville – In November, the Graham County Board of Commissioners was split over whether to continue providing the emergency contraceptive called Ella through the Public Health Department.
Commissioners Connie Orr and Nelms voted to continue offering the drug, while commissioners Keith Eller and Lynn Cody voted to end it. Then-commissioner Dale Wiggins voted with Orr and Nelms.
Wiggins was the most vocal board member in advocating for the drug.
He said the use of emergency contraceptives should be a private discussion between a woman and her health care provider, adding that for women with low income and little – or no – insurance, the health department is their only option.
He said removing Ella as an option in Graham County would only be symbolic, since the health department would still be required to ensure that the medication be available from other sources.
Wiggins’s term expired this month. He was replaced by newly-elected Republican Natasha Williams, which could potentially change the outcome if it comes up for another vote.
A different mix
In early November, county commissioners received an in-depth report from county attorney Jay Coward about the situation. Board members also heard public comments during a joint session with the health advisory board in November, as well as at a second meeting where the decision about Ella was made in the 3-2 vote.
Williams took her oath and was seated after all that happened.
The meetings, which were live-streamed by The Graham Star, drew a large audience both during the livestream and afterward. According to sources, the audience included advocates on all sides of the abortion debate, locally and throughout the state – and perhaps beyond.
Supporters of the drug say it is safe and legal and the only effective emergency birth control for heavier women. Supporters also say that if the county stops prescribing the drug, it would have to pay for the same treatment out-of-county at a higher cost, or stop altogether and endanger state and federal funding for some health-department programs.
Opponents say the drug is a form of abortion, and that it is legally and morally wrong for the county to dispense it.
The Coward Report
Coward’s report was spurred by an incident earlier this year at the Graham County Public Health Department, between staff and Brandi Adams, a peer-support specialist at Appalachian Mountain Community Health Center in Robbinsville. Adams was concerned about emergency contraceptives being dispensed by her employer and went to the Public Health Department seeking more information.
It appears that the meetings led to her being fired. More about that can be found at grahamstar.com/local-regional-newsletter/county-not-liable-firing, as well as The Graham Star’s Dec. 15 edition.
As part of his report, Coward said he looked into the family planning program’s administration of two emergency contraceptives, Plan B and Ella, which are both administered in pill form and are often referred to as “morning after” pills.
Plan B has been available through the health department for decades, while Ella was approved by the Food and Drug Administration to be administered in 2010. It has been offered as an option to eligible patients since 2015.
A female takes one of the pills up to five days after unprotected sexual intercourse so that she does not become pregnant.
“Some believe that the morning after pill is an abortifacient, meaning they can cause an abortion to occur,” Coward wrote.
The active ingredient in Plan B delays the release of the egg from a woman’s ovary, so that any sperm in the uterus dies and contraception is never achieved. It does not require a prescription unless the female is under the age of 17.
Ella’s active ingredient is a progesterone antagonist that inhibits or delays ovulation; however, alterations to the endometrium may affect implantation of a fertilized egg, a fact that triggered Pro Life opposition. Ella is effective up to 120 hours and requires a prescription.
Ella has never been administered since it became an emergency contraception option in Graham County in 2015, officials say.
Under Title X guidelines, it is health-department protocol to provide consultation services surrounding pregnancy with patients and to administer a pregnancy test if patient agrees with – and meets – criteria for emergency contraceptives.
If the female is pregnant, there is no need to discuss the use of Plan B or Ella, Coward wrote.
The programs
Coward said there is a complex interaction between federal, state and local agencies; the regulations and contractual obligations; and the funding of local health care, specifically regarding family planning at the health department.
The 2022-23 fiscal year budget for the Graham County Public Health Department is $1.76 million. Two-thirds of the department’s revenue is from federal dollars directly, and by N.C. Department of Health and Human Services federal/state pass-through, including Medicaid.
“It would be impossible to run the HD without private money, and the HD Director (Beth Booth) has either written and/or executed over $1,000,000 in private grants since 2019,” Coward wrote.
In the past decade, very few local tax dollars have supported the health department, he said – adding that in the past three years, no local dollars have supported that budget.
Family planning at the health department is budgeted at $64,000, most of which is designated to salaries.
A Division of Public Health Agreement Addendum for Family Planning is executed annually by the HD and submitted to the Women’s Health Branch of the N.C. Department of Public Health. The federal program – called “Title X” – is the bedrock funding program upon which all local public health family planning services rely, Coward wrote.
Title X is a grant program created in 1970 to provide comprehensive and confidential family-planning services, and preventative-health services. Services provided include contraception counseling and provision, breast and cervical cancer screenings, testing and treatment for sexually transmitted infections, and pregnancy diagnosis and counseling.