Call it the lack-of-paper anniversary: One year ago this week, the Food and Drug Administration finally made its poky, grudging, altogether shifty decision to approve Plan B emergency contraception for over-, well, behind-, the-counter sales. That is, to approve Plan B for certain people. Meaning, you need to be 18, and prove it, in order to get the pill. Teens, you've got to stick to stuff you can buy without an I.D., like condoms, yes, plus Astroglide and Spanish Fly. Undocumented women or anyone else without an I.D., you're pretty much SOL. Women enrolled in state-funded health insurance programs may also still need a prescription. Oh, and let's not forget that just because Plan B is "available" doesn't mean it's available.

The Oakland, Calif.-based Pharmacy Access Partnership, whose purpose is "to expand consumer access to contraceptive commodities and reproductive health services in pharmacies, and to give pharmacies a stronger role in promoting community health," is observing this anniversary by looking both back and forward. On the upside, for one thing, eight states (Iowa, Illinois, Massachusetts, New Jersey, New York, Oklahoma, Oregon and Washington) have now confirmed Medicaid coverage for Plan B. On the downside, for one thing, one wonders what might have happened if former Surgeon General Richard H. Carmona had not been silenced on emergency contraception and other issues.

Belle Taylor-McGhee, the PAP's executive director, said (PDF), "The FDA decision left behind the most vulnerable populations: young women, low-income women and women without proof of age, which often includes undocumented women. Although unintended pregnancy rates are declining nationwide, we're still not where we need to be. What we still lack is healthcare policy that supports women of all ages and backgrounds who may someday need EC," Taylor-McGhee says. (She'll have an editorial on the topic Thursday at RHRealityCheck.org.)

According to Taylor-McGhee, not only must we lift the age restrictions on Plan B, we must also keep fighting to expand Medicaid coverage, ensure fair reimbursement to pharmacies serving low-income populations, and support education about how E.C. works -- and doesn't -- and where to get it. Some pharmacists themselves, of course, could also still use some schooling.

That, or -- in one of PAP's bolder initiatives -- you could go to one-hour pharmacy school (PDF), hang out a shingle and dispense E.C. yourself. Update/clarification: ...that is, if you are a pharmacist. (Sorry, I didn't spell out everything in the links.) Through the Pharmacy Access Model, in place in AK, CA, HI, MA, ME, NH, NM, VT, WA, specially trained pharmacists, under specificed conditions, may provide Plan B to women of any age, eliminating the need for an advance prescription from a doctor or clinic. More here (another PDF).