Articles from January 2012
[This letter from Lon Newman appeared at Factcheck.org.]
Thanks for the fact check on the South Carolina Gingrich-versus-Romney ad [“Gingrich’s ‘Baloney’-filled Attacks on Romney,” Jan. 11]. Confusing the public about emergency contraception pills (ECP) is deliberate, pervasive, and routinely served by opponents of contraception.
Although fact-checking the fact-checking seems tedious sometimes, it is important to explain that available research on Plan B One-Step (“the morning after pill”) shows that it prevents pregnancy by preventing ovulation and/or fertilization.
Ron Hamel, a Catholic ethicist publishing the conclusions of five years of scientific review in the January-February 2010 issue of Health Progress, said: ” … virtually all of the evidence in the scientific literature indicates Plan B has little or no post-fertilization effect, that is, it has little or no effect on the endometrium that would make it inhospitable to implantation. Its mechanism of action is to disrupt ovulation.”
One objection frequently repeated by Plan B opponents is that there is language in the pill package that the drug may prevent implantation. However, Nicanor Pier Giorgio Austriaco, a priest, theologian, and scientist also studied the active drug’s effects and determined that it has no post-fertilization effect. On the argument of labeling, he stated that: “ … labels mean nothing without the scientific data to back up their claims.”
These conclusions are reinforced in the 2010 World Health Organization’s fact-sheet on levonogestrel (LNG) which states: “… LNG ECP use does not prevent a fertilized egg from attaching to the uterine lining.”
The important answer to the question on emergency contraception is that there cannot be an abortion before there is a pregnancy; therefore, preventing unwanted pregnancies prevents abortions. But even if you believe pregnancy is the same as fertilization, you no longer have to put up with the warmed-over baloney that Plan B is an “abortion pill.”
Thanks, again, for your excellent work.
Executive director, Family Planning Health Services
[This piece was written by Dr. Ron Hamel. It appeared in the January-February 2010 Journal of Catholic Health Association publication HEALTH PROGRESS. We think it is an important piece and should foster some great discussion.]
Volume 91, Number 1
Thinking Ethically About Emergency Contraception
Critical judgments require adequate and accurate information.
BY RON HAMEL, Ph.D.
The controversy over the use of emergency contraception in Catholic hospitals for victims of sexual assault continues to be played out in various forums — in the literature, state legislatures, pharmacies, professional groups, state Catholic conferences, dioceses and Catholic hospitals themselves.
At its heart is whether medications used for emergency contraception have an abortifacient effect, that is, whether they prevent the implantation of a fertilized egg by altering the lining of the endometrium. On the belief that they do have such an effect, some either object to or prohibit their use in Catholic hospitals or agree to their use only in conjunction with testing for ovulation to ascertain whether the woman is at or around the time of ovulation (and, therefore, could become pregnant).1 Obviously, for women who have been subjected to a sexual assault and who seek assistance at a Catholic hospital, much hinges on accurately understanding how these hormonal medications work.
Unfortunately, such understanding is not always in play. In many instances, critics base their moral judgments on prevailing beliefs or assumptions about mechanisms of action that may be based on drug manufacturer labeling, or on outdated scientific literature, or on mere supposition. Researchers have been virtually certain that the drugs prevent or disrupt ovulation, but they have generally been uncertain about other possible effects on sperm, cervical mucus, the process of fertilization and on the endometrium. Yet manufacturers and others typically list these specific effects as possible mechanisms of action.
But are such beliefs and assumptions about emergency contraceptives accurate and adequate? This is a critical question, for women who have been sexually assaulted and for the Catholic hospitals that care for them.
One of the well-known truisms in ethics is that good moral judgments depend in part on good facts. Absent adequate and accurate information, there is an increased possibility of a faulty analysis and, therefore, of an erroneous judgment. In addition, the moral judgment itself might be seen to lack credibility either because its basis is unclear or because it seems to fly in the face of reputable data.
Take one example. In late February 2007, in a LifeSiteNews interview, Bishop Elio Sgreccia, the then-president of the Pontifical Academy for Life, reaffirmed the academy’s 2000 statement that the “morning-after pill” is abortifacient and that physicians and Catholic hospitals are prohibited from administering it, even in cases of sexual assault.2 Unfortunately, the 2000 statement employed the generic term “morning-after pill,” which can refer to a variety of medications with different mechanisms of action, and the statement made no reference to scientific literature substantiating its claim that the pill is abortifacient. In addition, the comment in the 2007 interview seemed not to take account of recent scientific literature on how these medications work, particularly in the case of levonorgestrel, also known as Plan B, the current standard treatment for women who have been sexually assaulted. Yet after the interview, despite the lack of evidence, some described both the bishop’s comment and the Pontifical Academy’s statement as “authoritative.”
GOOD FACTS ARE NECESSARY FOR GOOD ETHICS
What, in fact, do we find if we look at the scientific literature on how Plan B, a progestin-only form of emergency contraception, works?
Over the past five years, CHA staff have collected, reviewed and summarized the great majority of articles on emergency contraceptive medications’ mechanisms of action — both for combination drugs (such as Preven) and Plan B.3 In addition, CHA obtained two independent analyses of the literature — one by an ob-gyn and the other by a pharmacist. The reviews concluded that virtually all of the evidence in the scientific literature indicates Plan B has little or no post-fertilization effect, that is, it has little or no effect on the endometrium that would make it inhospitable to implantation. Its mechanism of action is to disrupt ovulation.
In a thorough review of the scientific literature, Fr. Nicanor Pier Giorgio Austriaco, OP, Ph.D., a priest, theologian and scientist, wrote in the Winter 2007 issue of The National Catholic Bioethics Quarterly:
Studies published in the past few months provide mounting evidence that levonorgestrel has little or no effect on post-fertilization events. In other words, given the limitations of scientific certitude, they suggest that Plan B, when administered once, is not an abortifacient. These human studies correlate well with earlier findings in rodents and monkeys that convincingly showed that the postcoital administration of levonorgestrel in amounts several times higher than typical doses given to women does not interfere with the post-fertilization processes required for mammalian embryo implantation. The evidence also addresses what until now has been a nagging, unanswerable question for pharmacologists: Why would levonorgestrel, a progesterone agonist that mimics the effect of progesterone, prevent implantation, when progesterone produced from the corpus luteum immediately after ovulation actually promotes implantation by converting the endometrium to deciduas? Answer: It does not.4
Several months later in the Autumn 2008 issue of the quarterly, responding to his critics, Fr. Austriaco offered an even more detailed argument in support of his conclusion.5 If Plan B is abortifacient, the author observes, it can have this effect in three primary ways. The first is by increasing the rate of ectopic pregnancies. However, he notes that the “combined data from five clinical trials with nearly six thousand women showed that the rate of ectopic pregnancies in women who have used Plan B is 1.02 percent as compared to the overall national ectopic pregnancy rate between 1.24 percent and 1.97 percent. In light of this finding, it is unlikely that Plan B increases the ectopic pregnancy rate … .”6
The second way in which Plan B could be abortifacient is by preventing implantation of an embryo. Fr. Austriaco noted that there are three ways in which this could occur. One is by altering the lining of the endometrium, making it inhospitable to implantation. “[M]orphological and biochemical analyses of endometrial biopsies of women who had taken Plan B eight or nine days prior to the biopsy have revealed that the drug does not dramatically alter the structures of this tissue. This suggests that the drug does not compromise endometrial development.”7
Another way in which the drug could make the endometrium inhospitable is by disrupting the function of the corpus luteum which releases hormones that are necessary for the proper development of the endometrium, including making it receptive to an embryo. After reviewing the scientific literature, Fr. Austriaco concluded that “[T]ogether, these data suggest that the risk of a post-fertilization effect from this mode of action for any particular individual woman, if it is real, would be vanishingly small.”8
The final manner in which Plan B could prevent implantation is by directly interfering with the implantation process itself. Fr. Austriaco replied: “[O]ne study that directly tested the ability of human embryos to implant on endometrial tissue exposed to LNG — though grossly immoral — does not support this mode of action for Plan B.”9 Two other recent studies confirm this conclusion.10
A third way in which Plan B could be abortifacient is by destroying an already implanted embryo. With regard to this possibility, Fr. Austriaco wrote: “[A] report from the FDA shows that Plan B does not increase the rate of pregnancy loss or the frequency of fetal abnormalities once a pregnancy has been established.”11
Fr. Austriaco concluded his article: “[I] stand by my earlier conclusion: In light of the available scientific evidence and given the inherent limitations of the studies, it is unlikely that Plan B is an abortifacient.”12
What about the manufacturer’s label which claims that one of the drug’s mechanisms of action is to prevent implantation of a fertilized egg? Many appeal to the manufacturer’s label in their arguments against the use of Plan B. In Fr. Austriaco’s judgment, “labels mean nothing without the scientific data to back up their claims.”13
MORAL CERTITUDE, NOT ABSOLUTE CERTITUDE
While the preponderance of scientific evidence strongly suggests that Plan B does not have an abortifacient effect, the evidence stops short of providing absolute certitude. But is absolute certitude needed?
In the Catholic moral tradition, what is required of an agent when he or she makes a moral judgment is that he or she have moral certitude about the correctness of the action. In the words of Thomas Slater, SJ, author of a manual of moral theology: “In order to act lawfully and rightly, I must have at least moral certainty of the imperfect kind that the proposed action is honest and right. This degree of certainty will be sufficient, for ordinarily no greater can be had, as we have just seen. It is also required for right action; for if I am not at least to this extent morally certain that my action is right, I am conscious that it may be wrong.”14
What is meant by moral certitude? Moral certitude means that the agent has excluded all reasonable possibility of error. It stands between mere probability, where alternative opinions are equally plausible, and absolute certainty, where any theoretical possibility of error is not only excluded, but is impossible. Again, in the words of Fr. Slater:
Certainty in general is a firm assent of the mind to something known, without the fear of mistake. In mathematics and in other branches of exact science we can often attain absolute certainty, which rests on the evident truth of the principles which are employed to arrive at it. … In the science of morality we have frequently to be content with a lower degree of certainty than this; there is often some obscurity about the principles to be applied, and human acts are not the matter of necessary and unvarying law. We have to be content with what is called moral certainty. … I may be conscious that mistake is possible but not probable, as when a man has been condemned on evidence which has satisfied a jury of intelligent men. In such cases if there can be no prudent doubt about the justice of the verdict I have moral certainty of an imperfect but real kind. … Ordinarily greater certainty cannot be obtained in human affairs. … If I have this imperfect moral certainty that my action is right, I am justified in acting … .”15
How does moral certitude play out with regard to emergency contraception, and Plan B in particular? The first consideration deals with Plan B’s mechanism of action. Is there sufficient moral certitude that Plan B is not abortifacient? In other words, do the results of scientific research on how Plan B works rise to the level of moral certitude? Given the mounting evidence from the scientific literature that Plan B does not prevent implantation, there does seem to be moral certitude, of the imperfect kind, about the mechanism of action. It is, of course, theoretically possible that all of the studies that have been done could be mistaken, but this is not likely. Hence, if these scientific studies are correct, then Plan B is consistent with Directive 36 which states that a woman who has been sexually assaulted may be “treated with medications that would prevent ovulation, sperm capacitation, or fertilization.”16 Thus its use would not be prohibited by what follows in Directive 36: “It is not permissible, however, to initiate or to recommend treatments that have as their purpose or direct effect the removal, destruction, or interference with the implantation of a fertilized ovum.”17 Targeting implantation is not the purpose or direct effect of Plan B. Rather, its purpose and direct effect is to interfere with ovulation.
Second, is there moral certitude that a fertilized ovum will not be destroyed? Some argue that in order for moral certitude to be present, the woman who has been sexually assaulted must undergo an ovulation test to ensure that she is not at or around the time of ovulation such that she could become pregnant from the rape. For example, one advocate of ovulation testing says: “[C]atholic hospitals must have moral certitude that the possibility of an abortion is excluded. The ovulation test provides this certainty. … Therefore, moral certitude can be achieved only through the administration of the [luteinizing hormone] test. To administer emergency contraception when there is insufficient information as to its effect on the specific patient in question is not only morally illicit but medically unsound.”18
Given what has been said about Plan B’s mechanism of action, such testing is not required to achieve moral certitude. Furthermore, moral certitude in these situations is strengthened by the fact that the incidence of a pregnancy after rape is between <1 percent and 5 percent. Typically the estimate is put at about 3 percent.19 Given the scientific evidence regarding Plan B’s mechanism of action and the high probability that there is no fertilized egg present subsequent to the sexual assault, the requisite moral certitude exists that a fertilized ovum would not be destroyed by the administration of Plan B.
Finally, it is generally maintained in textbooks of moral theology that when human life is involved, one should always take the safer course. This is sometimes illustrated by the example of the hunter in the woods who sees movement behind bushes. Is the hunter free to shoot, believing that the movement results from a deer? The response in the manuals is no, because the movement could be caused by another hunter. Unless the hunter can resolve his doubt, the hunter must take the safer course and not shoot. This example might suggest that Catholic hospitals must not use emergency contraceptive medications at all in the belief that they might have an abortifacient effect — or, at least, that hospital personnel do as much as they can to reduce the possibility there might be an egg present that could be or might have been fertilized. They would do this by testing for ovulation.
In the situation under consideration, if there were a likelihood that a fertilized egg were present and if there were a likelihood that Plan B has an abortifacient effect, then the example and the obligation to take the safer course would be applicable. However, neither of these conditions is the case, because there is virtually no evidence that Plan B is abortifacient and, in cases of sexual assault, there is a very high probability that there is no fertilized egg present.20 Hence, there does not seem to be an obligation to take the safer course. If one were obliged to take the safer course in these situations, in order to be consistent, one would also have to take the safer course in many of life’s other activities (e.g., driving one’s car, flying in a plane) as well as in the practice of medicine generally (e.g., agreeing to a surgery with a 25 percent risk of dying, undergoing chemotherapy that could have a lethal effect).
The administration of emergency contraception to women who have been sexually assaulted is a matter of utmost seriousness since it touches on human life. It is also a matter of utmost seriousness because it touches on the well-being of women who have been subjected to one of the most heinous of crimes. Any decision about whether or not to permit the dispensing of emergency contraceptive medications in Catholic hospitals and about the protocols for their administration has profound consequences.
Those who make such decisions, whether bishops, hospital executives, emergency room physicians, nurses or others, have a grave moral obligation to take seriously one of the first rules in making good ethical judgments, namely, to obtain adequate and accurate information about the matter at hand. To do any less is not only to shortchange the moral process, but also to risk significant harm to others. And once the best possible information is obtained, those making the decisions need to keep in mind that the use of emergency contraception for women who have been sexually assaulted is a matter about which moral certitude is sufficient. Given what is currently known about Plan B from scientific research, Catholic hospitals can respond with sensitivity, compassion and assistance to women who have been raped and are in need of care, while being confident that they are also remaining true to Catholicism’s fundamental commitment to respect for human life.
- If ovulation testing determines that the woman is at or around the time of ovulation, generally emergency contraception would not be administered out of concern that a possible abortifacient effect of the medication could result in the loss of an embryo.
- Pontifical Academy for Life, “Statement on the So-Called ‘Morning-After Pill,’” (October 31, 2000), http://www.vatican.va/roman_curia/pontifical_academies/acdlife/documents/
- For information about the mechanism of action of emergency contraceptive medications generally: www.chausa.org/ECmedicationsReview; for information about Plan B’s mechanism of action: www.chausa.org/LevonorgestrelReview.
- Nicanor Pier Giorgio Austriaco, “Is Plan B Abortifacient? A Critical Look at the Scientific Evidence,” The National Catholic Bioethics Quarterly 7, no. 4 (Winter 2007): 707.
- Nicanor Pier Georgio Austriaco, “Colloquy: More on Plan B — Fr. Austriaco Replies,” The National Catholic Bioethics Quarterly 8, no. 3 (Winter 2008): 421-25.
- Austriaco, 422.
- Austriaco, 423.
- Chun-Xia Meng et al., “Effect of Levonorgestrel and Mifepristone on Endometrial Receptivity Markers in a Three-Dimensional Human Endometrial Cell Culture Model,” Fertility and Sterility 91, no. 1 (2009): 256-64; Natalia Novikova et al., “Effectiveness of Levonorgestrel Emergency Contraception Given Before or After Ovulation: A Pilot Study,” Contraception 75, no. 2 (2007): 112-18. The immoral, but important study to which Austriaco refers is P.G.L. Lalitkumar et al., “Mifepristone, But Not Levonorgestrel, Inhibits Human Blastocyst Attachment to an In Vitro Endometrial Three-Dimensional Cell Culture Model,” Human Reproduction 22, no. 11 (2007): 3031-37.
- Austriaco, 424.
- Austriaco, “Is Plan B Abortifacient?”, 707.
- Thomas Slater, SJ, A Manual of Moral Theology, (New York: Benziger Brothers, 1925), 1:31.
- Slater, 1:31-32.
- United States Conference of Catholic Bishops, The Ethical and Religious Directives for Catholic Health Care Services, (Washington, D.C.: USCCB, 2001), Directive 36.
- United States Conference of Catholic Bishops.
- Marie Hilliard, “Dignitas Personae and Emergency Contraception,” Ethics and Medics 34, no. 2 (February 2009): 4.
- Melisa M. Holmes, et al., “Rape-Related Pregnancy: Estimates and Descriptive Characteristics from a National Sample of Women,” American Journal of Obstetrics and Gynecology 175 (August 1996): 320.
- Gerald McShane, et al., “Pregnancy Prevention after Sexual Assault,” in Peter Cataldo and Albert Moraczewski, eds., Catholic Health Care Ethics: A Manual for Ethics Committees, (Boston: The National Catholic Bioethics Center, 2001), 11, 16-17.
RON HAMEL is senior director, ethics, Catholic Health Association, St. Louis. Write to him at firstname.lastname@example.org.
[From our friends at Catholics for Choice.]
President Obama listened to all of the women and men who called, e-mailed and wrote to the White House to express their support for family planning decisions staying in the hands of women. In so doing, he remained true to the original vision of the Affordable Care Act (ACA) and refused to bend the knee to intense lobbying from the United States Conference of Catholic Bishops, the Catholic healthcare industry and other special interests who wanted him to expand a refusal clause that would have denied millions of women access to affordable family planning.
The president of Catholics for Choice, Jon O’Brien, said, “The bishops pulled out all the stops in their campaign against women’s access to contraception. The Obama administration stood with those who support religious liberty and believe in giving women the freedom of conscience to make their own reproductive health decisions.
“While the refusal clause that is contained in the legislation is still too expansive, denying many women, as it does, affordable access to contraception, we are relieved by this announcement. Catholics for Choice and our colleagues in the reproductive rights movement expended a huge amount of energy and resources mobilizing the public to take action on this pivotal issue. In the final analysis, this was a victory for common sense and scientific advice in the interests of the common good.
“The battle over this issue is a warning about what is to come, especially as the bishops are playing the victim card in their pleas for special treatment and their false assertions about alleged attacks on religious freedom. The president and Congress will need to get real about what is going on, and remember that this coming November the electorate will not be listening to the bishops, so neither should they.”
Catholics for Choice shapes and advances sexual and reproductive ethics that are based on justice, reflect a commitment to women’s well-being and respect and affirm the capacity of women and men to make moral decisions about their lives.
[This blog post appeared here. We think the message is simple and direct. Thank you to Laura Kendellen for such a well written response.]
Thank you for contacting me regarding right to life and the issue of abortion.
I fully understand the controversy and diverse opinions surrounding this issue. My own views have been forged over a lifetime of raising a family and following the national debate. In all sincerity, and with due respect to the beliefs of others, I believe that life begins at conception.
Our founding documents establish that we have an unalienable right to life endowed by our creator. Because the abortion debate concerns more than one life, there is not a national consensus as to when life begins or when the life of an unborn child should be protected.
Unfortunately, the Supreme Court in Roe v Wade imposed a judicial dictate that did not end a debate that would be better resolved through the legislative process. As a result, the controversy over abortion has raged for over 3 decades, and there will continue to be attempts to come to a better resolution of the issue legislatively.
I have cosponsored two current bills in the Senate that help define and resolve the issue. I support S. 91 that defines life as beginning at conception, and S. 906 that prohibits the use of taxpayer funds for procedures that so many Americans strongly believe are morally wrong.
Thank you again for taking the time to share your thoughts. It is important for me to hear the views and concerns of the people I serve. Since taking office, I have received over 300,000 pieces of correspondence and have had over 150,000 people participate in live forums and telephone town hall meetings. Please feel free to contact me in the future if I can further assist you or your family. It is an honor representing you and the good people of Wisconsin in the U.S. Senate.
United States Senator
I received the above email this morning. I immediately posted it on Facebook and the comments keep coming.
I’m not sure which email Sen. Johnson is replying to here, but I am so appalled by his use of religious language in official correspondence that I have to share it.
I’m referring specifically to Sen. Johnson’s candid mention of “our creator.” As if everyone believes whatever Sen. Johnson believes. As if imposing his religious beliefs on his constituents is part of his job as a U.S. senator.
Regardless of “our founding documents,” I am a strong proponent of separation of church and state. Everyone is entitled to their own religious beliefs or having no religious beliefs, but religion should have no place in government- in theory and practice.
Unfortunately, that’s not the reality. After all, organizations like NARAL wouldn’t have to exist if it weren’t for the religion-politics crossover.
Although the majority of Americans identify as Christians, 3.9-5.5% identify as non-Christian, and 15% don’t identify with any religion at all.
- A recent Gallup poll shows that those who believe that abortion should be illegal in all cases are the minority;
- A Guttmacher report shows 78% of women who have abortions have a religious affiliation;
- And the Religious Coalition for Reproductive Choice, for example, is made up of about 40 national religious and religiously affiliated organizations from 15 denominations and faith traditions
Clearly, religion and anti-choice sentiments don’t always go hand in hand.
I expected Sen. Johnson’s response to be anti-choice, but I did not expect such a blatant disregard for religious freedom and separation of church and state. Like many politicians, he is using “the issue of abortion” as a platform to promote his personal religious beliefs rather than to simply state his position.
Sen. Johnson’s response illustrates that he is both out of touch and out of line.
Submitted by National Womens Law Center on Jan 5, 2012
By Leila Abolfazli
Here’s to a new year.
Arriving at the National Women’s Law Center three months ago, I never anticipated just how sustained and systemic the efforts to dismantle women’s health and reproductive rights had become. Sure, I had paid attention to the Planned Parenthood defunding fight (which included the “trade” for a ban on DC funding of abortion services and the “this is not meant to be a factual statement” debacle) and had heard about HR 3and the disgusting “forcible rape” debate. Indeed, it was those events that informed my decision to work on reproductive rights issues full time. But even though I was aware of what was going on, it was only when I became involved with the issues on a daily basis where I gained a whole new perspective on just how far those who oppose reproductive rights are going in order to completely unravel women’s rights. And it got me thinking, if so many bad things can happen in just my three months here, what will 2012 look like?
So in order to be prepared for this year, I decided to give a quick review of my first three months – a recap of the numerous anti-choice measures that cropped up in just the final months of 2011. Because when you lay it all out, you can’t ignore how serious these efforts really are.
In my very first week, the House of Representatives voted on HR 358, which literally would allow women to die at hospitals instead of getting the emergency care they need if it included abortion care. Seriously? Ok, next? How about the Rehberg Draft, the House’s version of the Labor, Health and Human Services Appropriations bill, which was never reviewed, debated, or marked up in subcommittee before the subcommittee chair posted it online (meaning circumventing the typical process for getting bills through). The draft included defunding Title X (the family planning program), ensuring Planned Parenthood gets no federal funds whatsoever (once again), expanding refusal rights, and taking away funding for implementing the Affordable Care Act. So basically everything that would hurt women’s and their families’ health. Thankfully, these provisions did not make it into the final appropriations bill (although there was a cut in Title X funding), so take a momentary sigh of relief. But with this sigh of relief there is also one of frustration when considering the 2012 appropriations didn’t include provisions providing coverage of abortion in case of rape, incest, or life endangerment for Peace Corps volunteers or permanently banning the global gag rule. Oh, and don’t forget, the bill prevents DC from using its own funds to cover abortion services. Sigh.
Ok, next up we have the debate of the National Defense Authorization Act, where Senator Shaheen was trying to include an amendment in the bill that would correct a very serious gap in coverage for women who rely on the military for insurance. Does it make sense that military women who fight and sacrifice for our country are left without any health insurance coverage for abortion services when they find themselves pregnant after surviving sexual violence? Does it make any more sense that civilian federal employees and those on Medicaid get such coverage and women in the military do not? Despite it making no sense for not providing this coverage to military women, the amendment was blocked from coming to a vote.
Now back to the House again, where there was a hearing in the Subcommittee on Health of the Energy & Commerce Committee on whether the groundbreaking HHS rule guaranteeing no cost sharing coverage of contraception should have an even bigger exemption for more religious entities, like hospitals and universities. Even though the rule in no way forces someone to take contraception, several witnesses at the hearing said that the rule still impinges on hospitals’ and universities’ consciences. Contraception is widely accepted, widely used, and used to be non-controversial. So it makes you think, are we really debating this? Is this where we are now, that even contraception is now up for negotiation? Ugh.
Just weeks after the HHS rule hearing, there was another House hearing, “HHS and the Catholic Church: Examining the Politicization of Grants” where HHS officials were questioned why a grant to help survivors of trafficking (including sex trafficking) wasn’t given to the U.S. Conference of Catholic Bishops. Although claims were made of an administration bias against the Catholic Church, the issue boiled down to the fact that the Bishops would not provide or refer for all services that were required to get the grant. This includes providing or referring for the full range of gynecological care (remember what we are talking about here – providing care to sex trafficking survivors). The Bishops weren’t going to provide what the grant required, so they didn’t get the grant. Simple enough.
Next, we move on to a real roller coaster of a week. First, the House held a hearing on the Susan B. Anthony and Frederick Douglass Prenatal Nondiscrimination Act of 2011, a bill that would criminalize race and sex selective abortions. The hearing was unbelievably depressing as members of the House advanced the extremely anti-choice, anti-woman bill in the name of civil rights, even quoting famous civil rights leaders, all the while ignoring the very big elephant in the room – i.e. the fact that those touting this “civil rights” law voted against every other civil rights legislation in the past several years. This one requires a big sigh…
Ok, but no time to dwell on a bill that would basically require doctors to racial profile patients, because now we are at one of the most stunning decisions of the year – i.e. Secretary Sebelius’s alarming decision to overrule the FDA’s conclusion that Plan B should be given over the counter status. Ouch, this one really hurt. And just to add salt to the wound, the next day President Obama said he agreed with the decision,because he didn’t want his daughters to be able to get Plan B between the bubble gum and batteries.Thud, my head has officially hit the table. There are so many problems with this decision (including ignoring the difficulty women can face in obtaining Plan B at a pharmacy) and the subsequent commentary, but, at its core, the decision to deny women over the counter access to contraception is a huge loss for this country.The decision has done great damage to the message about the benefits of access to contraception, women’s ownership of their reproductive health decisions, and elevating science over an incorrect political calculation (yeah sometimes I really want to think global warming isn’t happening, but then I look at the science…). Oh, and did you know that Obama’s daughters could get a lot more dangerous medicines at the pharmacy next to the bubble gum that is a lot cheaper than the $50 needed to buy Plan B… But that’s beside the point, right?
And so, with that great disappointment, 2011 is over, and with it the end of my first three months at the Law Center. Oh, and just as an fyi, this is just what happened on the national level, I did not even step into theNINETY-TWO anti-abortion restrictions passed in the states, which would make this blog even more depressing than it is and, not to mention, as long as the dictionary. But just as a reference - this total is almost THREE times higher the last highest number of state anti-abortion restrictions, which was 34 in 2005.
All of these attacks on women’s reproductive health, what is it about? Is it about controlling women’s decisions? Is it about nervousness about people having sex? Or is it just about scoring political points, and getting reelected?
Whatever it is or isn’t, it is madly saddening. Not only because women’s bodies are being used as political points, but because the conversation that happens in Washington about women’s bodies is completely ignorant of the conversation that is happening in the rest of America. That conversation is that there is an America that is struggling to make it. That there is a stubborn high unemployment rate (which, if the proponents of sex and race selection abortion were really concerned about discrimination and civil rights issues, they would work on legislation to help with the fact that black women in America have been particularly hit by job loss during the recovery). That the income gap is growing, people’s houses are underwater, extreme poverty is rising. These are all serious issues that are affecting Americans. But instead of dealing with these real issues, Washington is focused on women’s reproductive organs and figuring out new and unique ways to restrict, deny, and control them.
It is all very maddening, but if you think of a silver lining, think that the public gets it even if Washington doesn’t. Think about the Personhood Amendment failing in Mississippi by a large margin (yes, Mississippi).
And be ready for 2012.
[This story comes from Anna Merlan at the Dallas Observer.]
?One night late last year, Jason Melbourne walked into a CVS pharmacy in Mesquite, hoping against hope to walk out with an emergency contraceptive, or “the morning-after pill.” It wasn’t the morning after. He and his wife had their “accident” a few days before, and the 72-hour window in which EC is most effective was closing fast. The first four pharmacies he visited had told him they were out of stock.
He was finally referred to a CVS in Mesquite, some 15 miles away. They told him they had just one box left. But when he finally got there, the overnight pharmacist, Minni Matthew, told Melbourne she wasn’t going to sell it to him.
In order for him to buy the meds, the pharmacist said, she’d need to talk to and see the ID of his wife, who was at home with their two young children. He asked why, and she pointed to the fine print on the medication’s box, which says it can only be sold to someone age 17 or older. Melbourne pointed out that he was well over 17.
“I’ve bought this plenty of times in my life, and it’s never been a problem,” he said. “Are you telling me every other place I’ve bought it from has been wrong?”
Didn’t matter, Matthew said, since the medicine obviously wasn’t for him.
“Why don’t you show me the law that says you can’t sell this to a man?” Melbourne replied.
Things devolved from there. Melbourne Googled emergency contraception on his phone and confirmed that there was no law against selling the product to a man. He tried to show his phone to the pharmacist, he says, “but she didn’t want to see it.”
“You’re the only person who has it in the city, and I’ve driven 15 miles to get here,” Melbourne recalls telling her. “My wife is home with our 4-year-old and newborn son. She’s breastfeeding. She can’t drag my infant child out of the house and down here just to satisfy you.”
At that point, Melbourne says, Matthew retreated behind the counter. He shouted after her, “You got a pillow, Minni? Because I’ll be here all night. I’m not going anywhere until you show me a law against selling this to men.”
A pharmacy technician, who gave his name only as “Robert,” jumped in. He let Melbourne know that they don’t sell emergency contraception to men because they might be giving it to “rape victims.”
By then, Melbourne says, he was starting to “freak out.”
“I’m standing in line trying to get something that’s already a little controversial, a little embarrassing,” he says. “It’s for my wife. There are three customers behind me when the guy says that, so it looks like I’m a piece of shit now.”
Matthew then tried to tell Melbourne that the real reason he couldn’t buy the drug was because it was Plan B, the brand name, and that previously he’d always bought the generic version of the drug.
“What does this have to do with anything? It’s the same drug,” Melbourne, a full-time student who happens to be entering nursing school in the fall, shot back. He called his wife and put her on the phone with the pharmacist, but that wasn’t enough. Melbourne then asked for Matthew to call her supervisor, but the supervisor said no, too. At that point, Melbourne’s wife called a nearby Walgreen’s, who agreed to sell him the medicine. Melbourne went there, bought it, then promptly filed a complaint with the ACLU for gender discrimination.
Lisa Graybill, the legal director at ACLU of Texas, says that while denying emergency contraception to a man isn’t technically illegal, “it’s my understanding it’s contrary to the FDA guidelines. They say the medication is available to people over the ages of 17.”
Graybill says that refusing to sell EC to men on the grounds they may give it to minors is “misguided,” as she put it after a polite, diplomatic pause. “I’m not aware of a single case of a man reportedly buying it to push on his underage pedophile victim,” she says. She’s also not aware of men buying EC to force on people they’ve just raped.
“I don’t know where these ideas comes from,” she says. “I’m not telling you there’s never a case that that’s happened, but I’m not aware of any. That’s a sensational story that would get coverage if someone was criminally accused of doing that.”
The ACLU’s been down this road before. They received reports in July of 2010 that Walgreens stores in Texas, Mississippi and Oklahoma were refusing to sell EC to men. The ACLU called Walgreens out publicly, which seemed to solve the problem.
In an email, CVS spokesman Mike DeAngelis insisted to Unfair Park that they’ve already responded to the incident and appropriately briefed their stores on official company policy.
“CVS/pharmacy’s policy is to follow FDA regulations for the sale of emergency contraception, which allows this product to be sold without a prescription to customers who are at least 17 years old, regardless of gender,” he wrote. “It is our pharmacists’ responsibility to ensure that all customer needs are promptly and completely satisfied. As such, there is no company policy that prevents the sale of emergency contraception to a male customer.”
But DeAngelis was referring to a similar incident in Houston, which he called “isolated.” We told him that actually we were talking about incident in Mesquite. We also informed DeAngelis that we’d spoken with Angela Soto, the store manager of that particular Mesquite CVS. Though she wasn’t specifically aware of the incident with Melbourne, she confirmed to us that as she understood it, it’s “store policy” not to sell EC to men, “because we have to prove that whoever we sell it to is not any minor person.”
We pointed out that Melbourne was over 17. “Well, that’s the issue,” she replied. “We don’t know who he’s going to give it to.” She said she had also heard that “other stores” won’t sell EC to men on the grounds they may give it to women they’ve just raped.
“Those statements are contrary to our company policy,” DeAngelis said when we relayed the manager’s response. He said the company would look into it.
“I’m outraged,” Melbourne says. “I chased this thing all over town, then I get accused of using this for rape, even after they’ve talked to my wife on the phone. It makes me feel like a piece of crap.”
Graybill says that she “won’t contest” that the store’s policy, however logically shaky, may come from “a place of genuine concern” about underage girls. But ultimately, she says, “I think there’s just a gap in communication from corporate to the people on the line.”
“I really want them to be educated,” Melbourne says. “I’m tired of having to tell a pharmacist who’s in charge of a lot more drugs than that one what she can sell. They need to get it right. They need to do some follow up training. I don’t want this crap happening to me again, or to someone else.”
Happy New Year, ASEC Community!
Today (Friday, January 6th), the President’s Council on Science and
Technology will hold its bi-monthly meeting, and 5 representatives from
different sectors of the reproductive health community will address the
Council during the public comment period at 1:30. The speakers will be:
* Dr. Francesca Grifo, Program Director of the Union of
Concerned Scientists Scientific Integrity Program
* Dr. Susan Wood, Associate Professor at the Jacobs Institute of
Women’s Health, George Washington University School of Public Health and
* Mr. Wayne Shields, President and CEO of the Association of
Reproductive Health Professionals
* Dr. Doug Laube, MD, Obstetrician and Gynecologist; Board Chair
of the Physicians for Reproductive Choice and Health
* Ms. Kelly Cleland, MPA, MPH, Executive Director of the
American Society for Emergency Contraception; Research Staff at the
Office of Population Research at Princeton University
If you’re interested in watching a webcast of the meeting tomorrow,
click here. Each
speaker only has 2 minutes, so hopefully we will succeed in getting the
attention of the Council (and the President) in that brief amount of
In this podcast we talk to Cynthia Peason of the NWHN. Cyndi tells me the reaction of the NWHN to the historic decision regarding Plan B Emergency Contraception.