In this podcast I talk to Bill Albert from the National Campaign to Prevent Teen and Unplanned Pregnancy. We talk specifically about THIS REPORT, and more broadly about the state of RH health for teens in this country.
For more information about The Campaign try these links.
http://www.thenationalcampaign.org/
http://www.stayteen.org/
http://bedsider.org/
Irin Carmon is a staff writer for Salon. Follow her on Twitter at @irincarmon or email her at icarmon@salon.com.
It started around February, when Republicans were still eager to talk about contraception. The Obama administration, or so Mitt Romney charged in Colorado, was forcing religious institutions to provide “morning-after pills –in other words abortive pills — and the like, at no cost.”
It was, of course, a lie. Romney was conflating two different pills: emergency contraception, known as the morning-after pill, which prevents a pregnancy; and chemical abortion, or mifepristone, which ends a pregnancy of up to seven weeks’ gestation and isn’t covered under the new guidelines. Since both pills were marketed in the U.S. around the same time, even some pro-choicers have gotten confused. But Colorado happens to be the epicenter of people confusing them on purpose. It’s the birthplace of the Personhood movement and home to Focus on the Family, both of which have strategically called emergency contraception “abortion” on the scientifically unproven basis that they could block a fertilized egg from implanting.
There are a host of ironies here. Obama has earned the renewed support of reproductive-rights advocates by requiring health insurers to cover contraception, but the Center for Reproductive Rights is still taking him to court – with oral hearings being held this week before a New York federal court -– for overruling the FDA’s recommendation to lift the prescription requirement on emergency contraception for women under 17. That litigation has been winding its way through the system for over a decade, throughout the Bush-era politicization of the FDA, eventually resulting in a federal judge concluding that “the FDA repeatedly and unreasonably delayed issuing a decision on [the emergency contraception pill] Plan B for suspect reasons.” The FDA was ordered to explain why Plan B shouldn’t be available over the counter for girls 13 and up. When the Obama administration overruled the FDA’s recommendation to make it over the counter, U.S. District Judge Edward Korman suggested the Center for Reproductive Rights reopen its case.
“It seems to me that what we’re going through is a rerun of what happened before,” Korman remarked, referring to politics trumping the recommendations of medical professionals.
The Obama administration’s unspoken but unmistakable fear was of an election-cycle attack line that Michele Bachmann would use anyway: That teenage girls would be able to get Plan B from “the grocery store aisles next to bubble gum and next to M&Ms.” That was, in fact, an echo of the language President Obama himself used to invoke a highly unsupported bogeyman: that “a 10-year-old or 11-year-old going to a drugstore would be able to, alongside bubble gum or batteries, … buy a medication that potentially if not used properly can have an adverse effect.”
But there is another twist, so far mostly overlooked: Emergency contraception won’t be covered by insurance for everyone, since it’s available over-the-counter for those who can show I.D. proving that they’re 17 or older. They’ll still have to fork over around $50 a pop. But as long as girls 16 and younger need a prescription for the morning-after pill and they have insurance, it will be fully covered — effectively free. The same goes for women older than 17 who decide to jump through the hoops of getting a prescription, either for over-the-counter Plan B or the prescription-only generic and Ella versions.
As much as pro-choice advocates want to lift the barriers that make emergency contraception hard to get — because it’s more effective the faster you use it — one of those barriers, the prescription requirement, also mitigates another, the high cost. Said Adam Sonfield, a senior public policy associate at the Guttmacher Institute, of this catch-22, “It presents a tradeoff between cost and access.”
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Part of the reason people get confused about emergency contraception and abortion is because lots of people are confused about the basic biology of pregnancy: specifically, that it doesn’t necessarily happen instantaneously and that sperm can live in the body for several days, during which time a woman can ovulate and an egg can potentially be fertilized and implant. Regular use of hormonal contraception prevents ovulation and the chance for fertilization; emergency contraception essentially works the same way except that it’s taken after sex, by which point ovulation may have already happened. But according to recent studies, there is no evidence that taking emergency contraception after ovulation and fertilization will stop the egg from implanting.
But the misinformation and misunderstanding have created a contradictory public health picture when it comes to emergency contraception. In some ways, it’s become more accessible. In 2010, the U.S. approved a longer-acting French variant of Plan B, known as Ella, and there are scattered experiments in convenient delivery, from a birth-control vending machine at Shippensburg University in Pennsylvania to a new bike messenger service in London, both of which caused minor news sensations. The annual “Back Up Your Birth Control” campaign has been promoting the line “EC=BC,” emphasizing that emergency contraception is birth control, not abortion — just in case that is a barrier for women who are considering taking it. And the Center for Reproductive Rights’ petition did manage to lower the age restriction from 18 to 17.
But there are more disturbing suggestions that misinformation is triumphing. A recent Boston Medical Center study found that many pharmacists were still often misinformed about the age requirement and were even more likely to wrongly refuse emergency contraception to 17-year-olds in low-income neighborhoods, where the rate of unintended pregnancy is higher. In Honduras, the Supreme Court upheld the criminalization of emergency contraception, which means women who use it could be jailed. Personhood initiatives, which oppose the morning-after pill, have so far failed in Colorado, Mississippi and Oklahoma, but they’ve introduced false doubts by providing even more opportunities for pundits and candidates to say “the morning-after abortion pill.”
It’s a problem that dates back decades: When, throughout the ’90s, the U.S. considered approving a French chemical abortion pill known as RU-486, it was widely called the “morning-after abortion pill,” including, often, in the New York Times. The distinction wasn’t pressed by the pro-choice community itself. “At the time, the prevailing medical wisdom was that there is a continuum rather than a bright line between EC and mifepristone,” said Gloria Feldt, who was president of Planned Parenthood at the time, with the benefit providing more options for women who did not wish to be pregnant. “It was also assumed that a formulation of mifepristone would eventually be made for use as a true ‘morning-after’ pill.” The widespread belief, she recalled, was that a chemical abortion pill would “solve all the abortion debate problems and guarantee privacy.”
Another problem was that although doctors and non-professionals had been giving women high dosages of regular birth control pills for decades as a form of emergency contraception, the science of exactly how emergency contraception worked remained unclear. The medical definition of pregnancy remains “implantation of a fertilized egg,” but let’s say you believe, as the Catholic Church does, that fertilization itself creates a human life. Anti-choice advocates obsess over what would happen if a woman who took emergency contraception did happen to ovulate anyway and an egg potentially was fertilized, which is enough reason for some of them to call postcoital contraception “abortion.” They have claimed that hormonal contraception makes the lining of the endometrium inhospitable to a fertilized egg, constituting “murder.” Even the official packaging for Plan B, the single-step version of emergency contraception, suggests that “in addition” to blocking ovulation and fertilization, “it may inhibit implantation (by altering the endometrium).”
Except that we now know it doesn’t, even if you walk down the path of remote maybes, which requires you to believe that a zygote, which may not implant for unknowable reasons, has the same rights as a living woman who doesn’t want to be pregnant. As Princeton’s Kelly Cleland pointed out recently, “The science has evolved considerably in the last 13 years. Newer evidence, published since the Plan B label was approved, provides compelling evidence that levonorgestrel EC (LNG EC) works before ovulation, but not after.” The International Consortium for Emergency Contraception and the International Federation of Gynecology & Obstetrics also note that two new studies have shown conclusively that if a woman has ovulated and an egg has been fertilized, it’s too late for emergency contraception to work. They recommended that the language on the product labeling be changed.
Of course, scientific evidence has rarely had much place in this debate. In the meantime, even the most non-ideological news sources keep making the mistake alongside the ideologues. Last week, a furor erupted after the Associated Press reported that “Women seeking to take emergency contraception like the so-called ‘morning after’ pill would have to do so in the presence of a doctor under a bill before the Alabama legislature.” That is, until Erin Gloria Ryan from Jezebel read the actual bill and saw that it was, in fact, a law meant to limit chemical abortion, not emergency contraception. (A spokesperson for the AP said a correction was being prepared). “The confusion over this issue is probably one of the reasons emergency contraception hasn’t had as positive an impact as hoped when it comes to lowering the abortion rate,” wrote Amanda Marcotte at RH Reality Check. “If women think it is some kind of abortion-ish thing, they probably think taking it is a big deal, instead of thinking of it more like taking the pill, since it’s basically the same thing.”
But talk about moved goalposts. If ’90s-era advocates had hoped that the ability to end a pregnancy in the safety of your home with RU-486 — the actual abortion pill, not the morning-after one — would defuse the abortion debate, their more recent counterparts hoped to take it to the next technological level by providing “tele-med” abortions. They would involve doctors seeing a woman over webcam with a nurse practitioner physically present, helping women in remote areas with ever-dwindling options for safe abortions to access them. But four states have already passed requirements meant to undercut these options by forcing a doctor’s presence, and the bill the Associated Press misreported was aiming to add Alabama to the list. All in all, there have been fewer gamechangers, and more cases of one step forward, two steps back.
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In this podcast I talk to Rep. Sandy Pasch about the legislative session in Wisconsin that was just completed. She and I talk about the impact of passed legislation on women, families, and medical professionals.
In this podcast I speak to NFPRHA President Clare Coleman about the Affordable Care Act. Clare talks about the impact that the ACA has, and will have on the lives of people going forward.
In this podcast I ask Rep. Cory Mason(D) about his reaction to the flurry of Reproductive Health Care legislation that passed during the final evening of the session.
The Bills discussed are…
[This came to us today from the US Conference of Catholic Bishops. We felt we should run it unedited.]
United for Religious Freedom
A Statement of the Administrative Committee
Of the United States Conference of Catholic Bishops
March 14, 2012
The Administrative Committee of the United States Conference of Catholic
Bishops, gathered for its March 2012 meeting, is strongly unified and intensely focused
in its opposition to the various threats to religious freedom in our day. In our role as
Bishops, we approach this question prayerfully and as pastors—concerned not only with
the protection of the Church’s own institutions, but with the care of the souls of the
individual faithful, and with the common good.
To address the broader range of religious liberty issues, we look forward to the
upcoming publication of “A Statement on Religious Liberty,” a document of the Ad Hoc
Committee for Religious Liberty. This document reflects on the history of religious
liberty in our great Nation; surveys the current range of threats to this foundational
principle; and states clearly the resolve of the Bishops to act strongly, in concert with our
fellow citizens, in its defense.
One particular religious freedom issue demands our immediate attention: the nowfinalized rule of the U.S. Department of Health and Human Services that would force
virtually all private health plans nationwide to provide coverage of sterilization and
contraception—including abortifacient drugs—subject to an exemption for “religious
employers” that is arbitrarily narrow, and to an unspecified and dubious future
“accommodation” for other religious organizations that are denied the exemption.
We begin, first, with thanks to all who have stood firmly with us in our vigorous
opposition to this unjust and illegal mandate: to our brother bishops; to our clergy and religious; to our Catholic faithful; to the wonderful array of Catholic groups and
institutions that enliven our civil society; to our ecumenical and interfaith allies; to
women and men of all religions (or none at all); to legal scholars; and to civic leaders. It
is your enthusiastic unity in defense of religious freedom that has made such a dramatic
and positive impact in this historic public debate. With your continued help, we will not
be divided, and we will continue forward as one.
Second, we wish to clarify what this debate is—and is not—about. This is not
about access to contraception, which is ubiquitous and inexpensive, even when it is not
provided by the Church’s hand and with the Church’s funds. This is not about the
religious freedom of Catholics only, but also of those who recognize that their cherished
beliefs may be next on the block. This is not about the Bishops’ somehow “banning
contraception,” when the U.S. Supreme Court took that issue off the table two
generations ago. Indeed, this is not about the Church wanting to force anybody to do
anything; it is instead about the federal government forcing the Church—consisting of its
faithful and all but a few of its institutions—to act against Church teachings. This is not a
matter of opposition to universal health care, which has been a concern of the Bishops’
Conference since 1919, virtually at its founding. This is not a fight we want or asked for,
but one forced upon us by government on its own timing. Finally, this is not a Republican
or Democratic, a conservative or liberal issue; it is an American issue.
So what is it about?
An unwarranted government definition of religion. The mandate includes an
extremely narrow definition of what HHS deems a “religious employer” deserving
exemption—employers who, among other things, must hire and serve primarily those of their own faith. We are deeply concerned about this new definition of who we are as
people of faith and what constitutes our ministry. The introduction of this unprecedented
defining of faith communities and their ministries has precipitated this struggle for
religious freedom. Government has no place defining religion and religious ministry.
HHS thus creates and enforces a new distinction—alien both to our Catholic tradition and
to federal law—between our houses of worship and our great ministries of service to our
neighbors, namely, the poor, the homeless, the sick, the students in our schools and
universities, and others in need, of any faith community or none. Cf. Deus Caritas Est,
Nos. 20-33. We are commanded both to love and to serve the Lord; laws that protect our
freedom to comply with one of these commands but not the other are nothing to
celebrate. Indeed, they must be rejected, for they create a “second class” of citizenship
within our religious community. And if this definition is allowed to stand, it will spread
throughout federal law, weakening its healthy tradition of generous respect for religious
freedom and diversity. All—not just some—of our religious institutions share equally in
the very same God-given, legally-recognized right not “to be forced to act in a manner
contrary to [their] own beliefs.” Dignitatis Humanae, No. 2.
A mandate to act against our teachings. The exemption is not merely a
government foray into internal Church governance, where government has no legal
competence or authority—disturbing though that may be. This error in theory has grave
consequences in principle and practice. Those deemed by HHS not to be “religious
employers” will be forced by government to violate their own teachings within their very
own institutions. This is not only an injustice in itself, but it also undermines the effective
proclamation of those teachings to the faithful and to the world. For decades, the Bishops have led the fight against such government incursions on conscience, particularly in the
area of health care. Far from making us waver in this longstanding commitment, the
unprecedented magnitude of this latest threat has only strengthened our resolve to
maintain that consistent view.
A violation of personal civil rights. The HHS mandate creates still a third class,
those with no conscience protection at all: individuals who, in their daily lives, strive
constantly to act in accordance with their faith and moral values. They, too, face a
government mandate to aid in providing “services” contrary to those values—whether in
their sponsoring of, and payment for, insurance as employers; their payment of insurance
premiums as employees; or as insurers themselves—without even the semblance of an
exemption. This, too, is unprecedented in federal law, which has long been generous in
protecting the rights of individuals not to act against their religious beliefs or moral
convictions. We have consistently supported these rights, particularly in the area of
protecting the dignity of all human life, and we continue to do so.
Third, we want to indicate our next steps. We will continue our vigorous efforts at
education and public advocacy on the principles of religious liberty and their application
in this case (and others). We will continue to accept any invitation to dialogue with the
Executive Branch to protect the religious freedom that is rightly ours. We will continue to
pursue legislation to restore the same level of religious freedom we have enjoyed until
just recently. And we will continue to explore our options for relief from the courts,
under the U.S. Constitution and other federal laws that protect religious freedom. All of
these efforts will proceed concurrently, and in a manner that is mutually reinforcing.Most importantly of all, we call upon the Catholic faithful, and all people of faith,
throughout our country to join us in prayer and penance for our leaders and for the
complete protection of our First Freedom—religious liberty—which is not only protected
in the laws and customs of our great nation, but rooted in the teachings of our great
Tradition. Prayer is the ultimate source of our strength—for without God, we can do
nothing; but with God, all things are possible.
[This article appeared first in the New York Times.]
CAN we still be arguing about a woman’s ability to control her own fertility? Almost 50 years ago in Griswold v. Connecticut, the Supreme Court struck down state restrictions on contraception because they violated a right to privacy. But the issue has not gone away. Rick Santorum injected it into the presidential race by indicating that Griswold should be overturned so that states could ban contraception altogether. And the Senate just voted down a Republican effort to allow employers and health insurance companies to refuse coverage for contraceptives if they had moral or religious objections.
Why are issues that the courts decided so long ago still unresolved? Maybe it is time to recognize that law alone is not enough to effect social change. It must be linked to social activism on behalf of women’s rights.
I should know. Fifty-five years ago, I had an opportunity to take a stand in favor of the right of women to control their fertility — and I did so through the courts.
It was 1957, and fresh out of the University of Wisconsin I enrolled in the Yale Law School — one of only six women in my graduating class. In my second year at Yale, several of our professors asked my husband and me to join a lawsuit challenging Connecticut’s birth-control law, which outlawed the sale and use of contraceptive materials and prohibited a doctor from prescribing birth control even to married women. One goal of the lawsuit was to remove the statutory obstacle to opening Planned Parenthood clinics in Connecticut so that poor families could have access to family-planning services.
I immediately agreed to join the case. Others did as well, but my husband and I were the only ones to use our real names. Because people used pseudonyms, the lead case came to be called Poe v. Ullman, but there was a companion case called Trubek v. Ullman. Poe raised a variety of grounds for challenging the statute and eventually landed in the Supreme Court.
I was proud to put my name on the case. To serve as a plaintiff, though a largely passive role, suited my vision of my future as a social justice lawyer. I supported Planned Parenthood. I believed women should have access to birth control so they could have both a career and a family. I wanted those things for myself. I was no sexual radical: I was married, a “good girl” uninterested in sexual freedom, and I thought of abortion as frightening. But I was planning to have a family and a career as a lawyer. I believed I should be free to choose the timing of my children’s births so I could do both.
Poe was thrown out by the Supreme Court on a technicality. To force the issue, Planned Parenthood opened a clinic, leaving the state with no choice but to close it down. This landed the issue back in the Supreme Court — this time with different plaintiffs, as Griswold v. Connecticut — which found the statute an unconstitutional intrusion on marital privacy.
The privacy argument in Griswold led to the legalization of contraception. But it also had a much larger impact: the privacy doctrine played a central role in Roe v. Wade (1973), which declared some barriers to abortion unconstitutional; was used by the court in Lawrence v. Texas (2003), which struck down bans on consensual same-sex sexual activity; and has been cited in state court decisions upholding same-sex marriage.
We can celebrate Griswold, Roe and all the cases that stemmed from the Poe litigation. They are important landmarks in American jurisprudence. But as I look back I am dismayed by how few of the issues I was fighting for at the time of Poe are resolved. To be sure, we have important rights and more legal privacy. But we still have not provided all the support women need to combine rewarding careers and healthy families. Planned Parenthood is under siege and poor women who are seeking comprehensive reproductive care are still at risk. Presidential candidates can get away with saying that all contraception should be outlawed. Comprehensive child care services are difficult to locate, and fully financed family and medical leave is still controversial.
In short, we won the legal battle but not the war. Women are still not guaranteed control over their lives, because the necessary social supports were never secure. The initial goal of Griswold was to help women — and even though the precedent has helped with same-sex marriage laws, those initial needs, especially of poor women, have been left largely unmet.
The universal coverage plan outlined in President Obama’s Affordable Care Act is a good step forward, and we should do all we can to ensure it. Perhaps if activism had been linked to the lawsuits, the aims I fought for would have been secured, and we would be spared the spectacle of Republican candidates threatening, yet again, a woman’s right to control her own fertility.
Louise G. Trubek is a public interest lawyer and an emerita professor at the University of Wisconsin Law School.
