“What are they doing out there?” is the question I am most often asked about the picketers standing in front of our family planning clinic.
What they are doing by holding signs that say “The Pill Kills” and “Stop Chemical Abortion,” is misinforming and misleading the public. They give the misimpression that we provide abortion services; or drugs that terminate a pregnancy; or that using hormonal birth control is a deadlier health risk than unplanned pregnancy.
Sometimes, what they are doing is intimidating our clients – especially the young women and children coming for WIC services. The most dangerous picketers have physically blocked entrances and exits and pushed literature at people walking past or driving through.
But “What are they doing out there?” isn’t really a question about effects, it’s about motivations — and I’m giving up mind-reading and name-calling for Lent, so I won’t interpret or judge them. Still, I have questions about whether the picketers are reasonable. Many of our neighbors have lost their jobs and their health insurance. Many have seen their income reduced or lost their bargaining rights as workers. Some are in danger of losing their Medicaid and Medicare benefits and we are all losing environmental protections and the constitutional right to see the Wisconsin legislature when it is in session. Around the world, people are struggling to win the right to elect their leaders and they are too often killed, imprisoned, and beaten. Our world neighbors and friends have been lost to earthquakes, tsunamis, to floods and storms; and in nearby Haiti, cruel and corrupt dictators return triumphantly to the crime scene in the midst of catastrophic events and an election.
That’s why I am troubled and unsettled by what the self-styled ‘prayer warriors’ are doing. There are so many struggles for freedom, social justice, and disaster relief right now, that I do not think it is justifiable to be blocking access to health care for our uninsured neighbors who want to delay childbearing so they can finish school or take a new job or even wait to have children until they can afford them.
Publicly-funded family planning saves millions of taxpayer dollars while improving public health, yet the picketers demand to know why their tax dollars should pay for STD testing, birth control, and cancer screening. They oppose hormonal contraception to prevent a high risk pregnancy or even (maybe especially) a teen pregnancy. The picketers disagree with these services and even sexual health education, so they demand that others be denied them (if only this argument would work for oil company subsidies or middle-east military interventions.)
Recently, former State Senator Walter John Chilsen, in a statewide radio program said; “The use of contraceptives does not prevent unwanted pregnancies. I think you could even make the argument that it increases them.” The program’s host quickly changed the subject – leaving the claim unchallenged.
The scientific truth and the medical fact is that contraceptives prevent unwanted pregnancy. The primary cause of abortions is unwanted pregnancy and both the abortion rate and the unintended pregnancy rate have been falling for a generation. FPHS changed our banners on the building from “Condoms Save Lives” to “Birth Control Prevents Abortion” because the persistent campaign of misinformation puts our services and our community’s health at risk. It’s time to be more direct.
It is within the rights of the picketers to argue that birth control and reproductive health care should not be available, but I believe it is unethical and wrong to do it.
Let’s carve a stake to drive into the heart of health promotion and prevention strategies that exclude sexual health as a vital and normal part of human health and health care. As a first step, you can speak up in the U.S. Health and Human Services’ process of developing a national prevention plan.
President Obama formed the National Prevention, Health Promotion, and Public Health Council in June 2010. The council posted a draft plan for moving “from a focus on sickness and disease to one based on wellness and prevention.” The goals include healthy communities, preventive clinical efforts, and empowered individuals. The four Cross-cutting Strategic Directions include:
Healthy Physical, Social, and Economic Environments
Eliminate Health Disparities
Prevention and Public Health Capacity
Quality Clinical Preventive Services
Complementing those Strategic Directions are six Targeted Strategic Directions:
Tobacco-Free Living
Reduce Alcohol and Drug Abuse
Healthy Eating
Active Living
Injury-Free Living
Mental and Emotional Wellbeing
You know what is missing. The National Healthy People goals for 2020 include specific objectives for family planning, sexually transmitted infections, maternal and child health, and adolescent health. In Wisconsin, our Healthiest Wisconsin 2020 goals include normalizing sexual health as well as objectives to reduce maternal and child health disparities related to sexual health risks and access to care.
But in the National Prevention, Health Promotion, and Public Health Council draft, we have a “Waist-up Wellness” model that seems timid about even mentioning sex. There are a few references to HIV/Aids and STD testing and treatment, but they are imbedded in the subsections. If, as the plan asserts, we are going to “expand and connect prevention-focused health care and community prevention efforts,” and if we are going to “empower and educate individuals to make healthy choices,” then reproductive health and family planning clinics and providers must be a component of the transition.
By “Component” I don’t mean a sub-goal vaguely referenced. How about a specific and explicit Targeted Strategic Direction titled “Sexual Health and Wellbeing”? Paraphrasing a few recommendations from the existing targeted strategic directions, the recommendation for Sexual Health and Wellbeing might include:
Use media and social support (e.g., social networks, shared space) to empower individuals to make responsible and well-informed choices about sexual health.
Expand opportunities for health within communities and populations at greatest sexual health risk.
Conduct research on promising strategies including research on reducing unintended pregnancy rates and measureable results for community-based and other types of reproductive health services.
Establish and maintain clinical practice standards for preventive reproductive health services to encourage continuous improvement and collaboration across health care provider entities and types.
Expand interoperable health information technology, including telemedicine and patient health records that are affordable to community-based primary prevention clinics and accessible to patients in rural areas.
Strengthen capacity to control and prevent sexually transmitted infections and to effectively respond to outbreaks in communities.
Protect the right of patients to choose a willing and qualified provider for the sexual health and family planning care they want and need.
Link community-based reproductive health prevention services with clinical care, acknowledging that technological innovation will increasingly integrate patient health records and telemedicine so that for a patient, a “Medical Home” is not a place, but a care coordination concept. In sexual health, the patient is probably the best coordinator.
These are the four main points of consideration that I am inviting you to emphasize to our decision-makers and within our community of advocates and health care providers:
1) The right to confidential reproductive health doesn’t mean very much without access to confidential, affordable, comprehensive, competent, and willing health care providers.
3) While the Patient Protection and Affordable Care Act will help, the right to choose a willing and capable sexual health care provider is still best left in the hands of the patient and not the private HMO, government regulation, or a hospital’s health information network. On a broader scale, the realities of a primary preventive health care delivery system with an existing and predictably continuing shortage of practitioners with extensive reproductive health care training and experience demands that we protect the existing infrastructure of family planning clinics and use technology to link it with other primary care providers.
4) Sexual health has been uniquely constitutionally-protected because reproductive self-determination is a core human right and because sexual behavior and decision-making is an extremely personal matter. Forty years ago, when legislators permitted Medicaid to establish managed care organizations, the regulations protected the right of patients to choose an out of plan reproductive health care provider. Sexual health lends itself to care models (such as individual Patient Health Records) which enable and empower patients to make their own choices. Advocates, community health providers, and public health policy-makers, must recognize that upholding the right of a patient to choose her own community provider or her own method or her own nurse practitioner is not only good policy — it leads to the best health results.
Wisconsin family planning advocates, providers, and citizens of reproductive age have another gift to be thankful for this holiday season. Wisconsin is the first state in the nation to win approval of a Medicaid (MA) State Plan Amendment (SPA) — making our very successful MA Family Planning Waiver a permanent part of our MA plan. Helping women and men protect their sexual health and future fertility; helping them take charge of timing their childbearing; helping them get testing and treatment for STDs; helping them complete their education and/or get the job training they need; these are perfect gifts in these tough economic times.
At the beginning of the year, Speaker-to-be John Boehner denounced inclusion of the plan in the American Recovery and Reinvestment Act to make it easier for states to expand their MA family planning programs saying it would not stimulate the economy. Speaker Nancy Pelosi seemed unprepared to make the economic argument for family planning services and President Obama pulled the language with a promise to bring it back later.
President Obama kept his promise. The Patient Protection and Affordable Care Act included language empowering states and the District of Columbia to have much easier access to federally-funded family planning services. In April, the Wisconsin Family Planning and Reproductive Health Association began working diligently with the Wisconsin Department of Health Services and the state MA program to enable and encourage an early application for an effective program. Using blogs, letters-to-the-editor, web video interviews, and even a professional lobbyist, we tried to inform legislators and advocates from Wisconsin as well as from other states and the District of Columbia about the opportunity. We hoped to establish a context where legislative leaders and state employees would feel they had a solid basis to proceed with an MA State Plan Amendment in Family Planning.
Faced with an end-of-year expiration of our existing Family Planning Waiver and armed with convincing evidence of cost-efficiency, our pro-family planning administration in Wisconsin submitted a request to make our family planning program larger and permanent. Wisconsin submitted a request before the Centers for Medicaid and Medicare Services even established the criteria. In an April 2010 RHRealitycheck.org blog, advocates set out our “recipe” for success:
Presumptive eligibility for immediate contraceptives and STD services.
Full eligibility must be processed quickly.
Income eligibility must be broad.
Covered comprehensive services must include most contraceptive methods and Emergency Contraception.
Eligibility for students and minors must be based on their own income.
On December 22nd Wisconsin’s application was approved. Although there were a few points of negotiation and compromise on structural points, all of the ingredients in our “recipe” were included. California and South Carolina have also applied for SPAs and are in the queue for approval.
The celebration is justified and the victory is truly monumental. However, there is no time to be self-satisfied. In Wisconsin, a new anti-choice administration and an anti-choice legislature is almost certain to test the federal maintenance of effort requirements for the family planning program. Although the program has established its cost-efficiency, ideologues are likely to try to use the budget pressures of a tough state economy as cover for efforts to dismantle the program. Because they have repeated it so often, the opposition believes that access to family planning and sexual health care undermines parental authority and encourages promiscuity.
Although the political battles are formidable, I don’t think the ideologues at the gates are the greatest challenge ahead to family planning and reproductive health access. I think our greatest challenge is our own vision for change in the new environment of primary preventive health care. How will we make the transition to electronic health records? How will we collaborate with other primary care providers? Will we see ourselves or be seen as competitors and be marginalized by our unwillingness or inability to be a part of the emerging systems? Even though Medicaid patients have a choice of provider for reproductive health care, how will we be their provider of choice? Are we ready to negotiate contracts with Health Maintenance Organizations (including state Medicaid plans) and to participate in the new Health Exchanges?
These challenges cannot be trusted to fortune. While the opponents of sexual health care must be vigorously resisted, we must simultaneously articulate and achieve a new complementary role for family planning programs and clinics in the reformed health care world. If we fail, the fault will not be our opponents or in our stars, it will be our own.
[This Letter to the Editor appeared in the Merrill Foto News Sept. 15, 2010 in regards to Comprehensive Sex Ed in Merrill, Wi]
Letter to the Editor:
Regarding the issue of sexual development, i.e. sexual education, in the schools, one important factor that has not been addressed is whether the school system is prepared, able to provide moral, ethical, spiritual, religious principles on which to build one’s sexuality.
It seems the only issue being tossed around is whether or not children should have information about STDs and contraception. This is putting the horse before the cart.
It is my right and responsibility to guide, teach and help my children come to full adulthood. But, to teach then the mechanics of sex and contraception is equal to showing them how a car works, giving them the keys and saying, “drive, just do it safely.” This is absurd.
Until the school system and whomever else may have an interest in teaching my children how to handle their sexuality shares my love, concern and pain with mistakes they may make – until they are able to impress upon them that sexuality is an awesome powerful gift, given by God. With it comes not only the physical responsibilities of the body, but the potential for deep emotional pain and brokenness of spirit.
Indeed sexuality in its whole is powerful, cementing a man and woman’s commitment and love.
As is with any powerful tool it has the potential to destroy. There are worse things than unplanned pregnancy and disease, such as damaged emotions, warped view of sex, shame, guilt, inability to bond, trust and ultimately love.
Until you are as concerned with my child as a spiritual being with emotions and you share my values and knowledge gained from failures and victories – until God gives you the responsibility and accountability He has given me as a parent – please stay out of my way.
“Thank God I was able to have the surgery I needed to save my life,” says a young woman who experienced an ‘out-of-place’ or ectopic pregnancy. She was able to terminate the pregnancy.
Although she was courageous enough to tell her story in an undisguised voice, I felt that it would be unwise to expose her to harassment. Her thoughtfulness; her personal sense of loss; her gratitude that she was able to receive the care she needed – as well as her anger at close friends who expressed a belief that she should not have terminated the pregnancy – all come through the distortion quite clearly.
Family Planning Health Services (FPHS) begins another “40 Days for Life prayer vigil” in front of a few of our clinics in Central Wisconsin. Although FPHS is not an abortion provider, the picketers come to conduct their public display of righteousness in part because we support the right of women to a safe and legal abortion. As health care providers, we must fully face the realities of our patients’ lives and each of us must struggle with informing a decision-making conscience.
Therefore, we think it is a good time to open a discussion about this medically necessary pregnancy termination service. We are grateful that a thoughtful and articulate woman, who received these services locally in June of this year, helped us by telling her story.
This podcast interview highlights some issues that are of great interest to reproductive rights and reproductive health care advocates and opponents. The young woman’s interview is followed by an interview with a Wausau OB-Gyn physician who provides a medical description of ectopic pregnancies as well as the risks and available methods of treatment and intervention.
Here are some other thought-provoking quotes from the podcast:
“I have had friends who said that I should have ‘gone with God’s will,’ imposing their beliefs on my will to live.”
“We told a few people we thought would be supportive. I chose poorly.”
“We need to train our physicians . . . They need to learn to do all of the procedures.”
“My husband and I really wanted this baby . . . It was DEVASTATING. To put on top of that grief, the insinuation that we did something wrong is completely insulting and heinous.”
“If they need to say they don’t provide abortions and then perform the life-saving procedures they did on me – then do it.”
“It’s difficult to know how many (pregnancies are ectopic) . . . but approximately 2% of pregnancies in the first three months.” Earl Zabel, M.D.
If the ectopic pregnancy is detected early enough, it can be treated with methotrexate administered by injection – and the pregnancy will deteriorate and disappear. Earl Zabel, M.D.
I wonder how much harm is done to women because they know very little about ectopic pregnancy and they cannot be sure they can get the care they need.
Richard Doerflinger, speaking for the United States Conference of Catholic Bishops, responded to a Wall Street Journal article about Wisconsin’s Medicaid Family Planning expansion saying: “It reflects a view of women which is extremely dismissive . . .” Mr. Doerflinger goes on to recommend that the expansion be rejected because family planning advocates are only interested in a woman’s reproductive function and making sure it isn’t used.
Family Planning Health Services, Inc. and the Wisconsin Family Planning and Reproductive Health Association are very proud to release this engaging video interview with Jon O’Brien, president of Catholics for Choice. Mr. O’Brien explores themes of political power and the hierarchy of the Catholic Church. He establishes a clear three-question structure within which legislators and the public can evaluate lobbying efforts and policy recommendations like Mr. Doerflinger’s:
Is it factually correct?
Who does the speaker represent?
What are the consequences to ordinary working people?
Mr. O’Brien says that good Catholics can support contraception. He describes the history of the Vatican’s Birth Control Commission which was: “far less than divine inspiration. It was a matter of stacking the deck!” Even though the outcome was pre-determined to oppose use of the birth control pill, according to O’Brien, education and dialogue . . . “changed the hearts and minds of the bishops” on the Commission. “Can you imagine how many lives could have been saved,” O’Brien asks, “if the Pope had enough faith in Catholics to accept the Commission’s recommendations?”
Mr. O’Brien’s emphasis throughout the interview is that the bishops and legislators must “Listen to the lives of ordinary Catholics. He says: “We are the ones who go to the ballot box.” On reproductive health issues, according to O’Brien, “The bishops have failed to convince Catholics not to use contraception. So what do they do? They go off to Capitol Hill or to your state assembly and behind the doors they try to pressure legislators into not allowing access to family planning.” With no equivocation he says: “There’s something that’s downright wrong and un-American about that!
O’Brien states that the information that the hierarchy gives on contraception and condoms is inaccurate and that the bishops do not speak for Catholic voters. But to make his most important point on testing the validity of lobbying by the bishops against family planning, Mr. O’Brien praises the courage and example of Bishop Kevin Dowling from South Africa. Paraphrasing Bishop Dowling, who has differed with Church teachings on the use of condoms to prevent HIV/Aids, O’Brien says: “Using condoms to prevent AIDs is not about preventing the transmission of life. It is about preventing the transmission of death.
If we apply the test to Mr. Doerflinger’s statement regarding Medicaid family planning, it is factually incorrect, it represents the view of some (but not all) of the 350 U.S. Catholic Bishops, and the consequence would be to reduce access to health care for thousands of American women.
After James Wagoner’s call for a ‘radical pragmatism’ to end the myth that sexual health care and education encourage risky behavior, we spoke with Congresswoman Gwen Moore (D-WI).
Congresswoman Gwen Moore explains that the consequences of ignorance about sexual health are too severe to permit ideological debate. Our next interview with Sarah Audelo of Advocates for Youth, says the age of sexual misinformation must end.
Sarah Audelo, of Advocates for Youth, says the high rates of sexually transmitted infections and unintended pregnancies among our young people compel us to teach them how to protect themselves. Our next interview, with Clare Coleman of the National Family Planning and Reproductive Health Association discusses that there are economic as well as health reasons to expand access to care.
Clare Coleman discussed patient care, standards of reproductive health care, and evolving health care delivery models. If the question is: “How can family planning clinics and programs put the pieces together in a patient-centered way,” her answer is that; “The source of funding has to be less important than the standard of care. She is leading a lively discussion about innovations and integration of family planning services in the primary preventive health care system. Congresswoman Lois Capps (D-CA) emphasizes that federal support for family planning services is key to our economic recovery.
After Congresswoman Capps talked about the immediate opportunity to receive federal support for expanded family planning services, Congresswoman Tammy Baldwin (D-WI) celebrates the end of ‘gender as a pre-existing condition’ in health care and what the health care insurance reform victory means for women’s health.
Congresswoman Baldwin (D-WI) summarizes the new opportunity and we wrap up this introductory video with a call to action. Look for expanded interviews as well as more interviews on this topic in the near future.
Juneau County District Attorney Scott Southworth wrote area school districts a letter which may intimidate teachers, administrators, and school board members from developing or teaching a comprehensive community-based human growth and development curriculum.
The unfortunate consequence of his action will not be to delay first sexual intercourse by Juneau County teens. It is more likely that those teens, when they do become sexually active, will not have the information they need to protect themselves from unintended pregnancies or sexually transmitted infections. Many people do not get any sex education after high school, so it is also likely those teens will not have the health information they need to make informed health care and family planning decisions when they marry and/or become sexually active as adults.
District Attorney Southworth’s statement that schools teach about sex for pleasure or that sex education is analogous to teaching people ‘how to mix drinks,’ makes it obvious that he either was not in a reputable sex education program or he wasn’t paying attention. Although there are always a few examples of highly publicized unacceptable behavior that opponents of sex education point to, there is no accepted pre-college program that teaches human sexual response to minors and I know there is no Juneau County school district curriculum that teaches techniques of sexual pleasure.
What do reproductive health educators teach young people?
They can prevent cancer by being vaccinated against HPV.
Consistent and correct use of condoms can prevent sexually transmitted infections.
Testicular and breast self-examinations are important preventive health care regimens.
Folic acid is important to pre-pregnancy planning.
Coercive sexual touching is illegal and destructive.
None of the material is erotic and none of it could be considered in a court of law to be “encouraging young people to have sex.”
Family Planning Health Services (FPHS) is a private non-profit corporation with a mission based on the ideal that information is better than ignorance when it comes to sexual health. When we are invited to participate in any classroom, our presentation respects school district standards. We strive to be age-appropriate and medically accurate. Our first concern is always the health and well-being of community families.
District Attorney Southworth has gained a lot of media attention and there will be controversy and fund-raising on all sides of this issue. Through that turmoil, FPHS will continue to provide the community with access to family planning services and education that is responsible and professional. We support Juneau county school districts who educate our young people and we promise to support any district or local teacher who provides lawful sexuality education as described in The Healthy Youth Act and who is charged with a crime by District Attorney Southworth.
The author of an opinion letter printed in the Wausau Wisconsin paper this morning was reacting to a reader’s letter that was supporting family planning. She said: “If by preventing unplanned pregnancies, he is referring to dispensing contraception, how does that prevent unplanned pregnancies?’
Like the majority of states, Wisconsin has a Medicaid Family Planning Waiver that expands access to routine preventive contraceptive and STD care. Overall, our program has been successful at reducing geographic gaps in access. By providing contraception, we are reducing unintended pregnancies, reducing teen pregnancies, and reducing the need for abortions – all at substantial savings to taxpayers. Wisconsin’s estimated five-year savings was $487 million. Best of all, for states with budget shortfalls, Medicaid Family Planning expansions provide $9 in federal funds for every $1 in state funds.
There is an enormous national opportunity before us and very little time to waste on efforts to reason with the irrational. Primary preventive health care delivery is changing and if we are to move closer to universal access to reproductive health care, reproductive health care providers and supporters must seize the opportunity. Federal health care reform law provides the 27 states with these expansions with an opportunity to strengthen their existing programs by requesting a permanent state plan amendment from the Centers of Medicare and Medicaid Services (CMS). For the other 23 states and the District of Columbia, there is a parallel opportunity to begin providing these services.
In Wisconsin, we must move quickly to strengthen our program and solidify the gains we have made under the Doyle administration and we don’t need legislative action. In eight months we will have a new governor and a new legislature. Even with a supportive administration, coordination and approval is not instantaneous. So it is time to move ahead and get to work. Here are the terms with which we will approach our Department of Health Services:
Presumptive eligibility must be available for provision of immediate (same day – same site) contraceptives and STD services.
Full eligibility must be processed in a timely manner to avoid gaps in coverage and gaps in care.
Income eligibility must be broad.
Covered comprehensive services must include most contraceptive methods and Emergency Contraception.
Services must be confidential.
Eligibility for students and minors must be based on their own income.
A successful Medicaid family planning program must contain these structural essentials:
A formally established state department-level workgroup or council that brings key leadership in public health, family planning, and primary preventive health care together in an advisory capacity .
A written commitment to integrating and normalizing sexual health care and education by fostering public-private partnerships.
A written assurance that reimbursement rates to reproductive health care providers will be sufficient to maintain statewide access to family planning services.
We are moving ahead right now to expand, improve, and strengthen our family planning program by negotiating a permanent state plan amendment based on what we have learned over the past seven years. That federal contract will protect and solidify our program’s gains. With that protection, we will continue to answer the question “How does dispensing contraception relate to preventing unwanted pregnancies?” not so much with rhetoric, but with results.
We recognize that the “Forty Days for Life” protests in front of our clinic bring us a lot of attention that can be put to good use. The picketing has resulted in many expressions of community support for Family Planning Health Services (FPHS) as well as a much higher level of visibility for the health care services we provide. On the other hand, the anti-abortion signs persistently misrepresent what FPHS actually does – confusing the public about whether FPHS provides abortion (we do not and we are prohibited by our grant contracts from even making referrals). FPHS provides contraceptive services, provides all-options information, and we are prochoice. That seems to be enough to draw the sanctimonious “prayer bullies” to our street corner . . . and soon they’ll be on yours.
Understanding that there is a need to connect the local to the state and the state to the national, FPHS is proudly supporting the newly launched “Forty 4 Forty” joint fund raising campaign of the Wisconsin Religious Coalition for Reproductive Choice and Pro-Choice Wisconsin. FPHS, because we are clearly not an abortion provider, can play an important role for all primary health care providers that the picketers are anti-contraception as well as anti-abortion.
The Forty4Forty campaign begins this week. A sign to solicit pledges for Forty 4 Forty will go up on our Wausau building tomorrow morning.
