“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.

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.

2)    When it comes to providing sexual health care, the realities are: sectarian provider institutions — gaps in insurance coverage — practitioners exercising a ‘right of conscience’ over their patient’s need for comprehensive care — and established institutions looking for ways to limit access to a full range of reproductive health care.

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.

I hope you will take a few minutes before January 13^th and go to http://www.hhs.gov/news/reports/nphps.html. Read the National Prevention and Health Promotion Strategy draft. Pick up that Boehner-sized mallet and help me drive that stake home

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 22^nd 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.

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.

Respectfully,

Melba Guzik

Gleason

Citizens of Lincoln County

“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.

You can hear and respond to her story at http://belowthewaist.org/2010/09/ectopic-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.

Jon O’Brien Interview from Family Planning Health Services on Vimeo.

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:

1. Is it factually correct?
2. Who does the speaker represent?
3. 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.

Part 1 – James Wagoner from Family Planning Health Services on Vimeo.

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).

Part 2 – Gwenn Moore from Family Planning Health Services on Vimeo.

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.

Part 3 – Sarah Audelo from Family Planning Health Services on Vimeo.

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.

Part 4 – Clare Coleman from Family Planning Health Services on Vimeo.

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.

Part 5 – Lois Capps from Family Planning Health Services on Vimeo.

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.

Part 6 – Tammy Baldwin from Family Planning Health Services on Vimeo.

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.

Contact us at www.belowthewaist.org

Mr. Newman Goes to Washington from Family Planning Health Services on Vimeo.

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.
• Hormonal contraception can prevent pregnancy.
• . . . and other information that helps people make informed decisions to protect their health.

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:

A successful Medicaid family planning program must contain these eligibility and coverage essentials:

• Enrollment must be convenient
  • 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 clear commitment to the principal that all participants receiving Medicaid-paid health benefits have a right to choose a willing and qualified provider (including out-of-plan) for the reproductive health services they need.
• 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.

These protests take place on the street corners of our nation, not just in our Central Wisconsin community, and it is important that the public and other health care providers know that they are opposed to contraception as well as abortion – that’s why they are picketing in Wausau.

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.

Last week, when one of the protestors said to me; “If they’re intimidated, that’s their problem,” he told me all I need to know.

Lon Newman
Executive Director
Family Planning Health Services

“A defender of the church,” proclaimed the Milwaukee Journal Sentinel headline for an extensive story about the new Archbishop-designate, Jerome Listecki. The subtitle for the article was: “Archbishop designate Listecki vows collaboration, but unafraid of debate.” The subtitle was probably derived from the bishop’s description of how he planned to participate in the political process. He said: “If we don’t challenge one another’s statements, then we’re relinquishing our responsibility to the common good.”

The following month, young Catholics for Choice (yCFC – a Washington D.C. based organization) and Family Planning Health Services (FPHS – an agency with family planning clinics in eight Wisconsin counties) formed a unique sectarian-secular advertising partnership, produced informational ads for broadcast, and then embarked on a two-day Wisconsin “road-trip” to draw media attention to their campaign and to build public (including the Catholic public) awareness and knowledge about emergency contraception.

The purpose of the joint media campaign was two-fold; 1) to inform the public about how Plan B works so they would have it on hand in advance of need and, 2) to inform Catholic women of reproductive age that the United States Conference of Catholic Bishops health care directives permit the use of emergency contraception to prevent pregnancies resulting from rape.

In the January 2010 issue of the Journal of the Catholic Health Association of the United States, Ron Hamel, Ph.D., makes it very clear that the ethics of access to emergency contraception for Catholics needs to be fully examined and explained. Professor Hamel’s article and the YCFC/FPHS EC campaign are an effort to fulfill that responsibility when there is significant resistance.

The campaign succeeded in getting a response from the Archbishop-designate and thus succeeded in its secondary purpose. The headline on the Christmas Eve edition of the La Crosse Diocesan newspaper is: “Bishop Rejects Young Catholics for Choice Message.” The front page column ran adjacent to the departing bishop’s message. But what he rejected so prominently: “ . . . that Catholics can disregard Church teaching on contraception, abortion, and human sexuality in general and remain Catholics in good standing,” was only weakly connected to the message that yCFC and Family Planning Health Services (FPHS) were promoting.

Bishop Listecki, like most of the Catholic protestors in front of the FPHS clinic, will allow “no room for interpretation,” once the bishop’s authority has been invoked. Many within the church see the bishop’s pattern of authoritarian rebukes, condemnations, and admonitions as futile efforts to suppress dissent and they understand they are not the views of other Catholics or even the other American bishops.  Just as importantly, the denials and condemnations are not solely inflicted on the faithful. The prayer vigil protestors’ and Bishop Listecki’s efforts to eliminate access to emergency contraception, if they succeed, would apply to women regardless of their faith.

Erik Cieslewicz and Brooke Sperry have produced a documentary about the joint campaign that will be released February 17^th, 2010.  The web-posting will occur on the same day that another Lenten prayer vigil outside an FPHS clinic (which does not provide abortion services) begins in central Wisconsin. The video shows the challenge as well as the fun of the effort to educate the public in the face of consistent efforts to suppress and to misinform. Earlier, “40 Days for Life” prayer vigils played a large part in motivating FPHS and yCFC to cooperate in the advertising effort to correct misinformation being spread by their opponents.

Enjoy the video!

Catholic leaders know they have not persuaded one another, the public, or their own laity, to agree that contraception is evil. So when it comes to public policy, rather than engage in dialogue and debate, they seem to make a statement and end it with a “Dixi” (Latin for “I have spoken”) as though that is all that should be necessary.

For those who accept the authority of the Catholic hierarchy, that is enough.  But in the democratic process of establishing public policies that are respectful of Catholics and non-Catholics, it is unresponsive and insufficient.

Nonetheless, reproductive rights advocates have recently witnessed ultimatum upon ultimatum.

• Contraceptive benefits?                                         This College will close!
• Gay discrimination prohibited?                              No more poverty programs!
• Emergency contraception required?                        Emergency rooms to close!
• Pharmacists required to fill prescriptions?               They’ll be forced to quit!
• Health insurance reform with abortion coverage?     No health care reform!

This kind of tactic is often inaccurately called “blackmail,” but a better description would be “tantrum.” Infants and toddlers who, frustrated in their efforts to control the environment or their parents, sometimes act out emotionally, physically, and inappropriately.  Adults try to ignore this behavior and toddlers outgrow it.  “But,” www.KidsHealth.org advises us; “do not reward your child after a tantrum by giving in. This will only prove to your little one that the tantrum was effective.”

The message that we must persuade our elected officials and policy makers to learn is that good policy-making must be based on evidence, science, justice and reason and that means a civil discussion with an informed and engaged audience is key. We may not always be able to ignore childish political tantrums, but we must never accommodate and encourage them.

For this reason, Young Catholics for Choice (yCFC) and Family Planning Health Services (FPHS) will collaborate and a launch a Wisconsin-based advertising and media campaign to promote information about emergency contraception (EC). 

In terms of public discussion, misinformation and distortion about emergency contraception has confused the public, policy makers, and especially Catholic parishioners. Most people have an incomplete and inaccurate understanding of EC. Until that changes, for women who need EC, neither the health care principle of ‘informed consent nor the religious principle of ‘informed conscience’ will have real meaning.  The purpose of the campaign is to replace misunderstanding with evidence and knowledge so individuals, including people of every faith, can make decisions about emergency contraception with a more fully informed conscience.

Each of the four cities where the informational ads will run has a distinct example of the need for a more informed public.

· In Eau Claire, a Sexual Assault Nurse Examiner reported to us that an area Catholic hospital is violating the intent of state law because it refuses to offer EC to rape victims unless the victim submits to time-consuming, expensive, and unnecessary testing. 

· In Milwaukee, the new archbishop has declared his opposition to Wisconsin’s “Compassionate Care for Rape Victims” law based on a medically-unsupported belief that the most common form of EC (Plan B ™) “causes abortions.”

· In Green Bay, two television stations refused to run the ads we produced with Young Catholics for Choice earlier than 9:00 p.m. because they were “too controversial.”

· In Wausau, local priests routinely pray the rosary in front of our family planning clinic (which does not provide abortions or medical referrals for abortion) with signs that say “Stop Chemical Abortion” and “Family Planners Promote Child Promiscuity.”

Our collaborative informational advertising about emergency contraception will begin this week and bring together secular and sectarian voices to inform our citizens. There will be radio and television ads throughout Wisconsin (and on the web) to encourage women of reproductive age to go to www.EZEC.org to learn more about EC and to have Plan B™ on hand before they need it.

Speaking about political engagement and the Catholic Church, the new Archbishop of Milwaukee stated: “If we don’t challenge one another’s statements, then we’re relinquishing our responsibility to the common good.”  Our emergency contraception information campaign will meet that responsibility with sectarian and secular voices.

In the politics of abstinence-only education, we have a lot to learn. With the full Senate poised to vote this month on the $163 billion Labor, Health and Human Services, Education, and Related Agencies (FY10 Labor-HHS) appropriations bill, advocates of evidence-based comprehensive sexuality education programs don’t have very much time for study.

The House appropriations bill and the Senate Appropriation Labor-HHS Subcommittee bill have replaced abstinence-only funding with evidence-based teen pregnancy and sexually-transmitted disease prevention funding. It looks like the end of the line for Abstinence-only. Before we can write our RFPs, we will have to maintain our position through the full Senate vote and then through the conference committee. Who will be our strongest player in these political poker games? It will be my Wisconsin Congressman, David R. Obey, House Appropriations Committee Chair.

Here, then, are the lessons I think we need to learn:

I. Dave Obey may be ill-tempered, stubborn, outspoken and egocentric, but in a tough game, those aren’t the only things to like about him. He is fiercely devoted to quality education and access to health care. He is even more intensely focused on getting the most progressive appropriations bill he can get through his committee and signed into law.

II. For the last ten years or so, opponents of comprehensive sex education have used abortion politics to make sex education and contraception bargaining chips in Washington. They often succeeded in the Appropriations Committee because they had the votes and they had the President. But that’s no longer an excuse for us to be outmaneuvered or a reason to be defensive. Let the programs the religious zealots won under the last administration be the first-on-the-table bargaining chips for awhile. Instead of trying to block every negative effort by our opponents, now we can work with our majority congressional leadership to promote sound health policy and to fund effective sex education and prevention programs.

III. Over those same ten years, feminists, family planning advocates, sex education supporters and others (me, for example) whispered and shouted in frustration about Dave Obey’s willingness to cut deals with our opponents. The reality has changed. The Appropriations Bill that passed the House is Dave Obey’s Bill. If he wanted to restore abstinence-only funding, he would have done it. He didn’t.

IV. Because the House appropriations bill has the language we want, Dave Obey will be playing our hand in the conference committee reconciliation process. We need to work as hard as we can to make sure he has the strongest cards possible because when it comes to bluffing, the proponents of abstinence-only education are world-class champions.

V. Over his 40 years in Congress, Dave Obey has offended Catholic Bishops, NARAL, SIECUS, pharmaceutical companies, Presidents Reagan, Clinton, Carter, and Bush. He’s offended Rush Limbaugh, Speaker Pelosi and he’s probably irritated President Obama. I know he’s made me furious many times, but I like him anyway because he is a principled equal-opportunity offender. The lesson is that his talent is not being agreeable, but getting an agreement.

The summary of these lessons (this will be on the quiz) is that we must work hard right now to preserve President Obama’s (and now Dave Obey’s) evidence-based pregnancy prevention funding through the full Senate vote and continue the alliance with Congressman Obey to maintain the initiative through the conference committee reconciliation. We must work with Dave Obey now because when it comes to sex education, our opponents will stop at nothing.

Originally published on rhrealitycheck.org

Read more at: http://www.huffingtonpost.com/sexual-justice/abstinence-education-dis_b_281014.html

This axe will certainly fall, but a new incarnation in the form of a redefined pitch for federal funding for “Abstinence-centered” programs is already in play.  In fact, repackaged “Abstinence-centered” programs are busily developing marketing approaches and preparing grant proposals for the President’s new teen pregnancy prevention initiative – the one that supposedly displaced Abstinence-only-until-marriage funding. On May 11th on Wisconsin Public Radio, Wisconsin’s Abstinence Coalition executive director and member of the National Abstinence Education Association (NAEA) board, Sally Ladky, expressed the national strategy to maintain their federal funding stream.

The strategy is to co-opt the language of comprehensive sex education and the reincarnation is already complete.  Here are the major marketing elements as Ms. Ladky expressed them:

• “We’re about risk-avoidance.”
• “We are evidence-based.”
• “We’ve never called ourselves ‘abstinence-only’. We’re abstinence-centered. . . We do talk about contraception.”
• “Comprehensive sex education just talks about the physical – we’re more holistic than that.”

A November 2008 NEAE letter to then President-elect Obama prophesies the transfiguration as evidence-based, risk avoidance, abstinence-centered, holistic sex education that includes contraception.  (That’s a pretty good description of programs that I’ve been supporting for thirty years.)

When the Department of Health and Human Services removes the abstinence-only restrictions from the federal funds and instead requires evidence-based medically accurate teen pregnancy prevention applications, the agencies sending in the Requests for Proposals will include the same agencies which are now receiving abstinence-only-until-marriage funds:

1. The crisis pregnancy centers that refuse to give out information about emergency contraception;
2. The ‘virginity pledges;’
3. The abstinence clown’
4. The folks who carefully explain the failure rates of condoms and contraceptives without explaining the infection and pregnancy rates when they’re not used.

As frustrating and perplexing as the reincarnation of abstinence-only-until-marriage programs will be, the principle of competition for grant funds is time-honored and broadly accepted. We would like to believe that the cards will be unmarked and the deck will not be stacked against comprehensive sex education. But if the NAEA has its way, there won’t be a fair deal.  In the May 11th WPR interview, Ms. Ladky says: “We’re looking for funding parity.  We think that each of us should have one-half of the funds.”

The advocates for abstinence-only-until-marriage programs argue that family planning funding, especially Title X, which provides medical services related to contraception, cancer prevention, and STD testing and treatment should be put into the pot with the sex education funds.  In other words, family planning funds should be added to the pot and the abstinence programs should be guaranteed half of the winnings before the cards are dealt.

Equating Title X family planning health care services with community and school-based sex education is problematic and unworkable.  Hundreds of thousands of women and men would potentially lose access to primary preventive reproductive health care. It is a cynical ploy to take funding away from Planned Parenthood and other family planning programs. The monumental irony in the “abstinence-centered” faithfuls’ request that half of the stakes be set aside for them before the game begins is that if abstinence-only-until-marriage and comprehensive sex education are both evidence-based and medically accurate – if both program models include risk reduction instruction such as contraceptive methods and condom use – on what distinction would the parity division of money be based?

It was simpler when comprehensive sex education advocates refused these funds and worked  to eliminate them because they are sectarian and because they have been ineffectively used. After Congressman Obey carries out the Presidential budget sentence, advocates on both sides will compete for the redefined “common ground” teen pregnancy prevention funds — and it will require an act of faith to tell them apart.

For almost a year now, Pro-Life Wisconsin (PLW) has maintained a protest campaign at our family planning and WIC clinics in Central Wisconsin. PLW activities have included a ‘verbal hijacking’ of our Raising Women’s Voices “Speak Out” on women’s health care so that those who wished to speak on issues unrelated to abortion or contraception were by-and-large unheard in the auditorium. Over the Lenten season, PLW and its local supporters participated in the “40 Days for Life” national campaign — conducting a ‘continuous’ prayer vigil outside our clinic offices.  When asked by local reporters why they were participating in this effort, they said it was to stop abortion.  We do not perform abortions at any of our facilities.  As the 40 Days effort has come to an end, we want to share what we have learned.

The 10 Suggestions:

I.    Publicly express sincere concerns about patient and public safety.
We wrote an editorial which focused on traffic conditions near the clinic and how patients had been affected by the protestors. After the editorial was printed, the protestors stopped harassing patients and obstructing visibility for drivers.
II.    Leave the religious debate to religious organizations.
We spoke with supportive local parishioners of many denominations and asked for their help. The Wisconsin Religious Coalition for Reproductive Choice held a news conference that received front page coverage and many church leaders explained that their religious traditions do not oppose family planning or, in many cases, abortion.
III.    Respect the rights as well as the responsibilities of the protesters.
We consistently and publicly expressed our respect for the right to protest, but we also reported any obstruction of clinic entrances or exits (a violation of federal law).
IV.    Maintain Security and Surveillance.
We used digital cameras and recorders to record video covering the entrances and exits at all time.  We also took routine photographs of the protesters. We reported the minor acts of vandalism, entrance and exit obstruction, and harassment to local law enforcement and were able to provide the computerized records as well.

V.    Act don’t React and have a sense of humor.
We hung three large red, white, and blue banners with one word on each one: Condoms Save Lives. When the local newspaper took photos of the protestors, the banners provided a public health message. We also ran general awareness ads on television talking about the services we provide and the value to women’s health. I put up a shadow box with a stone inside, a mallet on the side, and had the glass inscribed “The First Stone – John 8:1-11.” Someone in a hooded sweatshirt stole the mallet, but they left the stone where it was.
VI.    Keep your eyes on the majority.
Quantity matters in the political world, where public policy is decided.  Support for contraception and sex education is growing, even within the parishes recruiting protesters. There is no need to belittle our opposition or demean ourselves.
VII.    Stay focused on facts, evidence, and your mission.
We resisted temptations to be diverted from scientific evidence, provable facts, and the mission of our organization.  Ours is a health services mission of universal access to maternal and child health including reproductive care.  The mission of our opponents is theological and political, so we invited others to speak from those perspectives whenever possible.

VIII.    Follow the law and enforce the law.
One of the opponents complained to city zoning officials that the “Condoms Save Lives” banners intruded over the public right-of-way. We moved them to comply and showed the officials photographs of protestor signs placed in violation of the same ordinance. We asked for equal enforcement.
IX.    Thank contributors and supporters.
You can never express too much appreciation to your supporters, contributors, and your employees.  Use the opportunity to express appreciation and to network.

X.    Let them speak!
The opposition has been unsuccesful persuading even their parishioners(Catholics and Choice) on contraception and sex education. Since their position is fundamentally faith-based and authoritarian, it is unlikely to look rational from other perspectives. At the Women’s Health Speak Out, at our news conferences, in web-postings, in letters-to-the-editor, and even standing in front of our clinics, they communicate quite clearly.  Most people see them as they are and most people disagree with their beliefs and with their tactics.

As Pope Benedict boarded a plane to Yaounde, he said: “”You can’t resolve it (Africa’s HIV/Aids Epidemic) with the distribution of condoms. On the contrary, it increases the problem.”

Dr. Green’s research and his public presentations, by contrast, state that condoms are seldom used consistently and correctly in general populations and for many reasons, most of which are unknown, condom distribution programs in those areas of Africa have failed to show positive results on a population basis.  He explains that condoms are 80-90% effective at HIV transmission prevention when used consistently and correctly by individuals.

In fact, even in the Washington Post letter that is generating the public attention, Green says: “Don’t misunderstand me; I am not anti-condom. All people should have full access to condoms, and condoms should always be a backup strategy for those who will not or cannot remain in a mutually faithful relationship.”

Although Dr. Green’s research findings overlap with Pope Benedicts moral position that reducing multiple concurrent partners and promotion of fidelity and abstinence have been successful strategies for many people, we cannot ignore the distinction between the proven effectiveness of consistent and correct use of condoms by individuals at risk and our inability to show condom distribution program effectiveness in certain parts of Africa on a population research basis.

Dr. Green supports universal access to condoms and consistent and correct use by individuals at risk of sexually transmitted disease infection.  Pope Benedict XVI does not.

It is pointless to speculate on Dr. Green’s motivations for writing a letter to the Washington Post that minimizes the distinctions between the Vatican’s point-of-view and his own as a Harvard School of Public Health HIV/Aids researcher.  I am no Harvard epidemiologist, but I know that confusion resulting from Dr. Green’s letter will be used to oppose public health policies and programs that Dr. Green supports.  I know that opposition puts the lives and health of millions in Africa and across the world at risk.

Even American Catholics practice a fundamental, and not fundamentalist, right to reproductive self-determination. During the 2008 campaign, most Catholic voters ignored the sacramental threats of shepherds like Reverend Jay Scott Newman, who told his parishioners that their souls were at risk if they voted for pro-choice candidates. (Catholics voted for Obama with a 54 to 45 percent margin.) As Kathleen Kennedy Townsend and Patrick Whelan pointed out, voters may have noticed that abortion rates declined more under the Clinton administration’s policies than under Reagan’s or under either of the two Bush’s. Voters may have decided that there are higher priority pro-life issues; such as economic desperation, unending war, and global environmental degradation.
For some, positions on abortion and birth control are simply not susceptible to earthly persuasion. More than forty years ago, when a majority of a Vatican commission on birth control seemed ready to support a reversal of the church’s ban, Father Marcelino Zalba fervently asked the members what would happen “with the millions we have sent to hell” if previous teaching was invalidated. Commission member Patty Crowley responded: “Father Zalba, do you really believe God has carried out all your orders?”
Nancy Belden, a Washington-based public opinion researcher, recently showed that one side of the abortion debate is unlikely to change the hearts and minds of the other. Her polling demonstrated that support or opposition to legal abortion has moved a few polling points one way or the other in the last thirty-five years, but in 2007 56% favored legal access and 40% opposed – a return to 1973. American families have made up their minds and for the most part, they ignore the arguments and the arguers on the other side.

President Obama frequently demonstrates a pragmatic and realistic approach to reproductive health policy: rescinding the theological stem-cell federal funding restrictions; removing the ‘Global Gag Rule’ (Mexico City Policy) that penalized international family planning agencies for supporting reproductive rights, and; rolling back the Bush administration’s ideological 11th hour “conscience protection” regulations. While the President has reached out to listen to fundamentalist members of Congress and to interest groups who disagree, most of the time he has tried to set policy based on practical scientific decision-making instead of partisan crowd noise.
The new Congress and the new Administration must continue on this course of providing leadership on the principle that reproductive health care policy will be based on two foundations of American democracy – reason and science. We must not be distracted from that principle by battles over who holds the high moral ground. Instead, we must keep our attention on developing reproductive health care policy that is down to earth.

A young mother visiting our Women Infants and Children’s nutrition clinic in Central Wisconsin was frightened by a male picketer as she came into our clinic a few weeks ago.  Other women, sometimes our patients, sometimes our employees, have felt threatened by the “40 Days for Life” anti-birth control demonstrators leading a Lenten protest that began yesterday in front of our clinic in Central Wisconsin and in 131 other communities across the nation.

I haven’t asked the clients if they are visiting our clinic to get food for their infants or prenatal nutrition education. I haven’t asked whether they use natural family planning, or condoms, or hormonal birth control pills, or the patch, or an IUD.  I don’t ask whether they are married or faithful or abstinent.  I don’t ask whether they are Catholic, Protestant, Jewish, Buddhist or non-believers.  Neither do the demonstrators who intimidate them.

My agency is a non-sectarian health care provider with a mission to prevent unintended pregnancies and to improve maternal and child health.  We’re proud to support access to safe, legal voluntary reproductive health care as a human right. More than 95% of all American women use modern contraceptive methods. The women who come to us do not come to get an abortion or an abortion referral.  We prevent abortions, we do not provide them.

The 40 Days for Life demonstrators know that women and men come to us for birth control. Other local clinics also provide confidential birth control.  Unlike us, they may make medical referrals for pregnancy termination when necessary.  Walgreens and Wal-Mart deliver hormonal birth control pills and every hospital emergency room in Wisconsin is now required to give out emergency contraception to rape victims.

No theological or political issue is going to be resolved by frightening the women who come to us for health care.  We have been providing high-quality affordable and confidential health care for 36 years and we will continue to provide that care as long as there are women who choose to come to us to receive it.

It isn’t Speaker Pelosi whose thinking is seriously out-of-date. Inclusion of Medicaid family planning access in the economic stimulus package does not imply a belief that “more people mean less economic growth,” as the WSJ assumes. Equally unsubstantiated and even internally contradictory, is the editorial board’s rather medieval argument that we must produce more children to support us in our retirement (Although, after last year’s stock market crash, maybe children are the only pension plan we have left.) Although the editorial suggests that contraceptives as a part of an economic stimulus plan are ‘loopy,’ the editorial’s assertion that we need to have more children to maintain domestic consumption is clearly the all-out loopiest – tracing its roots, perhaps, to the ‘go shopping’ response to terrorist attacks. “Larger families have more credit cards, so have a larger family.”

Access to contraceptive care enables women to meet their educational goals, to participate fully in society, to time pregnancies for health as well as to achieve career aspirations.  Family planning is voluntarily prevention of unintended pregnancies — meaning women and their families are able to determine for themselves whether and when to have children. The human capital connection is that the cost of unintended pregnancy is also borne by employers in the form of higher insurance premiums, more family medical leaves, substitution expenses, rehiring/recruitment costs, retraining costs, and lost productivity.

Listening to the spokesperson for Pro-Life Wisconsin as he defended the new ‘right of conscience’ regulations on Wisconsin Public Radio last week reminded me of the wisdom of the tale.

For 30 years, regulations and federal laws have struck a delicate balance between the rights of patients to receive health care and the rights of health care providers. The new regulations, issued by Health and Human Services Secretary Leavitt, expand the rights of health care providers so extensively that the rights of the patient to receive care are obliterated. The new regulations give the right to refuse to provide health care to all virtually all employees for any health care service they might ‘morally object to.’

Matt Sande, speaking on behalf of Pro-Life Wisconsin, defended the broadest possible right to refuse saying: “These rights aren’t qualified in any way. That’s as it should be. We just have to work around it. We may not understand or agree with an individual’s objection, but we must protect and defend them. . . If we pick and choose which rights we protect, then we won’t have rights for anyone.”

Would this right to refuse apply to physicians who provide abortion services in South Dakota who have been required by state law to inform their patients that terminating a pregnancy is ending a separate, unique human life and that consequences may include depression and suicide? These physicians certainly have moral objections to the content of that message. Health and Human Services Secretary Leavitt has said that, where state laws and the rights of conscience regulations are in conflict, the federal government will help “bring the state into compliance.”

Would volunteers at federally funded abstinence-only “crisis pregnancy centers” have federal civil rights protection for refusing to give out inaccurate and incomplete information [Waxman Report] about the effectiveness of condoms to prevent pregnancy and HIV transmission? As he described patients who ‘may have to go somewhere else,” Mr. Sande said; “One person’s convenience should not trump another person’s right of conscience.”

The moral of the fable is that we are often the source of our own destruction.

The first weakness of the ‘rights of conscience’ regulation expansion is an assumption that only anti-abortion and anti-family planning advocates have moral convictions. The probability that health care employees will refuse to comply with anti-choice or anti-contraception requirements has been overlooked.

The second weakness is a faith-based denial that absolute rights do not exist on this earth. Individual rights require constant, vigilant, rational and empathic balancing. Whether it is the right of a patient to informed consent or the right of the state to protect a fetus, purity is an impossible standard.

The Obama administration must immediately refuse to enforce these regulations and Congress must immediately begin the process to rescind them. In this case, ideologues have given their enemies the means of their own destruction and the regulations must be brought to earth.

Reproductive health care advocates and providers have written extensively the last few weeks about proposed HHS “conscience protection” regulations — the period for public comment ends this Thursday, September 25.
In Wisconsin, approximately one-third of all health care organizations are religiously affiliated and many workers sign a contract promising to follow the United States Conference of Catholic Bishops Ethical and Religious Directives for Health Care Services. A July letter from the bishops to members of Congress eagerly embraced the regulations. But the bishops may have neglected the fact that many workers in Catholic hospitals and clinics have moral convictions supporting contraceptive care and reproductive rights and other health care the church does not sanction or permit.

If the regulations are adopted, family planning service providers, like us, could be forced to hire people who have moral objections to contraception and we would be unable to discipline employees who refuse to provide birth control or other services central to our mission.  Employees of sectarian health care institutions would operate under the same protections.

For example, clinic employees might refuse to distribute abstinence-only materials because they are incomplete, inaccurate, and deny a patient’s right to informed consent.  They might have a moral conviction to explain that condoms, correctly and consistently used, are a reliable means to prevent unintended pregnancies, and sexually transmitted infections — including HIV transmission to fetuses.

Catholic hospital employees might feel, as a matter of conscience, that to deny information about emergency contraception to a victim of rape is morally wrong or that providing pregnancy options information to a high-risk patient without discussion of termination as well as adoption is willful neglect.

Many health professionals in sectarian medical teaching institutions believe that physicians must be trained in modern contraceptive methods, sterilization procedures, and how to perform emergency abortions.
Earlier this year, a Colorado bill, parallel to these regulations, would have prohibited religion-based hiring discrimination.  It was loudly criticized by Denver Archbishop Chaput, who said the law would “…greatly hinder” organizations like Catholic Charities from maintaining their mission and purpose as specifically religious institutions.”

The federal regulations proposed by Secretary Leavitt and supported by the US Conference of Bishops incorporate moral conviction as well as religious belief and extend to all health care providers receiving federal funds. Speaking from the point-of-view of health care providers who understand unintended consequences, here’s a thought for the bishops and the Bush administration: “Asking for federal protection for employees who refuse to put patient welfare above personal belief may be equivalent to the fisherman’s wife wishing to be the ruler of universe.  By asking to rule everything, they ended up with nothing and there the fairy tale ends.”

Last week the Journal of the American Academy of Pediatrics published a study showing that urban minority teen girls lacked knowledge about emergency contraception. Almost all of the sexually active adolescents had heard of emergency contraception, but were not knowledgeable about how it works or when to take it. Girls who were not sexually active had less information.

In 2006, FPHS did a Wisconsin study on whether teens who called family planning clinics, emergency rooms, and crisis pregnancy centers got information to help them get EC. The findings were that family planning clinics did well, emergency rooms were not prepared to deal with telephone inquiries, and crisis pregnancy centers typically did not have accurate or useful contraceptive information.

As family planning providers, here’s what we are doing about it (with a lot of collaboration):

We explain to every woman and girl of reproductive age who calls the hotline or visits our clinics that she should have Plan B on hand and should understand when to take it. The most common reasons are that she may forget to take birth control pills, a condom may beak, or unplanned/non-consensual sex may put her at risk of an unwanted pregnancy. The woman at risk makes the decision when to take Plan B. Having it on hand enables her to act promptly.

Every female patient of reproductive age who visits any one of our seven clinic locations or who calls the statewide toll-free response line (1-866-ECFIRST) is offered Plan B and receives education that emergency contraception is more effective the sooner it is taken after unprotected sex. Most of our callers are low-moderate income and underinsured, so they are eligible for Wisconsin’s Medicaid Family Planning Waiver. For them, prescription Plan B will be provided at no charge.

• She can receive them in the mail to an address of her choice.
• She can pick up EC at any one of 62 family planning clinics throughout the state.

If it is an emergency and she can’t get to a local family planning clinic:

• She can have EC shipped via overnight express.
• She can go to a local pharmacy where we have faxed her prescription.
• She could go to one of several sexual assault service agencies with our EC on hand.
• She can go to an off-hours lock-box at one of our seven clinic sites.

That is focusing on the practical — As for dealing with other dimensions such as the moral, the medical, the historical and the political, there are good sources of information about emergency contraception and how we came to be where we are:

Health Care Education and Training has an excellent website about how EC works.

The Wisconsin Family Planning and Reproductive Health Association (WFPRHA) took several preparatory steps on the way to wide EC access, including:

1) an assessment tool to help nursing professionals determine whether and when a report must be made for a sexual assault under Wisconsin law.
2) several coalition-building conferences to build public/policy support.
3) statewide training for reproductive health professionals in 2005 on how EC works and what are the best medical practices for its use. The association is planning to review and update the training in 2009.

The most important piece of the puzzle is that Wisconsin’s Department of Health Services implemented policies that enable uninsured and underinsured low and moderate income women to receive Medicaid-paid contraceptive services and supplies. Being able to give EC at no charge in advance of need is the foundation on which EC access is based.

As for results: at FPHS clinics, positive pregnancy tests as an annual percentage of total patients has dropped from (pre-Family Planning Waiver) 5.5% (about 350 positive pregnancy tests) to 2% (about 180 positive pregnancy tests) for the last three years. There may be a non-EC explanation, but it’s not likely. Because preventing unwanted pregnancies is how we can define EC success, for FPHS, free EC in advance has been a success. Maybe it is as simple as that.

The New York Times recently uncovered that the Department of Health and Human Services is drafting regulations that would ‘prohibit discrimination’ against certain health care employees who refuse to deliver contraceptives because of religious or moral objections. Medical organizations, elected officials and activist citizens are protesting the proposed rules because they would declare many forms of contraception to be equivalent to abortion and impose unnecessary and burdensome personnel “conscience protection” rules on federally funded hospitals and clinics in a thinly-disguised effort to interfere with access to birth control. Help us stop the rule change.
Take action:
1) Read the draft regulations.
2) Thank your US Representative and your US Senator(s) if they signed on to the House letter or the Senate letter to the President opposing these regulations. Click here to contact the 104 US Representatives and 28 US Senators that signed the letter.
a. If you need to find your US Representative, click here.
b. If you need to identify your US Senator, click here.
3) If your US Representative or US Senator(s) did not sign on, contact them to encourage their opposition to these regulations.
Learn more:
• Letter from the American Medical Association (AMA) AMA Letter,
• Letter from the American College of Obstetricians and Gynecologists (ACOG) ACOG Letter,
• Information from the National Partnership for Women and Families (NPWF),
• Information from the National Family Planning and Reproductive Health Association (NFPRHA),
• Joint news release from the Wisconsin Family Planning and Reproductive Health Association and the Wisconsin Coalition for Reproductive Choice Joint News Release

Implicitly, Mr. Shorto draws a rough equivalence between the fears of the right and the rapidly expanding gap between global sustainability and increased resource consumption. The essay understated the effect of global population momentum and its consequences while it over-valued the fears of a few economists, philosophers, and theologians. In the July 13th edition, the magazine published several letters to the editor (including mine) with widely varying perspectives on these themes.

One shortcoming of Mr. Shorto’s piece is the acceptance of using regional or even ethnic birth rates to develop government policies that encourage women to bear more children. Globally, this response is disproportionate. Ben Wattenberg, of the American Enterprise Institute, has sounded this alarm for many years. The basis of this argument (and fear) is that if birth rates continue to decline at the current rate, world population may begin to decline in 2050. However, he fails to take into account advances that have improved child survival rates, which for many families mean fewer births. Mr. Wattenberg argues that we should act as though we are on the edge of extinction right now. Perhaps we can all agree that if we’re worried about species extinction, we should begin by providing clean water, adequate nutrition, and preventive health care for the children in need who are already living on this earth. Secondly, under Wattenberg’s 2050 scenario with 12 to 18 billion people on the planet, my fear is that population might NOT begin to decline or will be forced to decline due to a lack of resources.

Mr. Shorto’s essay also cited experts who were optimistic about increasing economic opportunities for women as well as egalitarianism in terms of family responsibilities. This is the preferred means through which we can achieve a decent and sustainable worldwide standard of living. Nevertheless, the improvement family planning and population stabilization on women’s health and well being was omitted. According to the United Nations Population Fund, a woman on this planet dies from pregnancy or childbirth every minute. In the context of improving the global standard of living, a declining birth rate can mean significant advances for the health of women and families everywhere. This reality is not mentioned in Mr. Shorto’s essay.

World Population Day brings these divergent themes together. For a ground level perspective on global population issues, www.Belowthewaist.org recently interviewed Dr. Ned Grossnickle, former national chairman of Sierra Club’s Global Population and Environment Program. In this two part feature, Professor Grossnickle discusses his world travels to study family planning programs, the environmental impact of population growth, and micro-economics. Among his world travels, he’s recently been to China and Ethiopia. Additionally, Dr. Grossnickle discusses his efforts to advocate for increased funding to programs that address population stabilization in a constructive way.

Last week, Congressional negotiators removed language from the Supplemental War Funding Bill that would have restored the ability of pharmaceutical companies to offer very low contraceptive prices to campus health centers and safety-net family planning clinics. We’ve been told that Congress inadvertently removed that authority when it passed the Deficit Reduction Act of 2005. Restoring the provision would cost taxpayers nothing and participation on the part of the pharmaceutical companies would be completely voluntary. Despite the no-cost no-mandate fix-a-mistake quality, access to reproductive health care for college students and low-income women was tossed off quickly.

Appropriations Chairman, David Obey said: “President Bush likely would have vetoed the package if it included the birth control pricing provision.”

Congress needs to stop using women’s health as a bargaining chip. Thirty years is long enough. Our reproductive health and reproductive rights must no longer be exploited or traded for partisan or ideological purposes because the consequences of sex trades like these in terms of risks to maternal and child health are far too high. It is time for our elected officials to stand for the principle that policy on reproductive health care must be evidence-based and medically sound.

Congress recently tossed a couple of chips in the form of a marginal Title X funding increase and flat-funding for abstinence-only programs to the reproductive rights and anti-choice organizations to keep them quiet, but “a bargaining chip is ultimately worthless if you’re not willing to bargain it away.” “Willing” is grossly understated for what happened last week. After this trade-off with opponents of contraception, Congressional negotiators can no longer claim that forcing college students to pay much higher costs for birth control is accidental.

Members of the Appropriations Committee are coming home in July for a Congressional Work Period. They will be making appearances and organizing for the next election. There is optimism and hope for change in Washington, but a new Congress and a new administration will replay the same old game if we don’t persuade them to take reproductive health and reproductive rights off the bargaining table.

At every appearance of every member of Congress and every candidate, we must demand that they no longer engage in political trade-offs of our sexual health and wellness.

May 7^th is National Teen Pregnancy Prevention Day and a good time to study what’s working and what’s hindering out national progress.  It would also be a good time for parents of teens to consider their own vital role in sex education.

A recent local radio call-in program appearance reminded me of how our beliefs and values about sex, sex education, and sexual health can twist policy discussion and interpersonal communications into a maze of confusion and conflict.  It seems that one of the reasons the United States has the highest teen pregnancy rate of all the industrialized nations might be that our teens have to try to make sense out of nonsense.

Several callers to the radio program made these points: 

·        Teen pregnancies are increasing.

·        Abortions are increasing.

·        Sex education encourages risky sexual behavior.

·        Access to birth control encourages risky sexual behavior.

·        Requiring parental consent for birth control would reduce risky sexual behaviors.

·        Gardasil (new cervical cancer-prevention vaccine) is dangerous, even killing girls and young women.

·        Access to reproductive health care “gives teens permission” to become sexually active.

The reality is that, according to research and evidence, none of those points is true:

·        Even though the national teen birth rate rose 3% between 2005 and 2006 after a 34% fourteen year drop, the pregnancy rate continued to decline.

·        In 2005, the abortion rate was the lowest in 34 years at 19.4 abortions per 1,000 women aged 15 to 44 compared to 29.3 abortions per 1,000 women in 1981.

·        Comprehensive sex education does not increase sexual activity, lower the age of first sexual intercourse, or increase the frequency of sex or the number of sex partners among sexually active youth.

·        Access to birth control and reproductive health care does not encourage risky behavior; in fact it reduces the risks of those behaviors among sexually active people.

·        Requiring parental consent reduces the number of teens who seek health care, but does not reduce their sexual risk-taking behaviors.

·        Gardasil is safe and effective, with the most common side-effect being pain at the injection site.  The FDA is constantly monitoring vaccine recipients and safety. Girls and young women should be vaccinated.

·        Access to cardiac care doesn’t give us permission to overeat and watch TV and seatbelts don’t encourage us to drive recklessly.  Unfortunately, teens don’t ask health care providers for permission to have sex and if they did, we wouldn’t give it to them.

Before we teach teens about sex, we have to make sense out of the nonsense ourselves. We have to update our knowledge – especially in areas that are controversial or challenging to our cherished beliefs.  Most important, we have to be able to distinguish between fact and opinion and between science and belief.

Through the past generation, our sex education and our sexual health care policies have been determined more by politics and ideology than by science or evidence. Add the rapidly expanding knowledge about reproductive health and the result is that most adults are poorly prepared to educate teens on sexual health and wellness or about risks and consequences.

Beyond the basic biology of reproduction, here is a contemporary study guide for parents of teens:

• One in four teens has a sexually transmitted infection:  what are the most common diseases and how should you protect yourself?
  • What is HPV and how does it relate to cervical cancer? 
  • What is Gardasil?
• What is emergency contraception (Plan B)?  How does it work?  When should a reproductive age female take it?
• What is the law on minors and sexual activity?  When is it legal to have sexual intercourse?  What are the penalties?
• What is the effectiveness of condoms?
• What are the most common and effective forms of birth control? How do they work?
• Can my teen get confidential reproductive health care?  Where? Why? How?

Parents are the primary sex educators of their children. The more parents know, the more likely they are to do a good job — but it isn’t called “The FACTS of life” for nothing.

Pat Peckham, a reporter with Wausau, Wisconsin’s weekly newspaper, City Pages, discovered the alternate site and pursued the story to its end. In this case, the end was that Hope Crisis Pregnancy Center took the website down because others might see their deceit as ‘untoward.’

Others might see it for exactly what it was.

Crisis Pregnancy Centers often set up “look alike clinics” near abortion clinics in an effort to lure women into their pseudo-clinics. There are many descriptions this month of these kinds of tactics on www.RHRealitycheck.org.

Coincidentally, a couple of weeks ago I received an email from a friend in the community. He told me that the daughter of one of their employees had gone to one of our family planning clinics. The staff prayed with her for an hour, convinced her that she was a sinner, gave her a Bible and sent her home. He asked if this was a new requirement for our federal grant. (Witty guy)

We investigated.

My third thought (after the ‘Someone’s had a breakdown’ and ‘We’ve hired a ringer.’) was that the young woman had visited the phony fphs.com website and been misdirected to the Crisis Pregnancy Center. We were able to contact her and she was willing to post an audio interview on our website at www.belowthewaist.org . It wasn’t that she had been misdirected by the cybersquatting, but she was very upset about what happened while she was there. She told us about her visit in great detail.

The local picture came together pretty clearly. With good reporting and a young woman willing to tell her story, we have revealed the ethical standards of this Crisis Pregnancy Center to our community.

. . . but the PLW ad goes on to state that; “emergency contraception is a powerful, high dose of steroids that tricks a woman’s body into thinking it is pregnant” and can cause “chemical abortions and deadly blood clots.” PLW promiscuously crammed as many misleading and unsupported claims into one short statement as it possibly could, but the main and most clearly refutable points are often heard and too often echoed across the country: ‘chemical abortions’ and ‘blood clots.’

The latest World Health Organization information is explicit that EC works by preventing ovulation and fertilization. There is no evidence that EC prevents implantation and there is substantial evidence that Plan B’s rate of not preventing implantation of a fertilized egg fully explains the pregnancies that occur after the pills have been taken. In other words, the primary argument that opponents of EC make (we should not risk the destruction of a single fertilized egg) is scientifically, theoretically, and statistically head-of-a-pin microscopic.

Weighed against the larger risks of an unwanted, untimely, or risky pregnancy or perhaps an abortion at a later stage of a real pregnancy, the microscopic objection should vanish completely. And, since unlike many forms of hormonal birth control, Plan B does not contain estrogen, PLW’s warning about ‘blood clots’ seems to be based on their own beliefs and very little else. Again, weighing the risks of a real pregnancy against the theoretical . . . this argument should also disappear completely.

What will not disappear and what is impossible to ignore in this debate about possibilities, is the question of why an organization opposed to abortions would discourage women at risk of unwanted pregnancy from acting to prevent those pregnancies? Why is an organization repulsed at the idea of risking a single fertilized egg acting in a way that puts women (including those who will subsequently abort an unwanted pregnancy) at a greater risk of pregnancy?

To a rational person seeking to reduce abortions, an unproven possibility of the presence of a fertilized egg and a theoretical possibility of preventing a potential implantation on the uterine wall is simply not morally or ethically equivalent to an unwanted pregnancy. The imbalance is dramatically and clearly shown when the woman at risk is likely to have an abortion if she becomes pregnant.

Spring break is a good time for anti-abortion advocates and supporters of accurate safer-sex education alike to call for sexual responsibility and restraint. Perhaps we can agree to exercise responsibility and restraint in our advertising too. Opponents of abortion, like Pro-Life Wisconsin, could demonstrate that they will not risk increasing the number of abortions to quench an insatiable desire for public attention.

When I was one year old, she decided to place me in a foster home. Nine years later, when she remarried, I decided to stay with the foster parents I’d come to think of as my parents, too. She had two subsequent failed and deeply mourned pregnancies, but at last, she had two healthy births.

On the 35^th anniversary of Roe v Wade, I’m thinking of the pain she went through with the failed pregnancies and her pain at the end of her life. I’m also reminded of a story broadcast on National Public Radio last year just before her death.

Victims of Chinese government officials in Quangxi Province described their forced abortions to NPR reporter Louisa Lim. The women told of involuntary injections and officials without the simple decency to provide follow-up medical care. Denying the accusations, local officials said: “We really love and care for women here.”

According to Lim, “investigators” were hurriedly cleaning up the hospital beds and dispersing the young victims to rural and remote parts of the province.

I am also thinking of last year’s U.S. Supreme Court ruling that denies a few desperate women access to what may be an ugly and troubling but would have been safe and legal late-term abortion. The Court has brought the government and the opposition to abortion together in an effort which: “ . . . furthers the legitimate interest of the government in protecting the life of the fetus that may become a child.”

Although one government claims to respect life and the other government acts to extinguish it, I have a sickening sense that these actions are not related by love and care for women. Instead, they are connected by a conviction that women must be prohibited from making their own decisions about pregnancy and reproduction. As justification, the Court’s majority opinion says: “While we find no reliable data to measure the phenomenon, it seems unexceptional to conclude some women come to regret their choice to abort the infant life they once created and sustained. . . . Severe depression and loss of esteem can follow.”

Justice Kennedy, writing for the majority of the court, admits using an unsupported belief that many women later regret having had abortions to justify a prohibition. The chilling common thread is an enforceable faith that the government’s end justifies the brutal means they use to achieve it.

How is a preventable maternal death less repugnant than a late-term abortion?

There are parallel moral, ethical and spiritual issues at the end and at the beginning of life. Thankfully, despite its love and care for women, the administration did not interfere with my mother’s final days. On the 35^th anniversary of Roe v Wade and in her memory, I am compelled to say that if we love and care for women, we will stand together to respect and guarantee the human rights of each one.

My mother was entitled to her regrets, but when she told me she wasn’t always there for me, she was wrong. She did the right thing for the right reasons.

Senator Hillary Clinton (RH Issues) recently called on activists to include access to reproductive health care in every discussion of health care reform. In thoughtful comments, she cautions us to leave “nothing to the imagination” because opponents will take advantage of any loophole.

Senator Clinton took the opportunity to demonstrate a broad and detailed understanding of practical solutions to address gaps in access to reproductive health care. In this four minute vignette, she outlines a three-point immediate action plan to address gaps in the reproductive health safety net. We can act on each point right now:

1) Explicit and specific inclusion of contraceptive care and preventive reproductive health services in every discussion of health care reform. This means clear integration in health insurance coverage as well as regulatory reform. The senator says we can leave nothing to chance.

By including Senator Clinton’s Unintended Pregnancy Reduction Act language in the Children’s Health and Medicare Protection Act (as is done in the House version of the reauthorization bill), we integrate family planning with other maternal and child health services.

2) To insure that Title X’s mission of access to reproductive health care for all regardless of income is fulfilled, Senator Clinton calls for adequately funding the Title X family planning program but she does not stop there.

3) When she mentions campus health care providers, she is referring to the loss of nominal pricing that was available prior to the passage of the 2005 Deficit Reduction Act.

There is language that would permit pharmaceutical companies to voluntarily offer nominally priced contraceptives included in CHAMP HR 3162, but Representative Bobby Rush has proposed much more comprehensive legislation to improve the integrity of the public sector drug pricing program – H.R. 2606.

Senator Clinton calls on us to “sound the alarm” on opponents of family planning services who are not just anti-abortion. They are anti-contraception and anti-women’s rights. This is a challenge we can meet, beginning with advocacy for family planning integration in the CHAMP act.

The US Senate (SCHIP) and the House (CHAMP) passed Children’s Health and Medicare Protection Act bills at the beginning of August. It will go to conference committee when they reconvene.

Now, for the first time, the Congressional Budget Office has recognized in a very conservative cost analysis, that expanding Medicaid-paid access to contraceptive care saves taxpayer dollars. Those savings can and should be used to offset the costs of providing coverage to uninsured children.

Reauthorization of the State Children’s Health Insurance Program is extremely important and must be acted upon before the end of September. Because the Senate language does not include family planning access expansions, it is essential that senators and representatives hear from you right now how important it is that the conference committee’s final product expands access to family planning services. With the House CHAMP bill language, we could do much more and we could do it with much less administrative red tape.

Leave nothing to chance – take these three action steps:

1) Contact Senator Clinton to thank her for her support for integrating reproductive health care access in every health care reform proposal, specifically in Children’s Health Insurance negotiations.

2) Visit the ‘Write Your Representative” website and the “Find Your Senator” website and communicate to them your support for family planning in Children’s Health Insurance legislation.

3) Ask friends and organizations who support expanded access to Children’s Health Insurance coverage and primary care that includes reproductive care, to contact congress. Direct them to this website and ask them to help spread the word.