In 2008, Family Planning Health Services and the Adams County Health Department presented a combined educational program for medical professionals visiting the US from Uzbekistan.

The group consisted of doctors, nurses and administrators of health programs. They were well educated, caring individuals who wanted to understand how public health departments and non-profit family planning agencies were run in the US. They cared very

much about their citizens and providing quality health care to their people. They expressed that they had lived a long time under Russian rule and they now saw their independence as an opportunity to improve their health care delivery systems.

We read with dismay the recent article in the Canadian Press attached below. It would appear those very motivated health providers are now caught in a government supported program to sterilize poor women…even against their knowledge and will.

Long ago someone asked us if teen girls shouldn’t be forced to have a Norplant Implant contraceptive inserted in their arm at age 13. Norplant provided contraception for 5 years by preventing ovulation. The questioner thought this would be a good way to prevent teen pregnancy…at least until the girl graduated from high school. I was shocked by the question and replied that I don’t believe in involuntary birth control. I believe in voluntary birth control and family planning services. This is a nation founded on freedom of the individual and I could never condone forcing someone to contracept just like I could never see forcing someone to conceive.

Too many of our ancestors fought and died to see that we have freedom in this country. Freedom to make our own choices. Many, many of our ancestors came to the USA seeking just those freedoms for themselves and their children. Forced contraception, whether temporary or permanent, is un-American[1] and should be outlawed anywhere in the world.

________________

1 un-A·mer·i·can

–adjective

not American; not characteristic of or proper to the U.S.; foreign or opposed to the characters, values, standards, goals, etc., of the U.S.

By Mansur Mirovalev (Canadien Press)

GULISTAN, Uzbekistan — Saodat Rakhimbayeva says she wishes she had died with her newborn baby.

The 24-year-old housewife had a cesarean section in March and gave birth to Ibrohim, a premature boy who died three days later.

Then came a further devastating blow: She learned that the surgeon had removed part of her uterus during the operation, making her sterile. The doctor told her the hysterectomy was necessary to remove a potentially cancerous cyst, while she believes he sterilized her as part of a state campaign to reduce birthrates.

“He never asked for my approval, never ran any checks, just mutilated me as if I were a mute animal,” the pale and fragile Rakhimbayeva said through tears while sitting at a fly-infested cafe in this central Uzbek city. “I should have just died with Ibrohim.”

According to rights groups, victims and health officials, Rakhimbayeva is one of hundreds of Uzbek women who have been surgically sterilized without their knowledge or consent in a program designed to prevent overpopulation from fuelling unrest.

Human rights advocates and doctors say autocratic President Islam Karimov this year ramped up a sterilization campaign he initiated in the late 1990s. In a decree issued in February, the Health Ministry ordered all medical facilities to “strengthen control over the medical examination of women of childbearing age.”

The decree also said that “surgical contraception should be provided free of charge” to women who volunteer for the procedure.

It did not specifically mandate sterilizations, but critics allege that doctors have come under direct pressure from the government to perform them: “The order comes from the very top,” said Khaitboy Yakubov, head of the Najot human rights group in Uzbekistan.

Uzbek authorities ignored numerous requests by The Associated Press to comment on the issue. Most western media organizations have been driven from the country, and government officials face serious reprisals for contacts with foreign journalists. However, the AP was able to interview several doctors, sterilized women and a former health official, some on condition of anonymity.

This Central Asian nation of 27 million is the size of California or Iraq, and population density in areas such as the fertile Ferghana Valley is among the world’s highest.

Rights groups say the government is dealing with poverty, unemployment and severe economic and environmental problems that have triggered an exodus of Uzbek labour migrants to Russia and other countries.

Heightening the government’s fears is the spectre of legions of jobless men in predominantly Muslim Uzbekistan succumbing to the lure of Islamic radical groups with ties to Afghan Taliban and al-Qaida.

Uzbekistan is not alone in coming under allegations of using sterilizations to fight population growth: Authorities in China’s Guangdong Province were accused by Amnesty International in April of carrying out coerced sterilizations to meet family planning goals. But no other country is known to use that method as a government policy.

Uzbekistan once had one of the Soviet Union’s highest birthrates, four to five children per woman, and Communist authorities even handed out medals to “heroine” mothers of six or more. Young army conscripts from Uzbekistan and the four other Central Asian republics made up for a declining ethnic Russian population.

Now, as authorities try to unravel that legacy, the birthrate has dropped to about 2.3 children per woman — still higher than the rate of 2.1 that demographers consider sufficient to replenish a falling population.

The sterilization campaign involves thousands of government-employed medical doctors and nurses who urge women of childbearing age, especially those with two or more children, to have hysterectomies or fallopian tube ligations, said Sukhrobjon Ismoilov of the Expert Working Group, an independent think-tank based in the capital, Tashkent.

The surgeon in Rakhimbayeva’s case, a burly man in his 40s named Kakhramon Fuzailov, refused to comment on her claims and threatened to turn an AP reporter over to the police for “asking inappropriate questions.”

In 2007, the UN Committee Against Torture reported a “large number” of cases of forced sterilization and removal of reproductive organs in Uzbek women, often after cesarean sections. Some women were abandoned by their husbands as a result, it said.

After the 1991 Soviet collapse, Karimov, a former Communist functionary, remained at the helm and retained many Soviet features, such as strict government control of public health. Government-paid doctors and nurses are assigned to each district or village.

Family planning is far different from western norms.

Instead of focusing on raising awareness of widely available condoms or birth-control pills, the Health Ministry has chosen to promote uteral resections nationwide as the most reliable method of contraception.

Some women do volunteer. Khalida Alimova, 31, a plump, vivacious sales manager from Tashkent, agreed to a resection in March, almost a year after her third child was born.

She said her husband, Alisher Alimov, 32, an occasional cab driver who spends days playing backgammon with his friends, refused to use condoms or allow her to take birth-control pills.

“Now I feel relieved,” Alimova said over a cup of green tea in the kitchen of their shabbily furnished Tashkent apartment. She added, though, that she never told her husband about the operation.

Many other women, especially from poor rural areas, say they face coercion from health workers or even potential employers to agree to sterilization.

A 31-year-old mother of two from the eastern Uzbek city of Ferghana said the director of a kindergarten where she sought a job told her to show a certificate confirming she had been sterilized.

After consulting her disabled husband, who receives a government pension of $40 a month, she said she agreed to the procedure, produced the certificate and got the job.

“We just had no choice,” the woman, who gave only her first name Matluba, said by telephone from the eastern city of Ferghana. She refused to provide her last name or identify the kindergarten for fear of being fired.

Several health workers, who spoke on condition of anonymity also because they feared dismissal or persecution, said the authorities are especially eager to sterilize women with HIV, tuberculosis or a drug addiction. Instruments often are not sterilized properly and can infect other women, they said.

Inexperienced medical workers can also cause serious health complications. “Any negligence can do a lot of damage,” said Shakhlo Tursunova, a gynecologist from Tashkent.

Health workers involved in the campaign are threatened with salary cuts, demotion or dismissal if they do not persuade at least two women a month to be sterilized, a former high-ranking Health Ministry official told the AP on condition of anonymity.

Veronika Tretyakova, a 32-year-old doctor from Tashkent, said she came under pressure from health workers to be sterilized.

“The nurse said, ‘They would hang me if I let you have another child,’” Tretyakova said. “I told her to think about her soul.”

Tradition plays a strong role in this male-dominated society, where a large family is seen as a blessing from God, and women are often blamed for childless marriages.

After checking out of the maternity hospital in Gulistan where she lost her son, Rakhimbayeva said she shared her anguish with her husband, Ulmas, a 29-year-old bus driver who refused to be interviewed for this story. Their marriage was arranged by their parents in 2008.

Instead of consoling her, she said, he told her to move back to her parents’ house and wait for divorce papers as he did not want to live with a barren wife.

“He never even questioned why the doctors maimed me, just blamed everything on me,” Rakhimbayeva said wringing her hands. “Now I have no hope of having children, no job, no future.”

I am also tired of the assumptions that Planned Parenthood is the sole provider of reproductive health care in America. There are many, many family planning providers who are non-profit, private providers. There are many, many family planning providers that are within public health departments.  Federal funding goes to support family planning services to improve and enrich the health of America’s families. These programs are successful. ‘None of the federal dollars received are for abortion care.’

Taxpayers save $3.74 for every dollar expended on family planning services. Seven million US women use family planning providers yearly and 1.5 million unintended pregnancies are prevented. This federal funding is preventing abortion and increasing healthy outcomes for US men, women and their children.  Contrast that with supporting the efforts of BP and you can conclude that the legislators noted in the article may be bought and paid for and have completely forgotten the constituents they are supposedly representing.

From RH Reality Check, and the great Jodi Jacobson…

What would you say if I offered you an investment that yielded nearly $4.00 in value for every $1.00 invested…and could prove it?

And what would you say if the yields from this investment over the long-term meant better health, higher educational attainment, higher economic productivity and lower social costs for US citizens, benefitting by extension our country as a whole in the short- and long-term?  What if this investment contributed meaningfully to reducing poverty and to increasing the freedom of individuals to make decisions about their own lives but still be socially responsible?

If you’re a smart investor, I am guessing you’d be interested. On the face of it you might think that people across the political spectrum could agree that such investments would be a good idea.

But in the United States today, of course, things are never that simple.

The investment in question is government funding for Title X, Medicaid and other programs that support voluntary family planning and related sexual and reproductive health services, as well as education and training of health professionals, and outreach to adolescents and young adults. These funds provide millions of Americans with access to routine primary health exams and screenings (such as for breast and cervical cancer), access to contraception, testing and treatment for sexually transmitted infections, and increased access to treatment for AIDS-related illnesses. They also enable women to avoid unplanned pregnancies, thereby reducing the need for abortion. This money saves and improves lives.

In 2008, for example, publicly-funded clinics provided over 7 million female clients with contraceptive supplies, helping to avert an estimated 1.5 million unintended pregnancies. The Guttmacher Institute estimates that of these pregnancies, 656,000 would have resulted in an unplanned birth and 616,000 would have resulted in an abortion (the remainder would have resulted in miscarriage). Overall, concludes Guttmacher, by helping women avoid unintended pregnancies and plan how many children they want and when to have them, publicly supported family planning clinics save taxpayers $3.74 for every $1 that is spent providing contraceptive care. These savings are net of the total that would include early detection and treatment of cervical and breast cancers caught during regular exams, sexually transmitted infections avoided and those treated, and any number of other benefits of access to these basic primary health services.

So…what’s not to like?

Ask Congressmen Pete Olson (R-TX) and Mike Pence (R-IN).

In the ongoing witch hunt to eliminate access to reproductive and sexual health care in the United States, Olson and 31 Republican colleagues requested a report from the Government Accountaility Office (GAO) on federal spending for organizations most experienced in providing the services and programs that yield the above-noted social and economic benefits.  Their purpose? To vilify the funding.

The recently released report, notes the GAO summary:

responds to [the Congressional] request for information on federal funds provided for fiscal years 2002 through 2009 to selected organizations involved in health-related activities and their affiliates: Advocates for Youth, the Guttmacher Institute, the International Planned Parenthood Federation, the Planned Parenthood Federation of America, the Population Council, and the Sexuality Information and Education Council of the United States.

Reports reviewed included:

expenditures of federal funds that HHS agencies and offices and USAID provided both directly and indirectly to the selected organizations and their affiliates, as well as expenditures of funds provided directly and indirectly by federal agencies other than HHS and USAID, such as the Department of Housing and Urban Development, which provided grants totaling about $4.1 million to Planned Parenthood affiliates who reported such expenditures during the period of our review.

What was the conclusion?

“For fiscal years 2002 through 2009, the selected organizations and their affiliates in our review reported total expenditures of about $967 million in federal funds provided directly and indirectly.”

More than one-third of this amount, about $342 million, was reported as expenditures from an HHS program for family planning services.. Nearly all (about $942 million) of the reported expenditures were from programs administered by HHS and USAID; the remaining $25 million in reported expenditures were primarily from programs administered by the U.S. Department of Housing and Urban Development, the U.S. Department of Agriculture, and the U.S. Department of Justice.

The nakedly ideological nature of this effort is underscored by the lack of any “smoking gun” in the GAO report, of which none was expected in any case. We all know the U.S. government provides public funding for basic reproductive and sexual health care, funding that enables people to protect their health, exercise their rights, and yields numerous social and economic outcomes. Reams of scientific data have been published on the benefits of these funds.  None of the funds, by law, are spent on abortion care, except in those circumstances in fact allowed by law, such as in cases of rape or incest, circumstances which in any case the anti-choice movement is ever-seeking to further restrict.

In an interview with the Houston Chronicle, Rochelle Tafolla, a spokeswoman for Planned Parenthood of Houston and Southeast Texas said that their organization provides “crucial services to people in a city with the highest number of uninsured of any city in the nation.”

“None of the federal dollars received are used for abortion care,” Tafolla said. Planned Parenthood affiliates in Texas that provide abortion services “are required to be separately incorporated from the entity that provides family planning services,” she said.

No news flash here.

But what the GAO report does do is allow these good gentleman–otherwise known as the people that love to hate Planned Parenthood–to further waste your own and my tax dollars and our time by trying to eliminate funding for Title X and related programs. They do so ostensibly because they feel they have a monopoly on “morality,” and find the thought of women planning their families to be a moral affront, while, for example, losing no sleep over concurrently defending British Petroleum and deepwater oil drilling as we witness the largest ecological catastrophe in this country’s history unfold before our eyes.  Olson, referred to by one of his constituents as an “oil-soaked congressman” for his reliance on campaign funds from the oil industry, has introduced a bill to lift the moratorium on deep water drilling.

Pence is one among several usual suspects, such as Congressman Chris Smith (R-NJ) and the Family Research Council, leading anti-choice fundamentalist colleagues in and outside of Congress in their newest effort to eliminate government funding for all forms of sexual and reproductive health care by introducing a bill entitled the Title X Abortion Provider Prohibition Act. Their strategy appears to be taking a page from the health reform debate and all past efforts to equate contraceptive delivery with abortion and to draw equivalency between government-funded family planning services, and abortion care.  This completely bogus piece of “legislation” confirms what someone wrote on Twitter the other day, and I paraphrase: “The far right is the group that likes to complain government does not work, and then seeks office to prove the point.”  To put that in bold, Pence rails against abortion and defends BP in a single segment on Hardball with Chris Matthews.

The irony is that by fruit of their efforts to restrict women’s access to primary preventive care, these men and their comrades are likely responsible for more unintended pregnancies and abortions in the United States than any other single factor. Meanwhile they rabidly opposed and continue to oppose sane regulations that might have prevented the loss of lives from the explosion on the Horizon rig, and might have prevented the utter devastation we will see for decades to come in one of the richest ecosystems in this country.

I call all of this immoral.

We’d like to thank all the colleagues, advocates, friends and supporters who cared about and worked for a positive outcome for women and families. Our friends at Raising Women’s Voices for the Health Care We Need put out two fact sheets this week detailing the pros and cons of the new health insurance reform. We like their fact sheets and include them here for our visitors to access.

The Raising Women’s Voices for the Health Care We Need bulletin stated, “After the hard fought debates about health reform, there’s a lot of misinformation about the legislation out there. “ We want to do our part in promoting the facts about health insurance reform.

Family Planning Health Services Administration and Staff

You can download this fact sheet here.

And a second one here.

Health Reform and Reproductive Health: Positive and Negative Effects March 30, 2010

1.            Of the 12.4 million uninsured women of reproductive health age (15 to 44) in the United States, 94% would qualify for either Medicaid or federal subsidies to help them buy health insurance.1 They will receive, among other things, contraceptive counseling and services, STI prevention, Pap smears, mammograms and complete maternity coverage. Effective in 2014.

a.            Slightly more than half of these women (55% or 6.7 million) would qualify for Medicaid coverage. Medicaid eligibility is expanded up to 133% of poverty (29,327 annual income for a family of four). Most reproductive health care is included, but not abortion coverage, except in case of rape, incest or life endangerment, unless the state pays for it. (See “negative effects” for further discussion.)

b.            Another 4.8 million women of reproductive health age will qualify for federal subsidies to help them purchase private health coverage. Individuals and families with incomes up to 400% of poverty ($88,400 for a family of four) will be eligible for federal subsidies. Women living in some states will be able to buy abortion coverage. (See “negative effects” for further discussion.)

2.            Young adults will be able to stay on family health insurance policies until their 26th birthdays, thus providing them access to reproductive health care. Effective 2010.

3.            Almost $75 million per year will go to states over five years for a “personal responsibility education program” that will largely focus on preventing pregnancy and STIs through a combination of abstinence and contraceptive education. (2)

4.            States will be more easily able to expand Medicaid coverage to both men and women solely for family planning services up to almost the same eligibility level as for pregnancy-related care (200% of poverty). Some 21 states have done this already. The rest will be able to do so without having to go through a time-consuming and costly federal waiver process. (3)

5.            Community health centers, where many low-income women and undocumented immigrant women receive primary and reproductive health care, will receive $11 billion in new funding. In addition, insurance plans will be required to contract with 2 community health centers and other essential community providers such as family planning centers, public hospitals and HIV/AIDS clinics. Effective beginning in 2010.

6.            Insurance companies will not be able to cancel our policies if we get sick, including with ovarian cancer, cervical cancer, breast cancer or HIV. Effective in 2010.

7.            Insurance companies will not be able to deny us coverage for such “pre-existing conditions” as pregnancy or having had a c-section delivery in the past. Effective 2014, except for 2010 for children.

8.            All private insurance plans will be required to offer a package of women’s preventive and screening services, such as such as pap smears and mammograms, without requiring co-pays. Effective January 1, 2011.

9.            Licensed practitioners serving women using free-standing birthing centers will be eligible for Medicaid reimbursement. Effective within 90 days of enactment. Some states may have to adopt new laws or policy to implement this provision.

10. New funds ($1.5 billion over five years) are appropriated for maternal, infant and early childhood home visiting programs.

11. New funds ($50 million a year) are appropriated for school-based health programs, which often provide STI and birth control counseling and services.

12. Medicaid reimbursements for primary care doctors will be increased, making it easier for Medicaid recipients (including women of reproductive health age) to get preventive office visits with more physicians. Effective 2013.

13. Insurance companies will no longer be able to set lifetime or unreasonable annual limits on the amount of medical care they will cover. This is especially important for women who have expensive maternity care or abortion services, or treatment for such illnesses as breast cancer, ovarian cancer or cervical cancer, which can costs thousands of dollars. Effective 2010.

Negative

1.            There still will be no use of federal funds for abortion services (except in cases of rape, incest or threat to the life of the woman). This provision was included in the health reform bill and restated in an Executive Order issued by President Obama on March 24, 2010.

a.            Women on Medicaid and those who will become eligible for Medicaid in 2014 will not be able to use their coverage for abortion services in most cases, except in the circumstances stated above, or if they live in one of the 17 states that use state-only dollars to provide abortion coverage under Medicaid.

b.            Low-income women receiving care at Community Health Centers still will not be able to receive federally-subsidized abortion services, making it more difficult for CHCs to provide this care. The health centers will have to continue to scrupulously segregate federal funds from any other funds that are used to provide abortion services. Women may be asked to use their own money to pay for abortion services if no non-federal subsidies are available.

c.            No federal subsidies can be used toward abortion coverage in any private health insurance plans purchased through insurance exchanges.

2.            States could prohibit abortion coverage in health insurance plans offered in new insurance “exchanges” that will become available in 2014. While states already are able to prohibit abortion coverage in private health insurance (5 states have done so to date), the advent of the state insurance exchanges may present new opportunities for anti- choice forces to advocate for abortion bans. Reproductive justice advocates will be forced to fight these proposed prohibitions state by state.

3.            In states where abortion coverage is allowed in the exchanges, women will have to send in two checks – one for abortion coverage and one for everything else. This requirement (the “Nelson language”) is burdensome and unnecessary, since insurers will be required to segregate federal funds from private payments going to abortion coverage. Moreover, experts predict it could lead insurance companies to simply drop abortion coverage, rather than comply with the requirements.(4)

4.            There is a one-sided “conscience clause” that requires health insurers to protect providers that refuse to provide or refer for abortions, but does not protect those who do.

5.            New funding for ineffective abstinence-only sex education. Title V, the federal abstinence-only-until-marriage program is resuscitated and given $50 million a year for five years.

6.            Undocumented immigrants, including women of reproductive health age, are excluded from health reform. They are not eligible for Medicaid or federal subsidies to help them buy insurance and are even prohibited from using their own money to buy health insurance through the exchanges.

7.            Legal immigrants, including women of reproductive health age, still must wait five years to become eligible for Medicaid. Some states already provide Medicaid coverage to legal immigrants, especially pregnant women and children, within their first five years, and may continue to do so.(5)

1 Kaiser Family Foundation, Abortion and Health Reform, January 2010.

2 Guttmacher Institute analysis, March 29,2010, http://www.guttmacher.org/media/inthenews/2010/03/29/index.html

3 Guttmacher Institute analysis, March 29,2010, http://www.guttmacher.org/media/inthenews/2010/03/29/index.html

4 Analysis by Sara Rosenbaum of the George Washington University School of Public Health. 5 New York Immigration Coalition, March 2010

This fact sheet was developed using resources and guidance from The Guttmacher Institute, the ACLU Reproductive Freedom Project, Legal Voices, the Kaiser Family Foundation, Community Catalyst, the New York Immigration Coalition, the National Physicians Alliance, the National Institute for Reproductive Health, the Southwest Women’s Law Center and the American Association of Birth Centers. Thanks for all their generous assistance.

We thought it valuable to post a recent article from the Gloucester County News and NJ.com about the 50^th anniversary of the first “foolproof contraceptive” – the birth control pill.  Margaret Marsh, university professor of history and dean of the Faculty of Arts and Sciences at Rutgers-Camden says, “What the pill did do is make it possible for women to have careers. It really was the first foolproof contraceptive.”  Now, we all know the birth control pill isn’t “foolproof” and women can forget their pills or take them incorrectly…but the birth control pill was better than any reversible method available at the time and worked so well that women were indeed able to control their fertility.

Sue Kettner Public Relations Coordinator

Rutgers–Camden historian puts 50th anniversary of the pill into cultural medicine cabinet

By John Barna

March 20, 2010, 1:36PM
CAMDEN – Americans consume innumerable amounts of medicine, but only one pill is known precisely as “the pill.” This year marks the 50th anniversary of oral contraception, an innovative collaboration between Gregory Pincus and John Rock that some have called the development of the 20th century.

As Rock’s 120th birthday is commemorated on March 24, the only comprehensive biography on Rock has its origins at Rutgers University—Camden.  Margaret Marsh, university professor of history and dean of the Faculty of Arts and Sciences at Rutgers–Camden, with her sister Wanda Ronner, a clinical associate professor of obstetrics and gynecology at the University of Pennsylvania School of Medicine, were the first researchers granted access to John Rock’s personal letters. Together they wrote the book The Fertility Doctor: John Rock and the Reproductive Revolution (Johns Hopkins University Press, 2008).

According to Marsh, Rock did not fully appreciate the far-reaching impact of the pill. In fact, he predicted the pill would find its greatest popularity among married couples.  But when things turned out differently, Rock wasn’t upset.  “When people warned that the pill would allow even more unmarried couples to have sex, he would reply that if these couples are having sex anyway then they might as well be safe from pregnancy,” notes Marsh of Haddonfield.

But the Rutgers–Camden historian adds that no one could have possibly predicted all that transpired at the end of the 60s. “The first decade of the pill witnessed so many changes that sometimes I find it hard to believe that 1960 and 1968 are even in the same century,” says Marsh.

The sexual revolution, she points out, didn’t occur solely because of the pill’s existence. “There were many contributing factors like Baby Boomers coming of age, more people going to college, and the huge anti-war rebellion,” she says.  “What the pill did do is make it possible for women to have careers. It really was the first foolproof contraceptive.”

While there are many more oral contraceptive options available to women today – some 30 variations, in fact – one big difference since the pill was first created are the lower doses of the various drugs in it.

“The creators had no idea how low a dose could be and still prevent conceptions,” notes Marsh.

And unlike the 1950s, the average age of parents today is older.  Couples tend to live together and then get married when they decide to have children. “People can be engaged forever. In the 1950s and early 1960s, people got married and were expected to have children right away. Now we seem to postpone marriage until we’re ready to have children, increasing the age of when we do marry.”

What hasn’t changed since the early days of the pill is its tricky relationship with certain religious groups.  But Rock, an ardent Catholic, nearly convinced the church to reconsider its views on allowing contraception use by its members. According to Marsh, Rock didn’t completely fail in this pursuit.

“While contraceptives are against the laws of the Catholic Church, American Catholics have come to rely on their consciences more than on the pope’s pronouncements regarding birth control,” states Marsh. “The pope has never spoken infallibly on the issue. When he speaks ’ex cathedra,’ he can’t be wrong, because he’s speaking the direct word of God. But the pope has never spoken ‘ex cathedra’ on the issue of contraception.”

In fact, American Catholics are using birth control in the same numbers as the rest of the country. Today about 80% of women who have used any form of contraception have used the pill at one time or another in their lives.
What’s in the future for reproductive medicine? With the introduction of the pill and in vitro fertilization, b y the end of the twentieth century sex and reproduction had become uncoupled.  Now you can guarantee sex without reproduction and can also ensure reproduction without sex.  With even more advances on the horizon, Marsh predicts that our definitions of family will be reevaluated.

“All of these technological advancements enlarge the question of what it means to be a family. I see same-sex marriage as part of a family-building trend, even a conservative one,” posits Marsh. “A hundred years from now, we won’t think it’s a big deal.”

Rise in teenage pregnancy rate spurs new debate on arresting it
By Rob Stein
Washington Post Staff Writer

Tuesday, January 26, 2010
The pregnancy rate among teenage girls in the United States has jumped for the first time in more than a decade, raising alarm that the long campaign to reduce motherhood among adolescents is faltering, according to a report released Tuesday.
The pregnancy rate among 15-to-19-year-olds increased 3 percent between 2005 and 2006 — the first jump since 1990, according to an analysis of the most recent data collected by the federal government and the nation’s leading reproductive-health think tank.
Teen pregnancy has long been one of the most pressing social issues and has triggered intense political debate over sex education, particularly whether the federal government should fund programs that encourage abstinence until marriage or focus on birth control.
“The decline in teen pregnancy has stopped — and in fact has turned around,” said Lawrence Finer, director of domestic research for the Guttmacher Institute, the nonprofit, nonpartisan research group in New York that conducted the analysis. “These data are certainly cause for concern.”
The abortion rate also inched up for the first time in more than a decade — rising 1 percent — intensifying concern across the ideological spectrum.
“One of the nation’s shining success stories of the past two decades is in danger of unraveling,” said Sarah Brown of the National Campaign to Prevent Teen and Unplanned Pregnancy. “Clearly, the nation’s collective efforts to convince teens to postpone childbearing must be more creative and more intense, and they must begin today.”
The cause of the increase is the subject of debate. Several experts blamed the increase in teen pregnancies on sex-education programs that focus on encouraging abstinence. Others said the reversal could be due to a variety of factors, including an increase in poverty, an influx of Hispanics and complacency about AIDS, prompting lax use of birth control such as condoms.
“It could be a lot of things coming together,” said Rebecca Maynard, a professor of economics and social policy at the University of Pennsylvania. “It could be we just bottomed out, and whenever you are at the bottom, it tends to wiggle around. This may or may not be a sustained rise.”
The report comes as Congress might consider restoring federal funding to sex-education programs that focus on abstinence. The Obama administration eliminated more than $150 million in funds for such groups, but the Senate’s health-care reform legislation would reinstate $50 million.
The new findings immediately set off a debate over funding. Critics argued that the disturbing new data were just the latest in a long series of indications that the focus on abstinence programs was a dismal failure.
“Now we know that after 10 years and over $1.5 billion in abstinence-only funding, the U.S. is lurching backwards on teen sexual health,” said James Wagoner of Advocates for Youth, a Washington advocacy group.
Supporters of abstinence programs, however, said the findings provided powerful evidence of the need to continue to encourage delayed sexual activity, not only to avoid pregnancy but also to reduce the risk for AIDS and other sexually transmitted diseases.
“Research unmistakably indicates that delaying sexual initiation rates and reducing the total number of lifetime partners is more valuable in protecting the sexual health of young people than simply passing out condoms,” said Valerie Huber of the National Abstinence Education Association, who blamed the increase on several factors.
“Contributors include an over-sexualized culture, lack of involved and positive role models, and the dominant message that teen sex is expected and without consequences,” Huber said. The Obama administration is launching a $110 million pregnancy prevention initiative focused on programs with proven effectiveness but has left open the possibility of funding some innovative approaches that include encouraging abstinence.
The rate at which U.S. teenagers were having sex rose steadily through the 1970s and 1980s, fueling a sharp rise in teen pregnancies and births. That trend reversed around 1991 because of AIDS, changing social mores about sex and other factors, including greater use of contraceptives, which pushed the U.S. teen pregnancy rate to historic lows.
The U.S. rates still remained higher than those in other industrialized countries.
The decline in teen sexual activity had leveled off starting about nine years ago, and the teen birth rate began to increase in 2005. It wasn’t known before if the increase was due to more pregnancies or fewer abortions and miscarriages. For the first time, the new analysis uses those factors in calculating the teen pregnancy rate.
The analysis examined data on teenage sex and births collected by the federal Centers for Disease Control and Prevention’s National Center for Health Statistics and data on abortions collected by the CDC and Guttmacher — the two best sources of such data.
The abortion rate among teenagers rose 1 percent in 2006 from the previous year — to 19.3 abortions per 1,000 women in that age group, the analysis found. Taking that and miscarriages into account, the analysis showed that the pregnancy rate among U.S. women younger than 20 in 2006 was 71.5 per 1,000 women, a 3 percent increase from the rate of 69.5 in 2005. That translated into 743,000 pregnancies among teenagers, or about 7 percent of women in this age group.
“When birth rates go up and down, it could be the result of kids getting fewer abortions,” said John Santelli, a professor of population and family health at Columbia University. “This shows that it’s a true rise in pregnancies.”
The rate increase was highest for blacks. Among blacks, the rate increased from 122.7 per 1,000 in 2005 to 126.3. For Hispanics the rate rose from 124.9 per 1,000 women to 126.6. Among whites, the rate increased from 43.3 per 1,000 women to 44.0.

The controversy over the use of emergency contraception in Catholic hospitals for victims of sexual assault continues to be played out in various forums — in the literature, state legislatures, pharmacies, professional groups, state Catholic conferences, dioceses and Catholic hospitals themselves.

At its heart is whether medications used for emergency contraception have an abortifacient effect, that is, whether they prevent the implantation of a fertilized egg by altering the lining of the endometrium. On the belief that they do have such an effect, some either object to or prohibit their use in Catholic hospitals or agree to their use only in conjunction with testing for ovulation to ascertain whether the woman is at or around the time of ovulation (and, therefore, could become pregnant).¹ Obviously, for women who have been subjected to a sexual assault and who seek assistance at a Catholic hospital, much hinges on accurately understanding how these hormonal medications work.

Unfortunately, such understanding is not always in play. In many instances, critics base their moral judgments on prevailing beliefs or assumptions about mechanisms of action that may be based on drug manufacturer labeling, or on outdated scientific literature, or on mere supposition. Researchers have been virtually certain that the drugs prevent or disrupt ovulation, but they have generally been uncertain about other possible effects on sperm, cervical mucus, the process of fertilization and on the endometrium. Yet manufacturers and others typically list these specific effects as possible mechanisms of action.

But are such beliefs and assumptions about emergency contraceptives accurate and adequate? This is a critical question, for women who have been sexually assaulted and for the Catholic hospitals that care for them.

One of the well-known truisms in ethics is that good moral judgments depend in part on good facts. Absent adequate and accurate information, there is an increased possibility of a faulty analysis and, therefore, of an erroneous judgment. In addition, the moral judgment itself might be seen to lack credibility either because its basis is unclear or because it seems to fly in the face of reputable data.

Take one example. In late February 2007, in a LifeSiteNews interview, Bishop Elio Sgreccia, the then-president of the Pontifical Academy for Life, reaffirmed the academy’s 2000 statement that the “morning-after pill” is abortifacient and that physicians and Catholic hospitals are prohibited from administering it, even in cases of sexual assault.² Unfortunately, the 2000 statement employed the generic term “morning-after pill,” which can refer to a variety of medications with different mechanisms of action, and the statement made no reference to scientific literature substantiating its claim that the pill is abortifacient. In addition, the comment in the 2007 interview seemed not to take account of recent scientific literature on how these medications work, particularly in the case of levonorgestrel, also known as Plan B, the current standard treatment for women who have been sexually assaulted. Yet after the interview, despite the lack of evidence, some described both the bishop’s comment and the Pontifical Academy’s statement as “authoritative.”

GOOD FACTS ARE NECESSARY FOR GOOD ETHICS
What, in fact, do we find if we look at the scientific literature on how Plan B, a progestin-only form of emergency contraception, works?

Over the past five years, CHA staff have collected, reviewed and summarized the great majority of articles on emergency contraceptive medications’ mechanisms of action — both for combination drugs (such as Preven) and Plan B.³ In addition, CHA obtained two independent analyses of the literature — one by an ob-gyn and the other by a pharmacist. The reviews concluded that virtually all of the evidence in the scientific literature indicates Plan B has little or no post-fertilization effect, that is, it has little or no effect on the endometrium that would make it inhospitable to implantation. Its mechanism of action is to disrupt ovulation.

In a thorough review of the scientific literature, Fr. Nicanor Pier Giorgio Austriaco, OP, Ph.D., a priest, theologian and scientist, wrote in the Winter 2007 issue of The National Catholic Bioethics Quarterly:

Studies published in the past few months provide mounting evidence that levonorgestrel has little or no effect on post-fertilization events. In other words, given the limitations of scientific certitude, they suggest that Plan B, when administered once, is not an abortifacient. These human studies correlate well with earlier findings in rodents and monkeys that convincingly showed that the postcoital administration of levonorgestrel in amounts several times higher than typical doses given to women does not interfere with the post-fertilization processes required for mammalian embryo implantation. The evidence also addresses what until now has been a nagging, unanswerable question for pharmacologists: Why would levonorgestrel, a progesterone agonist that mimics the effect of progesterone, prevent implantation, when progesterone produced from the corpus luteum immediately after ovulation actually promotes implantation by converting the endometrium to deciduas? Answer: It does not.⁴

Several months later in the Autumn 2008 issue of the quarterly, responding to his critics, Fr. Austriaco offered an even more detailed argument in support of his conclusion.⁵ If Plan B is abortifacient, the author observes, it can have this effect in three primary ways. The first is by increasing the rate of ectopic pregnancies. However, he notes that the “combined data from five clinical trials with nearly six thousand women showed that the rate of ectopic pregnancies in women who have used Plan B is 1.02 percent as compared to the overall national ectopic pregnancy rate between 1.24 percent and 1.97 percent. In light of this finding, it is unlikely that Plan B increases the ectopic pregnancy rate … .”⁶

The second way in which Plan B could be abortifacient is by preventing implantation of an embryo. Fr. Austriaco noted that there are three ways in which this could occur. One is by altering the lining of the endometrium, making it inhospitable to implantation. “[M]orphological and biochemical analyses of endometrial biopsies of women who had taken Plan B eight or nine days prior to the biopsy have revealed that the drug does not dramatically alter the structures of this tissue. This suggests that the drug does not compromise endometrial development.”⁷

Another way in which the drug could make the endometrium inhospitable is by disrupting the function of the corpus luteum which releases hormones that are necessary for the proper development of the endometrium, including making it receptive to an embryo. After reviewing the scientific literature, Fr. Austriaco concluded that “[T]ogether, these data suggest that the risk of a post-fertilization effect from this mode of action for any particular individual woman, if it is real, would be vanishingly small.”⁸

The final manner in which Plan B could prevent implantation is by directly interfering with the implantation process itself. Fr. Austriaco replied: “[O]ne study that directly tested the ability of human embryos to implant on endometrial tissue exposed to LNG — though grossly immoral — does not support this mode of action for Plan B.”⁹ Two other recent studies confirm this conclusion.¹⁰

A third way in which Plan B could be abortifacient is by destroying an already implanted embryo. With regard to this possibility, Fr. Austriaco wrote: “[A] report from the FDA shows that Plan B does not increase the rate of pregnancy loss or the frequency of fetal abnormalities once a pregnancy has been established.”¹¹

Fr. Austriaco concluded his article: “[I] stand by my earlier conclusion: In light of the available scientific evidence and given the inherent limitations of the studies, it is unlikely that Plan B is an abortifacient.”¹²

What about the manufacturer’s label which claims that one of the drug’s mechanisms of action is to prevent implantation of a fertilized egg? Many appeal to the manufacturer’s label in their arguments against the use of Plan B. In Fr. Austriaco’s judgment, “labels mean nothing without the scientific data to back up their claims.”¹³

MORAL CERTITUDE, NOT ABSOLUTE CERTITUDE
While the preponderance of scientific evidence strongly suggests that Plan B does not have an abortifacient effect, the evidence stops short of providing absolute certitude. But is absolute certitude needed?

In the Catholic moral tradition, what is required of an agent when he or she makes a moral judgment is that he or she have moral certitude about the correctness of the action. In the words of Thomas Slater, SJ, author of a manual of moral theology: “In order to act lawfully and rightly, I must have at least moral certainty of the imperfect kind that the proposed action is honest and right. This degree of certainty will be sufficient, for ordinarily no greater can be had, as we have just seen. It is also required for right action; for if I am not at least to this extent morally certain that my action is right, I am conscious that it may be wrong.”¹⁴

What is meant by moral certitude? Moral certitude means that the agent has excluded all reasonable possibility of error. It stands between mere probability, where alternative opinions are equally plausible, and absolute certainty, where any theoretical possibility of error is not only excluded, but is impossible. Again, in the words of Fr. Slater:

Certainty in general is a firm assent of the mind to something known, without the fear of mistake. In mathematics and in other branches of exact science we can often attain absolute certainty, which rests on the evident truth of the principles which are employed to arrive at it. … In the science of morality we have frequently to be content with a lower degree of certainty than this; there is often some obscurity about the principles to be applied, and human acts are not the matter of necessary and unvarying law. We have to be content with what is called moral certainty. … I may be conscious that mistake is possible but not probable, as when a man has been condemned on evidence which has satisfied a jury of intelligent men. In such cases if there can be no prudent doubt about the justice of the verdict I have moral certainty of an imperfect but real kind. … Ordinarily greater certainty cannot be obtained in human affairs. … If I have this imperfect moral certainty that my action is right, I am justified in acting … .”¹⁵

How does moral certitude play out with regard to emergency contraception, and Plan B in particular? The first consideration deals with Plan B’s mechanism of action. Is there sufficient moral certitude that Plan B is not abortifacient? In other words, do the results of scientific research on how Plan B works rise to the level of moral certitude? Given the mounting evidence from the scientific literature that Plan B does not prevent implantation, there does seem to be moral certitude, of the imperfect kind, about the mechanism of action. It is, of course, theoretically possible that all of the studies that have been done could be mistaken, but this is not likely. Hence, if these scientific studies are correct, then Plan B is consistent with Directive 36 which states that a woman who has been sexually assaulted may be “treated with medications that would prevent ovulation, sperm capacitation, or fertilization.”¹⁶ Thus its use would not be prohibited by what follows in Directive 36: “It is not permissible, however, to initiate or to recommend treatments that have as their purpose or direct effect the removal, destruction, or interference with the implantation of a fertilized ovum.”¹⁷ Targeting implantation is not the purpose or direct effect of Plan B. Rather, its purpose and direct effect is to interfere with ovulation.

Second, is there moral certitude that a fertilized ovum will not be destroyed? Some argue that in order for moral certitude to be present, the woman who has been sexually assaulted must undergo an ovulation test to ensure that she is not at or around the time of ovulation such that she could become pregnant from the rape. For example, one advocate of ovulation testing says: “[C]atholic hospitals must have moral certitude that the possibility of an abortion is excluded. The ovulation test provides this certainty. … Therefore, moral certitude can be achieved only through the administration of the [luteinizing hormone] test. To administer emergency contraception when there is insufficient information as to its effect on the specific patient in question is not only morally illicit but medically unsound.”¹⁸

Given what has been said about Plan B’s mechanism of action, such testing is not required to achieve moral certitude. Furthermore, moral certitude in these situations is strengthened by the fact that the incidence of a pregnancy after rape is between <1 percent and 5 percent. Typically the estimate is put at about 3 percent.¹⁹ Given the scientific evidence regarding Plan B’s mechanism of action and the high probability that there is no fertilized egg present subsequent to the sexual assault, the requisite moral certitude exists that a fertilized ovum would not be destroyed by the administration of Plan B.

Finally, it is generally maintained in textbooks of moral theology that when human life is involved, one should always take the safer course. This is sometimes illustrated by the example of the hunter in the woods who sees movement behind bushes. Is the hunter free to shoot, believing that the movement results from a deer? The response in the manuals is no, because the movement could be caused by another hunter. Unless the hunter can resolve his doubt, the hunter must take the safer course and not shoot. This example might suggest that Catholic hospitals must not use emergency contraceptive medications at all in the belief that they might have an abortifacient effect — or, at least, that hospital personnel do as much as they can to reduce the possibility there might be an egg present that could be or might have been fertilized. They would do this by testing for ovulation.

In the situation under consideration, if there were a likelihood that a fertilized egg were present and if there were a likelihood that Plan B has an abortifacient effect, then the example and the obligation to take the safer course would be applicable. However, neither of these conditions is the case, because there is virtually no evidence that Plan B is abortifacient and, in cases of sexual assault, there is a very high probability that there is no fertilized egg present.²⁰ Hence, there does not seem to be an obligation to take the safer course. If one were obliged to take the safer course in these situations, in order to be consistent, one would also have to take the safer course in many of life’s other activities (e.g., driving one’s car, flying in a plane) as well as in the practice of medicine generally (e.g., agreeing to a surgery with a 25 percent risk of dying, undergoing chemotherapy that could have a lethal effect).

The administration of emergency contraception to women who have been sexually assaulted is a matter of utmost seriousness since it touches on human life. It is also a matter of utmost seriousness because it touches on the well-being of women who have been subjected to one of the most heinous of crimes. Any decision about whether or not to permit the dispensing of emergency contraceptive medications in Catholic hospitals and about the protocols for their administration has profound consequences.

Those who make such decisions, whether bishops, hospital executives, emergency room physicians, nurses or others, have a grave moral obligation to take seriously one of the first rules in making good ethical judgments, namely, to obtain adequate and accurate information about the matter at hand. To do any less is not only to shortchange the moral process, but also to risk significant harm to others. And once the best possible information is obtained, those making the decisions need to keep in mind that the use of emergency contraception for women who have been sexually assaulted is a matter about which moral certitude is sufficient. Given what is currently known about Plan B from scientific research, Catholic hospitals can respond with sensitivity, compassion and assistance to women who have been raped and are in need of care, while being confident that they are also remaining true to Catholicism’s fundamental commitment to respect for human life.

NOTES

1. If ovulation testing determines that the woman is at or around the time of ovulation, generally emergency contraception would not be administered out of concern that a possible abortifacient effect of the medication could result in the loss of an embryo.
2. Pontifical Academy for Life, “Statement on the So-Called ‘Morning-After Pill,’” (October 31, 2000), http://www.vatican.va/roman_curia/pontifical_academies/acdlife/documents/
   rc_pa_acdlife_doc_20001031_pillola-giorno-dopo_en.html
3. For information about the mechanism of action of emergency contraceptive medications generally: www.chausa.org/ECmedicationsReview; for information about Plan B’s mechanism of action: www.chausa.org/LevonorgestrelReview.
4. Nicanor Pier Giorgio Austriaco, “Is Plan B Abortifacient? A Critical Look at the Scientific Evidence,” The National Catholic Bioethics Quarterly 7, no. 4 (Winter 2007): 707.
5. Nicanor Pier Georgio Austriaco, “Colloquy: More on Plan B — Fr. Austriaco Replies,” The National Catholic Bioethics Quarterly 8, no. 3 (Winter 2008): 421-25.
6. Austriaco, 422.
7. Austriaco.
8. Austriaco, 423.
9. Austriaco.
10. Chun-Xia Meng et al., “Effect of Levonorgestrel and Mifepristone on Endometrial Receptivity Markers in a Three-Dimensional Human Endometrial Cell Culture Model,” Fertility and Sterility 91, no. 1 (2009): 256-64; Natalia Novikova et al., “Effectiveness of Levonorgestrel Emergency Contraception Given Before or After Ovulation: A Pilot Study,” Contraception 75, no. 2 (2007): 112-18. The immoral, but important study to which Austriaco refers is P.G.L. Lalitkumar et al., “Mifepristone, But Not Levonorgestrel, Inhibits Human Blastocyst Attachment to an In Vitro Endometrial Three-Dimensional Cell Culture Model,” Human Reproduction 22, no. 11 (2007): 3031-37.
11. Austriaco.
12. Austriaco, 424.
13. Austriaco, “Is Plan B Abortifacient?”, 707.
14. Thomas Slater, SJ, A Manual of Moral Theology, (New York: Benziger Brothers, 1925), 1:31.
15. Slater, 1:31-32.
16. United States Conference of Catholic Bishops, The Ethical and Religious Directives for Catholic Health Care Services, (Washington, D.C.: USCCB, 2001), Directive 36.
17. United States Conference of Catholic Bishops.
18. Marie Hilliard, “Dignitas Personae and Emergency Contraception,” Ethics and Medics 34, no. 2 (February 2009): 4.
19. Melisa M. Holmes, et al., “Rape-Related Pregnancy: Estimates and Descriptive Characteristics from a National Sample of Women,” American Journal of Obstetrics and Gynecology 175 (August 1996): 320.
20. Gerald McShane, et al., “Pregnancy Prevention after Sexual Assault,” in Peter Cataldo and Albert Moraczewski, eds., Catholic Health Care Ethics: A Manual for Ethics Committees, (Boston: The National Catholic Bioethics Center, 2001), 11, 16-17.

RON HAMEL is senior director, ethics, Catholic Health Association, St. Louis. Write to him at rhamel@chausa.org.

It appears Baltimore has found a solution to an issue that affects women seeking reproductive care across the United States. A disclaimer law would be a start at reducing the number of women who are unable to get the care they seek at a CPC.  Service agencies should not dupe the people who come to them seeking comprehensive care. This law would address just that issue.

This post first appears on RH Reality Check.   From Jenny Blasdell and John Nugent’s blog.

Imagine a friend of yours, a pregnant woman, walks into an office seeking information about her pregnancy. Only, it’s not a doctor’s office and they’re not going to tell her the truth.  Unfortunately, this happens every day across the United States.

Everyone can agree that women seeking information about pregnancy, birth control, abortion, or sexually transmitted diseases should receive timely and accurate information, not false political propaganda.  But there are facilities out there that spread misinformation about abortion and birth control in an effort to dissuade women from exploring those options.   These are known as limited service pregnancy centers or crisis pregnancy centers (CPCs).

In Baltimore and around the country, many facilities have neutral sounding names like “Center for Pregnancy Concerns.”  Sounds like a place you could get information or services for your pregnancy concerns, right?  Wrong.  Volunteers who visited these centers were told falsehoods like abortion increases your risk of breast cancer, that natural family planning is as effective as the pill, and that condoms do not protect against sexually transmitted diseases (STDs).  CPCs are concerned alright, but not about what’s in the best interest of women’s health.  They’re concerned with preventing women from exploring their full range of options to protect against unplanned pregnancy and STDs.

CPCs do not always disclose information about the limitations of services or their anti-choice agendas in their advertising, particularly their beliefs about birth control.  Low-cost birth control has been proven to be the most effective way to decrease the need for abortion, yet CPCs give false information about the safety and effectiveness of contraceptives.  Moreover, not a single CPC in Baltimore City contacted by NARAL Pro-Choice Maryland Fund volunteers would provide a referral for comprehensive birth control.

That’s why this week Baltimore City Council President Stephanie Rawlings-Blake introduced the Limited-Service Pregnancy Centers Disclaimer Bill.  Co-sponsored by ten other council members, this bill is a common sense measure that will ensure that women visiting a Baltimore CPC are informed that they will not receive comprehensive birth control or abortion services or referrals.  The measure does not ask CPCs to provide services they find objectionable.  It only asks them to be honest and straightforward with the women, so that they know up front whether the facility will suit their needs.  Having a more complete picture about the services that are and are not offered will also help provide a context for information they do receive.   The goal of this bill is to empower women to make decisions about their care, and decide if a so-called “Center for Pregnancy Concern” is, well, concerned about the same things as they are.

This bill is an exciting step in Maryland.  Although Maryland introduced a statewide bill to regulate CPCs in 2008, the bill, like all pro-choice bills in the last eleven years in our state, did not move forward.  But localities around the country have been enacting laws and policies to strengthen the reproductive rights of women.  For example, Pittsburgh enacted a buffer zone protecting patients entering reproductive health care facilities.  And Madison, Wisconsin created an ordinance requiring pharmacies to let customers know when emergency contraception is not available.

NARAL Pro-Choice Maryland and Planned Parenthood of Maryland are committed to ensuring that every woman has the best medical care possible – from birth control to prenatal vitamins, from pre-conception care to labor and delivery.  We have no objection to a center that offers women who have decided to carry their pregnancies to term any help they like.  But lines are crossed when a CPC is not up front about their services, or when a center misleads women. 

The Limited Service Pregnancy Centers Disclaimers Bill simply asks that Baltimore CPCs disclose what is true – that they do not provide or refer for comprehensive birth control services or abortion so that women know up front whether the facility suits their needs.   We believe this bill to be a common sense approach to a goal we all share – getting women the care they need. 

From Jenny Blasdell and John Nugent’s blog

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Our share of these costs comes out of our paychecks before we receive them. Are we paying attention to how much it is costing to provide health insurance for families in 2009?

These numbers jumped out of the page when I read Drew Altman’s article on the cost of employer provided health insurance. The projection for those costs to rise in the next 10 years reinforced for me the need for health care reform NOW.

Simple Arithmetic by Dr Drew Altman

This week we put out our annual benchmark survey of employer health coverage and costs. Two numbers jumped off the pages.

The first number was the average cost of a family health insurance policy in 2009: $13,375. To put that number in context, if you are an employer, you can hire an employee at the minimum wage for about $15,000 per year. If you are a consumer, you can rent an average two-bedroom apartment nationwide for $11,136 per year (though it is quite a bit more here in Menlo Park, California where our Foundation is based). You can also buy a new Chevy Aveo for $12,000, and it gets 35 miles per gallon on the highway.

The other result that jumped off the page was the stark contrast between increases in health insurance premiums and overall inflation in the general economy. Premiums went up 5% and prices overall fell 0.7% (mainly driven by a big drop-off in energy prices).

The 5% increase we found in premiums is moderate by long-term historical standards. For example, two different times during the last decade premiums increased by 13% a year, in 2002 and 2003. This year’s increase continues a multi-year period of relative moderation in premium increases. Still, over the last ten years premiums have increased by 131%, while wages have grown 38% and inflation has grown 28%. Consider this: If people (and businesses) are as concerned as they are now about rising health care costs in a period when they are actually moderating, how much more concerned will they be when rates of increase return to historic averages?

Let’s do some very simple arithmetic. Start with a fairly conservative assumption: If we assume that premium increases over the next ten years will average what they did over the last five (about 6.1% per year), the average premium for a family policy in 2019 will be $24,180. That’s a big number. On the other hand, if we assume increases revert to the average of the last ten years—an average annual increase of about 8.7% and a very plausible scenario—premiums in 2019 will average a whopping $30,803, a very scary number (Figure 1).

So many young women who have a teen pregnancy find it daunting to think of completing their education. There seem to be many barriers – time, support, money, good child care, etc. But completing their education is the second most important thing they can do for themselves and their children. (The first most important issue is to obtain adequate health and medical care for mom and for baby.)This book supports, encourages and identifies young women who met the challenge and obtained higher education after experiencing a teen pregnancy.  Education breaks the cycle of poverty; it enhances the potential for adequate income, health insurance, job security and a better life for her and for her child.

It happened again with a different person today — another donation because protesters were standing in front of the family planning clinic in Wausau.

It has been hard for FPHS staff, myself included, to understand the protests outside the clinic because we know that we provide caring, compassionate voluntary contraceptive care that prevents unintended pregnancy (and care that helps people take responsibility for their reproductive health including planning for healthy pregnancies when they are ready.)

Having two supporters take the time and make a gift to show their support for us and our services, makes all of us feel appreciated. I’d like to invite all of you to drive through (maybe pick up some condoms) or, if there’s no line, just tell the staff at the window that you support family planning.

I’m sure that there are many times when people speak up for access to birth control when it isn’t easy. To those who do, “THANK YOU!!”