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!

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).

Throughout rural America, there are nearly 50 million people who face challenges in accessing health care. The past several decades have consistently shown higher rates of poverty, mortality, uninsurance, and limited access to a primary health care provider in rural areas. With the recent economic downturn, there is potential for an increase in many of the health disparities and access concerns that are already elevated in rural communities. Hard Times in the Heartland provides insight into the current state of health care in rural areas and the critical need for health care reform.

Health Care and the Rural Economy

High poverty rates and job loss in the current economic
recession highlight the challenges of accessing health care
and rising health care costs in rural areas.

Rates of poverty are higher, with 15% of people in rural areas
living below the poverty level compared to 12% of people in
urban areas.1
The rural economy is dominated by small businesses,
which are struggling as the cost of health care continues to skyrocket.

In the current recession, the rural economy is losing jobs
at a faster rate than the rest of the nation, and loss of jobs
can lead to loss of health coverage. In particular, rural
communities dependent on manufacturing have lost nearly
5% of their jobs since the recession began – and these are jobs
that offer some of the best benefits.3

Limited Coverage and Burdensome Costs

Many rural residents work part-time, seasonally, or for
themselves, making them less likely to have private,
employer-sponsored health care benefits.

A multi-state survey of farm and ranch operators found that
while 90% of farmers have insurance coverage, one-third
purchased it directly through an insurance agent (compared
to the national average of 8%).4
Nearly one in five of the uninsured – 8.5 million people –
live in rural areas. This problem is worse for rural minority
populations, the rural poor, and those with less than a high
school education.5
Rural residents spend more on health care out of pocket
than their urban counterparts. Indeed, one in five rural
residents spends more than $1,000 out of pocket in a year,6
and rural residents pay on average for 40% of their health
care costs out of their own pocket, compared with the urban
share of one-third.7
The high costs of health care hit farmers particularly hard.
In a multi-state survey, one in five insured farmers had
medical debt,8 and in one state, farmers who purchased an
individual health plan spent an average of $2,117 more than
their colleagues who were able to purchase through a group
plan.9
As a result, rural adults are more likely than urban adults
to report having deferred care because of cost (15%
versus 13%). This problem is worse among rural minority
populations, who are twice as likely to have deferred care in
the past year as rural whites.10

The Need for More Health Care Providers

Along with comprehensive and affordable coverage,
access to high quality providers is also a key component
of obtaining high quality care. Rural areas continue
to suffer from a lack of diverse providers for their
communities’ health care needs.

There were 55 primary care physicians per 100,000
residents in rural areas in 2005, compared with 72 per
100,000 in urban areas.  This decreases to 36 per 100,000 in
isolated, small rural areas.11
There were half as many specialists per 100,000 residents in
rural areas compared with urban areas, and a third as many
psychiatrists.12
For persons of all ages who visited their usual care provider,
travel time was longer for rural than for urban patients.
Fourteen percent of rural patients traveled more than 30
minutes, while only 10% of urban patients did so.13
The problems of a thin provider workforce can be expected
to worsen if action is not taken. Rural areas have a higher
percent of physician generalists nearing retirement than
urban areas, and recruitment and retention continue to be a
challenge.14

Disparities in Health Need To Be Addressed

A scant provider network, lack of adequate and affordable
health coverage, and difficulty accessing high-quality care
can lead to worse health among rural populations.

The percentage of diabetes patients who received all three
recommended exams for diabetes is lower for patients in rural
areas than in metropolitan areas (32% versus 42%). Perhaps
as a result, rates of admissions for uncontrolled diabetes are
higher among residents of rural areas.15
Rural women are less likely than urban women to be in
compliance with mammogram screening guidelines (71%
versus 78%), and are less likely to have had a pap smear done
within the past three years (86% versus 91%).16
Rural residents are more likely to report fair to poor health
status than urban residents,17 and are more likely to have
experienced a limitation of activity caused by chronic
conditions than urban residents.18
Obesity is more common among rural residents (27%) than
urban residents (24%), as are diabetes,19  heart disease, and
high blood pressure.20

Comprehensive health reform is needed to bring affordable,
high quality health care to these populations that need it
most.

Sources

Report Prepared By

Meena Seshamani, MD, PhD
Joan Van Nostrand, PhD
Jenna Kennedy, BA
Carrie Cochran, MPA

Analysis and support provided by the Rural Health Research Centers

Report Production by the HHS Web Communications and New Media Division
1 DeNavas-Walt, C., Proctor, B. D., and Smith, J. C. (2008.) U.S. Census Bureau. “Current
Population Reports, P60-235, Income, Poverty, and Health Insurance Coverage in the United
States: 2007.” Washington, DC: U.S. Government Printing Office.
2 Ziller, E. C., Coburn, A. F., & Yousefian, A. E. “Out-of-pocket health spending and the rural
underinsured.” Health Affairs, Nov/Dec 2006; 25(6), 1688-1699.  See also “Helping the Bottom
Line:  Health Reform and Small Business” (2009). U.S. Department of Health and Human
Services. http://www.healthreform.gov/reports/helpbottomline/
3 Drabenstott, Mark and Moore, Sean. (March 2009). “Rural America in Deep Downturn: A RUPRI
Rural Economic Update.” RUPRI Center for Regional Competitiveness: Kansas City, MO.
4 The Access Project. (Sept. 2007). “Issue Brief: 2007 Health Insurance Survey of Farm and Ranch
Operators.” http://www.accessproject.org/adobe/issue_brief_no_1.pdf
5 Center for Financing, Access and Cost Trends, Agency for Healthcare Research and Quality,
Medical Expenditure Panel Survey, 2006.
6 Ziller, E. C., Coburn, A. F., & Yousefian, A. E. “Out-of-pocket health spending and the rural
underinsured.” Health Affairs, Nov/Dec 2006; 25(6), 1688-1699.
7 Ziller, E. C., Coburn, A. F., & Yousefian, A. E. “Out-of-pocket health spending and the rural
underinsured.” Health Affairs, Nov/Dec 2006; 25(6), 1688-1699.
8 The Access Project. (Sept. 2007). “Issue Brief: 2007 Health Insurance Survey of Farm and Ranch
Operators.” http://www.accessproject.org/adobe/issue_brief_no_1.pdf
9 Dohogne, Aaron. (Sept. 2008).  “Survey recommends remedies for farmers’ high insurance rates.”
The Missourian. http://www.columbiamissourian.com/stories/2008/09/26/missouri-farmers-
paying-more-individual-healthcare-insurance/
10 Bennett, K. J., Olatosi, B., & Probst, J.C. (2008). “Health Disparities: A Rural – Urban Chartbook.”
South Carolina Rural Health Research Center.
11 Fordyce MA, Chen FM, Doescher MP, Hart LG. (2007). 2005 physician supply and distribution in
rural areas of the United States. Final Report #116. Seattle, WA: WWAMI Rural Health Research
Center, University of Washington.
12  Fordyce MA, Chen FM, Doescher MP, Hart LG. (2007). 2005 physician supply and distribution in
rural areas of the United States. Final Report #116. Seattle, WA: WWAMI Rural Health Research
Center, University of Washington.
13 Agency for Healthcare Research and Quality, 2006 Medical Expenditure Panel Survey.
Calculations By Maine Rural Health Research Center.
14 WWAMI Rural Health Research Center. Aging of the rural generalist workforce. Seattle, WA:
WWAMI Rural Health Research Center, University of Washington; in press.
15 Health Care in Urban and Rural Areas, Combined Years 2004-2006. Update of Content in MEPS
Chartbook No. 13. Agency for Health Care Policy and Research, Rockville, MD. http://www.ahrq.
gov/data/meps/chbook13up.htm
16 Bennett, K. J., Olatosi, B., & Probst, J.C. (2008). “Health Disparities: A Rural – Urban Chartbook.”
South Carolina Rural Health Research Center.
17 Center for Financing, Access and Cost Trends, Agency for Healthcare Research and Quality,
Medical Expenditure Panel Survey, 2006.
18 Bennett, K. J., Olatosi, B., & Probst, J.C. (2008). “Health Disparities: A Rural – Urban Chartbook.”
South Carolina Rural Health Research Center.
19 Bennett, K. J., Olatosi, B., & Probst, J.C. (2008). “Health Disparities: A Rural – Urban Chartbook.”
South Carolina Rural Health Research Center.
20 Pleis JR, Lethbridge-Çejku M. Summary health statistics for U.S. adults: National Health Interview
Survey, 2006. National Center for Health Statistics. Vital Health Stat 10(235). 2007.

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.

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!!”

A few examples of what these damaging amendments propose:

* Require doctors to disseminate information that is not supported by science to women seeking pregnancy-related care, including abortion.
* Require parental consent for students who get services at school-based clinics.
* Violate patients’ rights and erode clinicians’ duties to their patients by encroaching on the right to receive health services and information, including contraception, fertility services and other health care necessary to meet established medical standards of care.
* Impose barriers to health care for immigrants by requiring that they be citizens for five years before participating in certain programs.
* Establish a program to promote crisis pregnancy centers that withhold full, accurate information about options from women facing an unintended pregnancy, and in some cases use deceptive, inaccurate and even intimindating tactics to influence their decisions.
* Scale back substantially the effort to strengthen and restore authority to the Office of Women’s Health that we depend on to provide leadership, expertise and guidance on women’s health concerns within the Department of Health & Human Services.

TAKE ACTION  Please urge the members of the Senate HELP Committee to vote against all amendments that threaten women’s health. Contact them as soon as possible, so your thoughts may be considered during the mark-up process.

Email your comments to help_comments@help.senate.gov and we encourage copying your own congressional delegation on the message as well. In addition, please copy info@raisingwomensvoices.net  so we know how many of you have raised your voices for quality, affordable health care that meets women’s needs!
Let them know that you want their leadership in establishing quality, affordable health care for all women and that you want to see the bill go forward without damaging amendments like the ones being offered by Senators Coburn, Enzi and Hatch.

Written by Elizabeth Alexander of the ACLU’s National Prison Project. 

Shackling pregnant women during active labor and childbirth is, unfortunately, all too common in our nation’s prisons and jails. One such victim of this practice was Shawanna Nelson, who entered the Arkansas prison system when she was six months’ pregnant, with a short sentence for a non-violent crime. When she went into labor, the correctional officer accompanying her shackled her legs to opposite sides of the bed, and removed the shackles only long enough for the nurses to examine her. Ms. Nelson remained with both her legs shackled to the bed until she was taken to the delivery room, and she was re-shackled immediately after the birth of her son, who weighed almost ten pounds. The shackles caused Ms. Nelson to suffer cramps and intense pain, as she could not adjust her position during contractions. After childbirth, the use of shackles caused her to soil the sheets, because she could not be unshackled quickly enough to get to a bathroom. The correctional officer knew that Ms. Nelson was not a flight risk, and knew that the restraints caused pain and unsanitary conditions. According to expert obstetricians, shackling women during labor is inherently dangerous.

A federal district judge ruled that a jury should decide whether Ms. Nelson’s treatment violated the Eighth Amendment, but the defendants appealed to the 8th Circuit Court of Appeals. A three-judge panel reversed the district court and dismissed Ms. Nelson’s case. With the help of the ACLU’s National Prison Project (NPP), Ms. Nelson was able to persuade the court of appeals to grant rehearing before the entire court and in September 2008 NPP staff argued on Ms. Nelson’s behalf that her case should go to trial. We await a decision.

Meanwhile, the ACLU works to persuade prisons and jails to end this barbaric practice. The National Prison Project, together with the ACLU’s Reproductive Freedom Project, the Women’s Rights Project, and many of our state affiliates are part of a national coalition advocating for changes in policy and law at the federal and state level. To date, the Federal Bureau of Prisons and the U.S. Marshals’ Service have both issued policies severely limiting the shackling of pregnant women and several state legislatures are now considering bills to limit or end the practice. Our policy and advocacy work continues to raise national awareness about efforts to ban shackling of pregnant women prisoners across the country. In addition we continue to negotiate with Immigration and Customs Enforcement to ensure that pregnant women held as immigration detainees in federal, state and local facilities are not subject to this cruel and degrading practice.

Learn more about how pregnant women prisoners are treated in your state.

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.