On Tuesday we told you about the bishops’ campaign to contest the decision to make no-copay contraceptive coverage available to employees, including those working for Catholic institutions. This Department of Health and Human Services ruling was an important victory for the many women and men who need this coverage, especially during these tough economic times. With your help, this victory will actually reach the pocketbooks of American workers.

Right now, the Catholic voice reaching the White House is almost exclusively coming from conservative Catholics, including the US bishops and their allies. The media is continuing this misconception by running these reactions as a reflection of a monolithic Catholic outrage. These protests are not on behalf of employees’ conscience rights, and do not reflect most Catholics’ convictions or practice related to contraception. We need to speak up now and let the administration know that US Catholics support the right to choose contraception, just as they support no-copay coverage for employees’ contraception.

We need you to call and e-mail the White House today with a simple message: the bishops do not speak for me on contraceptive coverage.

Use our action center here to contact the White House today.

Remember to include a personal story in your e-mail to the White House. Your voice is needed now more than ever to preserve this great advance for the well-being of US workers.

We are also looking to share your stories as part of a campaign bring a different vision of Catholics into the spotlight: the experiences of Catholics like you who believe this contraception coverage supports employees’ freedom of conscience and should be available to all Americans, regardless of their employer.

Share your story to help combat the myth that contraceptive coverage is anti-Catholic.

Share your story online and send this link to others you know. There is no more effective way to educate policymakers and the media about the widespread Catholic support for equitable access to contraception.

If you would like more information, please contact Marissa Valeri at activists@catholicsforchoice.org or by phone at (202) 986-6093.

Thank you for taking action with Catholics for Choice. Please forward this alert to your friends, family, colleagues or any others who may be interested in getting active on this important issue.

Thanks for the fact check on the South Carolina Gingrich-versus-Romney ad ["Gingrich’s ‘Baloney’-filled Attacks on Romney," Jan. 11]. Confusing the public about emergency contraception pills (ECP) is deliberate, pervasive, and routinely served by opponents of contraception.

Although fact-checking the fact-checking seems tedious sometimes, it is important to explain that available research on Plan B One-Step (“the morning after pill”) shows that it prevents pregnancy by preventing ovulation and/or fertilization.

Ron Hamel, a Catholic ethicist publishing the conclusions of five years of scientific review in the January-February 2010 issue of Health Progress, said: ” … 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.”

One objection frequently repeated by Plan B opponents is that there is language in the pill package that the drug may prevent implantation. However, Nicanor Pier Giorgio Austriaco, a priest, theologian, and scientist also studied the active drug’s effects and determined that it has no post-fertilization effect. On the argument of labeling, he stated that: “ … labels mean nothing without the scientific data to back up their claims.”

These conclusions are reinforced in the 2010 World Health Organization’s fact-sheet on levonogestrel (LNG) which states: “… LNG ECP use does not prevent a fertilized egg from attaching to the uterine lining.”

The important answer to the question on emergency contraception is that there cannot be an abortion before there is a pregnancy; therefore, preventing unwanted pregnancies prevents abortions. But even if you believe pregnancy is the same as fertilization, you no longer have to put up with the warmed-over baloney that Plan B is an “abortion pill.”

Thanks, again, for your excellent work.

Lon Newman
Executive director, Family Planning Health Services
Wausau, Wisc.

“I regret that HHS has stepped in and overridden the FDA’s long-overdue decision to remove the unnecessary age restriction on Plan B One-Step emergency contraception,” said Rep. Gwen Moore. “The FDA’s proposal would have meant that emergency contraception would be brought out from behind the pharmacy counter, onto the shelves with other similar contraceptive methods. Medical experts, including the American Academy of Pediatrics, agree that Plan B is perfectly safe for over-the-counter use for anyone at risk of an unintended pregnancy, including younger women. I fervently hope that HHS is not putting politics or ideology over science in their decision.” 

Plan B One-Step is a safe and effective emergency contraceptive that is meant to be taken within 72 hours after contraceptive failure or unprotected intercourse. Plan B prevents fertilization from happening, and does not work if the woman is already pregnant.

“I thought we could all agree on the importance preventing unintended pregnancy, especially among teenagers,” said Rep. Moore. For the past few years, my home city of Milwaukee has worked very hard to reduce our epidemic teen birth rate. We’ve seen a 15% drop since 2005, when our teen birth rate was second in the nation only to Baltimore. But we still have a long way to go. A recent study released by United Way of Greater Milwaukee showed that statutory rape is among our biggest challenges to reducing teen pregnancy. Seventy-one percent of babies born to Milwaukee’s teenage girls were fathered by men at least 20 years of age. These pregnancies have serious consequences not only for these young women—who often experience tremendous isolation and vulnerability—but for their communities at large. Decisions like the one made today by HHS will only exacerbate the problem in places like Milwaukee.”

The Catholic Church says new federalregulations requiring employers to provide no-cost prescription birth control as part of their health insurance plans infringe on their religious liberty.

“If we comply, as the law requires, we will be helping our students do things that we teach them, in our classes and in our sacraments, are sinful — sometimes gravely so,” Catholic University President John Garvey wrote in The Washington Post. “It seems to us that a proper respect for religious liberty would warrant an exemption for our university and other institutions like it.”

But while some insist that the rules, which spring from last year’s health law, break new ground, many states as well as federal civil rights law already require most religious employers to cover prescription contraceptives if they provide coverage of other prescription drugs.

While some religious employers take advantage of loopholes or religious exemptions, the fact remains that dozens of Catholic hospitals and universities currently offer contraceptive coverage as part of their health insurance packages.

“We’ve always had contraceptive birth control included in our health care benefits,” said Michelle Michaud, a labor and delivery nurse at Dominican Hospital in Santa Cruz, Calif. “It’s something that we’ve come to expect for ourselves and our family.”

Dominican is part of the Catholic Healthcare West System. A spokeswoman for the 40-hospital chain confirmed that it has offered the benefits since 1997.

Michaud, who was raised Catholic but doesn’t practice now, says she doesn’t see any problem for a Catholic hospital to provide a benefit that conflicts with the religion’s teachings.

“Oh no, because they don’t just employ Catholics,” she said. “They may be Catholic, but who they employ are not necessarily Catholic.” At the same time, said Michaud, “even practicing Catholics would want to have birth control options.”

Indeed, studies have shown that the vast majority of Catholic women in the U.S. use artificial birth control.

But while Catholic Healthcare West began offering coverage before it was legally required, today the landscape is quite different. According to the National Women’s Law Center, 28 states currently require contraceptives to be offered in health plans that also cover other prescription drugs; eight of those laws include no exemption for religious organizations.

Georgetown University in Washington, D.C., also offers contraceptive coverage to its employees – though not to its students.

That’s a relief for Andrea Waters, who works at the university’s law school. She’s 26, Presbyterian and lives with her boyfriend.

Without the coverage, she says, “I think I’d have to reevaluate what I spend monthly” in order to afford birth control pills.

Now some religious employers have been able to skirt state requirements by becoming “self-insured,” rather than buying insurance from a company. That makes them subject to federal, rather than state regulation. But they are wrong if they think that gets them out of having to offer contraceptive coverage, says Sarah Lipton-Lubet of the American Civil Liberties Union.

“Institutions like hospitals and universities … you’re required to include contraception coverage in your insurance plan where you include coverage for other prescription drugs, as a matter of basic gender equality,” she says.

That’s the result of a ruling in 2000 by the federal Equal Employment Opportunity Commission. It found that employers whose health plans offer prescription drugs and other preventive services but not contraceptives violated the Pregnancy Discrimination Act, 1978 civil rights law that amended the 1964 Civil Rights Act.

And what does contraception have to do with pregnancy discrimination? “Prescription contraception is a form of health care that is unique to women, and the consequences of the inability to be able to access contraception, those fall primarily on women,” Lipton-Lubet says.

The EEOC ruling isn’t technically binding unless people who are being discriminated against take action. That happened recently when some faculty members at a small Catholic college in North Carolina filed a complaint. The EEOC ruled in their favor.

What the Catholic Church’s leaders are now seeking from President Obama is a broader exemption from the new rules, which would let them not offer — or stop offering — contraceptive coverage. They have the strong backing of Catholic members of Congress like Pennsylvania Republican Tim Murphy.

“The foundation of our country is not to impose laws that restrict the ability of persons to practice their faith,” he said.

But Lipton-Lubet of the ACLU says this isn’t a fight about religious liberty.

“What the bishops and their allies are asking for is the ability to impose their religious beliefs on people who don’t share them,” she said.

A decision by the administration on the rules is expected soon.

The Obama administration has announced that starting as early as August of next year, many women will have coverage for contraception with no out-of-pocket costs. At the same time, many other women will be denied this coverage.

Understandably, the focus of the debate has been on the coverage, not the denial of coverage. But in the midst of the maelstrom surrounding the announcement by the Department of Health and Human Services (HHS) about new regulations for coverage of women’s preventive services, it is easy to forget that these are the facts as they currently stand. Sadly, the many women left behind by these regulations, those working for religious employers, have had their voices drowned out both by extremists opposed to all birth control and those ordering them to remain seated silently at the back of the bus—unseen and unheard as the limelight shines on the positive step for those women who will benefit.

Not surprisingly, the Catholic bishops have a hand in this debacle. Once again, the bishops and their allies seek to impose a refusal clause exempting some employers from having to follow the new and needed increase in coverage. Having failed to convince Catholics in the pews to follow their hard-line ban on all contraception, the bishops are ignoring the consciences of those who work for them by seeking to impose their extremist beliefs on all women, Catholic or otherwise.

As they assure pundits and policymakers that they have the right to determine what healthcare is best for others, the bishops and other conservative Catholics have hardly concealed their outright disdain for their own employees—those who work in diocesan offices, teach in Catholic schools and otherwise serve the Catholic community. Indeed, the head of the Catholic Health Association (CHA), Sr. Carol Keehan, went so far as to imply that the effect of these refusal clauses is somehow minimal by (erroneously) calling it “only” the “parish housekeeper exemption.”

It is disgraceful that the spokespeople for a faith that prioritizes the primacy of individual conscience would be so willing to trample the consciences of others, no matter the cost. It is disgraceful that the head of an organization supposedly committed to social justice would unabashedly look down her nose at a fellow human being simply because of that woman’s occupation. It is disgraceful that some reproductive justice advocates have thrown “the parish housekeepers” and other women affected by these exemptions under the bus. Simply put, they have all accepted a second-class citizenship designation for parish housekeepers and other employees of the church.

Downright discriminatory, however, is the fact that the Obama administration is willing to write all of this extremism into public policy.

In the summer of 2009, we outlined our hopes for what healthcare reform would look like. We believed then, as we believe now, that all women and men, regardless of income, should be able to access contraception that is not only affordable, but free. At the core of this belief is a sincere adherence to our faith’s respect for the primacy of every person’s conscience. Given the Obama administration’s professed commitment to healthcare reform that would be both cost-effective and that would guarantee equitable access, we hoped that those in power would share this belief.

The refusal clauses included in HHS’s regulations for contraception mean that the plan is fundamentally flawed. No person should be left behind in these steps forward, but the proposed regulations will do just that.

One woman who would be left behind is “Sandra,” a science teacher at a Catholic school in the Midwest whose story shows the reality of what many women can see in their future—and is an example of the many who will fall under the type of employer refusal clause that the bishops hope to extend to all.

As with almost all Catholic schools, her employers follow diocesan rules regarding employees’ insurance—meaning no contraceptive coverage, regardless of medical necessity. When she first learned of HHS’s regulations she was outraged. They added, as she explained, “insult to injury” by ignoring the healthcare needs of women like her and allowing her employers to continue denying her coverage.

“I just never assumed that in 2011 I would be denied birth control,” she said. “I’m in my mid-twenties. I have no intention of having kids at the moment. I like teaching kids, but it’s a whole other thing having them.”

“Sandra” lost coverage when she began working under the jurisdiction of her local diocese. “I went to fill my birth control prescription like I always do. I say ‘here’s my new insurance card,’ and they say I’m not covered,” she said. “They thought that it was weird and asked where I worked, and as soon as I said I worked in a Catholic school, they said, ‘Oh, 99 percent of Catholic schools will not cover it. We’ve never had it covered before.’ I had no clue.”

For “Sandra,” this posed a significant hardship. She had taken a salary reduction in order “to go to work everyday saying that it’s what I love” to do. She and her husband had carefully considered their insurance plans and determined that it was more economical for them to remain on separate policies, but once she had to pay out of pocket for the birth control that was best for her, a non-generic brand prescription, their careful financial planning went down the tubes.

“Birth control is a lot of extra money on top of the salary reduction, but the principle of it is really what gets me,” she told us. “I don’t like being told by some guy that I’ve never met that I can’t use it. The bishops are not even having sex in the first place. How are they supposed to know how to tell me what to do in that situation?”

Her story, as she recognized, is all too common and reflects the repeated marginalization of many women by the Catholic hierarchy—the same women whose voices have been deemed unimportant by those on both sides of the contraceptive coverage debate. She first noticed this silencing in her own Catholic home, where her devout grandmother and aunts all used birth control but were “quiet about it, because we didn’t want to anger the boys in the big house.”

With the bishops failing to convince Catholics in her own family, like the majority of Catholics, of their extremist views on birth control, “Sandra” saw the consequences of this extremism on her colleagues, Catholic and non-Catholic alike.

“Most of the girls, the first thing they complain about is the lack of birth control coverage. It’s one of those unspoken things that no one talks about, because no one wants to risk their job—it’s hard enough to find a job right now, anyway,” she said. “You also don’t have to be Catholic to work at a Catholic school. I respect the beliefs of some of the parents in our school and others, but for those who don’t believe that or who aren’t Catholic, I think that as your own person, you should be able to do what you believe.”

As she explained, the majority of Catholic school teachers are female, but their access to contraception is determined by those most out of touch with their healthcare needs. The cost, however—and the emotional toll of an unspoken vow of silence—extend far beyond this direct impact on teachers. In “Sandra’s” experience, for the spouses of male teachers, some of whom share their husbands’ insurance policies, and for all teachers’ dependents, some of whom need birth control to regulate medical conditions, the complete lack of access poses a serious hardship.

In the course of telling her story, this one teacher outlined in chilling detail the ways in which the bishops’ own failure to convince Catholics in the pews has translated into their forceful imposition of extremist beliefs on everybody. It is the same story that the bishops hope all women will share, and Obama’s Department of Health and Human Services seems quite willing to let this happen. These refusal clauses do not represent the vision for the Affordable Care Act that we were promised, and we hope that it is not one that the Obama administration is willing to accept.

There is still time for Secretary Sebelius and the Department of Health and Human Services to do the right thing for “Sandra,” her family, her colleagues, their families and the many others who are relying on healthcare reform to ensure contraceptive coverage for all women. While some are busy claiming that this woman and others like her are unimportant, we know better.

We believe that each woman—her conscience, and her health—matters, and we know that if we do not stand in solidarity with every one, we will not only compromise our morality, but we will eventually lose coverage for all. We also know that there are many others, Catholic and otherwise, men and women, who share this conviction. HHS must hear from these people who need to argue strongly and consistently that leaving any person behind is unacceptable.

“Sandra,” whose anonymity was required because speaking up about birth control coverage could mean the loss of her job, may have said it best: “I was told by everybody, ‘What can you do about it? The church is never going to change.’ If it’s just me whining about it, that’s true, but if every woman said something, they’d have to take us into account.”

We are certainly taking her into account. It is high time for others to speak up and tell the Department of Health and Human Services to do the same.

It used to be that opposition to publicly funded birth control was linked to abortion.

Either the birth control in question allegedly caused abortion, or the organization providing the birth control (read: Planned Parenthood) also performed abortions. But that’s changing.

These days, more and more voices are opposing the provision of birth control for its own sake.

“They’ve called it preventative medicine. Preventative medicine,” said Rep. Steve King, R-Iowa, on the House floor last month, shortly after the Obama administration adopted the recommendations of an expert panel and agreed to add contraceptives to a list of services insurance plans will be required to provide without a deductible or copayment. “Well, if you apply that preventative medicine universally, what you end up with is you’ve prevented a generation. Preventing babies from being born is not medicine.”

Some opponents, like conservative commentator Sandy Rios, say subsidizing birth control is simply too expensive in an era of tight budgets. “We have $14 trillion in debt, and now we’re going to cover birth control?” she said on Fox News, adding, “Are we going to do pedicures and manicures as well? I think that would be a good idea.”

Others, such as Jeffrey Kuhner, president of the conservative Edmund Burke Institute, say birth control is no less than an affront to God. “In short, liberals want to create a world without God and sexual permissiveness is their battering ram. Promoting widespread contraception is essential to forging a pagan society based on consequence-free sex,” he wrote in an opinion piece for the Washington Times.

Still others, like Marjorie Dannenfelser, of the anti-abortion Susan B. Anthony List, insist that providing birth control doesn’t even work at preventing abortions.

“As the money (for family planning) goes up, so do the number of abortions,” she said. “We have not seen a reduction in abortions since the full funding of family planning. We have seen an escalation.”

But that’s simply not the case, says Emily Stewart, director of public policy for Planned Parenthood.

“Without a doubt, when women have access to birth control, it reduces unintended pregnancies,” Stewart said. “The truth is we need to do more. And Americans agree that we need to do more to improve access to birth control.”

Abortion opponents are correct that widespread access to birth control hasn’t eliminated abortions in the U.S. — although the number has declined considerably over the last two decades.

But supporters of birth control like Stewart say the reason is that there hasn’t been enough access to contraception. Funding for Title X, the federal government’s main family planning program, has largely remained flat — mostly due to abortion-related fights. So it hasn’t kept up with inflation or population growth. As a result, Stewart says, “millions and millions of Americans in need of publicly funded family planning services today are not getting access to family planning services.”

But Helen Alvare, a law professor at George Mason University, says she thinks there may be yet another reason why widespread use of birth control hasn’t brought down the rate of unintended pregnancy more dramatically – something economists call risk compensation.

“If you lower the cost of things, people will buy more of it,” she says. So “if you lower the cost of uncommitted sexual encounters, you completely dissociate sex from pregnancy and birth and a lifetime of child care. People will engage in more uncommitted sexual encounters.”

And because birth control is not perfect, and people don’t use it perfectly or consistently, she says, that will result in more unintended pregnancies.

Still, the question remains, why is it only now that objections to birth control are being raised in public? John Green, a political science professor who studies religion and politics at the University of Akron, says he thinks it has a lot to do with the recent battles over federal spending in general, and the new health law in particular.

“I think for a lot of conservative activists, it’s almost as if a bit of a threshold has been crossed in the debate,” he said. “Because they believe that at least in this area, the public sector has become a little larger than it should be and is threatening some of the basic values that they hold.”

But while calls to end federal funding for contraception may be on the rise, the public remains strongly on the other side, at least for now. A survey released last week by the Kaiser Family Foundation found two-thirds of respondents in favor of the new requirement for insurance plans to offer prescription birth control without a copay or deductible.

By Molly Skyles

Truman Index

Published: Thursday, August 18, 2011

Updated: Thursday, August 18, 2011 17:08

Margaret Sanger founded the American Birth Control League in 1921 to ensure every woman possesses the power and freedom to prevent pregnancy if she chooses. Ninety years later, this country has taken the next imperative step toward Sanger’s goal.

The U.S. Department of Health and Human Services recently approved new guidelines requiring health insurance plans to cover the entire cost of preventative services like birth control and voluntary sterilizations. This will take effect Aug. 1, 2012, according to an article on CNN.com.

Before arguments ensue, this column is not encouraging premarital sex. However, we must not be ignorant. No matter how much we pay in taxes toward sex education classes for children as young as kindergartners, intercourse outside of wedlock will occur. But, this new legislation will make the inevitable a little easier to manage.

The rationale behind free birth control is obvious — avoid unwanted pregnancies. In 2006, there were 2 million publicly funded births, 51 percent of which were results of unwanted pregnancies. This alone accounted for $11 billion in costs out of the public’s pocket, according to the Guttmacher Institute. Yes, there will be initial costs for providing these preventative services, but that is chump change compared to the $11 billion that could be saved if more people had feasible access to contraceptives.

While the topic of birth control often leads to a heated religious debate, we must set down our Bibles and look toward the logistics. In 2000, there were an estimated 1.3 million legal abortions performed in the U.S., a number that steadily has grown since Roe v. Wade in 1973, according to the Guttmacher Institute. Free birth control leads to fewer unwanted pregnancies, which leads to fewer abortions. This should be something all people, regardless of religious affiliation, look toward as positive. I don’t think anyone is pro-abortion, just pro-choice. Therefore, this new insurance plan allows for the best of both worlds.

There is more to the battle against birth control besides just the issue of abortion, though. Take the Duggar family from the well-known TLC show “19 Kids and Counting.” Jim Bob and Michelle Duggar are fundamentalists who have decided to let God control how many children they have. Have a big family if you so choose, but shouldn’t there be a limit? When your 19th child was born via emergency C- section weighing only 1 lb. and spent the first 6 months of her life on a ventilator due to a life-threatening illness, do you honestly think you’ll get that lucky next time? Michelle Duggar was lucky to survive the birth, much less her daughter.

The Duggar family is a rare case, not because they don’t believe in contraceptives, but because they have the financial stability to afford raising 19 children and the hospital fees that accompany such close calls. Not everyone is that fortunate. That’s why every woman deserves to be on birth control if she chooses, despite financial limitations.

Yes, there are “natural” ways to avoid unwanted pregnancies. My high school religion teachers made sure I was well aware of this fact. Practices such as natural family planning — where a woman refrains from intercourse while ovulating — exist, but they rarely are reliable. The only true way to avoid an unwanted pregnancy is abstinence. It’s easy to say that to a teenager, but what about a married woman? She already has four kids and is living below the poverty line. She can’t afford to raise another child, much less afford to be on birth control. Is she supposed to just give up sex with her husband?

It doesn’t seem fair. Lucky for women, someone else decided it wasn’t right either, and a year from now, the size of your pocketbook won’t inhibit your sex life.

Molly Skyles is a senior  communication major from St. Louis, Mo.

http://www.trumanindex.com/free-birth-control-benefits-all-1.2548944

[From Guttmacher]

In a move that could significantly improve access to contraceptives for millions of women, the U.S. Department of Health and Human Services (DHHS) on Monday announced that it is adopting in full the recommendations for women’s preventive health care the Institute of Medicine (IOM) issued in July. The services recommended by the IOM, including contraceptive counseling and provision of all methods approved by the Food and Drug Administration, will be covered without out-of-pocket costs to patients by new private health plans written on or after August 1, 2012.

Making contraceptive counseling, services and supplies—including long-acting, reversible methods (the IUD and the implant), which have high up-front costs—more affordable addresses the fact that cost can be a daunting barrier to effective contraceptive use. Removing that barrier for women covered by private health plans not only makes it easier for them to use contraception generally, but will also allow them to use the most effective methods, which they might not previously have been able to afford.

The evidence strongly suggests that insurance coverage of contraceptive services and supplies without cost-sharing is a low-cost—or even cost-saving—means of helping women overcome barriers to effective contraceptive use. The IOM recommendations fill important gaps in three existing sets of services that are already covered without cost-sharing under a provision of the 2010 health reform legislation. Developed after an exhaustive review of the scientific evidence, the recommendations also include coverage for an annual well-woman preventive care visit, specific services for pregnant women and nursing mothers, and counseling and screening services related to HIV and other STIs, cervical cancer and domestic violence.

Government bodies and private-sector experts have long recognized contraceptive services as a vital and effective component of preventive and public health care. A strong body of research shows that contraceptive use helps women avoid unintended pregnancy and improve birth spacing, resulting in substantial benefits for the health and well-being of women, infants, families and society.

However, while endorsing the IOM recommendations in full, DHHS also included an exemption that makes it possible for religious employers to opt out of the contraceptive coverage provision. Such an exemption was not required by the health care reform law and could potentially inhibit some women’s access to the contraceptive services and supplies on which they rely to prevent unintended pregnancy. Special care must be taken in implementing this exemption to mitigate any harmful impact on women who are affected.

Moreover, not all plans would be affected by the preventive services requirement—at least, not in the short run. Existing plans are “grandfathered”—meaning they are exempt from the requirement—so long as no significant negative changes, such as cutting benefits or raising cost-sharing, are made to them. DHHS has said that most plans will likely lose grandfathered status within a few years.

For more information:

The case for insurance coverage of contraceptive services and supplies without cost-sharing

Contraceptive use is the norm among religious women

Contraception is highly effective when used consistently and correctly

Facts on contraceptive use in the United States

Is there nothing in last year’s Affordable Care Act that people won’t fight over?

The latest battle is set to come to a head Wednesday, when the independentInstitute of Medicine is expected to make recommendations about preventive health care services for women. And one service that’s drawing a lot of the attentions is contraception.

Depending on the group’s recommendation, contraception could become part of a package of preventive benefits that every health plan would have to cover without patient cost-sharing. In other words, it would become effectively free.

That would have made a big difference for Andrea Leyva, of Tucson, Ariz. A few years ago, following the cancer death of one of her three children, she and her husband — both employed and with health insurance — were nonetheless struggling to pay the bills for them and their remaining two children.

The $25 copay for her monthly birth control prescription “began to fall into the category of a luxury for us,” she said, and they stopped filling the prescriptions regularly. At age 36, Leyva found herself pregnant with what she calls her “blessed surprise,” daughter Alexandria. “So while we’re happy that she’s here, it was not planned, and had we had some better finances, we probably could have made some better decisions,” Leyva says now.

Deborah Nucatola, senior director for medical services for Planned Parenthood Federation of America, says Leyva’s story isn’t unique. “Half of all pregnancies that happen in the U.S. every year are unintended,” she says. “And if we could prevent an epidemic of this proportion, that should be justification enough that contraception is preventive care.”

But at the same time, says Nucatola, who’s also an OB-GYN, birth control is about more than just preventing pregnancy. “We can also use it as essential preventive medicine for the 4 million women who have babies every year in the U.S.,” she says. “Babies born at least 18 months apart are going to be healthier than those born closer together, and closely timed births are risky for their mothers, too.”

Earlier this year, NPR and Thomson Reuters polled people for their views on whether private insurance plans should cover contraceptives. About three-quarters of Americans believe private insurance, including employer-based policies, should cover all or some of the cost of oral contraceptives. Support was just about the same when people were asked if government assistance was used to make the purchase of insurance more affordable.

But not everyone agrees that contraception should be available to the same extent as mammograms or childhood immunizations.

“There are two reasons we oppose the inclusion of contraceptives as a preventive service,” says Jeanne Monahan. She’s director of the Center for Human Dignity at the conservative Family Research Council.

One big problem, she says, is that requiring insurers to cover contraceptives violates the conscience rights of people who belong to religions that don’t believe in artificial contraception. “Say for example that I had a problem with it; I would be paying into a plan that would be covering them,” she says. “So in a way I would be forced to pay for it myself.”

The other problem, says Monahan, is abortion. Specifically, abortion opponents argue that some emergency contraceptives — so called morning-after pills — can cause very early abortions by preventing the implantation of fertilized eggs into a woman’s uterus.

“So those 7 to 10 days before a baby can implant, Plan B can prevent implantation and thereby cause the demise of that baby. So we’d be opposed to those drugs being included because they act as abortifacients.”

Plan B is one of two emergency contraceptives that have been approved by the FDA. They are different from the abortion pill mifepristone. Neither can disrupt a pregnancy that has already begun. But Planned Parenthood’s Deborah Nucatola says the argument about preventing implantation has been exaggerated by abortion opponents. “If people want to postulate on the theoretical risk of prevention of implantation, they’re entitled to do that, but there is no scientific evidence that that is a mechanism of action,” she says.

Still, it was the divisive politics of birth control that prompted the Department of Health and Human Services to punt the matter to the Institute of Medicine in the first place. On Wednesday, the IoM officially tosses the decision about whether insurers should cover contraception back into the government’s lap.

BY LINDSAY BEYERSTEIN | POSTED 03/15/2011 AT 08:32 AM

Kirsten Powers of Fox News took to The Daily Beast to make the bizarre case that birth control doesn’t prevent abortions. In an attempt to show that abortion rates had remained suspiciously constant over the past decade, she accidentallycompared the same 10-year-old study to itself. “I am deeply sorry for the error, which invalidates my piece,” Powers later admitted in an author’s note.

Anti-contraception cranks often cite research on populations to show that rates of contraception and abortion can rise in tandem. Then they use those studies to argue that birth control doesn’t generally prevent abortions. But without a control group, you never know whether the abortion rate would have been even higher without birth control.

An estimated 85 percent of couples who are having regular intercourse without birth control will get pregnant within a year. Whereas, the typical use failure rate for birth control pills is 3 percent and the perfect use failure rate is .1 percent. The efficacy rates of major birth control methods have been rigorously tested, so we can make causal claims about how many unplanned pregnancies a particular method prevents, relative to unprotected sex.

About half of all unplanned pregnancies end in abortion in the U.S., no matter how many hurdles the anti-choicers put between women and the constitutional rights.

If you take 100 healthy couples who are having sex, but who aren’t planning to get pregnant, and let them go at it for a year without birth control, you can expect about 85 pregnancies, and 42 abortions. If those same couples were using the Pill in the basically conscientious but slightly imperfect way that most people do, you’d expect about 3 unplanned pregnancies and 1.5 abortions. 42 is greater than 1.5. QED.

Obviously, birth control doesn’t work if you don’t use it, and the further you deviate from perfect use, the less reliable it is. Powers cites a study of women getting abortions as evidence that access to birth control doesn’t decrease the abortion rate. Only 12 percent of women who weren’t using birth control when they got pregnant cited lack of access as a reason why not. Powers claimed that not a single woman cited lack of access, but she got that wrong and The Daily Beast still hasn’t fixed her mistake, despite my request for a correction. That relatively low percentage suggests that organizations like Planned Parenthood are doing a good job providing birth control to those who want it, regardless of their ability to pay.

As Amanda Marcotte points out at RH Reality Check, self-reports of reasons for not using birth control may not tell the whole story. There are all kinds of systemic barriers and hassles that discourage contraceptive use, or push typical use further from perfect use, and thereby increase the unintended pregnancy rate — but which the average person probably wouldn’t describe as an absolute lack of access. Having legal access to something in principle is not the same as having ready access to it at an affordable price.

There’s an even deeper logical flaw in Powers’ analysis, however. If you only look at women who are getting abortions, you only see cases in which birth control didn’t work or wasn’t used. You will miss the millions of people who successfully use birth control and therefore never need abortions.

For someone who already admitted that her entire argument is invalid, Powers got awfully defensive on twitter when Marcotte pointed out even more flaws in her reasoning.

For some who can’t afford contraception and reproductive exams, the state and federally funded programs provide coverage for these services. These programs save a phenomenal amount of taxpayer dollars by preventing unintended pregnancies. They reduce the numbers of abortions because there are less unintended pregnancies. They reduce poverty for women, children and families.

The “straight white-guys” who oppose these programs want to deny the cost-savings and health enhancing outcomes of these programs. Don’t let them do it. Call them on it each time you hear or see them attacking family planning services.

Editor’s Note: This post was originally published on RH Reality Check.

By Amanda Marcotte

When it comes to the world of feminist writer/activists, I definitely fall on the “writer” side of the line. Most of my life is researching, conducting interviews, pitching pieces, and, of course, staring at my computer, trying to think of a verb that’s dynamic but not pretentious. I love giving speeches, but they’re usually of the 20-60 minute long variety meant to educate, analyze and entertain (and there’s always a Q&A), and I’m always on a roster with journalists and academics. So how was it that Saturday afternoon, I found myself standing outside with feet growing numb in the cold amongst actors, musicians, organizers and oodles of politicians, trying to think of what I could say in 120 seconds that would be meaningful to the crowd of thousands of people waving signs and periodically erupting into chants?

Well, mostly I was there because Planned Parenthood of New York City graciously asked me to speak at a rally in support of Title X funding, which has been zeroed out by the House of Representatives in the continuing resolution to fund the government, a move that can be stopped by the Senate and President. I said yes because while drum-beating and sign-waving is really outside of my comfort zone, I consider this issue too important not to grab opportunities to speak out. For years I’ve been writing about something that most of the media tragically ignores, which is the growing radicalism of movement conservatism regarding women’s sexual health. Anti-choice is also about resisting birth control and any other health care that relates to sexual activity, on the grounds that women who have sex should face “consequences”, i.e. be punished. (As a good example, I saw my friend Katie Halper fighting some guy on Twitter over whether or not Planned Parenthood offers breast exams, something anti-choicers are trying to deny because, as Katie put it, “I guess even the most heinous distortion of punitive conservatism can’t make breast cancer a woman’s fault.” Notice that they’re not trying to deny that Planned Parenthood does a million cervical cancer screenings a year, but I guess they don’t care about those lives, since cervical cancer is usually caused by HPV, and they can convince themselves those women brought their deaths on themselves.) Even though we’ve seen evidence of the anti-choice movement pushing for abstinence-only education and fighting the HPV vaccine and emergency contraception, in most of the media, the discussion is still incorrectly framed as fetus-centric.

And now the anti-choice has scored a major victory in the war on women’s health, amongst many other programs that help people that conservatives disapprove of, such as people who want to have more energy-efficient homes and women who have to work for a living and therefore can’t play unpaid preschool teacher to their kids. So I had to speak out. Conservative activists are dropping the word “abortion” a lot, because it performs well as a conversation-stopper that allows them to continue working against women without suffering too much investigation into their real aims, but this time, people aren’t fooled. Pap smears and condoms aren’t abortion. The anti-choice resistance to them makes it clear that the concern for fetuses is actually a concern that women are having sex without facing sadistic punishments that, in the past (and sadly still today) left them traumatized, mutilated, and often dead.

That era isn’t far enough in the past that women today really can take for granted all that we have, but I thought the best way to speak out against the encroachments on women’s rights was to talk about all the ways our lives have been quietly saved by doctors, nurses, and educators who give us the tools to be, as women always have been before us, sexually active without giving up our health and dreams. For most of us, having to live without birth control would have meant drastically different, sadder lives. How better than to highlight the radical nature of this move against Title X than to instigate a speak-out about how the biggest target — Planned Parenthood — helped us, usually in ways that the vast majority of the country finds completely non-controversial?

For this purpose, I started the Twitter hashtag #thanksPPFA, where people could talk about how Planned Parenthood had improved their lives. And for this purpose, when I stood up at the rally Saturday, what I did was tell a (very short) story: I had gone to a Catholic university, and the health center didn’t offer birth control. (Boooooo!, said the crowd, surprising me and then making me laugh.) So I went to Planned Parenthood, where I could afford it, and that clinic basically was my doctor for the next five years. And I spoke briefly about the stories that came out on Twitter, 140 characters at a time: women who finished school, married the right guy, had kids when they were ready, all because of Planned Parenthood. Women who are still with us, because their cervical cancer was caught by Planned Parenthood’s routine screening. Lives are saved every day, and it’s usually not remarked on, because most of us expect it will always be there.

But if the conservative movement gets its way, it won’t be there.

While Planned Parenthood is the touchstone for this outrage, people are standing up for more than just this one large organization. We’re standing up because we believe that women, gay people, poor people, people of color, young people, and people who fall outside the gender binary are just as much people as the rich straight white guys that dominate the ranks of those trying to shut down access to sexual health care. And as people, we have the same rights as those rich straight white guys to our health, to our hopes and dreams, to our relationships, and yes, to our sexual pleasures as they do. Planned Parenthood offers substantial services that save lives every day, but they’re also a symbol in this war over who gets to decide if The Rest Of Us are people, too. In the 21st century, are we going to expand the rights of man to all of us, or are we going to slide backwards to a time when only the few got access to what we all deserve?

GRAND FORKS — Like Rod Lammer, I too have noticed the 40 Days for Life campaign’s signs urging North Dakotans to “pray and fast to end abortion” (“Advice for the faithful: Trust but verify,” letter, Page A4, Sept. 30).

I found myself asking how prayer and fasting compares to proven means of reducing abortions.

Unlike comprehensive sex education and access to birth control, neither prayer nor fasting has been shown to prevent abortion. Instead of depriving one’s self of nourishment or mentally soliciting supernatural intervention, individuals opposed to abortion should make contraceptives available and ensure that consumers know how to use them correctly.

But it’s no secret that access to contraception and complete sex education programs face the greatest resistance from Catholics and other religious conservatives.

Presumably, most people who display these “pray and fast” signs would like elective abortion to be illegal. But outlawing abortion doesn’t “end” it. A 2007 comprehensive international study by the World Health Organization and the Guttmacher Institute found that women undergo abortions at a comparable rate in nations where abortion is outlawed. The only effect of outlawing abortion is a greatly increased number of women who are maimed or killed from unsafe attempts.

The data from this and countless other studies shows that the best way to reduce abortions is through greater access to birth control.

Correctly using contraception almost completely eliminates the risk of unplanned pregnancy, but contraception and information won’t stop abortion if it isn’t made available. Randomized controlled studies have shown that abstinence-only programs lead to higher percentages of unplanned pregnancy and sexually-transmitted infections among teens.

Religious conservatives are doing a great disservice to their sons and daughters by keeping them uninformed.

We can all agree that unplanned pregnancies must be reduced to “end” abortion. Let’s invest our precious energy only in the most effective ways of doing so: sex education and birth control, not prayer or fasting.

Meg Brown

By DAVID WAHLBERG | dwahlberg@madison.com | 608-252-6125 | Posted: Monday, October 4, 2010 5:10 am

Family planning advocates hope Wisconsin’s bid to make permanent its expanded birth control services under Medicaid is approved before the Nov. 2 election so the program will be harder to cut if Republican Scott Walker becomes governor.

Whether Walker or Democrat Tom Barrett wins the governor’s race, opponents say they will fight the program, especially its inclusion of teens as young as 15. Federal officials are reviewing Wisconsin’s application, submitted in June before any other state.

The proposal, allowed under the new health care reform law, would let the state provide free birth control pills, vasectomies and other contraceptives to more low-income people than some states without having to periodically reapply as the state must do now.

The state also wants to start giving the services to men and women 15 and older who make as much as $32,940 a year, up from the current annual income limit of $21,660.

Wisconsin’s proposed start date for the permanent program is Nov. 1. “It has nothing to do with the election,” said Marlia Moore, a benefits policy administrator for the state Department of Health Services. “It’s just a coincidence.”

But advocates say they hope the federal Centers for Medicare and Medicaid Services approve the bid by then to codify the program before the election.

“There is definitely an advantage to getting as much done as we can while we still have (Democratic) Gov. (Jim) Doyle in office,” said Nicole Safar, legal and policy analyst for Planned Parenthood of Wisconsin.

Getting approval by Nov. 1, or at least before January when Republicans could take control of the governor’s office, would “hopefully ensure that the program will continue,” said Lon Newman, executive director of Wausau-based Family Planning Health Services.

Wisconsin is one of 27 states that provide family planning services — which also include Pap smears and testing for sexually transmitted diseases — to more people than required by Medicaid, the state-federal health plan for the poor. The state’s expanded program started in 2003, and men were added this year.

Wisconsin spent $18.4 million to provide the services to 65,000 people in 2008, saving $139.1 million in costs from unintended pregnancies, according to the state health department.

“It’s good for the public health, and it’s good for the public purse,” said Clare Coleman, president of the National Family Planning and Reproductive Health Association. She praised Wisconsin’s leadership in being the first state to pursue a permanent program.

But Julaine Appling, president of the conservative group Wisconsin Family Action, said spending more money on birth control when the state faces a budget deficit makes no sense. “That’s an unwise and irresponsible use of taxpayer money,” she said.

Matt Sande, director of legislation for Pro-Life Wisconsin, questioned the state’s claim that birth control saves money. Like Appling, he vowed to fight the program and at least get the qualifying age moved from 15 to 18.

“Government-funded birth control, liberally distributed to young women and girls, increases and encourages sexual promiscuity,” Sande said. “What comes at the end of that? Abortion.”

Pro-Life Wisconsin and Wisconsin Right to Life have endorsed Walker. In a debate in August, Walker said BadgerCare Plus, Wisconsin’s main Medicaid program, has become too large and should be cut.

“Scott supports returning BadgerCare to its original purpose,” said his spokeswoman, Jill Bader.

Barrett supports the state’s application to make the expanded family planning services permanent, said his spokesman, Phil Walzak.

Shinie Tho, a 19-year-old student at UW-Madison, said she has been getting the NuvaRing birth control for free through the program at Planned Parenthood in Madison.

“Most college students are broke,” she said. “This helps a lot.”

Frances Kissling

Princeton University

Visiting scholar at the Center for Bioethics at the University of Pennsylvania

September 27, 2010

RESPONSE TO: “THE SURGERY I NEEDED TO SAVE MY LIFE”

Posted on www.belowthewaist.org

There is much in the literature by moderate Catholic bioethicists which indicates that using Methotrexate to terminate an ectopic pregnancy is permissible. The intention of the use of the drug is to act on the trophoblastic tissue attached to the fetus. The intention is not the destruction of the fetus which will definitively result but is not the motive. Thus, most Catholic hospital ethicists judge it to be licit.

Here’s a quote from a recent article on the issue from William May. “Methotrexate attacks the DNA in the trophoblastic tissue that attaches the unborn child to its site within the mother’s body; it thus attacks the trophoblast attaching the child to the fallopian tube or cervix or other part of an ectopic pregnancy (I prescind from unborn children implanted in the mother’s abdomen insofar as this is very rare and children so implanted usually can survive until birth).”

“With other moral theologians I thus judge that use of methotrexate can be used to “remove” the unborn child implanted outside the womb; the death of the child is the foreseen but not intended side-effect of an action morally specified as the necessary removal of the unborn child from the mother’s

body as the means, not morally evil in itself, chosen to protect the mother’s life.”

Are there very conservative Catholic hospitals that will not accept this opinion? Yes.

However, since we, as Catholic bioethicists and advocates, agree with most hospitals and physicians that using methotrexate to end an ectopic pregnancy is acceptable under Catholic Ethical Directives, how much emphasis do we give to the much smaller number who disagrees? How is our purpose of better patient care more effectively advanced? Is it not better to stress the positive view which permits its use rather than focus all attention on the minority which is  outside the mainstream of medical and ethical opinion of even Catholic medical and ethical opinion?

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.”

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.”

“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!

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.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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.

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

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

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

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

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

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