Catholics Call on Pope Benedict to Reconsider Vatican’s Ban on Contraceptive Pill

Fifty years ago this week, the US Food and Drug Administration approved the contraceptive pill. The man most prominently associated with the development and introduction of the pill, John Rock, was an Irish Catholic doctor from Boston. Dr. Rock didn’t set out to make waves with the Vatican; in fact, he was sure that his invention would gain approval from the Vatican and finally allow Catholics to practice safe and effective family planning. He was successful on both counts. Three different layers of a Vatican commission approved the pill back in 1965. But Pope Paul VI decided to ignore the findings of those panels and condemned Catholic women to a variety of unreliable methods if they were to follow the Vatican’s dictates. To this day, most Catholic women ignore the Vatican’s decree, and many millions of them have safer and more reliable family planning thanks to Dr. Rock’s pill.

The story of the pill’s genesis is a fascinating one. John Rock was an infertility expert who was a pioneer behind many modern methods of assisting couples to conceive. In the course of his work, he also met many fertile Catholic women who wanted to space the births of their children, and sometimes to avoid having children. The Vatican’s ban on artificial methods of contraception meant that they had to rely on so-called natural methods, when a couple can only have sexual intercourse during the time each month when a woman is infertile if they want to avoid pregnancy. This was unacceptable to many, unworkable for those who have unreliable cycles and impossible for women who could not negotiate their sexual relationship with their partners.

Rock, who worked with biologist Gregory Pincus to develop the pill, was convinced “that every couple should be able to choose freely the number of children they could afford — materially and emotionally — to bring into the world.”

Rock figured that he could invent a hormonal pill that suppressed ovulation and therefore extend the safe period for sex as long as a woman stayed on the pill. He reasoned that the Vatican would accept this, and Catholic women who did not want to go against the Vatican would be able to have a healthy sex life.

Contraception was an issue the Vatican had addressed before, and the advent of the pill raised new questions about Catholics and family planning. The Vatican had imposed a ban on “artificial” methods of contraception, such as condoms and diaphragms, in the1930 encyclical Casti Connubii. There was growing debate in the church about whether this ban should be continued, and if so, whether it should be broadened to include the new pill.

This was a huge issue for the Catholic church, and not long after the introduction of the pill, in 1963, Pope John XXIII convened a panel to study the matter. The papal commission on birth control was composed of bishops, priests and lay people, including married Catholic women. They considered Catholic theology, modern science and the lives that married Catholics lead. The commission voted overwhelmingly to recommend that the church rescind its ban on contraception. The pope, concerned that overturning the ban would call all of the hierarchy’s teachings into question, appointed a second commission, made up of 15 bishops, which also voted overwhelmingly to recommend that the church rescind its ban on contraception.

The results of these votes were leaked, and there was widespread rejoicing among Catholics. It was therefore a significant shock to Catholics — and indeed most of the world — when the encyclical Humanae Vitae was finally released by Pope Paul VI on July 29, 1968, proclaiming the teaching on contraception unchanged and unchangeable.

The pope had completely ignored the work and recommendations of his own commission, despite five meetings over three years and a vote by 30 of the 35 commission’s lay members, 15 of the 19 theologians and 9 of 12 bishops that the teaching be changed (three bishops abstained).

There is little need to reconvene a commission to study this issue. Not much has changed to negate the findings of the majority votes in the commission. Indeed, we have learned so much more about safe reproductive health that supports the real world application of the commission’s findings. It makes no sense to continue the Vatican’s wrong-headed approach to family planning. Even without the twin scourges of maternal mortality and HIV/AIDS, there are billions of good reasons to allow women to plan their families and to allow them to decide when and whether to have children: namely the 3.5 billion women in the world, of whom about 600 million are Catholic.

It would be a lasting and wholly positive legacy if the current pope got behind the majority report of the 1963-68 commission and lifted the ban on the use of contraceptives to allow Catholics to plan their families. Given the fact that today, in the United States, 97 percent of sexually active Catholic women above the age of 18 have used some form of contraception banned by the Vatican, it makes little sense to continue the ban. In fact, the ban does more harm to the Vatican and its teaching authority than would changing it.

Dr. Rock was a Catholic champion of women’s health. If the Vatican wants to regain some relevance and respect on this issue, it’s time to join him in his support for contraception.

Jon O’Brien is the president of Catholics for Choice

“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!

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

NOTES

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

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

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.

Please find below my summary and interpretation of a recent decision in Peru. My thanks to our colleagues at the Center for Reproductive Rights for helping me understand the implications of this case. Any errors are mine alone!

Peru’s Highest Court Rules Against EC

Peru’s Constitutional Court (Tribunal Constitucional) has stopped the Ministry of Health’s free distribution of EC in a decision issued on October 22^nd. In addition, this decision requires local distributors of EC to add a warning to the package insert stating that this product could cause an abortion.

The Court has decided on a case brought to them by a non-profit advocacy group in 2004. The decision released last week states that the Ministry of Health failed to adequately prove “the inexistence of the abortifacient effect, the inhibition of the implantation of the fertilized ovum in the endometrium.” The Court therefore concluded that EC could in fact cause an abortion, in violation of Peru’s constitutional protection of life. This decision contradicts the Mechanism of Action Fact Sheet issued by ICEC and the International Federation of Gynecology and Obstetrics issued in October 2008, as well as the World Health Organization’s Fact Sheet on Levonorgestrel-alone EC. Both these statements summarize a growing body of scientific literature that shows that delaying or preventing ovulation is the most likely and perhaps only mechanism by which EC effectively prevents pregnancy.

The decision means that the Ministry of Health cannot distribute EC for free through its public clinics. EC can still be sold in Peru, but only with a warning stating that it might cause an abortion.

The Court cited the US FDA website as well as drug labeling for Plan B and several other EC products as evidence that EC may prevent the implantation of a fertilized egg. It is clear that drug labeling is playing a key role in these cases, and it is unfortunate that many levonorgestrel-alone EC products carry labels that do not reflect current science.

This Peru case is very similar to ones in Ecuador and Chile, and may represent a trend towards protecting the rights of the “conceived” using weak science as a strategy to limit access to EC. Clearly, some Latin American courts are now considering that life begins at conception and not at implantation.  Along the same lines, efforts have been launched in several states in the US to “protect life from the beginning of biological development.”

The Associated Press is reporting that Plan B (emergency contraception) will soon be available without a prescription for teens 17 and under. We expect the FDA to shortly announce its compliance with the court decision we reported on last month that slammed the FDA for its politically driven decision to impose an age restriction. We hope that this is the first step in making Plan B accessible and affordable for all women who need it.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

King County wants to ax family planning services for poor women & teens in Rainier Valley, White Center, etc. Can you help?
Many of you already know that King County is facing a major budget crisis. What you may not know is that the budget currently being deliberated by the King County Council eliminates no less than FIVE family planning clinics – including the valley’s own Columbia Public Health Center in the Genessee Business District – as well as family planning and STD services for teens in juvenile detention. The clinics on the chopping block could close as early as the end of 2008.

According to our friends in the family planning loop:
Eliminating Family Planning just doesn’t make financial sense. Making free family planning services available to poor women actually saves us money. In fact, for every $1 invested in family planning, we save $4.

Cutting family planning and STD services constitutes a misuse of taxpayer money, as we are only deferring the cost until a later time. Furthermore, we are doing so at the expense of poor women and their families. I realize that cuts must be made somewhere, but to do so by targeting the most vulnerable members of our community is simply unethical.

Access to birth control and STD services is the single most effective way to reduce unintended pregnancies, to reduce state-supported births and abortions, and to contain the spread of STDs. Additionally, these services function as a critical entry point into broader medical care and social services for low-income women and their families.
Now, while some teen patients may be able to continue getting family planning services at the pediatric clinic, if these budget cuts pass there will be no services whatsoever for adult women.

In other words, without these clinics, thousands of poor women and teens in King County will have no place else to go for reproductive and sexual health care.

For more information, go here.

You can help!
Take a moment to urge lawmakers against this short-sighted solution. Tell them not to balance the budget on the backs of our neediest neighbors and to restore funding to the family planning clinics at White Center, Columbia (Columbia City), Renton, North (Northgate), and Northshore (Bothell), as well as family planning and STD services at juvenile detention, in the 2009 budget.

There is no time to waste, as the King County Council will adopt the 2009 budget by next Mon., Nov. 24, so if you’d like to see funding restored to these vital family planning services, contact the council TODAY urging them not sacrifice the reproductive health of our community’s most vulnerable citizens.

Three ways to make your voice heard:
1. Attend the last remaining County Council Budget Hearing TODAY at 1:30 pm at King County Council Chambers (516 Third Ave., Room 1200). Sign up to testify or hold a “save family planning” sign.

2. Testify electronically to the County Council – it only takes a minute – go here to share your comments.

3. Email the King County Council directly:
bob.ferguson@kingcounty.gov, larry.gossett@kingcounty.gov,
kathy.lambert@kingcounty.gov, larry.phillips@kingcounty.gov,
julia.patterson@kingcounty.gov, jane.hague@kingcounty.gov,
pete.vonreichbauer@kingcounty.gov, dow.constantine@kingcounty.gov,
reagan.dunn@kingcounty.gov

cc: Executive Ron Sims (exec.sims@kingcounty.gov), David Fleming, Director of Public Health – Seattle & King County (david.fleming@kingcounty.gov), Bob Cowan, Director of the Budget Office (bob.cowan@kingcounty.gov), and your state legislators. To find your legislators, go here.

A Range of Concerns Would Need to Be Addressed
To Ensure that All Women Benefit

A growing number of women’s health advocates are urging bolder and potentially transformative steps toward greater “contraceptive convenience,” with the aim of making contraceptive use easier and more sustainable for women, according to a new Guttmacher policy analysis. These advocates argue that many of the ways in which contraceptives are made available in the United States are no longer grounded in the reality of current scientific advancements or modern women’s lives.

Research shows that half of all adult women at risk of unintended pregnancy are inadequately protected because, over the course of a given year, they don’t use contraceptives at all, use them inconsistently or incorrectly, or have a gap in use lasting more than a month. A complex web of reasons contributes to women’s difficulties in using contraceptives, ranging from method dissatisfaction to life disruptions. Advocates of a contraceptive convenience agenda are pushing for measures to break down many of the medical and societal barriers to better use.

“In a variety of ways, society makes women’s contraceptive access needlessly hard, and it can and should be made easier. By stripping away layers of medical intervention or requirements that are outmoded or unnecessary, we can go beyond current efforts to make contraceptive service delivery more user friendly,” says Sneha Barot, author of the new analysis. “For instance, many women’s health experts have concluded that a number of hormonal contraceptives—including the birth control pill—should be available to women directly at pharmacies, without the requirement of a doctor’s prescription. Such steps would make contraceptives easier to obtain and use without interruption, and would also decrease other financial and logistical hurdles.”

Barot’s analysis points out, however, that proposals to “demedicalize” contraception also raise serious concerns. For example, removing the prescription requirement for oral contraceptives could make pills unaffordable for low-income women if it also resulted in the removal of private insurance and Medicaid coverage. Likewise, eliminating the need to go to doctors or family planning clinics for contraceptives could jeopardize access to other preventive health services normally provided in these settings. Minority communities, especially, could be affected, potentially aggravating existing inequalities.

“Any efforts to push for over-the-counter status would need to resolve serious challenges —including cost and access to health care—that marginalized populations would be facing,” says Barot. “To make contraceptives easier to use, even without the benefit of instructions from a doctor, would also mean revamping package labeling to make it more comprehensible and accurate.”

Barot further notes that a number of other measures also need to be pursued to truly make contraceptives easier for women to obtain and use. One of the most important of these is to create a fundamental shift in societal attitudes toward contraception, so that users will face fewer restrictions—and more support.

“Making access to and use of contraceptives easier is not trivializing an important reproductive health issue or promoting irresponsible attitudes or behavior—quite the opposite,” says Barot. “‘Convenience’ in the area of contraceptive access would translate into practical and meaningful support for women who are trying to avoid unwanted pregnancies, improve their health, and better plan their lives.”

Click here to read “Making the Case for a ‘Contraceptive Convenience’ Agenda,” by Sneha Barot, in the Fall 2008 issue of the Guttmacher Policy Review.

Click here for more information on:

Improving contraceptive use in the United States

Facts on contraceptive use

Facts on contraceptive services