Women’s health services shouldn’t (and now don’t) come with a co-pay! Happy one-year anniversary, ACA’s preventive services benefit for women. Essential preventive services at no additional cost for women and their families. Share widely!
Redux – The personal is political
Teaching children to understand and cope with bullies is essential, but bullying isn’t limited to elementary school. Bullying may not be physical or direct. It is persistent, intimidating, and it flourishes when victims and witnesses are afraid to speak up or speak out. It is time to identify reproductive coercion for what it is and call the bullies what they are.
“Reproductive coercion” includes sabotage of birth control by abusive partners and occurs in all social and economic groups and most frequently to unmarried sexually active women. Male partners seek control over their partner’s reproductive options, even whether and when to have sex, to assert and maintain power.
Just as the pattern of intimidation, harassment, aggression and control is not limited to schools, reproductive coercion is not limited to interpersonal relations. It is ubiquitous at public forums, health care settings, legislative discourse, and campaign politics. This bullying is intended to intimidate, to silence people who disagree, to deny people access to health care they want or need, to pass legislation that denies reproductive justice, and to maintain power by opposing reproductive rights and justice.
Last week, one of Family Planning Health Services’ (FPHS) employees was participating in a health fair sponsored by our local United Way and county health department. It happened to be hosted at a Catholic hospital. One of the medical directors required the employee to remove information on emergency contraception. The doctor then used post-it notes to obscure “prescription contraception” and “non-prescription contraception” on the FPHS display.
The hospital has been recognized for its work with sexual assault victims and the hospital president is on the state attorney general’s sexual assault task force. We can assume the hospital is in compliance with state law to provide emergency contraception in the emergency room and we know that many of the physicians provide prescription and non-prescription contraception to their patients. But, like the classic elementary school bully, the physician used position and status to censor and deny information to participants.
Victims and bystanders might excuse the bully; “I should have known this would provoke him,” or “I should have known better than to be in this neighborhood,” but motivation does not excuse intimidation, bullying and harassment. On a public level we may understand religious objections, but using status, position, power, volume or force to control someone else’s reproductive health and behavior must be challenged and condemned if the culture of sexual coercion is to change.
Several days ago, Wisconsin’s State Senator Mike Ellis used the power of the majority and the gavel to silence debate and fast-track a bill that requires women to undergo a medically unnecessary ultrasound procedure and morality message before they can have an abortion. In our state assembly, our state representative shared her experience as a child rape victim and spoke very personally to how she felt as a victim and as the mother of three daughters, to a law requiring victims to undergo a re-invasion of privacy and self-control. On-line bullies vilified and harassed her for speaking out as a victim against the “pro-life” legislation.
There are self-styled “prayer warriors” standing outside our family planning clinics for a few months each year. They know that many of our patients and WIC participants/children are intimidated by their presence, but they justify the bullying on the basis of their religious beliefs about abortion, which we do not provide.
Victims and witnesses to reproductive coercion, intimidation and bullying must try to speak up, seek help, or intervene as the situation requires. When it comes to public and political behavior, calling reproductive coercion what it is the first step to ending it.
1. Roe was too focused on doctors and didn’t talk enough about women.
“It’s about the doctor’s freedom to practice his profession as he thinks best. If you read the Roe opinion, you will never see the woman standing alone. It’s always the woman in consultation with her physician.”
Ginsburg believes that the Roe ruling would have been stronger if it hadn’t involved the distinction that abortion is a decision left up to the woman and her doctor. (The opinion itself states that “the abortion decision and its effectuation must be left to the medical judgment of the pregnant woman’s attending physician.”) She elaborates:
“It’s about a doctor’s freedom to practice his profession as he thinks best. It wasn’t woman-centered. It was physician-centered.”
2. The ruling should have left room for individual states to make their own decisions.
“It’s not that the judgment was wrong, but it moved too far too fast,” Ginsburg said at the Columbia Journalism School last year:
“The court made a decision that made every abortion law in the country invalid, even the most liberal. We’ll never know whether I’m right or wrong … things might have turned out differently if the court had been more restrained.”
Ginsburg believes that the Justices should have passed a ruling that would have just struck down the Texas-specific ruling. As her moderator at the University of Chicago talk Geoffrey Stone explains, “By instead reaching out to decide the much more broader question – whetherany prohibition of abortion is constitutionally permissible in the first twenty-four weeks – the Court, in her view, short-circuited the democratic process and failed to allow the states to work out for themselves how best to regulate abortion.”
3. “A woman’s right to choose” should have been protected with a different court case.
According to Ginsburg, there was a case that was a better fit for setting a standard for reproductive freedoms than Roe. 1971′s Struck v. Secretary of Defense involved a female U.S. Air Force Captain who was in Vietnam when she became pregnant, something that, according to Air Force Regulation, made her ineligible for military work. At the time, Ginsburg was not yet a member of the Supreme Court and was representing Struck. Though the case was never heard – and the Air Force rules were changed – she wrote an interesting merits brief about the case:
“The central question raised in this case is whether the Air Force, consistent with the equal protection principle inherent in the due process clause of the fifth amendment, may call for immediate discharge of pregnant women officers…It is petitioner’s position that this distinction reflects arbitrary notions of woman’s place wholly at odds with contemporary legislative and judicial recognition that individual potential must not be restrained, nor equal opportunity limited, by law-sanctioned stereotypical prejudgments. Captain Struck seeks no favors or special protection. She simply asks to be judged on the basis of her individual capacities and qualifications, and not on the basis of characteristics assumed to typify pregnant women.”
Since then, Ginsburg has explained her thoughts more succintly (and with less legalese):
“The idea was: ‘Government, stay out of this.’ I wish that would have been the first case. The court would have better understood this is a question of a woman’s choice.”
4. It wasn’t the right time.
“The court can put its stamp of approval on the side of change and let that change develop in the political process,” Ginsburg says now of Roe v. Wade – leading some to speculate that it’s possible she’s going to be hesitant to pass anything broad-sweeping when it comes to marriage equality rulings.
5. It gave the pro-life movement something to attack.
“The sweep and detail of the opinion stimulated the mobilization of a right-to-life movement and an attendant reaction reaction in Congress and state legislatures. In place of the trend ‘toward liberalization of abortion statutes’ noted in Roe, legislatures adopted measures aimed at minimizing the impact of the 1973 rulings, including notification and consent requirements, prescriptions for the protection of fetal life, and bans on public expenditures for poor women’s abortions.”
“What a great organizing tool it is: You have a name, a symbol—Roe v. Wade.You could aim at [the fact] that this decision was made not in the ordinary democratic process.”
Ruth on Roe = the end = maybe no one will ever talk about abortion again?
President Obama recently reassured women’s rights advocates: “As long as . . . we’ve got to fight to protect a woman’s right to make her own choices about her own health, I want you to know that you’ve got a president who’s going to be right there with you.” Right now, he seems to be in both corners of the ring.
In this corner
Under federal court order the Food and Drug Administration (FDA) was to make Plan B™ available over the counter without age or prescription restriction by May 10th. (Plan B™ is a pill taken as soon as possible and up to 120 hours after unprotected sex to prevent a pregnancy.)
The FDA had determined Plan B ™ to be safe over the counter (OTC) for all girls and women at risk of unwanted pregnancy. In what appears to be an attempt to evade the court order, the Whitehouse engineered an FDA compromise requiring women to show identification and proof of age (15) before they can purchase Plan B™.
Judge Edward Korman sharply denied the Department of Justice (DOJ) request for a stay of his order. He said that the DOJ’s arguments on EC contradict the FDA’s own recommendations and he pointed out the administration’s inconsistency in its positions that requirements for photo IDs are unconstitutional barriers to voting rights, but photo IDs are acceptable for women who need to exercise their reproductive rights.
And in this corner
Meanwhile, half the country away in Denver, the DOJ is defending policy that health insurance should include preventive coverage, including hormonal contraceptives and emergency contraception, without copays or deductibles. Consistent with President Obama’s 2009 directive that political officials should not influence scientific findings and conclusions, he commissioned the National Institute of Medicine (IOM) to make recommendations on prevention for women’s health. In stark contrast to the Plan B ™ FDA case, the President implemented the IOM recommendations and is vigorously defending policies to give women access to EC and other contraceptives against secular corporations such as Hobby Lobby which are claiming a religious exemption so they can deny employees reproductive health coverage guaranteed to others.
When the DOJ asserted “public interest” to Judge Korman, he invited them to explain what public interest is served by unplanned pregnancies and abortions. That is the standard by which this dispute should be decided. No public interest is served by unplanned pregnancies. Which policy best prevents them?
- Unwanted pregnancies – like unplanned and involuntary sex — are more likely to occur to teens, to present higher medical risks, and are more likely to be terminated.
- Judge Korman’s comparison between reproductive rights and voting rights is important because pregnant teens and low-income minorities have the fewest resources to overcome obstacles placed in their way. Those same women and girls also have the greatest difficulty overcoming the health and social consequences of an unplanned pregnancy.
- For almost ten years, FPHS has dispensed 10,000 cycles of EC to our patients — quickly, confidentially, and at low or no cost. We have seen our unplanned pregnancy rate drop. We have identified the greatest obstacles to effective emergency contraceptive use are cost and a lack of accurate knowledge about how it works and when to take it. OTC status is an inadequate and imperfect solution, but adding unnecessary photo ID requirements only amplifies its imperfections.
The Obama administration’s now repeated politicization of the EC issue, in contrast to the Obama administration’s defense of contraceptive coverage in primary care, adds to the stigma and enables the opponents of contraception in their efforts to misinform.
It is unclear in its fight against itself, what the Whitehouse will win, but in the fight to prevent unplanned pregnancies and abortions, it is too clear what women and girls might lose.