Written by Martha Kempner for RH Reality Check. This diary is cross-posted; commenters wishing to engage directly with the author should do so at the original post.

Last week, New York City’s Department of Health released numbers showing that teen pregnancy rates in the city have fallen considerably in the last decade. So for some reason, the New York Post, the city’s conservative home town paper decided it needed to stir up a fake controversy by suggesting that the Bloomberg administration is trying to keep the data on how much birth control schools have really distributed under wraps.

Health Commissioner Tom Farley certainly didn’t seem to have anything to hide when he hailed the city’s 27 percent decline in teen pregnancy. Farley suggested that the drop comes because fewer teens are having sex and more teens using birth control.

Farley said “It shows that when you make condoms and contraception available to teens, they don’t increase their likelihood of being sexually active. But they get the message that sex is risky.”

The commissioner is referring, in part, to the school district’s CATCH Program, Connecting Adolescents To Comprehensive Health, which uses Health Department doctors and school nurses to prescribe and distribute birth control to students. The program also provides pregnancy tests; education on contraceptive methods, including condoms; STI prevention education; education on pregnancy options and referrals to primary care; STI testing and treatment; and mental health counseling. The program started in 2011 with five schools and expanded to 13 schools by the beginning of the 2012-13 school year.

The CATCH program made headlines at the start of the school year when a New York Post article said it was giving out Emergency Contraception to students has young as 14 without their parents’ knowledge. This was not accurate. The Health Department says that parents were made aware of the program and told them that they had the right to “opt-out” if they did not want their child to be allowed to receive contraception at school. Only one to two percent of parents at these schools chose to “opt-out.”

Despite this, the Post insisted the program was controversial and parental authority was being usurped. That article, which ran with the headline “NYC schools give out morning-after pills to students—without telling parents,” quoted one parent saying that she’d never been told about the program and that she wouldn’t want her daughter to have access to EC in the nurse’s office because “Parents should know if their daughter is pregnant.” The article also reports that school insiders “dislike the lack of parental involvement” because of the dangerous side effects of EC and quotes another school employee who said that she worries that EC might encourage careless sex. All of these quotes represent common misperception about EC: it prevents fertilization and therefore pregnancy, it is safe for young women, and it does not change sexual behavior.

This weekend, the Post continued its effort to make the CATCH program seem more controversial than it is when it ran an article with this first line: “Plan B has become Plan A in the Bloomberg administration’s stealth war on teen pregnancy.”  According to the article, the paper used the Freedom of Information Act (FOIA) to find out exactly how many dose of EC were distributed at New York City schools last year. The FOIA request yielded the following data:

• 22,400 students received reproductive health care between 2009 and the beginning of this school year
• 40 separate school-based Health Centers doled out 12,721 doses of Plan B in 2011-12, up from 10,720 in 2010-11 and 5,039 in 2009-10

The article notes that this is far higher than the 547 doses of EC that the officials cited as having been handed out last September when they announced the expansion of the CATCH program.

Though the Post seems to be suggesting a big cover-up, the paper is, deliberately or not, mixing up its numbers. There are only 13 CATCH schools and the program didn’t start until 2011. The 40 school-based health centers in city schools that “doled out Plan B” are not part of the CATCH program. These health centers are privately run and have been distributing/prescribing contraception for a number of years.

And the city is not trying to hide the school-based health centers either.  In fact, a department spokesperson told me in an email that the CATCH program is:

A pilot program to see if we could provide the same essential services through regular school nurses and physicians in schools that don’t have school based health centers.

She described it as part of a comprehensive approach to reducing teen pregnancy in the city.  And the best part, it seems to have worked (or at least helped). The health department released these numbers:

• The teen pregnancy rate for girls ages 15 to 19 was 72.6 per 1,000 in 2010 down from 98.8 per 1,000 in 2001.
• There were about 19,080 teen pregnancies in 2010 down from 24,815 in 2001.
• Sexual activity among high school students is down by 26 percent since 2001 when 50.9 percent of high school students reported having had sex compared to 37.8 percent in 2011.
• More girls were using the Pill or other long-term birth control methods the last time they had sex up from 17.3 percent in 2009 (the first year it was collected) to 26.9 percent in 2011.

These data reflect national data that show the rates of teen sexual activity and pregnancy have been dropping in recent years. New York City’s teen pregnancy rate is still remains higher than the national rate but it has seen a steeper decline.

The teen pregnancy rates do vary widely in the city with the Bronx having significantly higher rates than other areas. In addition, the rates among Black adolescents (110.7 per 1,000 girls aged 15 to 19) are much higher than those for Whites in the city (just 16 per 1,000). Teen pregnancy is a multi-faceted issue that is woven into the socio-economic fabric of communities, so it is not surprising that these disparities still exist. Nonetheless the dramatic reduction in teen pregnancy rates across the city shows that access to contraception is an important first step.

Instead of lauding the success of the city’s efforts, the Post just continued to claim the city is hiding the program. It even quoted one mother who suggested that the fact that the schools with CATCH Programs were in Black and Latino neighborhoods proved that they were part of an effort by Mayor Bloomberg to control the minority population.

This seems like irresponsible reporting to me. The program is in these neighborhoods because these neighborhoods have the highest rate of teen pregnancy. The program is not a secret.  Parents were informed and given how few “opted out,” most seemed to approve.  Moreover, the Health Department is lauding the program’s success pretty loudly. They told me in a statement:

Since 2009, birth control use has increased yet the rates of teen sexual activity and pregnancy continued to decline, sharply refuting the myth that access to information and birth control encourages sexual activity.

A more accurate headline would have been “Congratulations New York City for Helping Teens Prevent Pregnancy.”

Written by Debra Haffner for RH Reality Check. This diary is cross-posted; commenters wishing to engage directly with the author should do so at the original post.

Freedom from contraception? (Photo: Beatrice Murch / Flickr).

The Catholic bishops have begun a two-week campaign leading up to July 4^th with the central focus of removing contraceptive coverage from health insurance reform. Of course, the Supreme Court any minute now may end or modify the Affordable Care Act, which may make this debate moot.

The bishops are calling their campaign a “Fortnight for Freedom” and cloaking their objection to modern methods of contraception in a religious liberty argument. It is a classic example of those on the religious right who would restrict individual freedom to make private sexual choices co-opting language to confuse and gain supporters. It is reminiscent of the right’s coinage of “partial-birth abortion” for abortion procedures after 20 weeks and the use of the term “death panels” in health care debates.

As a religious leader and as a person of faith, I of course support religious freedom. So does the U.S. Constitution and so, I presume, do you. To me, and millions of people of faith, religious freedom means that all persons should be free to make their own personal decisions about their sexual and reproductive lives, including their decisions about when, whether, or if to have children. These decisions are optimally informed by their conscience, faith tradition, religious beliefs and families, but ultimately they are deeply personal decisions that individuals can and should have the freedom to make for themselves.

Religious freedom means that the government should not privilege the teachings of one religion over another or deny individual religious freedom. Individuals must have the right to accept or reject the principles of their own faith without legal restrictions. The Catholic bishops do not speak for all faith traditions on contraception; indeed they don’t even speak for the people in their pews who use and support family planning in overwhelming majorities. It is past time for the Vatican and the American Bishops to understand that they cannot claim final moral authority in domestic or (as we saw in Rio last week) international discourse.

It is up to each of us to not allow the Catholic bishops or anyone else to co-opt religious freedom. Universal access to family planning does not require anyone to use contraception – rather it assures that individual moral agency and conscience are respected. Supporting religious freedom means supporting the right of all of us to make our own moral decisions. We know a wolf in sheep’s clothing when we see it.

Written by Rep. Nita Lowey for RH Reality Check. This diary is cross-posted; commenters wishing to engage directly with the author should do so at the original post.

Cross-posted with permission from Impact, a magazine produced by Population Services International.

Few examples of U.S. foreign assistance provide benefits as tangible, cost-effective, life-saving and critical for both the United States and aid recipients as do international family planning and reproductive health services. Women and families across the developing world are healthier and stronger – and societies are more stable – as a result of access to basic health services.

According to the Guttmacher Institute, for every $10 million invested in international family planning and reproductive health:

➤ 610,000 women and couples receive contraceptive services and supplies;

➤ 190,000 fewer unintended pregnancies occur;

➤ 83,000 abortions are avoided;

➤ 500 maternal deaths are averted; and

➤ 2,300 fewer children lose their mothers.

According to the Council on Foreign Relations, studies indicate that meeting the unmet need for family planning could reduce maternal deaths by approximately 35 percent, reduce abortion in developing countries by 70 percent and reduce infant mortality by 10 to 20 percent. Read the rest of this entry →

Written by Editor-in-Chief Jodi Jacobson for RH Reality Check. This diary is cross-posted; commenters wishing to engage directly with the author should do so at the original post.

In 2002, Alyne da Silva Pimentel, a 28-year-old Afro-Brazilian woman, died after being denied basic medical care to address complications in her pregnancy. Her death might be like any one of the other hundreds of thousands of women who die of complications of pregnancy or unsafe abortion each year worldwide, but for one thing: It was taken to court.

Maternal mortality in Brazil is high, especially for a country of its relative wealth and level of development. It is even higher among women who, like Alyne, are of Afro-descent, indigenous, and/or low-income. Alyne died of complications resulting from pregnancy after her local health center mis-diagnosed her symptoms and delayed the emergency care she needed to live.

On November 30, 2007, the Center for Reproductive Rights, with Brazilian partner Advocaci, filed Alyne da Silva Pimentel v. Brazil, brought the first ever maternal mortality case before the UN’s Committee on the Elimination of Discrimination Against Women (CEDAW). The Center’s petition argued that Brazil’s government violated Alyne’s rights to life, health, and legal redress, all of which are guaranteed both by Brazil’s constitution and international human rights treaties, including CEDAW. 

“Alyne’s story epitomizes Brazil’s violation of women’s human rights and failure to prevent women from dying of causes that, by the government’s own admission, are avoidable,” said Lilian Sepúlveda, the Center’s Legal Adviser for Latin America and the Caribbean. “We filed this case to demand that Brazil make the necessary reforms to its public health system—and save thousands of women’s lives.”

In its brief, the Center asked the Committee to require Brazil to compensate Alyne da Silva Pimentel’s surviving family, including her 9-year-old daughter, and make the reduction of maternal mortality a high priority, including by training providers, establishing and enforcing protocols, and improving care in vulnerable communities.

This week, the case was decided in a historic decision by CEDAW, establishing that governments have a human rights obligation to guarantee that all women in their countries—regardless of income or racial background—have access to timely, non-discriminatory, and appropriate maternal health services.

“Sadly,” said a statement from CRR, “Alyne’s story is one of thousands in Brazil, and all around the world, in which women are denied, and in some cases refused, basic quality medical care to address common pregnancy complications. And the countless lives lost unnecessarily as a result mean that today’s victory can only be regarded as bittersweet.”

Nonetheless, continued the statement, “today marks the beginning of a new era. Governments can no longer disregard the fundamental rights of women like Alyne without strict accountability. And while nothing can reverse Alyne’s fate, today’s decision means that Alyne’s mother and daughter will finally see justice served—and women worldwide will benefit from the ruling issued in her name.”

"Class War" by London Permaculture on flickr

Written by Amanda Marcotte for RH Reality Check. This diary is cross-posted; commenters wishing to engage directly with the author should do so at the original post.

Whilst whiling away my time in a manner greatly pleasing to myself—reading the Tumblr STFU Conservatives—I was genuinely startled to see that the blogger had curated this amazing bit of anti-choice propaganda from Live Action.

See image here.

I couldn’t have created a better distillation of how anti-choicers actually view women who are facing unintended pregnancies. I can just imagine how this particular ad came to be. One of the folks working at Live Action was flipping through stock photos of pregnant women—concentrating on very pregnant women in order to mislead people about the flat-tummied realities of abortion—and they were drawn to this one because it’s such a vicious stereotype. The woman pictured is clearly supposed to be young, adolescent even, and poor. You can tell she’s likely a teenager because she’s wearing trendy clothes like you get at Forever 21. And the clothes don’t fit well and are clearly supposed to be clothes from before she got pregnant, the implication being that she’s too poor to afford maternity clothes. This image characterizes young, poor women as stupid sluts who can’t manage basic responsibilities. And our youthful right wing propagandist saw this picture and thought, Perfect! This is exactly how I imagine life is like for the kind of women who get pregnant on accident.

The text indicates that whoever wrote this ad thinks that the intended audience—presumably young and likely poor women—is really stupid, and that the only reason a person might conclude that aborting a pregnancy isn’t the same thing as killing a baby is that they’ve been brainwashed by the condom-pushers at Planned Parenthood. In reality, people draw the conclusion that embryos aren’t babies so much as potential babies because they look at the obvious evidence on hand. They notice that people don’t have funerals for miscarriages, that we start counting someone’s age from their birth date and not their conception date, and that unlike babies, embryos can’t experience emotions or sensations, due to the lack of a functioning brain.

This particular ad further reinforces my sense that the anti-choice movement is increasingly moving away from the strategy they embraced for the past decade of feigning concern for pregnant women, and instead they’re moving back to old school hysterics about women’s sexual freedoms mixed in with overt classism and racism. The most obvious example of this turn has been the right wing reaction to the HHS ruling that will require insurers to cover contraception without a co-pay. All feigned concern for women flew out the window the second the possibility of free contraception was even raised, and so far the theme of the criticisms of the HHS has been, “Dirty, stupid, irresponsible sluts don’t deserve squat.” Read the rest of this entry →

"Drought in Africa" by United Nations Photo on flickr

Written by Editor-in-Chief Jodi Jacobson for RH Reality Check. This diary is cross-posted; commenters wishing to engage directly with the author should do so at the original post.

There’s a saying that if you are not part of the solution, then you are part of the problem. When it comes to news that Kenyan families, facing serious drought conditions and unable to feed their families, are now selling their young daughters off to buy food, the United States is a part of the problem.

A big part.

Why?

As we reported two weeks back, the GOP and Tea Party majorities in the United States House of Representative are hell-bent on re-imposing the Global Gag Rule on U.S. international family planning assistance in a back and forth on policy that rivals Wimbledon.  And, as we reported in December 2010, House Republicans banded together to kill the International Child Marriage Prevention Act for no apparent reason other than to be ornery and adhere to a baseless ideology. The act would have required the U.S. government to develop an integrated, strategic approach to combating child marriage by promoting the educational, health, economic, social, and legal empowerment of women and girls, using existing resources. As in revenue-neutral, one of the terms du-jour.

To top all of this off, Republican Congressmen Chris Smith (NJ), Joe Pitts (PA), and Mike Pence (IN) succeeded during the Bush Administration in forbidding the integration of family planning information and supplies into HIV and AIDS programs, though unprotected sex is the leading cause of HIV transmission and of course the cause of unintended pregnancy. This of course undermined cost savings in addressing the related problems of HIV infection and unintended pregnancy and also denied HIV-positive women in particular the right to decide whether or not to have another child. The United States Conference of Catholic Bishops was particularly incensed at the idea these women would have such power and so lobbied very hard against integration. Read the rest of this entry →

Written by Kimberly Inez McGuire for RH Reality Check. This diary is cross-posted; commenters wishing to engage directly with the author should do so at the original post.

It’s about time we had some good news. It’s been a long, hot summer in DC and a rough year of partisan attacks on women’s health in Congress and around the country. Like a cool rain after a long drought, the Department of Health and Human Services (HHS) recommendations that birth control be covered without co-pay brought welcome relief to women around the country.

A refreshing example of sound policy informed by scientific and public health experts, this decision will have profound ramifications for many women and families, and may have special resonance for Latinas, immigrant women, and others who continue to face multiple barriers in accessing birth control. So, that’s the good news.

The not-so-good news? We’re going to need a lot more rain before this drought is over.

In honor of Latina Week of Action for Reproductive Justice 2011, I’m going to celebrate the HHS recommendations, while at the same time keeping in mind the unfinished work of ensuring access to contraception for all Latinas, including immigrant women.

It is not my intention to undersell the importance of the HHS decision. On the contrary, for too long, a woman’s ability to pay for birth control has determined whether and when she can prevent pregnancy, and including birth control as no-copay preventive care is a big step in the right direction.

And for Latino communities, economic relief of any kind cannot come soon enough. A new study by Pew shows Latino families have been hit hardest by the recession, accounting for the largest single decline in wealth of any ethnic and racial group in the country. These recent economic losses compound longstanding wealth and health disparities experienced by Latinas and their families. For Latinas who do have insurance or will be able to get it under the new exchanges, not having to pay out-of-pocket for their birth control could be transformative: leaving a little more money in the bank each month to help them with rent, tuition, buying groceries, and taking care of the children they already have.

But—and this is a big but—nearly four in ten Latinos is uninsured. And it probably comes as no surprise that lack of insurance is just one of many roadblocks Latinas encounter when they need to access health care, including contraception.

The Spanish phrase “!Si, se puede!” has long been used by Latinos the world over as a political rallying cry—and the two very different meanings of this iconic phrase may be instructive in examining the complex picture of Latinas’ access to reproductive health care. On the one hand, “Si se puede!” means “Yes we can!” an appropriate statement of celebration in the wake of this recent victory. (As in, “Thanks, Secretary Sebelius! Si se puede!!”) On the other hand, “Si se puede…” can also mean “IF she can…” and this conditional statement hints at the obstacles that remain. IF a Latina can get health insurance, IF she can make it to a provider’s office who can provide culturally-competent care in her language, and IF she can obtain and fill her prescription, THEN she will be able to fully enjoy the benefits of no-copay birth control.

For some women, that’s a few too many “ifs.” In addition to being less likely to have insurance, some Latinas, particularly immigrant or Spanish-dominant women, do not know where or how to find safe and accessible reproductive health care in their communities. Immigrant Latinas may be particularly vulnerable to unscrupulous “providers” who offer substandard care or misinformation. Just last week, reports surfaced that a counterfeit emergency contraception (EC) pill had been targeted to Latinas in the US. Other women may be experiencing contraceptive coercion, a form of intimate partner violence where a partner restricts a woman’s access to her birth control pills or refuses to use condoms. So even in a world where birth control is covered and hundreds of Planned Parenthood and other health clinics do provide quality care, some women could still slip through the cracks.

How can we reach the women who may not reap the benefits of the no-copay birth control decision? We can start by giving them more highly-effective options that do not require a provider’s supervision. Removing the age restriction on Plan B® emergency contraception would be a great start, and bringing a daily birth control pill over-the-counter also shows promise. If a woman of any age (or her partner, for that matter!) can pick up her EC or monthly pill pack with the rest of the shopping, more women will have birth control when they need it. (Intrigued? To weigh in with your thoughts on an over-the-counter birth control pill, you can fill out this survey.)

Every woman also needs better education about the full range of birth control options available to her. When unplanned pregnancy does occur, women need access to a full range of services: abortion care, prenatal care, and adoption counseling. Finally, reproductive health care does not exist in a vacuum: women also need social, educational, and economic opportunities, freedom from violence and coercion, and resources to care for their children and loved ones.

For many Latinas, the world I’ve just envisioned is still a long way off.

Our vigilance is needed to make sure that we build on all our victories by continuing to fight for more and better options for women. Just as every woman has different life circumstances that help determine what kind of birth control is right for her, each woman faces different barriers to accessing that birth control—including the need for insurance coverage and many others as well. We need more policymakers to take a cue from HHS Secretary Sebelius, and help create a world where every Latina “se puede,” where every woman has the support, education, and options she needs to plan pregnancy, care for her family, and care for herself.

"Deadline" by betchaboy on flickr

Written by Editor-in-Chief Jodi Jacobson for RHRealityCheck.org. This diary is cross-posted; commenters wishing to engage directly with the author should do so at the original post.

See all of our coverage of the IOM report and HHS guidelines here.

Will women’s health insurance be held hostage to the debt ceiling fiasco?

On July 19th, an expert panel convened by the Institutes of Medicine (IOM) released a set of evidence-based recommendations on the range of basic preventive care services for women that should be covered by insurance plans without a co-pay under health reform.  The recommendations were requested by the Department of Health and Human Services (HHS) to guide its final decision-making on these issues, and to put the imprimatur of peer-reviewed public health and medical science as well as evidence from clinical practice behind the final guidelines.

Services recommended by IOM for coverage without a co-pay include an annual well-woman visit as well as contraception, sterilization, gestational diabetes screenings, cervical cancer screenings, HIV/STI annual testing, domestic violence counseling, and breastfeeding support.  The Administration could have included these same services–including those on family planning services and contraceptive supplies–as part of its initial guidelines based on existing evidence. But the IOM process was seen by some as necessary not because these findings were not already self-evident to clinicians and public health experts, but because it is widely known that fanatical anti-choice groups and legislators would object to and fight against anything that improves the reproductive and sexual health of women or enables them to exercise their right to self-determination. Read the rest of this entry →

"Gag Law" by gmcmullen on flickr

Written for RHRealityCheck.org by Editor-in-Chief Jodi Jacobson. This diary is cross-posted; commenters wishing to engage directly with the author should do so at the original post.

Yesterday, Congresswoman Nita Lowey introduced the Global Democracy Promotion Act of 2011, a bill that would permanently repeal the Global Gag Rule (GGR), a policy that has been applied and revoked via executive order at each change in the White House, beginning with Ronald Reagan and leading most recently to repeal by President Obama in 2009.

The GGR prohibits international health care providers from receiving U.S. international assistance for family planning if those organizations use other (non-US) funding to provide abortion counseling, referrals, or services, or seek to change laws regarding abortion care in countries in which abortion is a leading cause of death among women ages 15 to 49.  Access to contraception and to family planning counseling and information helps women and their partners to plan the number and spacing of children they want to have and to avoid unintended pregnancies that lead to abortion.  As such, by denying U.S. international assistance to groups that also provide safe, legal abortion, the GGR actually increases the number of abortions, rather than reducing them. Read the rest of this entry →