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What Would a Decent Teen Pregnancy Prevention Campaign Look Like?

10:37 am in Uncategorized by RH Reality Check

Written by Miriam Pérez 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 feels like every time I turn around, there’s another offensive teen pregnancy or parenting ad campaign. The Candie’s Foundation, which was created by Neil Cole of the apparel company Candie’s that is popular with young girls, joined the fray with its own offensive ad campaign for Teen Pregnancy Prevention Month in May.

Veronica Bayetti Flores at Feministing.com broke that one down nicely. Then an ad campaign was released by the Chicago Department of Public Health featuring alarmist photos of teenage boys with photoshopped baby bumps, like this one:

While campaigns like the one launched by the Candie’s Foundation have celebrity endorsements that propel them, I’m always more disgusted to see campaigns like Chicago’s, or the one in New York City earlier this year, where public funding has been used to make them happen—public dollars that could be used in many other ways that actually might have an impact on the lives of teenagers and parents of all ages. The Chicago campaign also has the strange side effect of being transphobic, accidentally depicting what could be a pregnant transgender man.

All of these campaigns have left me to wonder if there is a teen pregnancy prevention campaign I would support. Sadly, the crux of most of these campaigns, and especially the Candie’s Foundation and New York City campaigns, isn’t actually teen pregnancy prevention—they are teen parenting prevention campaigns, which I could never get behind. I would never support an initiative that shames and defames teen parents and spreads statistics that are taken out of context and claim teen parents, especially teen mothers, will never succeed.

This response to the Candie’s Foundation campaign illustrates how statistics commonly used to defend teen parenting prevention campaigns can be distorted:
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The Bishops v. Birth Control: It’s Not About the Money

11:45 am in Uncategorized by RH Reality Check

Birth control pills

Religion, birth control, and Obamacare — it’s not about the money.

In announcing its final rule concerning the Affordable Care Act’s guarantee of access to birth control without a co-pay for all American women—including the Catholics and non-Catholics who work in religiously sponsored schools, hospitals, and social service agencies—the Obama administration bent over backwards to accommodate the Church’s concerns. The goal was to spare Church fathers from the anguish of getting their pristine hands dirty by, as the Bishops charged, being forced to sell, buy or broker birth control coverage for women, including students. The final rule allows that either the insurance company used by the institution—or, if it is self-insured, its plan administrator—will have to pay, with reimbursement coming through a series of convoluted steps.

In a repeat of the Church battle over the Affordable Care Act, Sister Carol Keehan, head of the Catholic Health Association, last week publicly approved the administration’s final rule, issuing an explanation for the association’s members about how to implement it. Not so the U.S. Conference of Catholic Bishops. The week before, its head, Cardinal Timothy Dolan, released his statement expressing dissatisfaction with the compromise, saying that the bishops are subjecting it to further “analysis,” feel their “religious freedom” is still under threat, and plan to continue “defending our rights in Congress and in the courts.” Count on the 60+ lawsuits by Catholic diocese and universities around the country, joined by secular employers who also don’t like birth control and want to exclude it from their insurance policies, proceeding apace.

It is maddening that the Administration had to go to such extremes to placate the Church fathers, who dare to put “moral” and “money” as it applies to this deeply compromised institution in the same sentence. How pure, really, were the hands of the Church fathers who began decades ago to secretly spend millions of dollars in hush money to silence child victims of clergy rape and sodomy, and rid themselves of the evidence of their paternal crimes? Hush money that came from the faithful in the pews, who paid for all those ever-escalating insurance premiums, and from selling the churches and schools out from under those same working-class Catholics? The victims merited all the compensation they got and more, but the Church fathers literally stole that money from the Catholics they served and lied about it.

When the Bishops realized how much money they had to lose by even these secret settlements, hiding the goods from the victims became the next best strategy. So how pure, really, are the hands of Cardinal Dolan, the leading voice claiming the moral high ground in the battle to keep any of the church coffers from supporting birth control for women? Files just released by the Roman Catholic Archdiocese of Milwaukee turned up a letter showing that when Dolan served as the Archbishop of that diocese, he secretly and successfully, and even as the Archdiocese was preparing to file for bankruptcy, petitioned the Vatican to bury nearly $57 million in a cemetery trust fund in order to protect those assets “from legal claim and liability,” aka, child abuse victim compensation. And this was on top of his paying off some priest child sex abusers $20,000 a piece to leave the priesthood, reportedly defended by Dolan in one case as “an act of charity,” so that, irony of ironies, the priest “could pay for health insurance.”

And how pure, really, are the hands of the Church fathers regarding money when we look at the shenanigans at the Vatican bank? Still laughably named the “Institute for the Works of Religion,” the Vatican Bank is literally drowning in mounting accusations of money laundering and mobster connections. Most recently, Monsignor Nunzio Scarano, an accountant for the Administration of the Patrimony of the Apostolic See, which manages the Vatican’s property and investments (and a Vatican account-holder himself), was arrested and charged with conspiring to transfer some $26 million from Switzerland to Italy to dole out to his rich friends.

Given this sad financial state of affairs, how does paying for a health service like birth control for women become such a threat to Church fathers that they’ve made a major campaign out of it?

The bishops claim this mandate violates church teaching that artificial birth control is “intrinsically evil, “despite the fact that nearly 100 percent of Catholics don’t believe there is anything “intrinsically evil” about birth control and use it. The bishops claim birth control is the same as abortion; it isn’t. They claim to be protecting the institution’s “conscience,” thereby stepping all over Catholic Church teaching that defines conscience as “the most secret core and sanctuary” of a person, not an institution, and the Church not as the “men of God” but as “the people of God,” which would seem to include women. They claim the money at issue is “their” money, even though employees earn their health insurance as part of their compensation package, and many have to contribute to or pay the full amount of their health insurance premiums so this is at base a labor issue. And their claim that birth control is not a “health” service, in the face of current scientific knowledge and medical opinion, is tantamount to insisting that the sun revolves around the earth.

A hint of a far deeper motivator lies in a rarely regarded passage from Humanae Vitae, Pope Paul VI’s 1969 Encyclical letter, “On the Regulation of Birth,” which cemented the Church’s current intransigent opposition to birth control. The section on “Grave Consequences on Methods of Artificial Contraception” reads in part:

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Silencing Debate on Women’s Lives: It’s Happening In Wisconsin, Too, and the Catholic Church Is an Accomplice

11:37 am in Uncategorized by RH Reality Check

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

Redux – The personal is political

Wisconsin State Senator Mike Ellis (R)

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.

Griswold v. Connecticut and the Evolution of Personal Privacy Rights

8:16 am in Uncategorized by RH Reality Check

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

Birth control pills

How the fight for contraceptive freedom & LGBTQ rights sheds light on privacy protections.

Over the past three years, more than 60 lawsuits have been filed in federal court challenging the Affordable Care Act contraceptive coverage benefit. These legal challenges are based on a central theme of today’s conservative movement, which argues contraception is immoral, and that the Supreme Court decision preventing states from criminalizing birth control was wrongly decided. That’s where things stand on the 48th anniversary of Griswold v. Connecticut.

Why now? Why is the right gunning so hard to take down Griswold and gut individuals’ rights to privacy that include keeping the government out of their most intimate decisions? And what has changed legally, to bring this issue to a boil now? As it turns out, the answer has very little to do with contraception and more to do with same-sex marriage. At its core, the legal foundation of personal privacy rights rests in the institution of marriage and family. As older definitions of “traditional families” give way to more expansive realities, including same-sex partnerships, single-parenting, co-parenting, and myriad family arrangements today, conservatives must face a stark legal reality: Without drastically changing the way the courts define issues that once were simply matters of privacy, they will have lost the culture wars. It’s now or never.

The Supreme Court first laid the foundation for an individual right to privacy early in the 20th century in Lochner v. New York, a case that has become synonymous with activist judges looking for any means to support and expand corporate, monied interests. In Lochner the majority relied on the reference to “liberty” in the 14th Amendment’s Due Process Clause to support striking down a New York state law that restricted the number of hours bakers could work each week. The 14th Amendment states that no person “shall be deprived of life, liberty or property, without due process of law.” According to the court majority, the law was an unconstitutional violation of an individual’s privacy rights because the Due Process Clause implicitly guarantees citizens the “fundamental” right to enter into employment arrangements free from state intrusion in this “liberty” interest.

From Lochner, privacy rights more clearly became associated with the home and traditional, patriarchal constructions of family. In Pierce v. Society of Sisters (1925), the court ruled that an Oregon law banning all private education violated the Due Process Clause because it directed how parents may educate their children, infringing upon parents’ fundamental right to rear their children as they see fit. The majority opinion in Pierce lists a series of other privacy rights guaranteed by the Due Process Clause, including “the right of the individual … to marry, establish a home and bring up children … and generally to enjoy those privileges long recognized at common law as essential to the orderly pursuit of happiness by free men.”

But it wasn’t until 40 years later, in Griswold, that the Supreme Court turned its attention to whether the Constitution implicitly contains fundamental privacy guarantees that are not dependent on the Due Process Clause. Writing for the majority, Justice William O. Douglas departed from the Lochner line of privacy reasoning and held that a right to privacy exists not because of a specific constitutional provision but rather because it flows from several provisions relating to privacy, to create “penumbras”, or shadows, in which “zones of privacy” exist. Within these zones, the court explained, are other rights, including the right of married couples to determine whether or not to have children.

Two years later the court would again reach the issue of privacy rights in Loving v. Virginia, the famous case that challenged a Virginia law banning interracial marriage. In a unanimous decision, the court ruled the Virginia law violated the 14th Amendment’s Equal Protection Clause, which guarantees all citizens equal protection under the law and thus prohibits the government from discriminating on the basis of race. The court could have stopped there with its analysis, but it didn’t. Instead, it pushed further, moving beyond the obvious issues of racial discrimination to hold that the right to marry is itself protected by the Constitution. By the end of the 1960s, and with the civil rights and anti-war movements smoldering in the background, the Supreme Court’s jurisprudence showed both a slow acceptance of racial equality and a preference for the traditional construction of marriage and family.

Griswold v. Connecticut may have recognized a right of married couples to use contraception, but it wasn’t until March of 1972 in Eisenstadt v. Baird that the Court recognized a corresponding privacy right to use contraception for individuals. “If the right of privacy means anything,” Justice William Brennan wrote, “it is the right of the individual, married or single, to be free from unwarranted governmental intrusion into matters so fundamentally affecting a person as the decision whether to bear or beget a child.” The following year, the court famously extended these individual privacy rights even further when, in Roe v. Wade, it established a constitutional right to choose abortion grounded in an individual right to privacy and this legally recognized zone of intimacy that inherently surrounds issues of reproduction but that was no longer immediately anchored in the constructs of traditional marriage.

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Administration Again Fails on Over-the-Counter Emergency Contraception

10:47 am in Uncategorized by RH Reality Check

Editor’s Note: The Justice Department filed suit to block Judge Korman’s ruling.

The Obama administration said Wednesday that girls under 15 should not have access to the most common morning-after contraceptive pill as the Justice Department filed a notice to appeal a judge’s order that would make the drug available without a prescription for girls and women of all ages.

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.

This article was amended at 10:16 am, Wednesday, May 1, to correct the date of the amended application by TEVA to the FDA. It was resubmitted in 2012, not 2011.

See all our coverage of EC Over-the-Counter here.

Plan B contraceptive wrapper

New FDA emergency contraception regulations still do not go far enough.

Today, in a proposal that can best be described as adding insult to injury, the Food and Drug Administration (FDA) approved making emergency contraception (EC) available over-the-counter for teens and women ages 15 and up. This convoluted proposal from the Obama administration comes despite a court order in early April by U.S. District Court Judge Edward R. Korman to make EC available over-the-counter to all ages within 30 days of his decision. It comes from an administration which pledged to make science the cornerstone of public policy and instead has consistently flouted a wealth of accumulated evidence on emergency contraception. It also comes after several studies showing that current policy requiring prescriptions for some groups and not others has confused so many pharmacists that access to EC has been denied to many who were in fact legally eligible to obtain it quickly. In practice, the new policy will almost certainly perpetuate, not resolve, that confusion.

The battle to make EC available over-the-counter has gone on for over a decade and spanned both the Bush and Obama administrations. Judge Korman’s ruling was issued in response to the Center for Reproductive Rights’ (CRR) renewed lawsuit against the FDA seeking to expand over-the-counter access for all women to all brands of the morning-after pill, including Plan B One-Step and Next Choice. The most recent CRR lawsuit was filed after Kathleen Sebelius, secretary of the Department of Health and Human Services, overruled a 2011 FDA decision to make emergency contraception available over-the-counter to all ages, underscoring that the Obama administration, like its predecessor, has difficulties dealing with the realities of sex and pregnancy prevention.

The administration’s newest plan is to make EC available over-the-counter to individuals ages 15 and up, but still require prescriptions for those under age 15. While pharmacies can stock it in the family planning section of main store shelves, people seeking to buy EC will have to show identification with a birth date to a cashier. The plan comes after approval this week by the FDA of an amended application submitted by Teva, the manufacturer of Plan B One-Step, to allow OTC sale to those ages 15 and over, after an earlier request to do so had been denied by FDA in December 2011. The amended application was in any case superceded by the scientific evidence that led the FDA to rule in 2011 on making emergency contraception available OTC to all ages, the decision that was, as noted above, subsequently overturned by Sebelius. So in using the approved Teva application as the reason for this newest decision, the FDA is essentially reversing itself and ignoring the science on which its 2011 decision was based. Confused yet? Me too. It’s a complete circus, and I have no doubt that leadership at the FDA, which tried to make evidence-based policy in 2011, came under pressure from the White House to find the “fix” it announced today.

According to the FDA press release:

The product will now be labeled “not for sale to those under 15 years of age *proof of age required* not for sale where age cannot be verified.” Plan B One-Step will be packaged with a product code prompting a cashier to request and verify the customer’s age. A customer who cannot provide age verification will not be able to purchase the product. In addition, Teva has arranged to have a security tag placed on all product cartons to prevent theft.

In addition, Teva will make the product available in retail outlets with an onsite pharmacy, where it generally, will be available in the family planning or female health aisles. The product will be available for sale during the retailer’s normal operating hours whether the pharmacy is open or not.

NPR reported that “the FDA said … Plan B One-Step will be packaged with a product code that prompts the cashier to verify a customer’s age. Anyone who can’t provide such proof as a driver’s license, birth certificate or passport wouldn’t be allowed to complete the purchase. In most states, driver’s licenses, the most common form of identification, are issued at age 16.”

There are several serious problems with this approach, apart from the fact that it ignores scientific and medical findings that call unequivocally for over-the-counter access for all.

First, the policy is not in compliance with the court ruling and therefore may in fact be thrown out. The Department of Justice will have to bring it before Judge Korman for approval and potentially seek a stay of his ruling altogether, throwing EC once again back to the courts.

Second, it still requires a prescription for a subset of the population potentially in need of EC, and therefore creates a significant barrier, especially for low-income teens under 15 years of age or those without ID who “look” younger and are denied access. Emergency contraception is for emergencies. It prevents unintended pregnancy by preventing ovulation, and is therefore most effective when taken within 72 hours of unprotected intercourse (including in cases when another contraceptive method may have failed). The need to see a physician to obtain a prescription that the public health and medical communities have deemed unnecessary is both time-consuming and expensive, and will entail additional indirect costs in terms of loss of time at school and work, likely on the part of both teens and their parents. This requirement serves the interests of no one except anti-choice opponents of birth control, and those in the Obama administration who still seem unable or unwilling to think beyond their own fears of teens and sex, or to go beyond personalizing policy to accommodate their own paternalistic fears of their daughters as sexual beings.

Third, language, lack of identification, and other potential barriers will remain an obstacle for many communities. Many 15- and 16-year-olds do not have IDs that display birth dates, and those who are well above the age limit but “look younger” to a clerk will be required to produce identification, documentation that many people in this country still do not have readily available or that, in a hurry, some might not remember to bring with them to the store.

Latinas, for example, face many of these barriers to access. In reaction to the decision, Jessica González-Rojas, executive director of the National Latina Institute for Reproductive Health, stated:

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Why Does the ACGME Want to Eliminate Contraceptive Training for Family Physicians?

12:32 pm in Uncategorized by RH Reality Check


Written by Dr. Linda Prine and Dr. Ruth Lesnewski 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 one of the clinics where we work, a 16-year-old girl came in with a sprained ankle.  She left with a prescription for birth control.

This turn of events is not as surprising as it seems:  As family physicians, we treat the whole person.  A quick update revealed that our 16-year-old patient had recently begun to have unprotected sex — and had no plan to get birth control. One of the reasons we love practicing family medicine is that we get to know our patients over time and provide the preventive care they need at every possible opportunity.

That is why we are dismayed that the Accreditation Council of Graduate Medical Education (ACGME) has proposed changes to the guidelines for family medicine residency programs removing the requirement that residents learn to provide contraception. These changes will go into effect in 2014 unless the ACGME is convinced otherwise, during an open comment period taking place this week.

A majority of U.S. women get their basic health care from a family physician or other primary care provider, and often that includes reproductive health care. Especially in rural and low-income areas, family physicians do it all! They not only provide birth control but also provide prenatal care, deliver babies, manage miscarriages, counsel patients about unintended pregnancies, and, increasingly, offer pregnancy termination so that their patients do not have to travel long distances and see unfamiliar doctors for these services.

ACGME’s motivations are legitimate:  It seeks to simplify the rules for the nation’s family medicine residency programs — numbering over 450 — and to allow for more creativity and flexibility. In some areas of practice, this makes sense. Many programs will continue to teach contraception; it will depend on the culture of the institution. However, residency programs based in religiously-affiliated hospitals (which operate nearly 20 percent of inpatient community-hospital beds in the U.S.), will most likely drop birth control training immediately.

Because the ACGME currently requires birth control training, religiously-affiliated institutions must figure out a way to comply. Many rotate their residents through external clinics to learn these skills — which are essential since 99 percent of women in the United States who have ever had sexual intercourse have used a method of contraception other than natural family planning at some point in their lives. Without this requirement, residents in religiously-affiliated programs may get no training at all in contraception.

Just last week, we attended a meeting where an assistant residency director expressed satisfaction at the prospect of no longer needing to teach residents how to counsel patients with unintended pregnancies of all of their options. This is our concern: Limiting the training of family medicine residents in birth control will have a disproportionate impact on the millions of low-income and rural women and teens who rely on their family doctors to provide the full-spectrum of reproductive health care. The Affordable Care Act greatly expands access to contraception for millions of women in the United States. But, if clinicians aren’t trained in providing contraception, then that access is meaningless, even if it is covered. We need to make sure all clinicians who provide primary health care for women are trained to provide high-quality contraceptive care.

Our next generation of family physicians must learn and practice more contraception, not less. Otherwise our shamefully high rate of unintended pregnancy (the highest in the developed world) will rise further.

There is time to make a difference. The ACGME is accepting comments on the proposed guidelines until April 25, 2013. Click here to download our suggested version of the official comment form.  Fill in your information and email it to familymedicine@acgme.org.  The Reproductive Health Access Project has an online campaign for all of us to tell the ACGME that their changes affect our health care.

Emergency Contraception and Moral Panic: Dissecting the Newest Misinformation Campaign

1:53 pm in Uncategorized by RH Reality Check

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

Plan B contraceptive wrapper

Plan B emergency is under attack by religious conservatives again.

Reproductive rights advocates have something to cheer about: A federal judge ruled last week that the U.S. Food and Drug Administration (FDA) must allow universal access to Plan B over-the-counter for all ages. But anti-choice proponents want to have the last word on emergency contraception (EC), also known as the morning-after pill. Their strategy to limit access includes claiming that EC is unsafe for adolescents.

After Judge Edward Korman’s ruling, Charmaine Yoest of Americans United for Life said: “This decision allows the abortion industry to gamble with young girls’ health in distributing a life-ending drug, with no real understanding of the long-term implications on their bodies.”

A spokeswoman for the U.S. Conference of Catholic Bishops stated that the court’s action “undermines parents’ ability to protect their daughters … from the adverse effects of the drug itself.”

Once again, the anti-choice community is using inaccurate information to limit women’s and girl’s reproductive rights. There is no evidence that Plan B is a “life-ending drug:” EC is not the abortion pill. It works by preventing or delaying ovulation and does not interfere with implantation of a fertilized egg or with an existing pregnancy.

Nor do any studies demonstrate that EC has “adverse effects” let alone “long-term implications” for girls’ bodies. Plan B is safer than aspirin: It has few or no immediate side effects and no long-term side effects. In fact, the drug meets all of the FDA’s objective criteria for switching a drug from prescription to non-prescription status: It is non-toxic, it is impossible to overdose on it, it has no harmful effects on a woman or teen or a possible pregnancy, and it is not addictive. Girls and women are able to self-diagnose their risk and understand how to use EC from simply reading the label. Finally, Plan B does not require any medical screening or intervention from a health care worker to use it safely.

FDA Commissioner Margaret Hamburg recognized EC’s safety in December 2011 when she confirmed evidence of Plan B’s suitability for all ages without requiring a prescription. What’s more is that her approval for universal over-the-counter EC access has been endorsed by the American Academy of Pediatrics, the American College of Obstetricians and Gynecologists, and the Society of Adolescent Health and Medicine.

Judge Korman also took compelling scientific evidence for Plan B’s safety into account. He wrote in his opinion that Secretary of Health and Human Services Kathleen Sebelius’ countermand of FDA decision-making was “politically motivated, scientifically unjustified, and contrary to agency precedent.”

In 2011, Secretary Sebelius claimed her actions were based on lack of evidence that the drug was safe for girls as young as eleven. Judge Korman was right to counter that “the number of 11-year-olds using these drugs is likely to be miniscule.” A study published last week in Pediatrics bolsters his assertion: According to author Lawrence Finer, only 0.6 percent of 10-year-olds, 1.1 percent of 11-year-olds and 2.4 percent of 12-year-olds have ever had sex.

In the words of the federal judge, claiming that Plan B is unsafe for 11-year-olds is an “excuse to deprive the overwhelming majority of women of their right to obtain contraceptives without unjustified and burdensome restrictions.”

Curiously enough, Secretary Sebelius has made no move to impose an age limit on purchasing aspirin, an over-the-counter drug that is linked to Reye’s syndrome in children under age 16. Nor has the FDA restricted children’s access to energy drinks, despite the fact that over a dozen deaths have been linked to highly-caffeinated beverages that are marketed to youth.

There is no doubt, then, that Secretary Sebelius’ actions to limit EC, one of the safest drugs on the market, were political. The timeline of events indicates as much: The secretary’s FDA override took place in December 2011 immediately before she announced President Obama’s controversial contraceptive mandate one month later

When responding to Judge Korman’s decision, anti-choicers perhaps sensed that evidence-based arguments are effective in the courts. As a result, their offensive tactics have slightly shifted gears from making claims about EC’s safety to arguing that universal EC access potentially coerces girls and increases the risk of untreated STDs.

For example, Anna Higgins, director of the Center for Human Dignity at the Family Research Council, said, “There is a real danger that Plan B may be given to young girls, under coercion or without their consent.”

Donna Harrison of the American Association of Pro-Life Obstetricians and Gynecologists said in a statement, “You’re taking girls at highest risk of STD and isolating them from medical care.”

Harrison’s statement, however, misses the crux of why emergency contraception is important: It is to be used in an emergency. STD education, screening, and treatment are obviously vital components of sexual and reproductive health. Girls who have been sexually violated and potentially exposed to HIV are especially in dire need of HIV prophylaxis. But there is no conclusive evidence that providing EC to adolescents increases their risk of STDs or contributes to a rise in risk-taking behavior. Moreover, if a girl fears that she may become pregnant, she must be able to access EC as soon as possible — Plan B is most effective within 72 hours, and only up to five days, after unprotected sex.

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Court Orders FDA to Make Emergency Contraception Available Over-the-Counter for All Ages

11:42 am in Uncategorized by RH Reality Check

Written by 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 a long-awaited decision released early this morning, U.S. District Court Judge Edward Korman ordered the U.S. Food and Drug Administration (FDA) to make emergency contraception available over-the-counter to women of all ages, marking a major win for public health and women’s rights in a year that has seen science otherwise buried under an avalanche of anti-choice politics. In his decision, Judge Korman orders the FDA to make levonorgestrel-based emergency contraception available over-the-counter without an age or point-of-sale restriction.

Today’s order was issued in response to the Center for Reproductive Rights’ (CRR) renewed lawsuit against the agency seeking to expand over-the-counter access to all brands of the morning-after pill, including Plan B One-Step and Next Choice, to women of all ages.

The court has ordered the FDA to make emergency contraception available without a prescription and without point-of-sale or age restrictions within 30 days, with the option to limit the change to only Plan B One-Step if the agency “actually believes there is any significant difference between the one- and two-pill products” and to require new labeling if necessary.

Women’s rights groups are celebrating the decision.

“Today science has finally prevailed over politics,” said Nancy Northup, president and CEO of CRR, which brought this and other lawsuits. “This landmark court decision has struck a huge blow to the deep-seated discrimination that has for too long denied women access to a full range of safe and effective birth control methods. “Women all over the country will no longer face arbitrary delays and barriers just to get emergency contraception. It’s a true victory for all women, especially young women, women without government-issued identification, and those who live in areas with limited pharmacy hours,” she added.

Susannah Baruch, interim president and CEO of the Reproductive Health Technologies Project, which has been a leading advocate for emergency contraception, concurred: “Today we celebrate a long overdue victory for all women. Our decade long struggle is finally over. Emergency contraception will now sit on store shelves allowing timely access to this important product used to prevent unintended pregnancy. We urge Secretary Sebelius and the FDA to move swiftly to put emergency contraception on store shelves and into the hands of women and couples who need it.”

In a statement, the National Latina Institute for Reproductive Health applauded the ruling:

For Latinas in particular, expanded access to emergency contraception is critical for making the best decisions for our families and ourselves. For too long, this important backup birth control method has been kept behind the counter and out of reach. Immigrant women and new Americans of all ages have been hit particularly hard, since they are less likely to have government identification. This decision removes one barrier for Latinas who need contraception — though others, like poverty, discrimination, language and immigration status, remain.

This victory came after a long and unnecessarily difficult battle that was marred by politics, irrespective of the political party in charge. (See timeline following article.)

The FDA first approved emergency contraception (EC) for prescription use in 1999. Subsequently, study after study showed the safety of EC for women of all ages seeking to prevent an unplanned pregnancy after unprotected sex or contraceptive failure. In 2003, the first application was made to the FDA to approve EC for over-the-counter (OTC) sales. And thus began a long game of politics that has spanned both the Bush and Obama administrations. First, the Bush administration refused to act to make EC available OTC, resulting in the first successful lawsuit by advocates to ensure that science, rather than politics, governed women’s access to this method of basic preventive reproductive health care. EC was first made available OTC for women ages 18 and older, though the science clearly affirmed its safety for younger women.

After years of advocacy and further scientific proof of efficacy and safety, it seemed that finally EC would be made available over the counter for all women. However, in a deeply controversial move in December 2011, Kathleen Sebelius, secretary of the Department of Health and Human Services (HHS), overruled the decision by FDA Commissioner Margaret Hamburg to approve over-the-counter sales of Plan B One-Step. President Obama publicly supported Sebelius’ decision, in what was widely seen as a political move. Public health, medical, and legal groups went into overdrive, conducting a wide-ranging public education campaign, launching a citizen’s petition, releasing statements in support of EC OTC, and filing the lawsuit that led to today’s decision, in which Judge Korman called Sebelius’s actions “politically motivated, scientifically unjustified, and contrary to agency precedent.” Said Judge Korman, “The decisions of the Secretary with respect to Plan B One-Step and that of the FDA with respect to the Citizen Petition, which it had no choice but to deny, were arbitrary, capricious, and unreasonable.”

“It’s shameful it has taken over a decade and a federal court order for the U.S. government to implement in policy what studies and experience have proven time and time again — emergency contraception is safe and effective and should be available for women of all ages,” said Janet Crepps, senior counsel for CRR.

Currently, EC is available to women ages 17 and older without a prescription; young women under 17 are required to obtain a prescription from a physician. Even for women 17 and older, however, the medication is available only at health clinics or pharmacies, upon request and with adequate identification.

This unique and unnecessary dual scheme, notes CRR, has impeded access even for women who are allowed to obtain the drug without a prescription, as evidenced by several studies, including one published in the journal Pediatrics earlier this year. A total of 943 pharmacies in five major cities were contacted twice by researchers at Boston University — once the researchers posed as a 17-year-olds and another time as physicians. The study found that there misinformation was common regarding who can take EC and at what age it is available without a prescription, creating barriers to timely access. According to the research, nearly 20 percent of the drugstores contacted denied the “17-year-olds” access to the pill.

With the court’s ruling today, drug companies can now apply to make EC available to women of all ages and at stores other than just pharmacies — eliminating human error in determining who can and cannot purchase the medication.

#####

CRR Emergency Contraception Case Timeline

July 28, 1999: The U.S. Food and Drug Administration (FDA) approves Plan B, an emergency contraceptive medication, for prescription use.

February 14, 2001: The Center for Reproductive Rights files a Citizen Petition with the FDA on behalf of over 70 medical and public health organizations to make Plan B available without a prescription or over-the-counter (OTC).

April 21, 2003: Women’s Capital Corporation, the manufacturer of Plan B, files an application with the FDA to make Plan B available OTC.

Late December 2003/January 2004: After a panel of FDA experts recommends approval of the Plan B application, Dr. Steven Galson, the head of the office responsible for making the final decision, informs his staff that the regular procedures won’t be followed this time, and that that office won’t make the final decision. (Jenkins deposition)

December 2003 to Jan 17, 2004: Galson confesses to a co-worker that he has to reject the Plan B application because he’s afraid he’ll lose his job. (Jenkins deposition) Dr. Janet Woodcock, the second in command at the FDA, tells a colleague that the agency first has to reject the application, then approve the drug later with an age restriction in order to “appease the administration’s constituents.” (Houn deposition)

May 6, 2004: The FDA denies the manufacturer application and suggests Barr, the drug’s new manufacturer, amend the application to request an OTC switch only for women 16 and older. (Barr revises the application; the FDA schedules a decision for January.)

January 21, 2005: After the FDA fails to meet its deadline, the Center files a lawsuit against the agency for ignoring science and holding Plan B to a different standard than other drugs.

August 26, 2005: The FDA misses its second deadline to rule on Barr’s application. In a peculiar move, the agency requests the public provide input over an indefinite period of time on how to dispense the drug.

February 24, 2006: The Center is cleared to depose high-level FDA officials. The New York magistrate judge cites strong showing of “bad faith and improper behavior” by the FDA.

June 9, 2006: FDA denies Citizen Petition for the first time.

August 24, 2006: The FDA agrees to make Plan B available without a prescription, but only to women 18 and older who can provide government issued identification. The FDA also requires that Plan B be sold behind pharmacy counters.

March 30, 2007: Center files for summary judgment in the case, arguing that the undisputed facts found in evidence gathered through discovery make it unnecessary for the court to hold a trial, and that the court should order the FDA to make Plan B available without a prescription to women of all ages.

March 23, 2009: Court orders the FDA to approve Plan B for those 17 and older without a prescription and to reconsider the Citizen Petition and all age and other restrictions on OTC access.

July 10, 2009: The FDA approves Plan B OTC for those 17 and older. The FDA also approves Plan B One-Step, which is a product that consists of the same drug as Plan B but in one pill rather than two. Both Plan B and Plan B One Step are OTC for those 17 and older and prescription-only for those 16 and younger.

August 28, 2009: The FDA approves Next Choice, a generic version of Plan B, under the same regime: OTC for those 17 and older and prescription-only for those 16 and younger.

November 16, 2010: The Center files a motion for contempt of court against the FDA for failing to reconsider the Citizen Petition and the current restrictions on OTC access to Plan B.

December 1, 2010: After receiving FDA approval for prescription-only use, Watson Pharmaceuticals launches ella, another form of emergency contraception (ulipristal acetate).

February 7, 2011: Teva Pharmaceuticals, the manufacturer of Plan B One-Step, files a supplemental new drug application (sNDA) with the FDA so that the drug will be available OTC for women of all ages.

Dec. 7, 2011: HHS Secretary Sebelius takes an unprecedented step to block FDA Commissioner Hamburg’s approval of Plan B One-Step manufacturer’s application for OTC status, which included additional data that confirmed its safety for all-ages use. The next day, President Obama publicly supports Sebelius’s decision, “as a father of two daughters.”

Dec. 12, 2011: On the eve of a court hearing on the Center’s motion for contempt, the FDA denies the Citizen Petition for a second time based on a lack of teen-specific data for the two-dose medication, despite the volume of data before the FDA on two-pill emergency contraception products, which data for one pill products of emergency contraception confirmed.

Dec. 13, 2011: Judge denies contempt motion because FDA had ruled on the Citizen Petition the night before, but invites CRR to reopen the case. Judge notes striking similarities between recent actions and 2005-2009.

Feb. 8, 2012: CRR reopens its case, filing a motion for preliminary injunction and summary judgment for immediate relief that would allow OTC access for all levonorgestrel-based emergency contraceptives (both one and two pill versions) without any age or point of sale restrictions. CRR also adds Sebelius as a defendant and supplements the complaint.

February 16, 2012: Judge Korman issues Order to Show Cause to Defendants “why the FDA should not be directed to make Plan B available to those persons whom the studies submitted to the FDA demonstrate are capable of understanding when the use of Plan B is appropriate and the instructions for its due.”

March 9, 2012: Teva Women’s Health, Inc., the manufacturer of Plan B One-Step, files a motion to intervene in the case.

April 27, 2012: Hearing held on Court Order to Show Cause and Motion of Teva Women’s Health to Intervene.

April 5, 2013: Judge Korman orders FDA to make levonorgestrel-based emergency contraception available over the counter without age or point of sale restriction.

Plan B Vending Machine Survives Anti-choice Misinformation Campaign

2:09 pm in Uncategorized by RH Reality Check

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

Plan B contraceptive wrapper

Plan B emergency contraception is available 24 hours a day via public vending machine at one college, much to consternation of anti-choice advocates.

A little more than a year ago, during the same week that the Susan G. Komen Foundation  announced that it would no longer provide funds to Planned Parenthood, Shippensburg University, a previously little-known state college in Pennsylvania’s Cumberland Valley, captured media attention throughout the United States. The sudden spotlight on Shippensburg came as a result of a decision administrators had made five semesters earlier — at the end of the fall 2009 term — to sell Plan B Emergency Contraception (EC) from a vending machine located in a remote corner of the campus.

According to Dr. Peter M. Gigliotti, Executive Director for University Communications and Marketing at Shippensburg, roughly 300 students a year had swiped their college IDs to obtain access to the machine in the two-and-a-half years it had been operating. Each was given an opportunity to confer with a counselor in person or by phone before inserting $25 to obtain Levonorgestrel, AKA Plan B, a medication that prevents fertilization, preventing pregnancy if taken with 72 hours of unprotected intercourse.

Gigliotti believes that someone on campus — he does not know if it was a disgruntled student, faculty member, or staff person — tipped off the press that Shippensburg had a Plan B vending machine and within hours the story was garnering headlines and energizing anti-choice and abstinence-only advocates across the country. “What we did by making Plan B available in a vending machine is very emotional for a lot of people,” he begins. “When the story broke we immediately received more than 1000 calls and emails. Right away it became clear to us that people were confused about what Plan B is and how it works. The largest number of contacts came from people who oppose Plan B on a moral or religious basis and they did not want to listen to facts. In their minds Plan B is an abortion and no amount of scientific information will change their minds. They told us that we were killing babies and were all going to go to Hell.”

In addition, impassioned callers berated college administrators, arguing that they were kowtowing to the demands of a misinformed student body, 85 percent of whom had previously indicated — through a 2008 student survey — that they wanted on-campus access to the drug. “My ‘favorite’ email asked us if we would give dynamite to our students if 85 percent of them wanted it,” he laughs. “It was absurd. What they failed to recognize is that Plan B is legal and available in most pharmacies, without a prescription, to anyone who is over the age of 17.”

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Birth Control and “The Myth of the Judeo-Christian Tradition”

2:47 pm in Uncategorized by RH Reality Check

Written by Rabbi Dennis Ross and Rev. Tom Davis for RH Reality Check. This diary is cross-posted; commenters wishing to engage directly with the author should do so at the original post.

Myth of Judeo Christian cover

The Myth of Judeo-Christian Tradition by Arthur A. Cohen reminds us that no one group speaks for all members of these religions.

The U.S. Department of Health and Human Services (HHS) recently responded to the concerns of some religious groups and individuals by proposing yet another plan to provide prescription birth control insurance coverage under the Affordable Care Act (ACA). Although this HHS initiative respects religious concerns and ensures access to birth control, it received a negative response from the Catholic Bishops, just as the other initiatives had. New York’s Cardinal Timothy Dolan, who is president of the U.S. Conference of Catholic Bishops, explained the rejection, saying, “In obedience to our Judeo-Christian heritage, we have consistently taught our people to live their lives during the week to reflect the same beliefs they proclaim on the Sabbath.”

Now, it would be reasonable to come away from these words thinking that all Jews and Christians are of one mind about birth control — that is to say, opposed. On the contrary, many U.S. rabbis and ministers have long recognized the moral wisdom of ensuring wide availability of safe and effective birth control. Beginning in the late 1920s and the ’30s, many Jewish and Protestant groups formally endorsed access, including rabbis from Reform and Conservative Judaism, and ministers from Episcopal, Baptist, Congregational, Methodist, and Presbyterian churches. Clergy came forward with the support of their faith teachings, underscored by their real-life experience. The pastors were invited into the daily and private lives of congregants to witness, first-hand, that the ability to control one’s child-bearing makes for healthier children and mothers and for stronger families and communities. Today, one thing is certain: Differences in religious teachings remain, and no religious group or leader speaks for all of the nation’s faithful about birth control insurance coverage under ACA.

The recent HHS announcement affects employees of religiously-affiliated hospitals and the like; churches, synagogues, and mosques remain exempt. The reality is that these hospitals are not the same as houses of worship that conduct weddings or confirmations. They are not-for-profit businesses serving the larger public with secular services that are not specifically religious, like setting a broken ankle or performing an appendectomy. What’s more, a hospital employs staff from all walks of life, including faithful individuals in our communities whose fully informed moral decision may lead to a conclusion that differs from the faith of an employer. Besides, these workers earn their insurance along with wages and pension. The insurance belongs to the worker; an employer’s religious objection is irrelevant. A woman’s private decision about her birth control has a higher moral standing than her employer’s problem with her using it. And all we are talking about is insurance paperwork passing quietly through a human resources office — no one is being asked to use birth control.

Notably, the ACA’s birth control insurance provisions resemble those of New York state and California. These insurance requirements, tested in the highest courts of those states, were upheld as an equitable accommodation. And, as clergy, we emphasize that imposing a religious teaching about birth control into the private, personal home life of an American is an egregious violation of church-state separation. But all this is not enough to satisfy birth control opponents.

Arthur A. Cohen’s book, The Myth of the Judeo-Christian Tradition, encouraged a robust dialogue on our religious difference. He argues that the term “Judeo-Christian tradition” represents “a myth which buries under the fine silt of rhetoric the authentic, meaningful, and irrevocable distinction which exists between Jewish belief and Christian belief.” So let’s take Cohen’s advice and recognize that no one religious body or leader represents all Jewish belief — or Christian belief, for that matter. Where religions disagree, policymakers must not play umpire and pick their favorite “team.” Instead, they need to respect the boundary of church-state separation, leave it to the woman to decide about her health care, and ensure her access to the safe and legal preventive medicine she decides she needs.

Cohen calls our religious differences “meaningful.” So let’s ditch the rhetoric, embrace the wonder, grace, and strength of spiritual diversity, and enter a full-hearted and “meaningful” conversation across denominational lines and within religious groups about pressing issues, such as addressing the needs of the poor, the homeless, and immigrants. And let’s take the moral high ground by recognizing that women own their health insurance and deserve protection from the religious objections of others.