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.

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:

Read the rest of this entry →

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.

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 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.

Read the rest of this entry →

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.

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 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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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.

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.

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

Some Catholic universities were historic supporters of contraception.

If you weren’t eagerly checking the bishops’ blog for their feelings on your health insurance, you may not have known last week was Catholic Schools Week! I generally don’t participate in the bishops’ weeks (or fortnights), but I think this is an ideal moment to highlight the proud history of advocacy for contraceptive access at Catholic-affiliated Universities — which is relevant to all those lawsuits that won’t be going away now that His Eminence Timothy Cardinal Dolan has spoken.

We begin at Notre Dame in 1966. Faculty members formed a group to advocate for government funding of family planning programs and advertised a statement of support in Catholic publications. They received over 500 signatures in under a month from Catholic clergy, nuns, lawyers, doctors, and faculty members  at Catholic universities, including the deans of Notre Dame and Santa Clara’s law schools. The Notre Dame professor chairing the committee told the New York Times the group wished to emphasize that “in a pluralistic society, some legislation may be desirable even though it may not be in accord with the moral principles of a minority of the society’s members.”

The chairman explained that the impetus for the group’s formation had been an address by the Rev. Dexter L. Hanley to the American Bar Association arguing for government family planning programs. Father Hanley was a law professor at Georgetown University. Yes, that Georgetown. The same Georgetown that trained a lawyer named Sandra Fluke. Father Hanley also testified before a congressional subcommittee in support of access to contraception. So when Sandra Fluke did the same thing, not only was she acting like a lawyer, which is presumably what one attends Georgetown Law to learn to do, she was following in the footsteps of a revered Georgetown professor and priest who had inspired Catholics across the country to take action.

Though Fluke is regularly accused of demanding government funding for contraception, what she actually testified about was the sub-par plan available to Georgetown students (who are required to have health insurance). Typically, student health plans involve students paying money to a third-party health insurance company; neither government nor university funds are involved in these transactions. Father Hanley, however, was indeed advocating for taxpayer-funded contraception and education. He acknowledged Catholic teaching against contraception but testified that he could firmly maintain his moral positions as a Catholic while supporting a government program that “permits each citizen a fully free moral choice in matters of family planning, and aids him in implementing this choice.”

Today, rather than permitting its students a “fully free moral choice” as Father Hanley advocated, Georgetown has taken advantage of the safe harbor from the contraceptive coverage requirements, claiming it has a religious belief that bars providing insurance that covers contraception. This is hard to believe given that faculty members’ health plans have included contraceptive coverage for years. Also, Georgetown hosted an excellent conference on the Health and Human Services regulation where most scholars rejected the claim that providing coverage violated Catholic doctrine or that requiring it violated the law. The robust defenses of Sandra Fluke from the University President and the law school faculty were lovely, but fixing the problem she testified about is what’s needed.

Let’s return to Notre Dame. From 1963 to 1967 Notre Dame held an annual “Conference on Population.” The conference, organized with the help of the Planned Parenthood Federation of America, was intended from its inception to be a forum to develop a more liberal Catholic position on contraception. In 1965, thirty-seven scholars who attended the conference sent a statement to the Pope that declared “[t]here is dependable evidence that contraception is not intrinsically immoral, and that therefore there are certain circumstances in which it may be permitted or indeed even recommended.” Notre Dame’s President, Father Theodore Hesburgh, later got his friend John D. Rockefeller a secret meeting with the Pope to discuss the problem of overpopulation.

Despite this history, the University has now claimed in its lawsuit that Notre Dame, whoever that is, has a sincere religious belief that the Church’s “centuries’ old teachings” prohibit coverage. This is despite the fact that its own theology students and faculty can’t get their questions answered about what the theological claim for the prohibition of contraceptive coverage is and people like Kathleen Kaveny, a professor of both law and theology at Notre Dame, have argued the legality of the mandate in detail. A further troubling sign from an institution that was once the place for principled discussion of contraception, is that Notre Dame’s website refers students to what appears to be a “Crisis Pregnancy Center.” When I called up the “Women’s Care Center,” they told me they do not actually have doctors on staff or prescribe contraception.

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

Recently, the district court for District of Columbia granted a request by Tyndale House Publishers to block the Affordable Care Act birth control benefit ensuring that employer-sponsored health insurance include coverage of contraception without a co-pay. (Jessica Mason Pielko wrote about the ruling here.)

Like so many other organizations, both religious and secular, for-profit and non-profit, Tyndale’s complaints are the same: the birth control benefit in the ACA infringes upon their right to religious freedom:

Tyndale and its owners are Christians who are committed to biblical principles, including the belief that all human beings are created in the image and likeness of God from the moment of their conception/fertilization. But Defendants’ recently enacted regulatory mandate under PPACA forces Tyndale to provide and pay for drugs and devices that it and its owners believe can cause the death of human beings created in the image and likeness of God shortly after their conception/fertilization. The government’s mandate exempts what it calls “religious employers,” but denies that status to Tyndale House Publishers through its arbitrary definition.

What sets Tyndale apart from other companies challenging the birth control benefit, some of which have been successful in their challenges, and some of which have not, is that Tyndale is self-insured, whereas companies like Hobby Lobby purchase group health insurance plans from a commercial insurance carrier. In other words, Tyndale wholly assumes and underwrites the risk for providing health care to its employees (and pays for it out of its own coffers), while Hobby Lobby pays premiums to an outside insurance company. That it is self-insured means that Tyndale is paying directly for the insurance coverage of the contraception that it views as sinful, and the court found that this distinguishable fact rendered the birth control benefit sufficiently violative of Tyndale’s right to religious freedom.  

Now, the court did not reach this decision in a vacuum, mind you. The Obama Administration’s compromise with the United States Conference of Catholic Bishops (USCCB) paved the way. 

If you recall, the contraception kerfuffle began in February 2012 over one question: should employers be required to offer health insurance plans that cover contraception? In an effort to compromise with the USCCB and other religious organizations that balked at the notion of providing “slut-pills” to women, the Obama Administration allowed religiously-affiliated employers to avoid providing contraception coverage, and instead required health insurance companies to offer it directly. The Obama Administration allowed certain religious employers to keep their fingers entirely out of the contraception pie, and put the onus on insurance companies to fill the contraceptive gap. And in so doing, the Administration ceded that paying for contraception is, in and of itself, participation in sin, thus paving the way for self-insured organizations to raise Establishment Clause and Religious Freedom Restoration Act (RFRA) claims that will be (and are being) analyzed differently than the claims raised by organizations that are commercially insured.

Notwithstanding the distinction between self-insurance and regular commercial insurance, the claims challenging the birth control benefit are specious — both constitutionally and as a matter of church doctrine. Still, women’s rights activists and attorneys must adjust and re-frame the argument to take into account this new development in the birth control benefit lawsuits.  

Rather than focusing on who is paying money for what healthcare services, a better way to look at it — and, indeed, the most sensible way to look at it — is that companies providing a full range of health-care services, including contraception, are offering their employees a choice to participate in sin or not, just as employees who pay wages to their employees are offering employees that same choice.

Imagine if Tyndale filed a lawsuit challenging federal minimum wage laws. Would it make sense to allow Tyndale to argue that it should be exempt from paying its employees a fair wage out of fear that its employees would use that money to purchase contraception? Of course not. The religious nexus between paying employee wages and subsequent employee commission of sin is too great.

It might surprise you that Catholic scholars agree — at least one does. As Dr. Jeff Mirus of CatholicCulture.org notes, sometimes the remote participation in immorality is unavoidable:

In the absence of a contrary declaration by the Magisterium of the Church (to which I would submit immediately), it seems clear to me that the purchase of health insurance which includes some elements of immoral coverage is a matter of remote material cooperation with evil in a situation where it is all but impossible to avoid that remote cooperation. Just as we may morally pay taxes even though some tax money is used immorally and we may morally patronize various business which use a portion of their earnings immorally (and in fact this is inescapable in the modern world), so too I believe that if there is no reasonable way to avoid health insurance with some elements of immoral coverage, then it is not immoral to purchase such coverage.

If purchasing a group health insurance plan that includes contraception constitutes “participation” or “cooperation in evil,” then that participation is remote at best. For example, adhering to a hypothetical regulation requiring religiously-affiliated employers to shove contraception down the throats of female employees would certainly be a direct participation in evil. Requiring religiously-affiliated employers to purchase insurance that includes contraception coverage, on the other hand, is a remote participation in evil. And the Obama administration’s compromise — relieving religiously-affiliated organizations of the obligation to pay for contraception directly, and instead, shifting that burden onto insurance companies — falls somewhere between a remote participation in evil and a direct participation in evil.

It’s a sliding scale of sin.

The question becomes, at what point along the scale between remote participation in evil and direct participation in evil does the balance tip in favor of women and against religious organizations that believe it is their religious duty to ensure that women are stripped of the freedom to choose whether or not they want to use contraception and brand themselves as sinners?

At a certain point, the Catholic Church and other religious organizations must let their flock make their own choices. At a certain point, participation or cooperation in evil becomes far too remote to constitute an infringement on religious liberty. And ultimately, the pseudo-religious complaints about providing contraception, or paying for contraception must give way to common sense, fairness, and justice, whether or not employers pay directly for contraception, or do so through insurance carriers.

Certainly, the distinction between full insurance and self-insurance is an important one, and the religious outcry over the birth control benefit made it necessary for the Obama Administration to compromise, perhaps without giving much thought to how such a compromise would play out in the courts.  But the result of that compromise has paved the way for courts to hang their constitutional hat on the difference between self-insurance and “regular” insurance when it is a distinction without a difference.  

Tyndale claims that paying directly for contraception is a grievous violation of its religious freedom, and as a matter of law, courts are not permitted to nitpick those claims. Tyndale says it’s a sin? Fine. It’s a sin. But realistically, Tyndale could just as easily argue that paying workers a fair wage — or indeed any wage — is a religious violation, and I’m fairly certain that we can all agree that would be an absurd argument.

So what’s the point?

The point is this: We must begin discussion contraception access in terms of fairness. We must view access to contraception for women as being as important as the right to minimum wage.

The argument over contraception is not a religious one. It’s an argument about equality, health care, prevention, and basic human rights. We musn’t lose sight of that.

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

Published in partnership with the International Planned Parenthood Federation (IPPF) Live blog.

Photo: Beatrice Murch / Flickr

Crocodile feces, honey, dates, hot mercury, fish, opium, half a lemon, disinfectant, cola, animal intestines, weasel testicles, a hare’s anus, and the toxic sludge from a blacksmith’s workshop. Sounds like the contents of Heston Blumenthal’s kitchen cupboard.

In fact, these ingredients, in various combinations, have all been ingested, inserted, digested, or applied as contraceptive measures over the years. Few of them worked. Many resulted in death.

Wednesday, September 26th, is World Contraception Day. This is a day of campaigning for a world in which “every pregnancy is wanted.” Its mission is to improve awareness of contraception among young people, so that they can make informed decisions about their sexual and reproductive health (SRH).

Times have moved on since the days of such weird concoctions. More than 20 different methods of long-acting and short-acting hormonal and barrier contraception are now available, many of which are 99-percent-plus effective.

But strange superstitions live on. Take the pill, and you’ll gain weight, grow a beard, become infertile, and smell funny. HIV and STI cells are so small, so the story goes, that they can slip through the walls of a condom.

You can’t get pregnant if the girl’s on top, if you jump up and down afterwards, if you don’t have an orgasm, or if you have sex in a hot bath. (How hot? What size bath?) Plastic wrap works as well as a condom, toothpaste is an effective spermicide, and, of course, no one gets pregnant the first time.

Wrong, wrong, wrong, of course. But if your only access to information is peer-group-led Internet chat and street-corner gossip; if your mom, dad, and teachers consider sex totally taboo; if your doctor doesn’t approve; and you can’t get advice or supplies … well, basically, you’re stuffed.

There are people who say young people shouldn’t have sex until a relationship is seen to have some kind of social or religious legitimacy. There are people who say, whether you like it or not, many young people will have sex regardless of such strictures.

Either way — whether sex takes place on a wedding night, or before — it seems sensible to take the simple precautionary measure of ensuring that young people (or any people for that matter) know what they’re doing and are aware of the possible complications that attach. That applies whether people see it as a procreational duty, as a way of expressing love, or as something that is simply fun. Whatever way people choose to look at it, sex is an essential, enjoyable, and rewarding aspect of being alive. (Well, isn’t it?)

Look at it like driving. You can’t suddenly jump in a car one night and drive off safely if you don’t know the rules of the road, you’ve got no insurance, and you haven’t got the foggiest idea what the different pedals, switches, and controls are all designed to do, or where they are. So, why do we expect anyone (whether on his or her wedding night or not) to suddenly jump into a sexual union and head off safely into the sunset?

The earliest known illustration of a man using a condom is in a cave painting in France. It’s reckoned to be 12,000 to 15,000 years old. Clearly, this is where Stone- Age students gathered to take part in the world’s first comprehenisve sexuality-education program.

Have we moved on from the Stone Age?

Written by Ivy Abiona 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 is published in partnership with the National Coalition of STD Directors (NCSD) as part of our joint series on STD Awareness.

(photo: Thom Watson/flickr)

They are more common than an all-nighter to finish a term paper or cramming for a final exam. Okay, maybe that’s a little extreme. But the fact that STDS have a high prevalence among college aged students in the United States is alarming. One in four college students today has some kind of STD, a shocking 25 percent. And according to the Centers for Disease Control and Prevention (CDC) 19 million new cases of STDs occur every year, half of them occuring in people between 15 to 24 years old. I can’t say that I am a math whiz but let’s just say I don’t like the odds.

After doing some investigating I found that a primary reason for these high rates was a lack of education. As a New Jersey (yes, New Jersey) high school graduate I found this to be somewhat puzzling. I remember learning about different STDS and preventive measures. Even the nurse’s office had signs and posters describing this information. Don’t all students learn about prevention and safe sex in their health education courses in middle and/or in high school?

A 2006 study by the CDC demonstrates that my optimistic perspective is a utopian flaw. The CDC study indicated that among U.S. high schools, 28 percent taught 11 key pregnancy, HIV, or other STD prevention topics in a required health education course.  In addition, while 87 percent of high schools taught abstinence as the most effective method to avoid pregnancy, HIV, and other STDs in a required health education course, only 39 percent taught how to correctly use a condom in a required health education course.  Clearly, high school students are in dire need of preventive and safe sex education and just teaching abstinence isn’t going to cut it. Early last month, the Guttmacher Institute released new research reaffirming other data and information that a comprehensive sexual education (teaching both abstinence and preventive measures) not only helps teens delay sex but also has a positive impact on other decisions when they do, such as partner selection. Read the rest of this entry →