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Obama Administration Ordered to Make Some Forms of EC Available Without Restrictions

6:38 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.

Plan B contraceptive wrapper

Judge: Plan B must be available without restrictions.

The Second Circuit Court of Appeals ruled Wednesday that the U.S. Food and Drug Administration (FDA) must immediately comply with an earlier order by U.S. District Court Judge Edward Korman to make some forms of levonorgestrel-based emergency contraception available without a prescription and without point-of-sale or age restrictions.

The ruling came in response to the administration’s request for a stay while it appeals Korman’s order. The Second Circuit’s order, only two pages, is a partial win for women’s health advocates; while it lifts restrictions on two-pill variants of emergency contraception, it grants the Obama administration’s request to stay, or pause, Judge Korman’s order as it applies to one-pill products, such as Plan B One-Step, pending the outcome of the government’s appeal. That appeal will be placed on an expedited schedule as requested by the administration.

In a statement, Nancy Northup, president and CEO of the Center for Reproductive Rights, said: “Today’s decision from the 2nd Circuit marks a historic day for women’s health. Finally, after more than a decade of politically motivated delays, women will no longer have to endure intrusive, onerous, and medically unnecessary restrictions to get emergency contraception.”

The Obama administration appealed Korman’s decision earlier this month, just one day after the Food and Drug Administration (FDA) approved Plan B One-Step to be sold over-the-counter to consumers ages 15 and up. But even that approval was limited, restricting sales to stores that have an on-site pharmacy and only to those with identification. The Plan B approval was in direct conflict with Judge Korman’s April order requiring all emergency contraception be made available over-the-counter and without point-of-sale restrictions.

“Medical experts, the FDA’s own scientists, and a federal court have all agreed: there are no medical grounds to keep emergency contraception behind the counter for any woman” Northrup said. “Expanding access to this safe and effective way of preventing pregnancy after failed birth control or unprotected sex is the among the very best decisions our federal government can make for women’s health.”

A schedule for the full-appeal is not yet available.
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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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President Obama: Women Stood for You. Stand With Us and Remove Abortion Restrictions From Your Budget

12:43 pm in Uncategorized by RH Reality Check

Written by Ashley Hartman 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 election, I was proud to work with many young people to engage our communities and campuses in the issues that impact us. One issue that engaged many young women in the election work I did this year in Ohio was access to health care, especially pregnancy related services, such as pre- and post-natal care, maternity care, and abortion care. Sixty-five percent of 18-to-24 year-olds believe abortion should be legal all or most of the time, which is higher than any other age group. I am lucky to have employer-funded health insurance that allows me to access a full range of preventive services, including all pregnancy-related services.

Sadly, not all women — even women with insurance — have access to these services. Current law unfairly limits insurance coverage for abortion for women with government-funded insurance. This is because federal dollars are withheld from covering a woman’s abortion except in limited circumstance.

It seems unfair to withhold insurance coverage or try to influence a woman’s decisions about whether to end a pregnancy just because of the type of insurance she has. These are decisions best made by a woman, her family, faith and doctor, not politicians.

These laws also put the lives of women at risk. When a woman is pregnant, it is important that she has access to safe medical care. Providing insurance coverage insures she will be able to see a licensed, quality health care provider.

Even if we don’t personally agree with abortion, it is unfair to restrict insurance coverage, or try to influence a woman’s decision about whether to end a pregnancy, just because she has government-funded health insurance.

I care about women in Ohio, which is why I supported Barack Obama. He pledged to ensure all women have access to essential reproductive health care services.

Women and youth voters played a huge impact in Obama’s win this year. Not only did young people, 18-to-24 turn out for the president in 2008, they continued to turn out for him as they entered their late twenties. This demonstrates how important issues such as insurance coverage for abortion are to this generation.

Now my generation must hold Obama accountable to his commitments. That includes urging President Obama to submit a budget to Congress without unfair restrictions on coverage for abortion care. Obama Administration, take note that women will be watching to see if you live up to your commitments to women’s health care.

What Gun Control Advocates Can Learn from the Anti-Choice Movement

11:56 am in Uncategorized by RH Reality Check

No Hunting School Zone

No Hunting School Zone

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

Here are some things that have occurred in the immediate aftermath of the tragic slaughter of children and their teachers in Newtown, Connecticut: More signatures on a petition calling for gun control than any other petition that has been sent to the White House; conservative politicians from both parties — for example senators Joe Manchin of W. Virginia, and Marco Rubio of Florida — for the first time signaling their willingness to do something about gun regulation; changing poll numbers about gun control among the general population, with support for stricter control at a ten-year high. And perhaps most significantly, total silence for several days about this incident from the National Rifle Association (NRA), considered to be the most powerful lobby in the United States.

These post-Newtown reactions have led numerous observers to feel that this latest mass murder incident may be a game changer. For years, many politicians have been fearful of offending the NRA and the public has been divided about guns, if not largely indifferent. As a result, there has not been a visible or highly effective gun control movement in this country, in spite of the hard work for many years of groups such as the Brady Campaign to Prevent Gun Violence.  Correspondingly, there has been almost no Congressional legislative action to curtail guns during the Obama administration, and at the state level, there have been more efforts to expand gun owners’ prerogatives — for example, concealed carry laws — than to limit then.

To be sure, petitions and expressions of outrage by both politicians and the public do not necessarily lead to a social movement. Even if an assault weapons ban is passed — Senator Dianne Feinstein has pledged to introduce such legislation in January — that might be a one-off event (welcome as it would be), and politicians would then turn their attention to the many other issues on their plates. And recall that there was such a ban passed in 1994 during the Clinton presidency — and then that ban was allowed to quietly expire in 2004. That expiration is a textbook case of what happens when legislation is not accompanied by a vibrant social movement that is able to rally the public and to hold lawmakers accountable.
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ACA Qué (What)? A Policy Wonk’s Mother Still Wonders How it Affects Her and Latin@ Families

4:11 pm in Uncategorized by RH Reality Check

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

We are now in the aftermath of the historic and significant Supreme Court ruling in favor of the Affordable Care Act (ACA). Our celebrations have simmered down and now we are analyzing what it all truly means and educating our  communities, while pushing back against the relentless opposition (i.e. the 33rd vote by the House to repeal ACA).

As I monitored the SCOTUS blog at the crack of dawn on the day of the ruling, I reminded myself that my mother, who had already been at work since 5 a.m. inside the hotel where she has worked for over 35 years, probably did not hear about the decision. While those who work on reforming our health care delivery system blasted emails, tweeted, blogged, and spoke with media, I wondered what she would have thought if she heard President Obama speak. Despite having a health policy wonk for a daughter, she would probably still wonder how this decision affects her, as most people did that morning and still do.

Despite the onslaught of reporting that day, the majority of discussions did not address how the ACA would benefit Latina/o individuals and families. Based on a xenophobic narrative, coverage about the fastest growing ethnic group in the country falsely pegs Latinas/os as immigrants who “drain” the system, and ignores contributions of immigrant and non-immigrant families as well as the less than half of Latinas/os who have access to job-based health insurance.

Overall, California Latinas/os stand to gain the most with the ACA, whether currently insured or uninsured. Latinas are the most uninsured group in the state with 4 out of 10 of us lacking health coverage. With this decision, over 2 million more California Latina/os will have access to affordable health care in 2014. It will also help the Latinas/os who already have employer-based coverage through regulatory and broader public health provisions.

My family is part of the 38 percent of Latinas/os in California who have employer-based coverage. Despite a debilitating work-related injury to her shoulder, my mother continues to work full-time through the pain she feels when cutting fruits and vegetables for the hotel restaurant, so that she can obtain health coverage for herself and two of my younger siblings. Latinas/os value health care and will often go to great lengths to obtain affordable health care for their families.

For California Latinas/os, the ACA means:

  • About 1.1 million California Latinas/os who are low-income citizens or qualified immigrants with incomes under 133 percent of federal poverty level ($30,657 for a family of four) will qualify for Medi-Cal.
  • More Latinas will have access to no-cost basic women’s preventive health, including contraception and cancer screenings.  This is extremely important for Latinas who are disproportionately affected by breast cancer and cervical cancer.
  • More families will have access to no-cost preventive care, including physical exams and immunizations.
  • More funding will go to community health centers, where anyone regardless of insurance or immigration status can receive care.
  • For those whose employers do not offer health coverage, which is a large percentage among Latinas/os, the ACA will provide tax credits to families on a sliding scale to purchase their own insurance through new insurance marketplaces called Exchanges.

The ACA also keeps insurance companies in check:

  • Insurance companies now have to justify to the Insurance Commissioner if they plan to raise their rates by more than 10 percent.
  • Insurance companies can no longer charge women more than men for the same insurance policy.
  • Insurance companies can no longer deny coverage to children for pre-existing conditions.
  • Insurance companies must spend the bulk of our premiums on providing care and not CEO bonuses. Families will receive rebates for un-spent premium dollars.

While we share and celebrate the positive changes that the ACA has already accomplished and those to come, we must also continue to fight for equal access to health care for everyone in our communities, specifically our undocumented brothers and sisters. Twenty-six (26) percent of uninsured Latinas/os in California would be excluded due to citizenship and immigrant clauses that prohibit undocumented residents from participating in public programs, receiving tax credits and using their own money to purchase coverage through the Exchange. We must inform immigrants about which public programs and health centers they can access, and at the same time work on solutions to cover all Californians, regardless of immigration status.

Opponents of the ACA can use scare tactics to inflame “the taxpayers” about all of the immigrants they would have to be responsible for providing health care – but the bottom line is that when families in our community cannot access care we all lose. Emergency care costs are mounting and safety net providers are over-burdened and under-resourced. And let us not forget that our immigrant families are also “taxpayers” and contribute invaluably to California’s and the nation’s vitality. Immigrants, regardless of status, are equally entitled to their human right to health care.

This “win” was not just for the policy and advocacy community, it was for families–like mine, like yours, and many other Latina/o families in California. Because of the Supreme Court ruling, I can rest assured that when my mother, who is still far from Medicare eligibility, can no longer work the required hours, we will be able to find her affordable health coverage.  

While most people have moved on to the latest breaking news, the decision did pique people’s interest. They want to know more about the ACA and how it will affect them. We all have a responsibility to inform our family, friends and broader communities about the details and importance of the ACA especially as conservative politicians push back and muddle the facts. We must speak clearly, loudly and relentlessly. Now is the time to drown out the naysayers and stand up for health care for all.

A Pyrrhic Victory? In ACA Ruling, Roberts Court Takes Big Swipe At Social Safety Net

11:12 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.

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When the legal challenges to the Affordable Care Act first started taking form, the assertion that Congress did not have the power to regulate the health insurance industry under either the Commerce Clause or the Necessary and Proper Clause was largely seen as an academic argument that had percolated in law schools thanks to a robust presence of the Federalist Society. After all, how could an industry that accounts for approximately 16 percent of economic activity in this country be said not to affect interstate commerce? Of course it can be regulated. Under the even the most cynical view opponents of the Affordable Care Act peddled these arguments simply as political cover for the Court to invalidate the law since the tension between the Obama administration and the conservative wing of the Roberts Court was nearly palpable.

The Court declined the political cover, a fact I think speaks loudly to the rumors that Chief Justice Roberts was concerned about the partisanship and rancor brewing within and around the Court, and the implications of this for his legacy. But the Chief Justice hardly “joined the liberal wing” of the Court in upholding the law. In fact, his decision gives conservatives a potentially significant tool to further attack the social safety net in its limitation of the Commerce Clause.

People, for reasons of their own, often fail to do things that would be good for them or good for society. Those failures—joined with the similar failures of others—can readily have a substantial effect on interstate commerce. Under the Government’s logic, that authorizes Congress to use its commerce power to compel citizens to act as the Government would have them act.

That is not the country the Framers of our Constitution envisioned.

For centuries the Court has held that these congressional powers are broad and expansive, and that the main risk an expansive view of federalism poses is a political risk, not any real risk to individual rights or liberties. Then, in 1995, in the Court’s decision in United States v. Lopez, Chief Justice Roberts’ predecessor re-discovered those limits.

The Lopez decision invalidated the law banning the possession of guns near schools on the grounds that the activity challenged — gun possession and presumably gun use — was too far attenuated from the stream of commerce for Congress to regulate. Gun rights activists heralded the decision as a triumph of the Second Amendment, but social conservatives saw much more in the ruling. They saw the dawning of a new Golden Age limiting federal power and future legal avenues to challenge laws and policies they deeply opposed — like the Affordable Care Act.

In rejecting Congress’s ability to regulate the health insurance industry under the Commerce Clause while still upholding the mandate under Congressional taxing authority, Chief Justice Roberts builds on the Lopez line of reasoning in a way that did no broad political damage to the Court — after all, the mandate survived and only those on the hard right seem intent on calling for Roberts’ impeachment — while still giving lots of juicy tidbits for federal judges to cite in future rulings hemming in other Congressional action. And since so much of Congressional action on domestic programs relies on its authority under the Commerce Clause and the Necessary and Proper Clause, it’s too soon to say if this distinction is again merely academic.

More importantly, Roberts extends the logic of Lopez which may prove to be more significant than we realize even now as the Court considers future challenges to Medicaid funding, efforts to defund Planned Parenthood and affirmative action challenges. As the logic goes, just because social ills have a broad economic impact does not mean Congress is empowered to fix them.

It’s a logic that whole-hardheartedly rejects the very premise of the New Deal and our social safety system and one that was just reinforced within the confines of a win on health care reform. Those of us that support the bill should celebrate the victory but we cannot get comfortable now. Chief Justice Roberts made it clear he upheld the law because he had to, both legally and politically. But in many ways the decision is a chilling repudiation of the heart and soul of its reform and a rallying cry for more vigorous challenges to the safety net. And we can expect conservatives to heed the call.

The Sound of Silence: Catholic Hierarchy’s Lack of Response to Abuse of Women by “Project Prevention”

8:23 am in Uncategorized by RH Reality Check

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Written by Jeanne Flavin 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, an all-Catholic coalition of 43 dioceses, hospitals, church agencies, schools and other religious-owned or operated but public entities filed a dozen separate lawsuits against the Obama administration, protesting the requirement that insurance plans covering secular employees include contraceptive services. These lawsuits follow on the heels of the U.S. Conference of Catholic Bishops’ high-profile attacks on nuns and Girl Scouts.

What I find as interesting as who Catholic leaders have chosen to attack is when they choose to be silent.

I “get” that many Catholics have a moral objection to contraceptive use (though presumably this group does not include the 98 percent of sexually-active Catholic women who report ever using a contraceptive method other than natural family planning). I also concede that the selectivity of the “right to life” position is nothing new; the Church has yet to file lawsuits against Texas Governor Rick Perry and the state of Texas for their staggering stream of executions.

Still, it seems reasonable that the same Catholic officials who are incensed by the prospect of insurance coverage for contraception would take strong issue with Project Prevention, a program that pays a targeted group of women to be sterilized or use long-acting forms of contraception. A search of the Internet, however, indicates that Catholic leadership has said absolutely nothing on the matter.

Project Prevention is a national organization based in North Carolina that claims chapters in 27 states. It has a presence in the United Kingdom and Kenya and has floated plans to expand to Haiti, South Africa and Australia. Project Prevention pays $300 for women who “abuse” drugs or alcohol to undergo long-term birth control or sterilization. Project Prevention targets only the reproductive capacity of some low-income women; the organization does nothing to address women’s need for comprehensive reproductive health care, effective drug treatment programs, mental health services, and social, economic and educational support. Moreover, Project Prevention encourages dangerous stereotypes about the women and their children. (This video challenges such characterizations.)

Project Prevention has garnered considerable publicity since its founding in 1997, having been featured on national television shows and in most major newspapers. Its Facebook page features status updates such as:

“Excited to write several checks to addicts this morning, but most excited that 6 [women] were under age 20″ and “No better way to start my morning than writing 14 checks to addicts/alcoholics who obtained long term birth control.”

Earlier this year, Project Prevention proudly celebrated a milestone, having paid 4,000 women to undergo long-term birth control and sterilization.

Despite Project Prevention’s visibility, I could not find evidence that a single spokesperson of a major Catholic organization has ever weighed in on their activities.

Project Prevention was originally called Children Requiring a Caring Kommunity or “C.R.A.C.K.” The old name reflects the organization’s focus on crack cocaine rather than substances like alcohol, tobacco or prescription medicines that also pose a threat to fetal health but are more commonly used by white and middle-class women. Because another classy thing about Project Prevention is that more than half of its clients are racial or ethnic minorities. Mind you, founder Barbara Harris insists that Project Prevention doesn’t target any particular race. As she explains:

“We target drug addicts, and that’s it. Skin color doesn’t matter, and we believe all babies matter, even black babies,” and “If you’re a drug addict, we’re looking for you, and I don’t care what color you are, because we don’t even know what color your baby will be, because often these babies come out all different colors. They’re mixed.”

The heads of major Catholic organizations apparently have not seen fit to issue an official statement of any kind in the face of Project Prevention’s thinly veiled racial prejudice or its promotion of contraceptive use.

Disturbing? You haven’t heard the half of it. Project Prevention’s recruitment strategies rely on referrals from probation offices, jails, drug treatment programs, methadone clinics and law enforcement agencies. There have been reports of workers (and others) being paid a $50 referral fee.

“Project Prevention is growing and even making inroads into state institutions,” Harris has boasted. “We’ve had many organizations, county and state agencies come on board and start referring women to us. We have jails that allow our volunteers in to tell inmates about our program. We have drug treatment programs that are referring women to us. We have methadone clinics that have our information posted on the walls, and probation departments-just many, many agencies, in a lot of states, that are learning about us and making referrals to us.”

To recap: You have an organization that for 15 years has sustained a highly-publicized campaign of paying low-income women of color who struggle with drug problems to be sterilized or subjected to long-acting birth control, and which relies on government agents for referrals and government-funded agencies to provide the contraception and sterilization services.

In light of this, we might expect Catholic leadership to be at least as vocal in their opposition to Project Prevention as they are toward the coverage of women’s voluntary contraceptive use (or, say, the Girl Scouts).

Instead, we hear… crickets.

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Perhaps others, like me, find it increasingly difficult to listen to what some Catholic leaders have to say on the subject of morality when their silence on Project Prevention and many other matters of significant moral import has been nothing short of deafening.

Anti-Sex Ed Curriculum Makes the List: Don’t Blame Obama, Blame the System

9:23 am in Uncategorized by RH Reality Check

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Written by Norman A. Constantine, Eva S. Goldfarb, Danny Ceballos, and Carmen Rita Nevarez for RH Reality Check. This diary is cross-posted; commenters wishing to engage directly with the author should do so at the original post.

See all our coverage of Heritage Keepers Abstinence Education here.

A recently updated list of federally approved “evidence-based” teen pregnancy prevention programs has been causing a stir. This list specifies the programs that are eligible for federal funds and serves as the cornerstone of President Obama’s Teen Pregnancy Prevention Initiative.  Among the three programs making the list for the first time is the Abstinence-Only-Until-Marriage program Heritage Keepers Abstinence Education. Our friends and fellow advocates in the adolescent sexual health promotion field have denounced this program as medically inaccurate, biased, fear- and shame-based, and otherwise inappropriate for the classroom. Here we all agree, completely. A program like this has no place in our schools and communities, and especially not with government funding.

But we take issue with criticisms of the Obama administration for “backroom deals and secrecy,” “political expediency,” and “blatant hypocrisy,” among other barbs and arrows recently launched by understandably frustrated advocates. Rather than blaming Obama for this unfortunate development, we’d all do better to recognize that it was the result of a fundamentally flawed system operating according to explicit agreed-upon rules—a system sorely in need of review and repair.

What’s wrong with this system? Simply put, it is based on a fundamental misunderstanding of the nature of scientific evidence and its appropriate use. To earn a place on the list, a program needs only to produce one statistically significant outcome in one evaluation study–no matter how many outcomes were tested across how many studies. Yet it is a well-known principle of research statistics that the likelihood of a false finding increases as the number of outcomes tested increases. In fact, if a program has no effect, for every twenty outcomes tested one outcome can be expected to be incorrectly identified as a statistically significant effect merely due to chance alone. Even testing just two outcomes raises the probability of a false finding of effectiveness beyond the traditionally tolerated level of less than five percent. The technical name for taking advantage of this principle to obtain a statistically significant finding is “fishing for significance.”

And this is just one of the more blatant of the numerous problems with the evidence review system currently in place. These problems and their implications are described elsewhere in more detail. Suffice it to say that under current “evidence-based” standards of effectiveness, a Mickey Mouse cartoon could be listed as an effective teen pregnancy prevention program with just a moderate amount of evaluation creativity and persistence. Perhaps it is then no surprise that upon release of the original version of this evidence-based teen pregnancy prevention program list in 2010, the independent non-partisan research-use watchdog Coalition for Evidence-Based Policy commented that “HHS’s evidence-based teen pregnancy prevention program is an excellent first step, but only 2 of 28 approved models have strong evidence of effectiveness.”

The biggest challenge in research and research use in this area is that we as a field need to move away from asking these simplistic out-of-context yes/no questions about effectiveness of individual name-brand curricula. These types of questions inevitably lead to the picking and choosing of isolated favorable findings. Instead, we can do a better job of critically weighing and integrating the entire body of relevant program evaluation evidence —together with the broader body of scientific research evidence on adolescent health and development —as they inform a set of general principles of effective and responsible comprehensive sexuality education.

To complement this more encompassing view of evidence, while at the same time recognizing the understandable demand among funders and program providers for simple and straightforward guidance about program development and selection, we propose a move to standards-based lists. There are now many excellent sets of standards and guidelines for comprehensive sexuality education, from groups such as SIECUS, UNESCO, and IPPF, as well as the newly developed National Sexuality Education Standards.  These standards represent an enormous improvement over what is currently passing for comprehensive sexuality education, and enjoy widespread support from mainstream health and education organizations.  Any of these could be used as the basis of an objective and systematic process for rating curricula and other programs on the most important content and process criteria.

California has already provided a model of such a system, based on its Sexual Health Education Accountability Act and related California Education Code. These basic standards for comprehensive sexuality education provide 45 explicit criteria that serve as the foundation for an objective and systematic process used to rate curricula in California.  The successful experience in California with this system could help inform the adaption of such as system in other states, and for federal program review as well. It could be applied to any of the existing standards.

Advocates for Youth has promised to challenge the existing evidence-based paradigm and to “advocate for a recalibration of the current balance towards a vision of sex education that is evidence-informed and rights based.” We enthusiastically support this new focus, and will help however we can.

Teen Immaturity Is Not the Problem with Plan B. The Immaturity of Politicians Is.

11:56 am in Uncategorized by RH Reality Check

Plan B (photo: vixyview/flickr)

Plan B (photo: vixyview/flickr)

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

Teenagers get a lot of crap for going above, under, and around the laws that are established to keep them “safe.” Some of these laws are completely well-founded. Others are not.  President Obama and Kathleen Sebelius, betrayed millions of teens and young people (along with their doctors, parents, and supportive adults) by telling them that they were not mature enough to decide to prevent a pregnancy.

As a recent teenager, I want to set the record straight on some things that our politicians may not have realized. Teenagers do have the maturity to know how and when to take Plan B. Teenagers know that emergency contraception is what you use when the condom breaks, when pulling out doesn’t go as planned, when contraception wasn’t available. They know it can stop pregnancy from occurring and that they shouldn’t wait until Monday when they MAY be able to go to the doctor to get a prescription.

Because let’s face it, sex for teenagers happens more often when their parents are out for the night, when they don’t have school the next morning, and when they have the most free time. Monday isn’t going to cut it and while teenagers may want to go to the pharmacy and pick up Plan B because they want to protect themselves or their partners from becoming pregnant, they can’t. Not because they are going to abuse it, not because they don’t know how to use it, not because they lack the maturity to know what consequence the lack of action could have, but because politicians have deemed that it’s immoral to let teenagers to access Plan B. They are denying teenagers access to something that could help them continue being teenagers, because isn’t that what every parent, neighbor, and president wants?

Teenagers under 17, who can’t legally access Plan B, do sometimes have access to it. The majority of people that I know who have used Plan B were not 17 and they didn’t go to a doctor to get a prescription to get emergency contraception. Teenagers know that there are faster ways to get Plan B and so, while millions of adults don’t have the maturity to admit simple (or big) mistakes, teenagers admit to their friend, their sibling, their cousin that they messed up and they need that person to buy them or their partner emergency contraception. These teenagers use their birthday, babysitting, or lawn- mowing money to buy a $50 pill that will prevent a pregnancy and enable them to continue being teens. Read the rest of this entry →