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Vulnerable Women and Contraception: Obama Turns Clock Back Nearly 100 Years

3:31 pm in Uncategorized by RH Reality Check

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.

See all our coverage of the Administration’s 2011 Emergency Contraception Reversal here.

“For a woman to ‘ask her physician’ for a safe and effective contraceptive  presupposed that she had a physician, that she could afford a contraceptive, and that the physician would be willing to give it to her, regardless of her marital status.”

These are the words of the historian Sheila Rothman, writing about the setbacks Margaret Sanger faced in the 1920s and 1930s in trying to realize her vision of making birth control widely available to all women, including the poorest—and about the ultimate “ownership” of contraceptive services during that era by physicians. Sanger’s original vision was a fleet of clinics, to be run by public health nurses. But as Rothman and others have documented, when she attempted to open such clinics, she experienced repeated arrests and the closures of her facilities, as contraception was then illegal. In the years leading up to the 1965 Supreme Court Griswold decision, which legalized birth control for married persons, only physicians were legally permitted to provide such services, and as the quote from Rothman implies, this situation put poor women at a tremendous disadvantage.

Rothman’s critique, written in the 1970s about events in the ‘20s and ‘30s,  is remarkably relevant to today’s leading reproductive controversy: the Obama administration’s overruling of the FDA decision to allow over-the-counter status of Plan B, an Emergency Contraceptive product, for young women under the age of seventeen. If one substitutes “teenager” for “woman” and “Plan B” for “a safe and effective contraceptive” in Rothman’s quote, one can readily appreciate how, once again in America’s longstanding reproductive wars, the needs of the most vulnerable are willfully neglected.

Secretary of Health and Human Services Kathleen Sebelius and President Obama justified the Administration’s action because of concerns about pre-teens’ ability to use EC correctly. But as been repeatedly observed, only a tiny portion of this age group is sexually active.  It is 15- and 16-year-olds who are sexually active in far greater numbers, and therefore, far likelier to have need of EC (and to be able to use it correctly). But many in this group do not have a primary health care provider to whom they can go for a prescription.  Some of those who do have a relationship with a provider may be too embarrassed, or afraid of a breach of confidentiality, to ask for such a prescription.

To be sure, some things have improved in the contraceptive world since the dominance of private practice physicians in Margaret Sanger’s time. In 1970, Congress authorized the Title X program, which made federal funds available for family planning services for poor women including, notably, teenagers. (As a sign of how much the reproductive battle lines have hardened in the last 30 years, Title X was signed by a Republican president, Richard Nixon, and one of its most enthusiastic sponsors in Congress was a future Republican president, George H.W. Bush). A number of contraceptive products are available on the shelves of drugstores.

And it is no longer just physicians who can advise and dispense contraception. In public health clinics and Planned Parenthood facilities, nurses are in fact the main providers of contraception. We can hope that some portion of those teenagers who need EC can find their way to a Planned Parenthood or other Title X site in the three day window in which the drug is most effective.

But this recent decision of the Obama administration on EC occurs, of course, in an atmosphere in which Republicans in Congress are attempting to abolish Title X, and various states have defunded Planned Parenthood, leading to a closing of numerous clinics. The reproductive wars drag drearily on—and in our times, as in Sanger’s, the most vulnerable of women pay the greatest price.

“For a woman to ‘ask her physician’ for a safe and effective contraceptive  presupposed that she had a physician, that she could afford a contraceptive, and that the physician would be willing to give it to her, regardless of her marital status.” “For a woman to ‘ask her physician’ for a safe and effective contraceptive  presupposed that she had a physician, that she could afford a contraceptive, and that the physician would be willing to give it to her, regardless of her marital status.”

Denying OTC Access to Plan B Disproportionately Affects Latina Teens

3:25 pm in Uncategorized by RH Reality Check

Written by Jessica Gonzalez-Rojas 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 the Administration’s 2011 Emergency Contraception Reversal here.

This article was changed at 12:05 pm on Tuesday, December 13th.  The original mis-identified the author. It is Jessica Gonzales-Rojas. We apologize for the error.

Last month a ten-year-old girl in Puebla, Mexico gave birth, via c-section, to a premature infant. The girl says her stepfather raped her repeatedly. She only spoke out about the abuse after she gave birth when the glare of public attention gave her some measure of safety. Her stepfather immediately disappeared. This story has received wide attention in the Spanish language press and has sparked anger across Latin America.

I immediately thought of the girl from Puebla last week when President Obama expressed concern that an 11-year-old might go to a drugstore and purchase emergency contraception along with “bubble gum and batteries” because the drug could “have an adverse effect.” The image of a young child casually purchasing birth control was used to describe the “common sense” reasoning behind his administration’s refusal to allow the FDA to make emergency birth control available to young women below the age of seventeen. President Obama invoked the image of his daughters when discussing the drug store scenario, but I imagined the girl from Puebla, standing at the checkout counter with birth control, bubble gum and batteries in her hands. The profound injustice of her life brought me to tears, and the trivialization of her situation, as if girls at age ten would be purchasing birth control with the same weight that they would purchase the bubble gum, is enraging.

Whether President Obama was compelled to weave the bubble gum narrative for political gain or because it truly reflects his thinking, the result is the same. Complex sexual health issues get overly simplified, society focuses on stigma more than solution, and young people are left with policy decisions that don’t begin to match the weight of their lived experiences nor keep them “safe.”

What is repeatedly lacking in our narratives about adolescent sexual health is a human rights perspective. If our society were to seriously contemplate how to help children who are victims of sexual abuse, it would not be to make birth control access harder for teens. This tunnel vision ignores the complex social factors that foster abusive environments, and ignores the dignity and justice that every child deserves.

A real discussion about emergency contraception would focus on addressing the real needs of teens. Yet due to the structural barriers that our politicians and healthcare industry have erected, most Latina teens will not realistically be given this last chance to prevent an unintended pregnancy. More than any other racial or ethnic group, Latinas lack health insurance and their households struggle economically. Teens without health insurance or money will need to seek out a healthcare provider to write a prescription, collect the $50 for the co-payment to fill the prescription, and to take the pills within three days of unprotected intercourse. Furthermore, Latina teens that encounter additional barriers due to their immigration status or limited English-language proficiency are even more isolated. No one reasonably believes this is a recipe for success.

There has always been strong political interference in FDA rule making about emergency contraception. Politicians simply can’t let scientists and public health experts do what’s best for our young people. That’s why years ago the National Latina Institute for Reproductive Health was a plaintiff in a federal lawsuit (Tummino v. Hamburg), which resulted in the court directing the FDA to make emergency contraception available to teens age seventeen and above. And that’s why today our lawyers from the Center for Reproductive Rights will be back in federal court fighting against the continued political interference in healthcare access for younger teens.

A Young Doctor’s Response to President Obama’s Plan B Failure: Where Is the Scientific Integrity?

11:34 am in Uncategorized by RH Reality Check

Broken Caduceus (Photo: truthout/flickr)

Broken Caduceus (Photo: truthout/flickr)

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

Cross-posted in partnership with Amplify Your Voice. See all our coverage of Kathleen Sebelius’ 2011 Emergency Contraception Reversal here.

Like most of the pro-choice community, I was shocked by Secretary Sebelius of the Department of Health and Human Services overruling the FDA’s decision to make Plan B over-the-counter and available for all ages. This was unexpected, unprecedented, and extremely unfortunate.

Experts, who we count on for guidance and sound evidence-based medicine, have repeatedly shown Plan B to be not only extremely effective, but incredibly safe. Although the experts in the FDA agreed with the well-researched and well-presented data on Plan B, Secretary Sebelius and President Obama chose to ignore their expertise and base their decision on politics, not science.

Not only is this infuriating, but hypocritical. A certain document found on WhiteHouse.gov by The Obama Administration dated March 9, 2009 expresses quite the different sentiment. Interestingly, this release from The White House Press Secretary is entitled “Scientific Integrity” and the first line states “[s]cience and the scientific process must inform and guide decisions of my Administration on a wide range of issues, including improvement of public health…”

I suppose I missed the footnote that implied exceptions for family planning.

As I read the press releases on Secretary Sebelius’ decision and the news about President Obama’s unwavering support of her overruling, I could not help but pick apart their few but telling remarks:

President Obama stated that ten- to 11-year-olds would be able to buy Plan B next to “batteries and bubble gum,” potentially putting these young girls at risk for adverse events if they did not use Plan B correctly. Interestingly, Tylenol is over-the-counter and far more dangerous with far more potential for adverse outcomes. Oh, and pregnancy in a ten- to 11-year-olds also has FAR more adverse outcomes than a small, but effective dose of Plan B. Read the rest of this entry →

Disappointed Doesn’t Cut It Anymore: A Mother’s Rebuttal of President Obama’s Plan B Politics

1:38 pm in Uncategorized by RH Reality Check

Written by Kate Stewart 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 Kathleen Sebelius’ 2011 Emergency Contraception Reversal here.

Disappointed doesn’t cut it anymore.

Disappointed, angry, dismayed — these are only some of the emotions I am feeling this afternoon after hearing President Obama’s poor excuse for restricting access to Plan B One Step.

I am also scared.

Scared about the health of my daughters.  As the mother of two daughters, just like President Obama, I try to use “common sense” as much as possible. But, also like President Obama, I am not a doctor; I am not a scientist. I use my own judgment when it comes to things I am confident I can handle — a case of the sniffles, a little cold.

But, I also understand that it is my responsibility as a parent to know when I don’t know all the answers and it’s time to turn to experts. And that, apparently, is where the President and I disagree.

When my daughter’s pediatrician gives me medical advice, I listen. Carefully. American Academy of Pediatrics and the Society of Adolescent Health and Medicine make recommendations about my daughters’ health, that matters to me. A lot. And I believe it should.

Today, President Obama has made the irresponsible – and nearly incomprehensible — decision to support HHS Secretary Kathleen Sebelius’ move to block the FDA from expanding access to Plan B One-Step emergency contraception. Whether the President’s decision was motivated by well-intentioned ignorance or political cowardice is beside the point. Either way, this move will adversely impact millions of women, particularly young women, across the country.

President Obama has decided to ignore scientific research and medical advice and has sacrificed the health of young women. And I want to know why. Why, Mr. President? Why would you reject years of research and the best scientific thinking the medical community has to offer? Why, for the first time in U.S. history, did your administration intervene to overrule the FDA’s ability to make decision about medical science? Read the rest of this entry →

After the EC Decision, A Lifelong, Third Generation Democrat Wonders Where She Belongs

11:50 am in Uncategorized by RH Reality Check

Kathleen Sebelius (Photo: americanprogress, flickr)

Kathleen Sebelius (Photo: americanprogress, flickr)

Written by Kari Ann Rinker 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 Kathleen Sebelius’ 2011 Emergency Contraception Reversal here.

President Obama visited Osawotamie, KS on Tuesday and gave a speech about the economy.  His speech focused on fair play, fair shares and fair shots for all citizens.  I went to Osawotamie to ask the President to extend that message of fairness to the women of the nation, regardless of the religious affiliation of their employer.  I went to the speech to represent the interests of a coalition consisting of Planned Parenthood of Kansas and Mid-Missouri, MoveOn.org and Kansas NOW.  The following is from our press release…

President Obama has continually spoken out about his administration’s commitment to women and women have supported the President in many of his initiatives, including the passage of the Affordable Care Act.

We stand united in Kansas, encouraging the President to honor his commitment to all women by standing in firm opposition to the expansion of the conscience clause of the birth control mandate within the Affordable Care Act.

Peter Brownlie, President and CEO of Planned Parenthood of Kansas and Mid-Missouri said, “President Obama should reject efforts to take away the birth control coverage benefit from millions of Americans who work at religiously-affiliated hospitals, universities, schools, or organizations.  These are nurses, teachers, janitors, and other workers who should not be discriminated against and denied a benefit that the vast majority of Americans will receive.”

Kari Ann Rinker, State Coordinator of Kansas NOW stated, “We ask the President to stand up to the U.S. Conference of Catholic Bishops and other opponents of contraception and just say no to the continued bullying of corporate religious interests, whose demands run counter to the individual conscience of the millions of women who could potentially be effected by this expansion. The President’s vague answers and lack of official statement on this subject is disconcerting.” Read the rest of this entry →

Denying Access to Plan B: An Act of Political Cowardice

11:43 am in Uncategorized by RH Reality Check

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

Fool me twice. I’m an idiot.

I keep thinking someone in this administration is going to take a stand that will mean something.

It’s a small thing, really, but a huge thing when you’re a teenager. You need access to emergency contraception and you can’t get it because your government is controlled by fundamentalist body haters who think that sex is for procreation only.

*****

I’m still hunting for the right words to say. Nearly 40 years after abortion was made legal in this country, 50 years since we’ve had the Pill, and women are still told, day-after-day, that the only thing that matters about them is their ability to bear children. And if bearing a child costs you your life, well, what greater sacrifice can you make? (And besides, there are plenty of women to replace you.)

*****

To visit the local cemeteries is to see this philosophy carved in stone–acres of stones that tell the same story. One man will be buried with two, often three, wives. He died in his 80s. The first two wives died in their 20s or early 30s, but the third wife grew old with him. Frequently, there are newborns whose death dates approximate the death dates of their mothers.

We tell ourselves that this was before modern medicine. That puerperal fever, or ruptured uteri, or hearts weakened by childhood diseases and then too weak to bear the strains of pregnancy, that these things are all things of the past.

But, we maintain maternal mortality statistics because pregnancy is still potentially deadly. And lest any American think that we have the best health care system in the world, ask yourself why our rates of maternal death are among the highest in the industrialized world?

****

The FDA cannot find a single reason why Plan B contraception can’t be on a shelf where anyone can buy it. Katherine Sebelius, and her boss, Barack Obama, they moved the football again.

We were all so happy when Obama chose a pro-choice champion to head HHS. But, it turns out, just like her boss, she’s a political coward.

So what, the right wing thinks teenagers shouldn’t be having sex? How has that changed in all the years that we’ve been talking about it?

Sebelius, no doubt ordered to by her boss, overruled the FDA, denied scientific evidence, to make moralistic assholes happy.

I really thought you were going to hold the football steady this time, Obama. I really did.

I’m an idiot. I keep hoping against hope that you’re not going to throw women under the bus. That you can stand up to the ladies who swoon at the Concerned Women for America. You think they’re going to vote for you because you said no to Plan B?

I know you’re not stupid.

You’re a coward.