Repro Health Hub

When questioned by Rep. Christopher Smith (R-NJ) at a congressional hearing yesterday, Secretary of State Hillary Clinton vigorously defended the need for access to contraception and abortion, maternal health care, and the full range of reproductive health options for women across the globe.

By Tara Sweeney

Today was the final day for the public to weigh in on the Health and Human Services (HHS) “Provider Conscience Regulation.” As we’ve mentioned before, this rule, one of the “midnight regulations” that President Bush pushed through before leaving office, severely undermines women’s access to reproductive health services by allowing doctors, nurses, pharmacists, and other health care workers to refuse to perform or assist in abortions, sterilizations, and other contraceptive procedures on moral or religious grounds.

Thankfully, President Obama moved quickly to consider rescinding the regulation by opening a period of public comment to determine the effect of the new law on access to health care services. On April 7^th, 2009 the National Institute submitted comments, outlining some of the barriers that the regulation has created and urging for its full repeal. We noted that the regulation:

• creates confusion between the definition of “abortion” and “contraception,” allowing health care providers to deny women access to many forms of commonly used birth control

• dangerously expands health care providers’ refusal rights to include the provision of information on topics and treatments that providers find objectionable for religious or moral reasons

• directly conflicts with the requirements of the Title X program, which guarantees that the approximately 5 million low-income women who access reproductive health care services through this important safety-net program will receive non-directive counseling regarding all of their options related to their pregnancy

• jeopardizes access to health care services for the millions of women who depend on publicly-supported health services; without federally funded health care programs, most of these women would not have anywhere else to turn for and often lack the luxury of being able to shop around for alternate health care facilities

• needlessly reiterates the same opt-out provisions for providers that already exist in other laws

(View the National Institute’s full comments here.)

This regulation is utterly unnecessary, undermines women’s access to critical health care services and information, and leaves low-income women particularly vulnerable. As National Institute President Kelli Conlin wrote in conclusion:

The Rescission Proposal must be enacted to protect patients’ access to information and health care services, eliminate the confusion created by the HHS Regulation, and ensure access to health care for low-income women and other vulnerable populations. With approximately 46 million Americans uninsured, the Department should prioritize the expansion and protection of health care access for women, their families, and all Americans. We fully support the Rescission Proposal because we believe it will bring us one step closer toward that goal.

Hopefully, President Obama and HSS will hear the loud and urgent calls for repeal from reproductive health advocates across the country and this regulation will soon be a thing of the past.

By Maya Dusenbery

Our Repro Health Hero of the Week is West Virginia Free, an organization leading an important fight right now in West Virginia to maintain state Medicaid coverage for abortion. Earlier this month state legislators introduced H. B. 3159, a bill that would end state Medicaid coverage of abortion, except in the cases of rape, incest, and life endangerment. West Virginia Free has launched a statewide campaign to defeat this bill and is winning! West Virginia Free has launched a statewide campaign to defeat this bill and is working with advocates across the state. Click here for more information about West Virginia Free and how to get involved in the campaign.

In addition to the fact that this bill would be incredibly harmful to women across the state, West Virginia Free and other opponents argue the bill is entirely unconstitutional. The West Virginia Supreme Court has already ruled that denying poor and low-income women funding for abortions violates the protections afforded them by the state Constitution (established in Women’s Health Center v. Panepinto).

We thank the advocates in West Virginia for fighting this horrible bill! Currently West Virginia is one of only seventeen states that go above and beyond the federal Hyde Amendment restrictions to provide much-needed state Medicaid coverage for abortions in most cases. On the federal level, the Hyde Amendment bans the use of federal Medicaid funds from being used to cover abortions, except in cases of rape, incest or when a woman’s life is in danger. States that provide Medicaid coverage for abortions in additional circumstances must use their own state-only dollars to provide that coverage.

Thanks to West Virginia Free for working to ensure West Virginia remains one of those states! To find out about coverage in your state and how to get involved in the fight to repeal the Hyde Amendment, join the Hyde 30 Years is Enough campaign!

By Myra Batchelder
Director of Low-Income Access Program
National Institute for Reproductive Health

In one of the many heartening first steps he took after assuming the presidency, President Obama moved to rescind an HHS rule enacted at the last minute by the Bush administration.

The so-called “provider consciousness regulation” would severely undermine women’s ability to access reproductive health services by allowing doctors, nurses, pharmacists, and other health care workers to refuse to perform or assist in abortions, sterilizations, and other contraceptive procedures on moral grounds.

When the regulation was first proposed back in August, the National Institute acted swiftly to voice its opposition. President Kelli Conlin noted,

“With approximately 46 million Americans without health insurance in this country, we should be putting resources into expanding access to health care, instead of wasting much-needed funding on efforts to restrict access to health care.”

This extreme rule starts us down a slippery slope to a world where insurance companies could refuse to cover birth control pills, hospital employees could withhold emergency contraception from sexual assault survivors, and even the doctor’s office receptionist could block a woman from getting the reproductive health care she needs—all on the basis of their own personal beliefs.

Despite President Obama calling for its repeal, this rule will remain in effect at least until the period for public comment ends on April 9^th.

You can add your voice to the calls for repeal by telling the administration that this regulation is unjustified and dangerous. Visit the Center for Reproductive Rights to get talking points and directions for submitting your own comments online.

By Maya Dusenbery

As a former domestic violence shelter advocate, I am proud to be a part of today’s eighth annual Back Up Your Birth Control Day of Action, a national initiative to raise awareness of and increase access to emergency contraception (EC). At the moment, far too many women are excluded from the opportunity to plan if or when they have children. On this Day of Action, I encourage you to step into the shoes of one of these women.

Imagine you are a recent immigrant who is terrified of getting pregnant by your abusive husband. Your limited English prevents you from verifying whether he, a citizen, can have you deported if you leave—so you don’t take the chance. A social worker has told you about EC, but once you work up the courage to ask for it, the local pharmacist refers you somewhere else “as a matter of principle.” As you walk away from her, you consider the possibility that maybe it is immoral to take EC at all. But you can’t get pregnant right now. If you take the bus to another pharmacy, you will need to ask your husband for more money later in the week. Your husband will question and possibly hurt you. Even if you are a woman residing in the US in the year 2009, these may be your only options.

Why would anyone want to stop a woman from preventing an unwanted pregnancy? Despite bed shortages in domestic violence shelters across the country, some of us believe that most women are not the woman in this story. By extension, we do not worry about the difficulties women may face as a result of the 2006 FDA ruling that made EC available over-the-counter in pharmacies but only for women and men who are 18 or older, have government-issued identification, and can afford the $40-$70 price tag.

Misconceptions about domestic violence also prevent people from acknowledging and taking action against certain barriers to EC access. Some consider survivors responsible for any sexual contact with their abusers. However, it is important to acknowledge the constraints that make up many survivors’ lives. A survivor may rely on her abuser for financial support, lack transportation, speak little or no English, be unaware of American laws that define her husband’s abuse as a crime, and may be forced to seek help at a mainstream domestic violence shelter that cannot accommodate her religious and/or cultural way of life.

We need to acknowledge exactly how responsible the woman seeking EC in this story is. When critics cite fears of increased promiscuity in women following expanded access to EC, they are ignoring the reality of women’s lives. Women seeking EC take an honest look at their circumstances, make an educated decision, and pursue the means to make that decision a reality.

The question remains, then, are we interested in promoting responsible approaches to sexual and reproductive health, or are we more interested in ensuring that women are in some way punished for sexual contact?

By Rupali Sharma

Yesterday the U.S. Food and Drug Administration (FDA) approved a new female condom manufactured by the Female Health Company that improves upon many of the drawbacks of the original version.

The FDA approval not only means that the new female condom will soon be ready for sale in the U.S. but will also allow the United States Agency for International Development (USAID) to buy and distribute it to HIV-prevention programs abroad.

The original, while approved for use in 1993, never really broke into the male condom-dominated U.S. market. Consumers complained that it was too expensive (between $2.80 and $4.00) and too noisy during sex. The new product is 30% cheaper and made with a softer, quieter material.

As the only woman-initiated method of preventing HIV and unintended pregnancy, advocates have long believed the female condom holds enormous potential. And many are optimistic that with these improvements and a more aggressive marketing strategy, it will catch on this time around.

The Center for Health and Gender Equity praised the FDA’s approval:

We join women around the world in applauding the FDA’s swift action to approve the FC2 female condom,” stated Serra Sippel, executive director of the Center for Health and Gender Equity. “The HIV pandemic among women requires increased investment in woman-centered prevention options, and FC2 approval is an important step forward in putting the power of prevention in women’s hands.

By Maya Dusenbery

Another important national day is observed today: the National Women and Girls HIV/AIDS Awareness Day. The theme this year is “HIV is Right Here at Home.” Naina Khanna, Coordinator of the U.S. Positive Women’s Network, discusses the lack of awareness about the toll HIV/AIDS takes on women on RH Reality Check:

Here in the United States, women comprise about 27% of HIV infections, up from about 8% in 1984. In many countries around the world, women already represent over 50% of HIV infections.  Rates of sexually transmitted infections among youth and teenage pregnancy have risen over the last several years - both indicators that we may soon see a corresponding rise in HIV infections among both young women and men.  And, although generally considered a chronic manageable condition in the U.S., HIV continues to be the leading cause of death among African American women aged 25 to 34 years old.

Yet most of the general public in the U.S. think of HIV as a men’s disease and some members of the HIV advocacy/policy community have gone so far as to say “HIV/AIDS in this country is a men’s disease.”

In honor of the day, almost 100 female bloggers from across the country are participating in the Red Pump Project by using their platforms to write about the effect of HIV/AIDS on the lives and health of women and girls. Here’s what one the organizers has to say:

Also be sure to check out the National Women and Girls HIV/AIDS Awareness Day events page to find out about what’s going on in your area, and remember to take your sexual health into your own hands and know your status!

By Maya Dusenbery

This year marks the hundredth anniversary of the United States’ first celebration of a National Women’s Day, first observed on February 28, 1909. This declaration occurred in the midst of the developing women’s rights movement at the turn of the century.

In 1908, just one year before, women marched through the streets of New York City demanding better pay and working conditions, as well as the right to vote. In 1910, a hundred women from 17 countries gathered in Copenhagen for the second International Conference of Working Women, where the idea of an international day to recognize women and their rights was first introduced by Clara Zetkin of Germany and garnered unanimous approval from the other attendees. By 1911, an International Women’s Day (IWD) had been officially established in several European countries. Today, March 8th is recognized as a national holiday in many countries, with events held in 60 countries. In addition, the United Nations holds annual IWD Conferences in order to coordinate and evaluate women’s rights work, with a specific focus on women’s achievements in the social, political and economic spheres.

But the question remains: how much progress have we actually made in the past century? True, the Obama administration has made important strides so far: in January, the first bill President Obama signed was the Lily Ledbetter Fair Pay Act, which allows women to seek legal recourse for unequal pay in the workplace. And on Friday, he announced that he will rescind a midnight HHS resolution made by Bush that, if passed, would legalize the obstruction of women’s access to basic reproductive health care. On an international level, Obama reversed the global gag rule, also known as the Mexico City policy, so that international organizations receiving US funds can continue to offer family planning and reproductive health services from their own budgets.

Despite these long-awaited actions, women are still struggling for their safety and well-being. In the US, community discussions surrounding health care focus on women’s restricted access to care and services, especially reproductive health care. In areas of conflict such as the Democratic Republic of Congo (DRC), women are subject to increased sexual violence, and in many developing countries women know very little about the basic medical facts of birth control. Even in America we are in dire need of an overhaul of our sexual education and attitudes – both in schools and in our societal culture in general.

So what can we do? Besides continuing advocacy work in the areas where we’ve been accomplishing so much ourselves, we can monitor the protection of human rights around the globe, and ensure that President Obama sticks to his promises for progress by encouraging him to put the United States at the forefront of the global women’s rights’ movement.

International Women’s Day is an opportune day to take a step back, breathe, and celebrate our achievements in women’s rights and equality. It is also the perfect time to evaluate the current state of women across nations, and decide what are the most important steps toward our goals in today’s quickly shifting world.

By Katie Rosenthal

Advocates in New York State this week are showing their support for Medicaid and other public health insurance programs by celebrating Medicaid Matters Week. The week of awareness is being organized by Medicaid Matters New York, a statewide coalition of over 125 groups representing those most affected by policy and legislative debates on Medicaid – over four million Medicaid consumers.

In celebration of Medicaid Matters Week, the coalition is asking advocates across the state to notify Governor Paterson, legislative leaders and Health Committee Chairs about the importance of Medicaid and the need to ensure the program’s continued improvement over the next year. Medicaid is a vital part of our health care system, providing health care to those that are most vulnerable. Medicaid insures disabled people, pregnant women, children, those with low-wage jobs, and it funds clinics and hospitals that provide quality health care for those who have no place else to turn for care. If only there were more events celebrating the importance of Medicaid in states across the country!

By Monika Grzeniewski

On February 25, the National Institute for Reproductive Health in combination with NARAL Pro-Choice New York kicked off a new six-part speaker series, “Choices: Achieving Reproductive Freedom for All.” The series aims to look beyond the right to abortion to more fully explore the meaning of reproductive freedom. Bringing together advocates from a range of fields, the series addresses the rights to adopt, to make parenting decisions, to live free from institutionalized discrimination, and to access the resources, support, and services necessary to make informed and empowered decisions.

In its first installment of the series, “Choices: Emergency Contraception,” the National Institute and NARAL Pro-Choice NY collaborated with colleagues from the Harlem Health Promotion Center, the New York City Alliance Against Sexual Assault, and Students Active For Ending Rape (SAFER). Panelists spoke eloquently about the numerous barriers to accessing emergency contraception (EC)—for low income women, for young people, and for survivors of sexual assault.

The National Institute’s Amy Boldosser, Director of Local Advocacy Initiatives, opened the discussion by describing EC as a second chance to prevent pregnancy AFTER sex, making EC an incredibly empowering contraceptive option. But misconceptions, restricted access, and cost barriers make the promise of EC largely unrealized. More than 60% of voters say they do not know about EC and only 6% report ever having used it. Although the approval of EC for over-the-counter use for women over age 18 was a step forward, the “dual-label” environment serves to exclude younger women, women without a government issued ID, and uninsured and low income women from timely access.

While there is no medical reason for denying younger teens over-the-counter access, in most states, women 17 years and younger still must get a prescription before obtaining EC—an unnecessary and cumbersome requirement that may prevent teens from getting EC quickly when it will be most effective.

In addition to restricted access, young people suffer from a lack of knowledge about EC. Tiffany Garcia of the Harlem Health Promotion Center sees first-hand the misconceptions about EC among teens. As the Mobile Health Team Outreach Coordinator, she helps deliver sex education workshops, as well as counseling and testing services, to at-risk teens in high schools and community organizations. She says the young people she encounters are often uninformed about EC, assume that they need parental permission to get it, or think that since they cannot obtain it without a prescription, it must be risky. The Harlem Health Promotion Center has worked with the NYC Department of Health to create an extensive social marketing campaign to educate teens about EC and let them know how to access it.

Myra Batchelder of the National Institute’s Low-Income Access Program spoke about barriers such as cost (EC costs $50 on average). 1 in 10 women of reproductive age depend on Medicaid, which, like many public and private health insurance programs, only covers EC with a prescription. While 8 states have changed their rules to allow coverage without a prescription, most Medicaid recipients must either pay out-of-pocket or take the time to see a doctor.

Add to that a host of additional possible barriers—lack of knowledge, language barriers, lack of transportation, etc.—and the appalling fact that 1 in 5 women of reproductive age have no health insurance at all and we’re looking at a lot women for whom access to EC is not a reality.

The National Institute works to combat these barriers by lobbying for Medicaid coverage of over-the-counter EC at the state and federal levels, collaborating with advocates in the Low-Income Contraceptive Access Coalition, and providing grants to local groups working on the ground. But there is still much to be done. Myra says: “We must ensure that everyone has not only the right to EC but also true access to EC.”

Access to EC is of particular importance among survivors of sexual assault. Each year, 25,000 American women become pregnant as a result of sexual assault. Harriet Lessel, Executive Director of the New York City Alliance Sexual Assault, and Nora Niedzielski-Eichner, board member of Students Active for Ending Rape (SAFER) discussed their respective organizations’ efforts to ensure that sexual assault survivors can obtain EC.

Harriet says that due to a variety of factors, most sexual assault victims do not receive EC. Many of the same barriers to access faced by all women—because of age, income, immigrant status—affect sexual assault victims. And although state law requires that emergency rooms provide EC to victims of sexual assault, the majority of victims don’t seek medical care and most don’t know they can get EC at a pharmacy. Furthermore, some hospitals still do not comply with the law.

To help expand access, the NYC Alliance lists free services on its website and created a Teen Health map that shows the location of teen-friendly services. The Alliance also helped pass the Forensic Payment Act in New York State, which ensures that victims do not have to pay for their own rape exams and successfully lobbied to require NYC ambulances to take victims to the nearest hospital with a comprehensive sexual assault care center.

Finally, Nora addressed access to EC within the relatively contained environment of a college campus. Given that 1 in 4 women is sexually assaulted during their time at college and that, due to a change in the law, the cost of contraception at college clinics rose dramatically in 2005, access to EC is an important issue on campuses.

SAFER’s College Sexual Assault Policies Database tracks information on the policies of colleges and universities, public and private, across the country. Nora noted that a school’s EC policy can be affected by a number of factors—religious affiliation, cost, reputation, etc.—but is usually highly responsive to student demand, as well as questions from prospective students and parents and pressure from alumni. SAFER provides organizing and leadership training to student activists interested in mobilizing a campaign on their campus.

“Choices: Emergency Contraception” illustrated how the issues of reproductive rights, sex education, economic justice, health care access, and sexual violence overlap and intertwine to create obstacles that prevent far too many women from having true access to EC and which must be broken down before we realize true reproductive freedom.

Look for more exciting “Choices” events in coming months!

By Maya Dusenbery