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Monday, December 09, 2019 {{ new Date().getDay() }}

The Contraceptive Mandate Finally Leads America Out Of The Victorian Era

The Affordable Care Act demonstrates an affirmative, proactive step from government for women’s access to reproductive health care, but conservatives are bent on moving backwards.

Contraception should be understood as a fundamental right of American women and a necessary foundation of human security. If that seems controversial, consider this: 99 percent of American women approve of birth control and the vast majority use it over many years of their lives. These women deserve and must continue to demand insurance coverage for the method of their choice, without qualification. That’s why the contraceptive mandate in the Affordable Care Act (ACA) is so important and potentially transformative. For the first time ever, all health insurance plans, whether paid for privately or with public subsidies, are required to cover all FDA-approved contraceptives at no additional cost.

Family planning is essential to securing the health and rights of women, but it is also the foundation of sound economic and social policy. Tragically, however, U.S. subsidized family planning programs currently serve just over half of those in need.

The stakes are especially high for poor women, who cannot afford the high costs of the most reliable and desirable methods and experience much higher rates of early and unwanted pregnancy as a result. Single women in poverty head a growing percentage of U.S. households. In “Breaking the Cycle of Poverty: Expanding Access to Family Planning,” a new white paper released today by the Roosevelt Institute, we argue that addressing their needs, and opening up opportunities to them and their children, will require multiple policy interventions, but none can work if women are denied the right and the agency to make, and act on, well-informed decisions about their own bodies.

Decades of social science research demonstrate that access to reliable and affordable family planning methods promotes responsible decision making and reduces unwanted pregnancy and abortion. It allows women to pursue educational and employment opportunities that strengthen their families and their communities. A majority of women who participated in a recent study by the Guttmacher Institute, for example, report that birth control enables them to support themselves financially, complete their education, and get or keep a job. Other recent studies also show that providing family planning services at no cost results in more effective contraceptive use, decreased rates of unintended pregnancy, and dramatic declines in abortion rates.

Many American conservatives, however, reject these claims. They blame single mothers for America’s rising tide of poverty and inequality, not the other way around. They insist that access to sexual and reproductive health information and services exacerbates social problems by promoting promiscuity and unintended pregnancy, when in fact, the exact opposite is true. They promote abstinence-education and marriage promotion programs that have been tried before and been discredited, because they simply do not work.

This conflict was front and center last week as the U.S. Supreme Court heard 90 riveting minutes of argument in Sebelius v. Hobby Lobby Stores, Inc. and Conestoga Wood Specialties Corp. v. Sebelius, a pair of cases brought by two privately held corporations owned by Christian conservatives. The owners claim that the ACA violates the religious freedom of employers forced to cover the costs of contraception. Much of the testimony turned on technical questions of whether corporations, as opposed to the individuals who own them, legitimately have rights to assert in this instance, and whether they may impose those rights on employees who don’t share their views. There were also important matters of scientific integrity at stake, with the plaintiffs claiming that Intrauterine Devices (IUDs) and morning-after pills constitute methods of abortion, despite overwhelming medical agreement and numerous reputable scientific studies showing that, like everyday birth control pills, they only act to prevent conception.

All but lost in the court’s conversation were larger concerns about the health and well-being of women and families – and of our society as a whole. The Supreme Court hearing comes in the wake of more than three years of persistent attacks by extreme conservative lawmakers who have already decimated publicly subsidized services in states across the country and left many low-income women without access to basic family planning and to other critical reproductive and maternal health care services.

As legal scholar and policy analyst Dorothy Roberts observed, “When access to health care is denied, it’s the most marginalized women in this country and around the world who suffer the most—women of color, poor and low-wage workers, lesbian and trans women, women with disabilities… And this case has far-reaching consequences for their equal rights. Birth control is good health care, period.”

Today, by government estimates, more than 27 million American women already benefit from the ACA’s contraceptive mandate, and 20 million more will enjoy expanded coverage when the law is fully implemented. Yet even by these optimistic assessments, many low-income women will continue to fall through insurance gaps, partly thanks to a 2012 Supreme Court ruling that enables states to opt out of Medicaid expansion mandated by the ACA. More than 3.5 million – two-thirds of poor black and single mothers, and more than half of low-wage workers – will be left without insurance in those states.

Conservative opposition to contraception is not new. As we observe in our paper, the U.S. controversy over family planning dates back to Victorian-era laws that first defined contraception as obscene and outlawed its use. Those laws carried the name of Anthony Comstock, an evangelical Christian who led a nearly 50-year crusade to root out sin and rid the country of pornography, contraceptives, and other allegedly “vile” materials that he believed promoted immorality. Sound familiar?

It took nearly a century for the U.S. Supreme Court to reverse course and guarantee American women the right to use contraception under the constitutional doctrine of privacy first enunciated in 1965. The ACA promises us even more. It places an affirmative, positive obligation on government to provide women the resources to realize our rights. The question before us is simple: Do we turn back the clock and allow a new Comstockery to prevail, or do we move ahead into the 21st century by defending the full promise of the Affordable Care Act’s contraceptive mandate?

Read Ellen and Andrea’s paper, “Breaking the Cycle of Poverty: Expanding Access to Family Planning,” here.

Ellen Chesler is a Senior Fellow at the Roosevelt Institute and author of Woman of Valor: Margaret Sanger and the Birth Control Movement in America.

Andrea Flynn is a Fellow at the Roosevelt Institute. She researches and writes about access to reproductive health care in the United States. You can follow her on Twitter @dreaflynn.

Cross-posted from the Roosevelt Institute’s Next New Deal blog.

Photo: WeNews via Flickr

Emergency Contraception Use Spreads, But Many Women Are Still Left Out

New evidence shows more young women are using emergency contraception, but we still have work to do to reduce all barriers.

A federal study released recently shows that use of emergency contraception (EC) in the United States, known colloquially as the “morning after” pill, has more than doubled in the past decade. This is good news. It demonstrates the critical and expanding role the method may now be playing in enabling women, particularly young women, to prevent unplanned pregnancies. But there are still serious hurdles women face in accessing this method of birth control. While access has expanded, there is still work to be done.

The study, conducted by the Centers for Disease Control and the National Center for Health Statistics, strengthens the case for promoting EC widely and making it more readily available. Based on interviews with more than 12,000 women from 2006-2010, the research finds that EC use among all sexually experienced women between the ages of 15-44 has increased to 11 percent (up from a baseline of 4.2 percent). That number is even higher among women 20-24, one of the highest risk groups for unplanned pregnancy. Nearly a quarter of this cohort now reports having used EC.

This is no coincidence. In 2006, nearly a decade after EC first entered the market under the trade name Plan B, and after years of stalling and political maneuvering by the Food and Drug Administration (FDA), the agency finally ruled that the product can be provided without prescription to women over the age of 18. A year later, a federal judge ordered the FDA to make it available to women over the age of 17. An important provision of the Obama administration’s Affordable Care Act (ACA) also now promises to cover the cost of all methods of contraception, including this one.

The government study confirms what we already know: accidents happen. Half the participants report having used EC out of fear that their initial birth control method had failed; the other half used it because they had unprotected sex. This reminds us that even women who have a “plan A” need a “Plan B,” or, as the product is now also marketed, a “Next Choice.” Nearly one third of all U.S. women using contraception rely on the pill, and approximately 16 percent use condoms – both effective methods when employed perfectly, but also ones prone to human error. Condoms break, and sometimes women forget to take a daily low-dose pill. And then there are still the many women who, because of lack of access, cost, forgetfulness, or spontaneity, still don’t consistently use birth control and need protection after the fact.

One of the most common arguments against EC is that it is really just an early abortion method masked as contraception. This simply has no basis in science, as most recently explained by the International Federation of Gynecology and Obstetrics. Unlike medication abortion, which terminates a pregnancy in its earliest stages, EC actually prevents a pregnancy from occurring.

The next most popular and equally erroneous claim is that increased access to EC – and, for that matter, any program or product that provides access to abortion, contraception, or sexuality education – will promote risky sexual behavior. Studies from diverse countries over many years tell us this is not the case. But new research coming out of New York City now confirms that access to EC right here at home does not encourage young people to become more sexually active. In fact, it does just the opposite. The NYC Department of Health recently reported a 12-point drop over 10 years, from 51 to 39 percent, in the proportion of public high school students who are sexually active. Over the past few years, the proportion of sexually active students using contraception, including Plan B, increased from 17 to nearly 27 percent. Both trends coincided with an expansion of school-based health centers that provide free contraception (including EC), counseling, and sexuality education.

So now we have homegrown data to show that when young people have access to sexual health information, no or low-cost products and services, they make better and safer decisions about their reproductive and sexual lives.

But while the federal data illustrates an overall increase in EC use, it also reveals an educational and economic divide among women who use it, suggesting the need for better information and access for low-income women. The CDC study finds that EC use is highest among college-educated women (12 percent), compared to women who have only completed high school or received a GED (7 percent). A 2011 study conducted by researchers at the Boston University School of Public Health also found that while a majority of pharmacies in low-income neighborhoods do have EC available, they often provide incorrect information about eligibility.

Add this to a number of other potential barriers, and it is clear why EC use isn’t higher.

The drug is not actually sold over the counter, where it would be most accessible, but rather behind the counter, where a pharmacist must retrieve it. (Still, this makes it more widely available in the 72-hour window after unprotected intercourse when it works most effectively.) Nine states around the country have a “conscience clause” on the books that permits pharmacists to deny filling a prescription on religious or moral grounds. Only 17 states and the District of Columbia explicitly require hospital emergency rooms to provide EC and related services to sexual assault victims.

The cost of EC is prohibitive for many potential clients. Plan B and Next Choice, the two most popular products on the market, range in price from $35 to $60 at a pharmacy and from $10 to $70 at Planned Parenthood and other public health clinics, which offer an income-based sliding fee scale and often include counseling and other services.

Even at these high prices, the limited market for the product may not provide private drug companies any incentive to advertise it beyond women’s magazines or other niche marketing sites. This means that young women just becoming sexually active, and all women who do not regularly visit a clinic or a private physician, may never learn about it. Age restrictions requiring a photo ID and concerns about confidentiality may also be intimidating and restrict use.

There are also a number of potential hurdles to EC provision under the Affordable Care Act. Will women be able to use their private insurance or Medicaid benefits to purchase it at a drug store? Or will they need to visit a Planned Parenthood or community clinic? What about the many states that are not planning to participate in the Medicaid expansion? How will low-income women in those states receive information about and access to EC and, for that matter, regular methods of contraception?

In recent years, Planned Parenthood has put forward an effective reproductive health information campaign using online and cellphone platforms. Millions of women, and especially young people, are now texting or visiting its website each month to learn about and gain access to EC, along with other important sexual health information.

The Obama health care plan needs to imitate and vastly expand this marketing approach if it is to be effective. At long last, the Affordable Care Act promises to provide a national policy that prioritizes women’s health and primary, preventive care. But we must seek greater clarity about its implementation. Our next challenge will be to buttress the ACA with an inventive, far-reaching public information campaign so a broad and diverse population can understand and access its many benefits. How about calling this campaign “Morning After in America”? For those Americans old enough to remember Ronald Reagan, this surely has a familiar ring!

Ellen Chesler is a Senior Fellow at the Roosevelt Institute and author of Woman of Valor: Margaret Sanger and the Birth Control Movement in America. Andrea Flynn is a Fellow at the Roosevelt Institute. She researches and writes about access to reproductive health care in the United States. 

Cross-posted From The Roosevelt Institute’s Next New Deal Blog

The Roosevelt Institute is a non-profit organization devoted to carrying forward the legacy and values of Franklin and Eleanor Roosevelt.

Photo by vixyview/Flickr

What Did The State Of The Union Say To Women?

The president didn’t just lay out specific policies that will benefit women. He also shifted the theory of how government can help them.

The State of the Union address is inherently a political exercise, intended to chart a course for governing but also to let important constituencies know that they are heard and valued. On Tuesday night, President Obama seemed intent on sounding down-to-earth, sensible, unthreatening, and easy to understand. He presented a long list of concrete proposals as if there couldn’t be any disagreement over their merits.

For women, a critical voting bloc that helped deliver his second term, the president checked off many important boxes. He spoke about ending violence against women, guaranteeing them equal pay, preventing teen pregnancy, providing working families with more daycare and early-childhood education, and promoting military women in combat roles. He also acknowledged that women around the world are drivers of prosperity and must be empowered if we hope to reduce global poverty and secure emerging democracies.

Hearing this litany of familiar issues was reassuring, but the overall theme of the speech provided an even more important takeaway. Without much fanfare, the president put forward a reshaped agenda for government programs that are, as he put it, not “bigger,” but “smarter.” This is vital for women because it would have the government target policies and marshal resources for women and families, which, in turn, prevent larger and costlier social and economic problems. It’s a welcome departure from forgetting about women and children and waiting around to address the unfortunate consequences after the fact.

No grand principles were enunciated. But the president craftily put forward a theory of change that emphasizes strategic and comprehensive investments and interventions to establish a floor of well being for at-risk women and families.

—He called on the House of Representatives to follow the Senate’s lead and reauthorize the Violence Against Women Act, not just as a moral imperative but because studies since its passage demonstrate the effectiveness of the social services and criminal justice reforms this pioneering legislation funds. Over two decades, rates of intimate partner violence and homicides have decreased dramatically, as the White House recently reported.

—He called for expanding mandatory and free early-childhood education – currently available to only 3 in 10 American children – not just because it’s the right thing to do for hard-pressed parents, but because the data shows that it also boosts graduation rates, decreases teen pregnancy, and even correlates with palpable reductions in violent crime in communities across the country.

—He promised to fight to increase the minimum wage and pass the Paycheck Fairness Act. This would close a real gender earnings gap. It would also benefit the nearly two-thirds of all minimum wage workers who are female, many of them single heads of households who can’t possibly lift their families out of poverty without this critical and long overdue intervention. Small businesses have long opposed a raise, despite studies that demonstrate a return to employers through increased productivity.

—He mentioned the Affordable Care Act only in passing, but it too provides many additional preventive policies, which, as he noted, are already improving services while driving down health care costs overall. For example, the ACA has already brought comprehensive, affordable family planning and reproductive health care to more than a million women. By 2016, it could extend those services to as many as 13 million additional uninsured women if the many state challenges to contraceptive coverage and the Medicaid expansion do not undermine its potential reach and impact. And here again, as we have written previously, data demonstrates incontrovertibly that these services will dramatically reduce rates of unintended pregnancy and abortion.

—While the focus of the president’s speech was primarily domestic, he also mentioned America’s responsibilities in the world and obliquely referenced the signature efforts of his administration to mainstream gender considerations into our diplomatic, defense, and development policies. Under the president and former Secretary of State Hillary Clinton, the United States has joined 30 other countries in adopting a National Action Plan on Women, Peace, and Security, facilitated by the United Nations, which applies gender considerations and disaggregates spending across all agencies to require focused investment to improve the status of women. The government recognizes that this is not just the right thing to do, but also the smarter course if our aim is to meet the security and development challenges of our foreign policy. This shift in thinking lies behind the decision to promote military women to combat rank, for example, because in conflicts that involve civilian populations, as in Afghanistan and Iraq, female officers on the front lines have played critical roles in connecting with local populations. And local women empowered by the U.S. presence have in turn become important agents in post-conflict resolution and peace processes and in relief and reconstruction efforts.

The president’s State of the Union provided a blueprint for a strong, positive government obligation to secure the well-being of women and families at home and abroad. Not a lot of detail was offered, nor was there any fancy philosophical framework for what would represent a palpable shift in U.S. priorities and our traditional ways of governing. He spoke as if this was all pretty much just common sense – the better part of wisdom.

But certainly if Senator Marco Rubio’s response is any indication, the president’s intentions, however masked in straightforward, anodyne rhetoric, face innumerable obstacles to their realization. That should not, however, stop us from applauding and getting behind the potential for meaningful policy change.

Ellen Chesler and Andrea Flynn are Fellows at the Roosevelt Institute.

Cross-posted from the Roosevelt Institute’s Next New Deal Blog

The Roosevelt Institute is a non-profit organization devoted to carrying forward the legacy and values of Franklin and Eleanor Roosevelt.

Photo credit: Official White House Photo by Chuck Kennedy

To Protect Women’s Health—And Drastically Reduce Abortion—There Is Only One Choice

We are American women with careers long devoted to women’s health who have been watching this election for many months, and we are not easily fooled.

Mitt Romney has asked us to give him a second chance. He now blithely asks us to forget his past pledges to “get rid of” Planned Parenthood, to eliminate Title X, the federal program that subsidizes contraceptive care for millions of low-income American women, and to overturn the Affordable Care Act, which promises historic increases in access to contraception and other critical preventive women’s health services. He now says all women deserve access to family planning, just not to have the government cover the costs, conveniently ignoring that who pays is precisely what this controversy is all about.

To us, federal funding for women’s health and especially for family planning is an issue of such importance that it alone should determine our votes. The choice is plain.  One candidate offers to build on the historic achievement of the Affordable Care Act in providing access to health care, with its many special provisions to preserve and advance the health and rights of women. The other vows to undo those gains on day one and reverse decades of progress.

A breakthrough clinical study of a large cohort of women in Missouri demonstrates just how high the stakes are and why the matter is critical not just to women but to the country as a whole. Released several weeks ago in the journal Obstetrics & Gynecology, the study shows conclusively that if Americans are serious about reducing unintended pregnancy and abortion, we must be willing to provide a range of  contraceptive choices to women at no or low cost. There has simply never been more compelling evidence that providing free contraception leads to positive outcomes and not to riskier sexual behaviors, as all-too-familiar conservative canards would have us believe.

The Contraceptive CHOICE Project, directed by researchers at Washington University in St. Louis, enrolled about 10,000 women ages 14 to 45 (with a mean age of 25) identified as being at risk of unintended pregnancy and desiring contraception. Each was given the reversible contraceptive method of her choice, at no cost, for two or three years.

The results are nothing short of remarkable. Contraceptive efficacy among participants increased significantly, and abortion rates fell to less than half the regional and national rates, even though the study participants were poorer, less educated, and therefore considered at greater risk than the overall population. The impact on the rate of births among teens was the most pronounced, with pregnancies falling dramatically to a rate of only 6.3 per 1,000, compared to a national average of 34.3 per 1,000.

The study contains a second dramatic finding. A majority of American women overall today use birth control pills or condoms for contraception—both low-cost methods but ones with a high rate of user error or failure. Most women in the CHOICE study, however, opted for longer acting and more reliable methods when cost was not a factor—75 percent selected an IUD or hormonal implant, and the greater efficacy of these methods is what accounts for the dramatic gains in the success rate across the group.

These are simply stunning outcomes. The study estimates that universal provision of contraception and the promotion of more effective contraceptive methods would result in fewer unintended pregnancies and would lower the number of abortions across the country by 62 to 75 percent every year.

That’s why the matter is so important to how we vote. Who pays for these services, and whether a trusted provider like Planned Parenthood is available to provide them, is exactly what’s at stake in this year’s election.

Unplanned pregnancies disrupt the lives of individual women and their families and levy a significant public health, economic, and social toll. No issue has done more to poison our nation’s politics. Despite a nearly universal desire for contraception, almost half of all U.S. pregnancies, totaling some 2 million each year, remain unintended or mistimed, and 43 percent of those pregnancies end in abortion. The estimated cost to taxpayers is $11 billion a year.

According to the Kaiser Family Foundation, the ACA has already expanded contraceptive coverage to more than 1 million young women who are now covered by their parents’ insurance through the age of 26. By 2016, approximately 13 million more uninsured women will be covered for contraception, including the IUD, hormonal implants, and injections that have been shown to be so much more effective.

New coverage will also provide other valuable and cost-effective care: at least one annual “well woman” visit to a primary care physician, access to emergency contraception (better known as the morning after pill), HPV testing, screenings for sexually transmitted diseases, and screenings for gestational diabetes, currently reaching epidemic proportions. And when a woman chooses to become pregnant, it will cover maternal health care, including breastfeeding support. The additional coverage for contraception alone will lead to nearly $3 billion in savings over five years, according to a study by the Oregon Health & Science University.

Simply put, the services guaranteed to women under the ACA represent the most significant advances in women’s reproductive health care since birth control pioneer Margaret Sanger went to jail for opening America’s first birth control clinic nearly a century ago, igniting a revolution that has inarguably changed the world. This historic event occurred on October 12, 1916. Ironically, this was 96 years ago to the day that Planned Parenthood became an issue of great contention in the second presidential debate.

Sadly, the controversies over women’s reproductive rights still live on. But one thing has surely changed: Today, American women have the right to vote. Exercising our suffrage to advance family planning will constitute our most powerful protest, one that may well determine the election’s outcome.

 Ellen Chesler and Andrea Flynn are fellows of the Roosevelt Institute and longtime women’s women’s health analysts and advocates. Chesler is the author of Woman of Valor: Margaret Sanger and the Birth Control Movement in America.

Photo credit: AP/Pablo Martinez Monsivais