#KeepItConfidential

Ruth Dawson, Resident Blogger (’12, Emory University School of Law)

Under a landmark California bill passed last year, individuals covered under another person’s insurance policy will soon be able to seek sensitive services such as birth control, STD tests, and mental health services, without worrying about the disclosure of these services to the policyholder. This person is usually a parent or spouse, a fact which often prevents people from using their insurance to get the medical care they need. Going into effect January 1, 2014, the Confidential Health Information Act (SB 138) closes a loophole in California law, where insurance plans unintentionally violate patients’ confidentiality by sending information about the services received home to the policyholder.

April is Sexual Assault Awareness Month, and is thus a particularly important time to be focusing on confidentiality of medical and mental health services. In addition to the common problem of young people heading to a free clinic for routine reproductive care and claiming no insurance (as many of my friends did instead of admitting to their parents that they needed care), this law will have a profound effect on survivors of sexual assault, domestic violence, and gender-based violence. Maintaining confidentiality is crucial for survivors of assault to feel comfortable and empowered to access the physical and psychological services they need, without fear of stigma, forced disclosure, or cruel yet common reactions, such as victim-blaming.

For this new law to have the wide-reaching impact advocates desire, we must create a smooth system for patients to request confidentiality, educate patients across the state that they have the option to request confidentiality, and train providers in how to effectively implement this system in service provision. The smoother the implementation of this bill, the more likely the new law will be used as a model for patient confidentiality of sensitive services around the nation.  I’m proud that California is making real strides to #keepitconfidential for all patients.

I’m a fan of birth control and religious freedom

Melissa Torres-Montoya, Resident Blogger (’11, University of California, Berkeley School of Law)

Admittedly, I’m a huge fan of March Madness. I jumped on board with the madness; making the effort to watch my favorite team (go Bruins!) specifically at the bar that serves as DC’s “official” UCLA bar, hanging out with friends who had brackets so we could enthusiastically and nonstop talk/compare our brackets, and basically addictively watching the games.  While this March Madness is at the end of the day all fun and games, the real madness that is going on this March is the Supreme Court hearing of Sebelius v. Hobby Lobby.
The precise legal question has to do with religious freedom.  As this National Public Radio piece points out, the legal standard for whether a law infringes upon the constitutionally granted right from laws “prohibiting the free exercise” of religion has changed over the years.  And this summer the Supreme Court will issue its decision as to whether  the new law requiring employers to provide health insurance that includes coverage for contraception poses a substantial burden on the corporate owner’s of Hobby Lobby’s right to free exercise of religion and whether as corporate owners they even have such a legal right.  The madness in this all, for me, is the non legal question here is that, for some, the question exists as to whether contraception is even considered a preventive health measure.  
Former Bush administration Solicitor General Paul Clement bemoans that “The federal government for the first time has decided that they are going to force one person to pay for another person’s not just … hip replacement, but something as religiously sensitive as contraception and abortifacients.”  Hobby Lobby, of course, would never challenge coverage of a hip replacement for a 75 year old employee who fell down the stairs.  Nor should they challenge the use of a medication by a 34 year old fertile woman to prevent pregnancy, a medical condition that changes a woman’s body so that she’ll grow a whole new human within her.  According to the world health organization family planning, ”allows spacing of pregnancies and can delay pregnancies in young women at increased risk of health problems and death from early childbearing, and can prevent pregnancies among older women who also face increased risks.“  Spacing of pregnancies, as experts at the Mayo Clinic describe, has medical implications.  So yes, contraception is just another medical treatment that should be included in health insurance coverage as routinely as say, a hip replacement or high cholesterol medication. Hopefully, a majority of the justices see it the same way and publicly identify contraception as a critical, routine and medically accepted preventive health measure.
Today, the Supreme Court is listening to oral arguments on this case and like most women in the U.S., I oppose Hobby Lobby’s attempt to carve out some contraception from the health insurance plan it provides its employees. I’m publicly acknowledging today that I’m a fan of birth control and religious freedom.  You should too.  Make your new cover page this or pledge your support here.

Would I trust my partner with birth control?

Melissa Torres-Montoya, Resident Blogger (’11, University of California, Berkeley School of Law)

Would I trust my partner with birth control?  Thinking of past partners the answer would have to be; yes, yes, no, maybe, absolutely not.  Which I guess mean that my answer to that question has changed over the years so it really depends. With technological breakthroughs and the eventuality of a male birth control, this is a question that will be contemplated more and more often.

Vogue recently published a story on their website where one man shared he and his wife’s exploration of this question.  While he brings up some interesting points, issues that I’m sure will cross the minds of many when tackling this question, their exploration of a male using birth control mostly reenforces gendered stereotypes, lacks real acknowledgment of how each relationship is unique as is their decisions about how to control their fertility.  When the writer of this Vogue profile & platform piece describes how he and his wife discussed the idea of a male in control of birth control more generally than just within their own relationship, he describes how his wife found the idea of “putting a male in charge of contraception” “amusing,” even suggesting “that putting the male in charge of contraception would just embolden him to have sex with random women, and riskier sex at that; unlike a condom, the pill would do nothing to prevent disease.”  Not surprisingly, these same concerns were expressed when a female birth control pill was developed.  These are also some of the same concerns that are currently being expressed about PrEP, a daily pill that works sort of like birth control but instead to reduce the likelihood of HIV transmission rather than pregnancy.  I won’t argue that social norms around sex haven’t entirely changed since the advent of the birth control pill, and while some conservatives would argue the family system has broken down, I think it’s pretty evident that monogamous relationships, marriage and family units still remain the overwhelming norm even while most women at one point in their lives use a form of contraception.  The birth control pill and other new contraceptive options have revolutionized sexual agency, allows couple’s to plan pregnancies and has been instrumental in women being able to enter into the work force.  Both PrEP and the male birth control pill could provide similarly positive social benefits.

Sure, there could be the instance where both people in a couple slip up on their pill, thinking they have double protection because they’re both using a form of birth control.  And maybe we might have to redouble sex education efforts to make sure that everyone ACTUALLY knows the only way to prevent STIs is through condom use.  But the addition of a male birth control pill as a contraceptive option, allows more individuals to take control of their fertility, allowing them to choose when and whether they ever want to become parents.  Similarly, while PrEP may not be a medication that should be recommended for everyone, it does offer one more avenue for people to engage in sexual activity while safeguarding their sexual health by reducing the likelihood that they will become HIV+.  I, for one, am all for developing more options that allow for sexual agency and overall improve the public’s health, as well as pushing forward a society in which we trust both men and women to each take actions to protect their sexual and reproductive health.

I’m in the 78%. Taking Back the Narrative: Asian American and Pacific Islanders DO Support Abortion.

Christine Poquiz, Resident Blogger (’12, University of California, Davis School of Law)

Working as a reproductive justice fellow at the National Asian Pacific American Women’s Forum (NAPAWF), we’re often combating myths (model minority anyone?) and misconceptions around the Asian American and Pacific Islander community.  AAPI women, activists, and organizers are speaking up, fighting back, and recreating the narrative around our community. A few months ago the hashtag #notyourasiansidekick took off on twitter to talk about the struggles that Asian American women face and AAPI feminism. The response to this hashtag was overwhelming and showed how many young AAPI women wanted a forum to talk about these issues. [click here to see the follow-up Google Hangout with NAPAWF’s executive director, Miriam Yeung]

On this 41st anniversary of the landmark decision Roe v. Wade, there are misconceptions that AAPI women aren’t affected by attacks on abortion rights. However, bans against public insurance coverage of abortion, like the Hyde Amendment, cause great harm for subpopulations of the AAPI community who depend on public insurance like Medicaid. Furthermore there is evidence that AAPI women use birth control at lower rates than the general public, have high rates of unintended pregnancies and utilize abortion services at higher rates. On top of all that, some legislators are using stereotypes about Asian American women to pass sex selective abortion bans that encourage racial stereotyping of AAPI women in the doctor’s office and could possibly even cause doctors to deny care to women in our community. AAPI women are significantly affected by attacks on abortion access.

The AAPI community needs to shape the conversation about us, or other people will do it instead. One traditional perception about the AAPI community is that we’re conservative in our values. However, from the National Asian American Survey (NAAS), which conducted opinion polling on over 6,000 AAPIs, showed that the AAPI community is progressive in our values. During this celebration of Roe, it’s crucial to highlight that 78% of AAPIs support some form of legal abortion. Furthermore, 69% of AAPIs believe that the government should stay out women’s personal decision-making.

Here at NAPAWF, we’re big proponents for data disaggregation, and the 78% is not reflective of each AAPI subpopulation. For example, the traditionally Catholic Filipino community is less supportive of legal abortion than the rest of the AAPI community. But even among the Filipino community, over 50% support some form of legal abortion. Moreover, there are higher rates of “I don’t know” within the Vietnamese and Hmong community, which shows advocates like us that there needs to be more culturally competent education around this issue for these communities.

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Most importantly, these top line numbers break the notion that AAPIs don’t support abortion. This year, NAPAWF is uplifting these numbers to show that AAPIs are supportive of abortion and a woman’s personal decision making. Our members, community leaders, and elected officials are taking part in a photo campaign saying that they’re part of the 78% and that they support Roe.

We’re working on changing the narrative. Send in your photo saying you’re part of the 78% today.

Comprehensive sex ed is essential, not “too racy” for youth

Melissa Torres-Montoya, Resident Blogger (’11, University of California, Berkeley School of Law)

2014 brought many fresh starts for me, most predominately the start of a new job in HIV/AIDs policy.  I spent much of my first week at my job better familiarizing myself with HIV/AIDs policy by plowing through many research studies and reports.

I happened upon a report by the Center for American Progress and my alma mater UC Berkeley School of Law exploring barriers to prevention and treatment of HIV among communities of color; making the case for a holistic approach to eliminate racial disparities in HIV/AIDs.  The report includes a recommendation for free comprehensive sex education. While comprehensive sex ed seems like a given for combating the epidemic of HIV, the report notes that despite the effectiveness of sex education, “conservatives have often opposed programs such as condom education and distribution.”  Such opposition to comprehensive sex education has led to “abstinence-only” education, most notably in the South, where the report also noted that the prevalence of abstinence-only education likely contributes in part to why residents of the South are  ”significantly less likely to obtain treatment to [HIV] once infected” than people in all other parts of the U.S.

It did not take long for the reality of this to come to light for me, as the same day I read this report one of the top stories in my google alerts was about how some parents in Charlotte, North Carolina find a sex education curriculum “too racy”to be taught at large to their ninth grade students because it includes a chapter entitled “How to Make Condoms Fun and Pleasurable.”  Teaching about how condoms can be fun and pleasurable is an effort to increase use of condoms among teens engaging in sexual activity to prevent unplanned pregnancy and transmission of HIV and other STIs.  Including a section in sex education curriculum that presents condoms in a way that tried to increase their use is a valuable and essential because it promotes safer sex practices among teens and the adults they will grow up to become.

As a former Law Students for Reproductive Justice fellow, it is obvious to me how reproductive justice intersects with health equity and justice issues, I only wish all policy makers and parents alike did too.

2014 New Years Resolution: Visit the Gynecologist

S J Chapman, Resident Blogger, (’12, Northwestern University Law School)

Couldn’t think of a new years resolution?  I have one for you: visit your gynecologist!  Women no longer have to worry about copays, coinsurance, or having to meet a deductible before seeing a gynecologist for preventive health services.

While most plans under the Affordable Care Act have deductibles – some as high as $5,000[1] – that must be met before insurance will cover medical services, the Affordable Care Act carves out an exception to this rule when it comes to preventive care for women.  Even if a deductible hasn’t been met, women are able to receive a range of preventive services – without even having to pay a copayment or coinsurance!

Covered services include well-woman visits, breastfeeding comprehensive support and counseling, and all FDA approved contraceptive methods.You can find a list of these preventive services at healthcare.gov.

This coverage is radically paving the way for 19 million uninsured women for whom access to insurance was not previously feasible[2] to empower themselves through preventive care.  Last year a review of 66 studies concluded that access to contraception positively impacts women’s participation in education and the workforce, contributes to earning power, family stability, mental health and happiness, and their children’s well-being.[3]

Even if you do have resolutions, go ahead and tack this one on: resolve to take advantage of your new legal right to preventive care, and visit a gynecologist in your network in 2014.

If your provider tries to charge a co-payment, deductible, or co-insurance for the covered preventive services, check out this toolkit created by our friends at the National Women’s Law Center with instructions for sending appeal letters.



[1] http://www.nbcnews.com/health/consumers-beware-not-all-health-plans-cover-doc-visit-deductible-2D11794861

[2] http://kff.org/womens-health-policy/fact-sheet/womens-health-insurance-coverage-fact-sheet/

[3] http://www.guttmacher.org/media/nr/2013/03/21/index.html

Do you know about the Helms Amendment?

Candace Gibson, Resident Blogger (’12, University of Utah S.J. Quinney College of Law)

Many of us know about the Hyde Amendment, but do you know about the Helms Amendment?  The Helms Amendment was passed in 1973 to the Foreign Assistance Act, restricting abortion funding abroad. Yesterday marked the 40th anniversary – here are the top 5 things you need to know about how it hurts women globally.

  1. Both the Helms Amendment and the Hyde Amendment are restrictions on abortion care that deny women at home and abroad the care they need.  Both were passed soon after Roe v. Wade became law.
  2.  The Helms Amendment attaches restrictions on abortion care to overseas federal funding.  It not only withholds access to safe abortion services but it also denies women information on abortion care.  Millions of women rely on U.S. funded programs in their countries for their reproductive health care.
  3. The Helms Amendment contributes to 47,000 deaths each year because women are forced to seek unsafe abortion services.
  4. Unfortunately, the Helms Amendment has also negatively impacted efforts to increase the use of contraception for women who would like to begin a contraception regimen after seeking abortion services.  Studies show that women are more likely to use contraception following abortion care when family planning services are offered at the same facility where they received abortion services.  Due to the Helms Amendment, women must find family planning counseling and services at another facility, lessening their ability to receive contraception.
  5.  Latinas in the developing world are greatly affected by the Helms Amendment because it deincentivizes efforts to decriminalize or legalize abortion care.  For instance, 18 states in Mexico have passed constitutional amendments that declare the sanctity of life since conception.  In these 18 states, women will not be able to get the care they need because they are less likely to have providers who are not receiving U.S. funding.

For more information, check out this factsheet by our friends at Ipas.

Reproductive Justice as Self-Determination

Ruth Dawson, Resident Blogger (’12, Emory University School of Law)

A report recently came out about the conditions of women members of the Revolutionary Armed Forces of Colombia (FARC), the country’s biggest rebel group.  Though there is a “veneer of [gender] equality” in the organization, the report tells horrific stories of women, including young teenagers, forced to receive contraceptive shots and forbidden from having children.  Perhaps most sickening are the accounts of FARC women being forced to have abortions, or losing their infants to infanticide, in the instances when they did become pregnant.

But I am not disgusted by the bare fact that the women had abortions or used contraception.  Instead, as a reproductive justice advocate, I am most deeply troubled by the way these women were stripped of agency.  Forced contraception, forced abortion, and – not unlikely – forced sex, all strip women of self-determination.

Reproductive justice encompasses far more than the affirmative right to access birth control or abortion, as many opponents seem to believe.  Instead, RJ is about all people deciding if they want to have children, and if so, when and how to have and raise them.  Reproductive justice represents a broad universe of control over one’s own body, and over one’s self.  And that control goes in both directions.  The key to reproductive justice, then, is not just that people are using birth control, or that people are having abortions.  Rather, it is that individuals are making these decisions, unforced and uncoerced, for themselves.

Taking the Morality out of Abstinence

Mangala Kanayson, Resident Blogger (’15, Emory University School of Law)

In our quest to destroy the virgin/whore dichotomy by de-vilifying those who do not conform to or believe in the idea that abstinence equates with inherent moral worth, we may inadvertently alienate those who do happen to conform to (but not necessarily believe in) this ideal. This presents the danger of continuing to play into the dichotomy while simply switching the moral values assigned to each role instead of destroying both roles completely and allowing women to assign moral worth to themselves on their own terms.

Perhaps because abstinence is so often considered an ineffectual waiting period rather than a tool (like a condom or an HPV vaccine) that one uses to acquire and maintain a level of security while achieving one’s goals, it is easily glossed over in conversations about sexual health and as a result is presented as a non-option for “normal” and “sexually healthy” individuals.

One harsh result of this inadvertent oversight is that aside from reiterating the media’s insistence that having sex must be our primary concern (billboards in a major city or ten minutes watching television will confirm this), it teaches those who have ever had a previous sexual encounter, whether consensual or not, that continued sexual activity is always the healthy course of action moving forward. Reclaiming one’s sexuality in the case of rape or other sexual trauma takes various forms as unique as the individual doing the reclaiming, but here the dismissal of abstinence as a valid and affirming decision actually limits the choices of survivors.

As much as we want to be sex-positive, we must not forget to affirm the importance of choice. The type of birth control a person chooses to use should not define her worth as a person, and the decision not to have sex should be just as validated as the decision to be sexually active. It’s high time we stopped aiming for extremes and began focusing on aligning in the center, away from competing notions of sexual liberation versus sexual repression. Let’s take the morality out of abstinence.

If I Were Ruth Bader Ginsburg…

Amanda Shapiro, Resident Blogger (’15, Brooklyn Law School)

Last week, I watched in horror as the Fifth Circuit approved a Texas law that will prevent one third of abortion providers from performing much-needed services. I had two thoughts: (1) I was reminded of the saying in Austin, TX, “The problem with Austin is that once you leave it, you’re in Texas;” and (2) if this gets appealed to SCOTUS (it did), and I were Ruth Bader Ginsburg (RBG), what would I do? If I (RBG) don’t grant certiorari,Texan women will face almost insurmountable barriers to abortion access and let’s face it this is just the latest terrible attack on access to reproductive health services; but if I do, I risk making the Texas law a model move in the war-on-women playbook.

After pondering RBG’s thoughts, I began to think about the cultural climate that produced anti-abortion sentiments today. We have movies like Juno and Knocked Up (recall “shmashmortion”) that gloss over unplanned pregnancies, and that refuse to entertain abortion as an option. But remember the ‘70s? Abortion wasn’t a bad thing. Remember Fast Times at Ridgemont High? That movie had an excellent abortion scene. Stacy has a regretful sexual encounter, she gets pregnant, and the guy (Damone, ugh.) refuses to help her pay for the abortion. But she gets one, and there’s no uproar. The outrage is correctly directed at Damone (ugh.) for just sucking overall. Let me be clear, Fast Times—the movie that features oral sex on carrots, and Sean Penn as a greasy-haired, Hawaiian-shirted stoner—handles abortion better than most of the country today. I don’t know what I would do if I were RBG, but if I were Harvey Weinstein, I would be getting at least one of my leading ladies out of maternity clothes, and into the abortion clinic.