Last week, I had the opportunity to participate in a really interesting webinar about Emergency Contraception with Dr. James Trussell, a leading researcher in contraceptive efficacy and contraceptive methods. The webinar was focused on updates on research about emergency contraception and some of its reasons for failure, as well as information about the newest EC option, Ella, which was recently approved by an advisory committee to the FDA. Much of the information presented related to the participants of the studies that were done to calculate the effectiveness of EC.

One of the most interesting aspects of the presentation was actually the question and answer period at the end of the presentation.  The main audience of this webinar turned out to be health care providers and medical professionals who counseled women about emergency contraception options across the country and even Canada. The questions that they asked Dr. Trussell reminded me that there are so many unique situations that people can find themselves in. Some expressed concern about their patient’s ability to access medication that is not available over-the-counter in rural areas, being able to afford emergency contraception without insurance, and whether using emergency contraception could interfere with breast-feeding. It was great to hear so many people who would be able to provide them with accurate information in a non-judgmental setting.  Since the announcement of the FDA’s consideration of Ella, the amount of misinformation represented on blogs, websites and news reports reminds me how important it is to have accurate, fact-based information from professionals readily available. It hopeful to know that many of the people giving advice and counsel to young women have taken the time to educate themselves on the facts of emergency contraception from one of the leading experts in the field.

Jeryl Hayes

When a friend of mine got married a few years ago, we joked that she and her new husband should take every opportunity available to consummate their new marriage.  Our goal?  For her not to have to be deployed to Iraq.  As a member of the armed forces, we knew that if she got pregnant, she wouldn’t have to go and wouldn’t be placed in harm’s way.  What we didn’t consider was what getting pregnant would have cost her in advancing her military career.

Getting pregnant in the military is a difficult situation for our servicewomen for a multitude of reasons.  First, her pregnancy could get her court-marshaled and possibly discharged, depending on her commander’s policy, as evidenced by Maj. Gen. Anthony Cucolo’s policy in northern Iraq.  At the very least, she risks her ability to move up the ranks in a military system that is already difficult for women to ascend.  One of the options not currently available to a servicewoman is the ability to safely terminate her pregnancy while she is on a military base, either within the US borders, where abortions are legal, or in other countries, where access to abortion may be restricted by that country’s laws.  Because of restrictions in U.S. law, servicewomen are unable to go to military hospitals and have an abortion performed safely, even if it’s with their own money.  Until recently, these women even had difficulty with getting consistent access to emergency contraception, which had not been previously considered a medication important enough to be carried at all military facilities.  In essence, the very citizens protecting our freedoms against those who oppose the freedoms enjoyed by Americans, are unable to exercise a right they risk their lives to protect.

While there is currently new legislation being proposed that would allow for privately-funded abortions at military facilities, this situation is a reminder that access to abortion is only part of a larger framework of reproductive justice.

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On January 1, 2010, I began a three-year service on the Board of Directors of Planned Parenthood of San Diego and Riverside Counties.  Last week, I experienced my first event as an official board member by attending the President’s Council Speaker Series at one of our local affiliates.  I was one of the first to arrive, and since I am new to the board, I only knew a handful of people.  However, I eventually found myself speaking with Dawn and Connie, two members of the community who feel incredibly committed to serving Planned Parenthood and its mission.  They recounted how they worked as volunteers for Planned Parenthood when they were in college in the 70’s and now that they are retired, they are feeling an urge to volunteer again.  These women were lovely to speak with; they were funny, intelligent, and passionate.  And then Dawn said, “Now tell me, Jenn.  Why are you the youngest person in this room?  Why aren’t more people your age here?”  I turned around and noticed that the reception area had filled with more than a hundred people in the time I had spent getting to know my new acquaintances . . . and they were right.  Aside from the Planned Parenthood staff, I was the youngest guest in attendance—it was easy to tell that everyone else was from a completely different generation.  And then it really hit me—why am I the only 20-something in this room?  Why aren’t my peers more represented?  Why aren’t more law students here? Aren’t law students interested in protecting “people’s rights”?

            Law students are busy.*  There’s no denying that.  And it can be difficult to motivate students to attend an event where there may not be many lawyers present.  But women (and men) worked hard to gain the rights my generation often takes for granted.  We forget that there was a time when our mothers and grandmothers couldn’t walk into their nearest health clinic and walk out with a year supply of birth control, no questions asked.  Many of us may enjoy certain rights today, but that doesn’t mean those rights aren’t limited for many people out there or can be taken away from the rest of us.  There are people out there actively opposing us and trying to limit our rights . . . especially our right to control our reproductive freedom.  I shouldn’t be the only 20-something in a room full of reproductive rights advocates and supporters.  I urge those of you who want to get more involved but haven’t been able to find the time, to make the time. 

*I realize that people may read this who are not law students.  However, this is the lens I am applying since I am a law student, surrounded on a daily basis by other law students.

Jenn Kish

As most of you heard the Nelson-Hatch amendment failed in the Senate this week. Many reproductive organizations, among others, launched a visible grass-roots campaign to make sure that this Stupak-like amendment was not included in the Senate’s version of a health reform bill. Some were critical that pro-choice groups did not work proactively enough to defeat these measures before the debate entered the public arena.  I had informal discussions with friends regarding the matter. On one hand, I am frustrated that advocates for reproductive justice are once again in a reactionary position (defeat Stupak-Pitts! defeat Nelson-Hatch!) rather than proactively advocating for expansive and inclusive reproductive justice measures. I am also concerned that other important reproductive justice issues are being ignored in the public debate. What about affordability, prevention, and immigrant rights?   

On the other hand, I do not think it is fair to place all responsibility and blame for the passage of the Stupak amendment on just two organizations. I have heard some say that advocates hoped to work quietly behind the scenes to avoid turning the federal health reform debate into an abortion debate. What is the appropriate role for reproductive health, rights, and justice organizations? What can we learn from the Stupak-Pitts and Nelson-Hatch advocacy efforts? How can we work better moving forward?

Jennifer Smith

President Obama has made health care reform a top priority, which is welcome news to millions of un- or under-insured Americans. Under the current system, women who purchase their own coverage already pay more then men – sometimes up to 50% more. As justification for the higher rates, insurers cite the fact that women tend to use more heath care, especially during their childbearing years. However, the rate disparity between women and men doesn’t disappear in insurance plans which do not cover maternity care. Healthcare reform holds the promise of more equitable pricing of insurance for men and women. 

Women (both insured and uninsured) shouldn’t breathe a sigh of relief just yet, however.  Women’s access to reproductive health care is currently under attack from both the left and the right. Nineteen House Democrats have said that they will not vote for healthcare legislation unless it explicitly excludes abortion coverage. The Republican leadership of the Senate Finance Committee is considering language in healthcare reform legislation that would eliminate coverage for abortion services. The exclusion of abortion services could result in women who currently have coverage losing that coverage, and prevent currently uninsured women from ever receiving coverage.

Health insurance is only as good as the services it covers, and having health insurance that doesn’t cover the services you need is tantamount to having no health insurance at all.  While healthcare reform is essential, reform at the expense of women’s health is too high a price to pay.  In addition to expanding the number of people who have health insurance, lawmakers should ensure that reform includes the healthcare services Americans need. In the case of American women, that need is comprehensive reproductive healthcare, including abortion coverage. Comprehensive health care reform should be just that – comprehensive.

-Megan Mullett

These days it seems like all I hear about are the twin crises of budget and healthcare, so I wasn’t surprised when one of my very first assignments this summer at LSRJ was to research religious hospitals and their funding. What did surprise me, however, was what I learned about the disparate standards of care between secular and religious healthcare facilities.

One out of every six patients in the U.S. is cared for in a Catholic hospital. In fact, the Catholic healthcare system is the largest private non-profit provider of healthcare in the nation – 70% of religiously affiliated hospitals identify as Catholic.  Because the Catholic healthcare system has significant medical responsibility for millions of Americans, the services they choose to provide or withhold can have a profound impact on the overall quality of care in the U.S. Additionally, religiously affiliated hospitals receive 50% of their funding from Medicare and Medicaid and also enjoy certain benefits like tax exempt status, low-cost financing through government bond programs, and in some areas, use of municipal buildings.

Because Catholic hospitals receive so much public funding and see so many patients, one might assume that the standard of care in a Catholic hospital is comparable to the standard of care in a secular hospital. Unfortunately, this assumption may not be true.

Some patients treated in Catholic hospitals – women in particular – may not be receiving reproductive healthcare considered basic and essential by secular medical facilities. That is because Catholic healthcare providers are governed by the Ethical and Religious Directives for Catholic Health Care Services, with which all Catholic health care providers are obligated to comply (Directive 5).

Under the Directives, Catholic hospitals are prohibited from providing contraception (Directive 52), sterilization (Directive 53), most infertility treatments (Directives 40, 41, 42), condom distribution for AIDS prevention (Directive 52 prohibits all contraception, regardless of the reason), or abortion services (Directive 45).  Directive 48 goes so far as to say no medical care that could be construed as abortion can be provided, even to a woman with an extra-uterine (ectopic) pregnancy.

It is also difficult to obtain emergency contraception in Catholic hospitals—even as treatment for rape or sexual assault. Despite the fact that it is expressly addressed in the Directives, the language of Directive 36 is unclear on when and under what circumstances EC can be provided:

Compassionate and understanding care should be given to a person who is the victim of sexual assault. Health care providers should cooperate with law enforcement officials and offer the person psychological and spiritual support as well as accurate medical information. A female who has been raped should be able to defend herself against a potential conception from the sexual assault. If, after appropriate testing, there is no evidence that conception has occurred already, she may be treated with medications that would prevent ovulation, sperm capacitation, or fertilization. It is not permissible, however, to initiate or to recommend treatments that have as their purpose or direct effect the removal, destruction, or interference with the implantation of a fertilized ovum.

Since emergency contraception is most effective in the first 72 hours, a healthcare provider’s refusal to provide comprehensive treatment can further traumatize survivors of rape and sexual assault by forcing them to leave the hospital and attempt to obtain EC elsewhere.

Catholic hospitals do provide a tremendous amount of care in rural and impoverished communities – indeed, they are often the only hospital in such communities. The question remains, however, whether funding institutions that refuse to provide the full spectrum of reproductive healthcare is really the best use of our scarce federal Medicaid and Medicare dollars.

-Megan Mullett

This is just great. According to Consumerist, a couple went to a Walgreens in Oxford, Mississippi and requested Plan B after presenting photo ID. The first pharmacy employee they encountered asked for proof of insurance (which is unnecessary if the consumer wants to pay for the medication herself). The couple requested to speak with a manager, at which point a pharmacist informed the customers that they were required to wait an hour before obtaining the medication, as well as receive literature on adoption. In the end, the couple got Plan B sans waiting period and adoption information, but apparently the store insisted on writing down the customer’s driver’s license number—not the first time pharmacies have illegitimately collected personal information from customers seeking Plan B.

Hmmm…this sounds familiar. A waiting period? Literature on adoption? For a high-dosage birth control pill that works better the sooner you take it?

This situation appears to be the sinister cousin of the old-fashioned pharmacist refusal—when the attending pharmacist won’t give the customer Plan B and won’t refer the customer to someone who can—the pharmacist resistance. It’s making what can be an uncomfortable situation for many—walking up to a complete stranger in a public store, often with other customers lingering within earshot, and saying, “Hi, I’d like the morning-after pill, please”—even more difficult. It’s the idea that, if enough people are afraid that they will be shamed or asked to do ridiculous things like read a brochure on adoption when they’re just trying to back up their birth control, they just won’t take emergency contraception. Even though the condom broke, or a pill was forgotten, or they just want to have some at home in case they need it some day.

I liken this situation to the spreading of misinformation at “crisis pregnancy centers” and the latest trend to require ultrasounds for women seeking abortions. Each of these scenarios seeks to exploit the position of power the doctor, counselor or pharmacist has over the patient, client or consumer by gleefully conveying misinformation to those in a vulnerable position. (For example, South Dakota requires that providers tell a woman seeking an abortion that the abortion would “terminate the life of a whole, separate, unique, living human being.”) Each of these situations operates on the assumption that erecting more barriers to services will finally “teach women” what’s best for them.

I argue that emergency contraception should be available truly over-the-counter, just like Tylenol, because of the drug’s safety and effectiveness at preventing unwanted pregnancies—and because of the prevalence of pharmacist refusals and now pharmacist resistance. A trip to the drugstore to pick up Plan B should not entail a skirmish with pharmacy personnel, misinformation about a required “waiting period,” a lecture about promiscuity, requests for private information, or a brochure about adoption.

-Amanda Allen