Archive for the ‘contraception’ Category

Oral Contraceptives and Why We Shouldn’t Count Out Over-The-Counter

Friday, September 19th, 2014

SJ Chapman, Resident Blogger (12, Northwestern University Law School)

Recently, some Republican candidates have entered the spotlight for doing a 180 on issues of contraceptive access. Take Congressman Cory Gardner (R-Col.) for example.  Gardner has a sinister record when it comes to matters of reproductive justice.  However, in a recent op-ed, Gardner argued for over-the-counter availability of oral contraceptives.

Practically overnight, leery reproductive justice advocates leapt to attack this position, denouncing it as an insidious political tactic to ultimately decrease access to oral contraceptives.  The logic goes like this: oral contraceptives are widely available without a copay under the Affordable Care Act, but would be costly (as much as $600 a year) OTC.  Women who had previously been able to access oral contraceptives thanks to the ACA would be squeezed out due to the price.

I have to say, although I am against most of Gardner’s positions on reproductive justice, this one might not be as bad as we’ve made it out to be.  In countries where oral contraceptives are sold, most already offer them OTC.  Even Planned Parenthood advocates for OTC oral contraception in the United States.  And I have to wonder – when drugs have gone OTC in the past, there have still been prescription-only versions.  Wouldn’t this be the case with birth control as well?

Even though it comes from someone with history of deplorable stances on reproductive justice, maybe we shouldn’t be so quick to denigrate this one.

Politician Advocates Birth Control for Welfare Recipients

Friday, September 19th, 2014

Elise Foreman, Resident Blogger (‘16, Emory University School of Law)

Stories depicting the regulation and subsequent criminalization of the poor are far too common, almost mundane, in a country that espouses the virtues of democracy and asserts constitutional rights in the drop of a hat. However, the recent kerfuffle in Arizona points to something even more sinister baked into America’s apple pie coating. Earlier this week, the state’s GOP vice president (rightfully) resigned his post after advocating for sterilization of the state’s Medicaid recipients. This cracker-jack reasoning was punctuated with the statement: “. . . if you want to (reproduce) or use drugs or alcohol, then get a job.” (Full story here). The debate over drug testing for government aid recipients has been dissected ad nauseum, and fortunately been struck down in the courts. (For a review of this issue, see The Huffington Post’s collection).

But this latest call for sterilization should cause hesitation in even the most conservative thinkers. In a political climate that still hotly debates abortion even 40 years following Roe v. Wade, these statements point to a dissonance in the reproductive debate. Certainly there is a difference between birth control and abortion, however the point remains centered over the control one has over his or her reproductive future. Individuals, by virtue of being human, claim the right to exercise complete autonomy over their reproductive choices; this right is not premised on his or her financial situation or employment status. Regulating the reproductive choices of an individual based upon his or her Medicaid status demonstrates that such individual should be disallowed of this inherent human right because he or she is in fact less than human. No person or entity should breach another’s bodily integrity, nor advocate for rules that do so. For once and for all, get the government out of these intimate decisions and focused on topics it should be discussing. I have a list.

Mirena IUD Litigation, Misinformation, and a Few Thoughts on Informed Choice

Thursday, July 10th, 2014

Gavin Barney, LSRJ Summer Intern (’16, University of California, Berkeley School of Law)

According to a recent commentary in the Association of Reproductive Health Professionals (ARHP) peer reviewed journal, Contraception, reproductive health care clinics are currently witnessing a notable upswing in the number of patients requesting the removal of their Mirena IUDs. Mirena is a hormonal intrauterine system that prevents pregnancy for around five years through the release of levonorgestrel. And like other types of IUDs and long-term birth control, Mirena is very popular among the public health community: the ARHP refers to the device as safe and effective a number of times throughout the commentary. However, many women are choosing to have their IUDs removed and report being frightened by prevalent online and television publicity of common and devastating side-effects, including migration, perforation, and infertility. The problem, explains ARHP, is that these side-effect are not common, and some of them are actually fake – or “medically implausible” as the article puts it.

The supposed dangers of the Mirena device have made their way into the public consciousness as the result of solicitations for plaintiffs in mass litigation against the device’s manufacturer Bayer. This all initially passed me by, but after researching for this blog post I can report back that there is a lot of if-you-or-a-loved-one-has-been… out there. Mirena, like any other form of birth control, has potential risks, but as a result of media and advertising coverage these risks appear hugely magnified. ARHP contends that this hurts women in two ways: 1) by decreasing the number of women using long lasting birth control, and 2) by deterring contraceptive development by threatening that future technology will be met with similar litigation – note that from the 1970s to the 1980s, the number of companies pursuing contraceptive research fell from 13 to 1.*

For me, the most significant impact that misinformation around the Mirena device causes is not a reduction in the overall number of women using long term contraception. Rather, I am most concerned that opportunistic Mirena litigation and junk science could dissuade women from pursuing or keeping a birth control method that they would otherwise have chosen. IUDs do have some common side-effects – especially immediately following insertion – that can range from unpleasant to awful, so there are entirely legitimate reasons to remove the device early. But for those who actually do want to use and keep an IUD, misinformation can be tantamount to manipulation. Therefore, the central question the ARHP article raises is: what does informed and dignified decision making actually look like when we are so often bombarded with misinformation?

A quick search of the word “Mirena” shows just how murky the waters are when it comes to information on this IUD. Case in point: the first search result on Google, after Mirena’s official website, is DrugWatch.com, which describes a terrifying and “frequently encountered complication,” called “migration,” in which the IUD perforates the uterus and enters the body cavity, causing pain, infection, and damage to nearby organs. The ARHP article, on the other hand, scathingly refers to this problem as “fictitious.” Another site, in its review of the truth behind Mirena lawsuit ads, refers to migration as “so rare that even with tens of millions of women using IUDs worldwide, we can’t estimate how often it happens.”

I can easily envision a situation where a woman may encounter that first explanation of migration and immediately visit her doctor to have her IUD removed. Should the doctor simply dismiss her concerns out of hand because she knows that they are unfounded? Or should the doctor obey her patient’s wishes with the knowledge that she may have been manipulated into removing a device she actually wanted? The answer, as answers so often do, falls somewhere in the middle. LSRJ’s definition of reproductive justice holds that people must be able to “exercise the rights and access the resources they need to thrive and to decide whether, when, and how to have and parent children with dignity…” Here, my hypothetical patient has the right to access the resources she actually wants and needs, so it is her doctor’s responsibility to explain the true nature of the risks and dispel the misinformation. Then, should the patient still decide that the risk is too great, that choice should be met with the same degree of respect. Of course this all relies on the doctors themselves being entirely up on the most recent data about the device they are inserting/ removing and that they themselves are not intent on spreading misinformation.  So… fingers crossed on that one.

*From the ARHP article, this appears to have resulted from the litigation concerning the Dalkon shield. I do not think the writer intended to suggest that that was a case of junk science or junk law. I certainly don’t suggest that.

Reproductive Oppression Comes at a Cost, Literally

Wednesday, July 2nd, 2014

Grace Ramsay, LSRJ Summer Reproductive Rights Activist Service Corps (RRASC) Intern (’16, Smith College)

In 2010, I needed emergency contraception.  Asking my moms (yes, moms) for help was out of the question. So, I waited in the CVS parking lot while my 18 year old friend bought it for me because I was sixteen and Plan B was not yet over the counter. If my friend had said no, if I couldn’t afford the $50 upfront charge, or if I lived in a different state, there’s a good chance I wouldn’t have gotten the morning after pill at all.

Contraception access should not depend on your age, your provider or pharmacist’s religious beliefs, or the employer you work for. Naturally, I was dismayed to see the Supreme Court decision that allows corporations to refuse birth control coverage on religious grounds.  Justice Ruth Bader Ginsberg  reminds us that reproductive oppression comes at a cost, literally: “It bears note in this regard that the cost of an IUD is nearly equivalent to a month’s full-time pay for workers earning the minimum wage.” 

My snarky feminist side can’t help but wonder, (as so many have already lamented,) how come Hobby Lobby still covers vasectomies and Viagra? And why are condoms are available at practically any store, to any age, but it took until last year to have OTC emergency contraception? Can it be as simple and paternalistic as men not wanting women to have control over their personal reproductive decisions? I’m trying to remain hopeful that the outpouring of negative response to the Hobby Lobby decision will translate into renewed activism for reproductive justice.  In the meantime, I have to keep remembering that progress does not move in a linear direction and we have to keep up the good fight.

Birth Control vs. Population Control, and Why it Matters

Monday, June 30th, 2014

Grace Ramsay, LSRJ Summer Reproductive Rights Activist Service Corps (RRASC) Intern (’16, Smith College)

Earlier this month, I attended a discussion hosted by Population Action International, NARAL, and the Ibis Foundation, addressing the global gag rule and its effects on reproductive health worldwide.  Basically, the gag rule is a U.S. executive policy that prevents any countries receiving U.S. family planning aid from offering abortion services, even if the country wants to use its own funds to do so.  It was created under the Reagan administration – every Democratic president has since reversed it, and every Republican president has reinstated it.  It’s a clear anti-choice policy that has disastrous effects on family planning initiatives worldwide.

During the talk, the NARAL representative alluded to allying with environmental action groups.  When birth control advocates/family planning initiatives “go abroad” and team up with environmentalists, I tend to get concerned.  The language can quickly move away from the need for universal access to the variety of contraceptive methods and instead focus on how developing nations are “irresponsibly reproducing”.   So often I hear rhetoric like, Lower birth rates will put less strain on our natural resources! Or, We’re reaching our carrying capacity!  Such statements are especially misleading because the U.S. actually consumes more natural resources than developing countries.  I was pleasantly surprised that this talk kept its focus on ensuring the right to family planning for all women.

As a person who cares about RJ, I absolutely support the right to global contraceptive access and I also think it’s really important to take a nuanced look at the way we talk about population control in relationship to birth control access, in the light of the U.S.’s own eugenic history.

Let’s not forget that not one generation ago we were forcing sterilization upon disabled people, incarcerated people, and poor people, in an attempt to create a more “fit” American population.

Let’s not forget that in the 1970s, African American and Puerto Rican women were disproportionately sterilized without their consent.  Meanwhile, white women were campaigning for the right to birth control.

Let’s not forget that the United States knowingly sold the dangerous Dalkon Shield contraceptive to developing countries, after it was removed for sale in America.

Let’s not forget that the reproductive justice movement aims for the freedom to choose when and how to have a family (or not).   When we introduce anything else into the equation – even for the sake of “saving our planet” – it becomes coercive.  If we shift away from this concept for the sake of “saving our planet” we lose the voices that matter most: the people in the population.  And if replacement population rates become the end goal for contraception distribution, rather than enabling women’s agency and autonomy worldwide, we’re at risk of replicating our eugenic past (and present).  Population control efforts and RJ efforts may both create the same result (a lower population), but to me, intent is what matters most.

#KeepItConfidential

Monday, April 7th, 2014

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

Tuesday, March 25th, 2014

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?

Thursday, February 20th, 2014

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.

Wednesday, January 22nd, 2014

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

Monday, January 20th, 2014

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.