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

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

Because most participants in the insurance exchange would receive some federal subsidy (the New York Times reports that “anyone earning less than $88,000 for a family of four — four times the poverty level — would be eligible for a subsidy under the House bill”), insurers in the exchange are strongly incentivized to cut abortion coverage from their offerings. The result?  A de facto ban on abortion coverage within the insurance exchange – a ban which would affect even those who don’t receive federal health subsidies.

There are many stories to be told here, but I’ll limit myself to just a few. First, even if we’re not losing the culture war, Democrats apparently think we are. Disturbingly, 20 Dems with pro-choice track records voted in favor of the Stupak Amendment; at least 11 of them are in vulnerable positions for 2010, and they presumably believe that a vote for reproductive health is more dangerous than a vote for health reform. (Nate Silver points out that voter polls indicate the contrary.) The Left collectively needs to grapple with some large questions around the future of RJ and the Democratic Party.

Our second story: Congress hasn’t simply sold out women’s health; they’ve specifically sold out the health of low-income women. As RJ activists, we should be particularly attuned to intersections of economic justice and reproductive health, and to the ways in which the Stupak Amendment furthers the economic stratification of abortion access. (more…)

A recent NY Times pair of articles focuses on the human, medical, and social costs of implanting multiple embryos via IVF and IUI, resulting in a spike in both multiple births and a litany of health risks to these babies. The articles, and ensuing barrage of public comments, can be read here: “The Gift of Life, and Its Price,” “Grievous Choice on Risky Path to Parenthood.” In IUI, parents who conceive multiples also face the decision of whether to terminate some fetuses using the procedure termed “selective reduction”. IUI is much cheaper than IVF, and more readily covered by insurance, but the chance of success is lower and ability to control multiples non-existent.

The most startling assertion in the IVF article was an analysis by reproductive health experts and providers explaining the financial and business motivations on providers to disregard medical guidelines by implanting more embryos than may be safe for mom or her babies. Fertility practices want to boost their success rates and attract clientele in a highly competitive and lucrative medical field, and parents apparently think that implanting more, or rejecting selective reduction in IUI, will secure greater chances of a viable pregnancy and satisfy their emotional or religious needs to a degree that makes the risks worth taking. If the underlying reason for the increase in multiple implantations and subsequent births is really a symptom of our profit-based medical system, some suggest we utilize insurance schemes as a way to address this issue. If insurance companies are required to cover IVF, whereas many now only cover IUI, they could regulate the financial incentives by only reimbursing doctors for single implantations. (more…)

I have been interning at LSRJ for over a month now, and it has been a great learning experience, even though much of what I have learned makes me simultaneously sick to my stomach and incredulous that such egregious violations of human rights can still go on in this day and age. I attended LSRJ’s first Summer Networking Lunch last week at Legal Services for Prisoners with Children (LSPC), a legal services and advocacy organization that, as the name implies, works with incarcerated parents, with an emphasis on prisoners from Communities of Color and low-income communities. Most of us are aware that in the U.S., incarceration disproportionately impacts People of Color, the poor, and other marginalized populations. However, it was not until this Networking Lunch that I began to more fully realize that the harms done by incarceration unjustly impacts, not just the individuals who are imprisoned - many of whom are sentenced for non-violent drug offenses - but also their families and communities. Those sentenced to prison are taken well outside of their communities – presumably to take them away from the “influences” that made them turn to crime in the first place – where they are separated from their loved ones and are unable to maintain ties to their community that, if preserved, would perhaps make reintegration into society much more successful. This is especially hard for prisoners with children; even though a great many of those incarcerated are imprisoned for non-violent drug offenses, incarcerated parents are regularly disallowed from even basic physical contact with their children for more than a year. They also have very little time to even see their children, as those looking after their kids must take time off of work and expend resources they probably don’t have to bring the children to the prison, where there is no real place for kids to be comfortably. Families, and therefore the community at large, are further ripped apart if family members of prisoners (often grandparents of those incarcerated) who are perfectly able and willing to take care of these kids are disallowed from doing so because of laws that restrict the placement of children with ex-felons – even if the felonies were for crimes completely unrelated to children and were non-violent and occurred many years ago. Though it might seem reasonable at first to disallow placement of children with felons, in many cases, it seems that placing children with family members who love them and their incarcerated parents, who will work to keep the family together and who are invested in the success of these kids, is much better than taking children completely out of their community and placing them in homes at great distance from all of their social ties, and often into communities that in no way resemble the ones from which they came. In this way, many communities not only lose members due to incarceration, but also lose a lot of bright kids due to the repercussions of the incarceration of their parents – and this loss of human capital is often permanent.

-Tina Sinha

When I tell people that I am interested in both criminal justice and reproductive justice, they often look at me askance, or raise their eyebrows.  Don’t these two fields clash a lot, they ask? Well, yes, in some ways. But women’s health advocates and prison reform activists have more in common than many might think. Beyond the fact that there are more women in prison than ever before because women’s incarceration rates have skyrocketed since the beginning of the so-called “war on drugs,” women’s lives are effected by high prison rates in multiple other ways. Feministing’s Samhita draws the connections in her most recent (and last) post on the Nation’s Passing Through.  One reason, she says, that the women’s health and anti-incarceration movements need to start talking to each other is that women’s STD rates are exponentially higher in communities that have the highest incarceration rates, even in women who are not engaging in so-called risky behavior. A recent Washington Post Op-Ed has more:

One obvious reason is that conversations about sexual behavior, race and sexually transmitted infections remain taboo. Another is that the incidence of many STDs, particularly HIV, is concentrated in poor, segregated neighborhoods that are characterized by high rates of incarceration. Inner-city populations of African Americans and Latinos account for almost two-thirds of the 2.2 million Americans in prison nationwide, and two disturbing trends are increasingly present in these communities.  

One is the shift in the patterns of marriage and courtship that result when so many men are removed from a community. The other is an increase in the number of “multiple concurrent sexual partnerships,” in which individuals are engaged in sexual relationships with more than one person at a time. In many communities, when one sexual partner is imprisoned, the person left behind chooses another partner. When widespread, this behavior creates an efficient, effective pattern for introducing and maintaining an STD through a network of sexual relationships. 

As the Op-Ed, written by two public health academics, later notes, we as a society ignore the fallout of our addiction to incarceration at the peril of our health — and particularly of women’s health.  But the op-ed gets something seriously wrong:  it suggests that we can place blame for the high rates of HIV and other STDs at the feet of the women left behind when their men are dragged off to jail. We shouldn’t be placing blame on the community at all. And as Samhita rightly notes, it’s not quite so simple:

High rates of incarceration has such deleterious side effects that we have only begun to understand. Beyond dismantling and shaming entire communities, the onslaught of emasculating practices via police has created greater threats to masculinity, which backfire in the form of unsafe sexual practices, multiple partners and in its extreme form, rape.  

It may be true that, as some claim, the feminist/women’s health movement fanned the flames of the incarceration fury — particularly in the 1990s with the push toward victim’s rights. But it’s time to move beyond the divisive past and start to work from our commonality — that women and men, both inside and outside the prison walls, deserve better. 

A book to add to my very long list of books to read: Dr. Susan Wicklund’s “This Common Secret:  My Journey as an Abortion Doctor.” In her book, Dr. Wicklund, an abortion provider who flies into underserved areas to perform abortions, takes on the abortion taboo.

We don’t talk about it,” she said in a telephone interview. “People say, ‘Nobody I know has ever had an abortion,’ and that is just not true. Their sisters, their mothers have had abortions.”

She’s right. We don’t talk about abortion. We don’t talk about how common it is. We don’t question loudly enough our tacit acceptance of abortion as something shameful. And - and this is a hard pill even for many RJ advocates to swallow - we don’t talk about how even with all the prevention in the world, abortion would still exist, would still be central to women’s reproductive health, and must still be legal.

That said, Dr. Wicklund’s not perfect. It seems she too is focused on the line of rhetoric we have been fed — the idea that the central problem of abortion opponents is that they do not support prevention, say. Yes, this hypocrisy is central to their advocacy, but it’s only one of many many hypocrisies. What about the fact that the antiabortion movement is also, on the whole, against childcare subsidies and universal healthcare, and even SCHIP?  What about the fact that a so-called “pro-life” stance should include helping protect the lives of teenagers by teaching them, through comprehensive sex-ed, how to prevent STDs? What about public financing for abortions (are you listening Mr. Hyde, you freedom of medal winner you?) so that women who want to terminate their pregnancies can do so as early as possible - when it’s safest and when Dr. Wicklund actually performs abortions?

I don’t want to bite a generous hand - and Dr. Wicklund certainly gets a lot of it right. But if we’re going to stop being so ashamed to talk about abortion, we’ve got to really talk. Not only about abortion per se, but about abortion as an integral part of a patchwork of social justice initiatives and conversations.

Last week, President Bush named the recipients of the Presidential Medal of Freedom. There are some good ones among them — Harper Lee, the author of To Kill a Mockingbird; and Benjamin Hicks, a civil rights pioneer. But there’s one real sleeper in there (warning: don’t have anything in your mouth while you read this or you may spit it out): Henry Hyde. Yes, he of the Hyde Amendment, which bans the use of federal medicaid funds for abortions except in cases of rape, incest, or if the woman’s life is threatened.  The same Hyde Amendment that places an enormous obstacle in the way of poor women seeking abortions in this country, and that discriminates against poor women (though the Supreme Court has said otherwise) in that federal medicaid funds cover other reproductive healthcare expenses for men and women. The same Hyde Amendment that a coalition of reproductive justice groups is currently fighting to repeal.

And for this, he gets the medal of freedom, complete with this citation from the White House:

Henry J. Hyde has served America with distinction. During his career in the House of Representatives, he was a powerful defender of life and a leading advocate for a strong national defense and for freedom around the world.

Ann at Feministing takes the words right out of my mouth:

 Because nothing says “freedom” like severely curtailing the reproductive rights of low-income women.

Hyde’s “defense of life” has meant that many women have been forced to carry pregnancies to term when they would have preferred to abort, often because they feel it’s what’s in the best interests of the child or children they already have. Or they have had to choose between buying food or paying the electric bill and paying for their abortion. Or they have been forced to consider dropping out of school to take care of a child when they would really rather graduate.

The good news is that some states provide public funding for abortions out of their own coffers. These states recognize that access to safe and legal abortion is a necessary part of a woman’s reproductive health, and of her life outside her reproduction. The bad news is that the President (et al.) think that denying this access warrants an award. And not just any award, but one that carries the name “freedom.” It would be funny if it weren’t real.