The Vatican’s Condom Conundrum

Frances Kissling

Recent news that the Vatican might slightly relax its opposition to both condom education and provision as a way of preventing the transmission of HIV and AIDS has been greeted with optimism by the media as well as the international HIV and AIDS community. Of course, those of us old enough to remember the Vatican Commission on Birth Control—which was widely expected to change the church’s position on contraception in 1966—know not to get our hopes up. Then, the vast majority of commission members recommended that the Vatican approve of contraception for married couples and said there was no theological obstacle to a change. Four dissenting members went to the pope and cautioned that any change might erode the overall authority of the church and lead people to believe that other things could change. The pope followed the minority view and ruled in favor of authority over the health and needs of Catholic couples.

Recent news that the Vatican might slightly relax its opposition to both condom education and provision as a way of preventing the transmission of HIV and AIDS has been greeted with optimism by the media as well as the international HIV and AIDS community. Of course, those of us old enough to remember the Vatican Commission on Birth Control—which was widely expected to change the church’s position on contraception in 1966—know not to get our hopes up. Then, the vast majority of commission members recommended that the Vatican approve of contraception for married couples and said there was no theological obstacle to a change. Four dissenting members went to the pope and cautioned that any change might erode the overall authority of the church and lead people to believe that other things could change. The pope followed the minority view and ruled in favor of authority over the health and needs of Catholic couples.

I would not be surprised if hard-liners in the Vatican prevailed on the question of condoms fearing that if condoms could be seen as the lesser of two evils by preventing death from AIDS, someone might claim that contraception could be seen as the lesser of two evils in preventing abortion.

It is perhaps appalling that the world community continues to be held hostage to the Vatican’s views on sexuality and reproduction, which are at the root of the current objection to a prevention strategy that includes condoms. However, that is indeed the case. If the Vatican’s view did not influence the larger, secular effort to prevent the transmission of AIDS it could be seen as the quaint and quirky view of sexuality and responsibility that it is. But the fact is that the Vatican’s objection to condoms has had a great effect on the larger community.

Of course, the greatest effect is on those who seek care in Catholic-controlled facilities. The church claims that 25% of those with AIDS get their health care from church agencies. That means a large number of them are either kept ignorant of the importance of condoms for those who are sexually active or simply not provided with the condoms they need. As AIDS treatment becomes more available and people live longer, this means more people will be infected.

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But more importantly, Vatican opposition to condoms has had a large influence on the major agencies responsible for AIDS prevention and treatment. The group includes ministries of health around the world, UNAIDS and private foundations like Gates and Clinton. The emphasis over the past decade on treatment over prevention is only partly due to an appropriate concern regarding the cost of drugs and the lack of access to them. It is also an easy way for these agencies to avoid controversy and attacks from the church.

One can only hope that the mere discussion within the church of a possible change in policy will give these agencies the backbone they need to once and for all reject the ignorant and irresponsible position of the church and stand up for the right of those at risk of transmitting or getting AIDS to have a healthy and responsible sexual life while preventing the transmission of a devastating disease.

Commentary Contraception

Hillary Clinton Played a Critical Role in Making Emergency Contraception More Accessible

Susan Wood

Today, women are able to access emergency contraception, a safe, second-chance option for preventing unintended pregnancy in a timely manner without a prescription. Clinton helped make this happen, and I can tell the story from having watched it unfold.

In the midst of election-year talk and debates about political controversies, we often forget examples of candidates’ past leadership. But we must not overlook the ways in which Hillary Clinton demonstrated her commitment to women’s health before she became the Democratic presidential nominee. In early 2008, I wrote the following article for Rewirewhich has been lightly edited—from my perspective as a former official at the U.S. Food and Drug Administration (FDA) about the critical role that Clinton, then a senator, had played in making the emergency contraception method Plan B available over the counter. She demanded that reproductive health benefits and the best available science drive decisions at the FDA, not politics. She challenged the Bush administration and pushed the Democratic-controlled Senate to protect the FDA’s decision making from political interference in order to help women get access to EC.

Since that time, Plan B and other emergency contraception pills have become fully over the counter with no age or ID requirements. Despite all the controversy, women at risk of unintended pregnancy finally can get timely access to another method of contraception if they need it—such as in cases of condom failure or sexual assault. By 2010, according to National Center for Health Statistics data, 11 percent of all sexually experienced women ages 15 to 44 had ever used EC, compared with only 4 percent in 2002. Indeed, nearly one-quarter of all women ages 20 to 24 had used emergency contraception by 2010.

As I stated in 2008, “All those who benefited from this decision should know it may not have happened were it not for Hillary Clinton.”

Now, there are new emergency contraceptive pills (Ella) available by prescription, women have access to insurance coverage of contraception without cost-sharing, and there is progress in making some regular contraceptive pills available over the counter, without prescription. Yet extreme calls for defunding Planned Parenthood, the costs and lack of coverage of over-the-counter EC, and refusals by some pharmacies to stock emergency contraception clearly demonstrate that politicization of science and limits to our access to contraception remain a serious problem.

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Today, women are able to access emergency contraception, a safe, second chance option for preventing unintended pregnancy in a timely manner without a prescription. Sen. Hillary Clinton (D-NY) helped make this happen, and I can tell the story from having watched it unfold.

Although stories about reproductive health and politicization of science have made headlines recently, stories of how these problems are solved are less often told. On August 31, 2005 I resigned my position as assistant commissioner for women’s health at the Food and Drug Administration (FDA) because the agency was not allowed to make its decisions based on the science or in the best interests of the public’s health. While my resignation was widely covered by the media, it would have been a hollow gesture were there not leaders in Congress who stepped in and demanded more accountability from the FDA.

I have been working to improve health care for women and families in the United States for nearly 20 years. In 2000, I became the director of women’s health for the FDA. I was rather quietly doing my job when the debate began in 2003 over whether or not emergency contraception should be provided over the counter (OTC). As a scientist, I knew the facts showed that this medication, which can be used after a rape or other emergency situations, prevents an unwanted pregnancy. It does not cause an abortion, but can help prevent the need for one. But it only works if used within 72 hours, and sooner is even better. Since it is completely safe, and many women find it impossible to get a doctor’s appointment within two to three days, making emergency contraception available to women without a prescription was simply the right thing to do. As an FDA employee, I knew it should have been a routine approval within the agency.

Plan B emergency contraception is just like birth control pills—it is not the “abortion pill,” RU-486, and most people in the United States don’t think access to safe and effective contraception is controversial. Sadly, in Congress and in the White House, there are many people who do oppose birth control. And although this may surprise you, this false “controversy” not only has affected emergency contraception, but also caused the recent dramatic increase in the cost of birth control pills on college campuses, and limited family planning services across the country.  The reality is that having more options for contraception helps each of us make our own decisions in planning our families and preventing unwanted pregnancies. This is something we can all agree on.

Meanwhile, inside the walls of the FDA in 2003 and 2004, the Bush administration continued to throw roadblocks at efforts to approve emergency contraception over the counter. When this struggle became public, I was struck by the leadership that Hillary Clinton displayed. She used the tools of a U.S. senator and fought ardently to preserve the FDA’s independent scientific decision-making authority. Many other senators and congressmen agreed, but she was the one who took the lead, saying she simply wanted the FDA to be able to make decisions based on its public health mission and on the medical evidence.

When it became clear that FDA scientists would continue to be overruled for non-scientific reasons, I resigned in protest in late 2005. I was interviewed by news media for months and traveled around the country hoping that many would stand up and demand that FDA do its job properly. But, although it can help, all the media in the world can’t make Congress or a president do the right thing.

Sen. Clinton made the difference. The FDA suddenly announced it would approve emergency contraception for use without a prescription for women ages 18 and older—one day before FDA officials were to face a determined Sen. Clinton and her colleague Sen. Murray (D-WA) at a Senate hearing in 2006. No one was more surprised than I was. All those who benefited from this decision should know it may not have happened were it not for Hillary Clinton.

Sometimes these success stories get lost in the “horse-race stories” about political campaigns and the exposes of taxpayer-funded bridges to nowhere, and who said what to whom. This story of emergency contraception at the FDA is just one story of many. Sen. Clinton saw a problem that affected people’s lives. She then stood up to the challenge and worked to solve it.

The challenges we face in health care, our economy, global climate change, and issues of war and peace, need to be tackled with experience, skills and the commitment to using the best available science and evidence to make the best possible policy.  This will benefit us all.

Analysis Politics

Timeline: Donald Trump’s Shifting Position on Abortion Rights

Ally Boguhn

Trump’s murky position on abortion has caused an uproar this election season as conservatives grapple with a Republican nominee whose stance on the issue has varied over time. Join Rewire for a look back at the business mogul's changing views on abortion.

For much of the 2016 election cycle, Donald Trump’s seemingly ever-changing position on reproductive health care and abortion rights has continued to draw scrutiny.

Trump was “totally pro-choice” in 1999, but “pro-life” by 2011. He wanted to shut down the government to defund Planned Parenthood in August 2015, but claimed “you can’t go around and say that” about such measures two months later. He thinks Planned Parenthood does “very good work” but wants to see it lose all of its funding as long as it offers abortion care. And, perhaps most notoriously, in late March of this year Trump took multiple stances over the course of just a few hours on whether those who have abortions should be punished if it became illegal.

With the hesitancy of anti-choice groups to fully embrace Trump—and with pro-choice organizations like Planned Parenthood, NARAL, and EMILY’s List all backing his opponent, Democratic nominee Hillary Clinton—it is likely his stance on abortion will remain a key election issue moving into November.

Join Rewire for a look back at the business mogul’s changing views on abortion.

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