Global EC: The Path to Access

Elizabeth Westley

Emergency Contraception was conceptualized internationally, born abroad, piloted around the world and currently marketed through a combination of both international and domestic agencies. Elizabeth Westley takes us on a worldly journey through EC's beginnings, recent challenges and future.

Editor's Note: This post is the first in a series of "EC on the Global Scene" posts coming this fall on Rewire.

When I was in college in the 1980s, we heard about the "morning after pill" – but not from health providers. After I graduated and moved to New York, I asked my gynecologist (this was in the early 1990s) if she mentioned emergency contraception (EC) to her clients who were barrier method users. She looked uncomfortable. She never provided information about EC to her patients (and certainly had never given an advance supply or prescription). She did provide EC prescriptions if specifically asked, she said, and insisted that her patients were all "highly educated" and already knew about EC. Of course, despite her assertions, we know that EC was still a "best kept secret" at this time.

More than twenty years earlier, in 1967, International Planned Parenthood Federation (IPPF) documented the use of estrogens for post-coital use in their medical bulletin, and other evidence has accrued over the last four decades. But despite a substantial body of strong scientific evidence, EC's transition "from research to reality" has been slow.

The International Consortium for Emergency Contraception (ICEC) was established in 1996 to increase access to EC, with a focus on developing countries. Given the potential for EC to help women meet their own reproductive goals, it was important to determine why awareness was so low, and why health care providers didn't talk about EC.

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One key issue uncovered was that there was no "dedicated product" on the market – one labeled specifically for post-coital use. With many brands of birth control pills available, there was no standard EC regimen (online bulletin boards around the world sported lists such as: Alesse, five pink pills per dose, Ovral, two white pills, Triphasil, four yellow pills, etc). Apart from being confusing, this approach did not foster the view that EC was a legitimate family planning method. Using a prescription drug "off label" can provoke unease on the part of consumers as well as providers. A drug cannot be marketed for an off-label indication, so no pharmaceutical company was putting its advertising budget behind EC. And, an off-label product does not lend itself to social marketing – a highly successful way to distribute EC now being undertaken by DKT International, Population Services International, Prosalud Interamerica and others. (DKT recently reported that together, these three organizations and other social marketing programs sold almost 4 million doses of EC around the world in 2006, averting an estimated 440,000 unwanted pregnancies.)

To meet the clear need for a dedicated product, the Consortium and its partners approached a number of pharmaceutical companies in the birth control pill business. The majority were uninterested in producing a birth control pill labeled for emergency contraception. Eventually, the Consortium negotiated with a European pharmaceutical company, Gedeon Ricther, to adapt a contraceptive pill they would manufacture into a product labeled to be taken after sexual intercourse, on an occasional or emergency basis.

Once a dedicated product was ready to be shipped from the Gedeon Richter factory, ICEC piloted EC "introduction strategies" in four countries: Mexico, Sri Lanka, Kenya, and Indonesia. Many of the challenges encountered in these and other developing country settings foreshadowed issues that later arose in the United States: regulatory delays (and delays, and delays), gathering opposition forces, the conflation of EC with abortion, and extremely low levels of general awareness that prevented women from even knowing to ask for EC.

While these international efforts were getting underway, the needs of U.S. women (and their sometimes secretive health care providers) were not forgotten. Although the mission of ICEC was specifically focused on developing countries, the founding coordinator, Sharon Camp (now the President and CEO of the Guttmacher Institute) saw the clear need for a dedicated product in this country. She left the consortium to found a venture capital company to bring EC – which she named "Plan B" – into the U.S. market, since no industry partners were interested at the time. Plan B was later sold to Barr Labs. Last year, after a protracted struggle, Plan B was approved (more or less) for over-the- counter sale. Without Plan B on the market, it is unlikely that use of EC would have increased substantially in the United States.

Today, EC is available in over 140 countries, and is available without a prescription in over 30 of them. While we have, to a large degree, been able to ensure basic access to a dedicated EC product in the majority of countries, new challenges face us in the Consortium's second decade. In a special series of "EC on the Global Scene" posts on Rewire coming this fall, we will share some of the more recent advances as well as challenges that affect women's ability to access this critical "second chance" method of contraception.

Commentary Politics

It’s Not Just Trump: The Right Wing’s Increasing Reliance on Violence and Intimidation as a Path to Power

Jodi Jacobson

Republicans have tried to pass Trump's most recent comments off as a joke because to accept the reality of that rhetoric would mean going to the core of their entire party platform and their strategies. The GOP would have to come to terms with the toll its power plays are taking on the country writ large.

This week, GOP presidential nominee Donald Trump stated that, if Hillary Clinton were elected and able to nominate justices to the Supreme Court, “Second Amendment people” might be able to do something about it. After blaming the media for “being dishonest” in reporting his statement, the Trump campaign has since tried to pass the comment off as a joke. However characterized, Trump’s statement is not only part of his own election strategy, but also a strategy that has become synonymous with those of candidates, legislators, and groups affiliated with the positions of the GOP.

To me, the phrase “Second Amendment people” translates to those reflexively opposed to any regulation of gun sales and ownership and who feel they need guns to arm themselves against the government. I’m not alone: The comment was widely perceived as an implicit threat of violence against the Democratic presidential nominee. Yet, GOP party leaders have failed to condemn his comment, with House Speaker Paul Ryan (R-WI) agreeing with the Trump campaign that it was “a joke gone bad.”

Republicans have tried to pass it off as a joke because to accept the reality of their rhetoric would mean going to the core of their entire party platform and their strategies. The GOP would have to come to terms with the toll its power plays are taking on the country writ large. The rhetoric is part of a longer and increasingly dangerous effort by the GOP, aided by corporate-funded right-wing organizations and talk show hosts, to de-legitimize the federal government, undermine confidence in our voting system, play on the fears held by a segment of the population about tyranny and the loss of liberty, and intimidate people Republican leaders see as political enemies.

Ironically, while GOP candidates and leaders decry the random violence of terrorist groups like Daeshitself an outgrowth of desperate circumstances, failed states, and a perceived or real loss of powerthey are perpetuating the idea of loss and desperation in the United States and inciting others to random violence against political opponents.

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Trump’s “Second Amendment” comment came after a week of efforts by the Trump campaign to de-legitimize the 2016 presidential election well before a single vote has been cast. On Monday, August 1, after polls showed Trump losing ground, he asserted in an Ohio campaign speech that “I’m afraid the election’s gonna be rigged, I have to be honest.”

Manufactured claims of widespread voter fraud—a problem that does not exist, as several analyses have shown—have nonetheless been repeatedly pushed by the GOP since the 2008 election. Using these disproven claims as support, GOP legislatures in 20 states have passed new voter restrictions since 2010, and still the GOP claims elections are suspect, stoking the fears of average voters seeking easy answers to complex problems and feeding the paranoia of separatist and white nationalist groups. Taking up arms against an illegitimate government is, after all, exactly what “Second Amendment remedies” are for.

Several days before Trump’s Ohio speech, Trump adviser Roger Stone suggested that the result of the election might be “illegitimate,” leading to “widespread civil disobedience” and a “bloodbath,” a term I personally find chilling.

Well before these comments were made, there was the hate-fest otherwise known as the Republican National Convention (RNC), during which both speakers and supporters variously called for Clinton to be imprisoned or shot, and during which New Jersey Gov. Chris Christie, a man not widely known for his high ethical standards or sense of accountability, led a mock trial of Hillary Clinton to chants from the crowd of “lock her up.” And that was the tame part.

The number of times Trump has called for or supported violence at his rallies is too long to catalogue here. His speeches are rife with threats to punch opponents; after the Democratic National Convention, he threatened to hit speakers who critiqued his policies “so hard their heads would spin.” He also famously promised to pay the legal fees of anyone who hurt protesters at his rallies and defended former campaign manager Corey Lewandowski after allegations surfaced that Lewandowski had assaulted a female Breitbart reporter.

A recent New York Times video compiled over a year of reporting at Trump rallies revealed the degree to which many of Trump’s supporters unapologetically express violence and hatred—for women, immigrants, and people of color. And Trump eschews any responsibility for what has transpired, repeatedly claiming he does not condone violence—his own rhetoric, that of his associates, and other evidence notwithstanding.

Still, to focus only on Trump is to ignore a broader and deeper acceptance, even encouragement of, incitement to violence by the GOP that began long before the 2016 campaign.

In 2008, in what may appear to be a now forgotten but eerily prescient peek at the 2016 RNC, then-GOP presidential nominee Sen. John McCain (R-AZ), and his running mate, former Alaska Gov. Sarah Palin, used race-baiting and hints at violence to gin up their crowds. First, Palin accused Obama of “palling around with terrorists,” a claim that became part of her stump speech. As a result, Frank Rich then wrote in the New York Times:

At McCain-Palin rallies, the raucous and insistent cries of “Treason!” and “Terrorist!” and “Kill him!” and “Off with his head!” as well as the uninhibited slinging of racial epithets, are actually something new in a campaign that has seen almost every conceivable twist. They are alarms. Doing nothing is not an option.

Nothing was in fact done. No price was paid by GOP candidates encouraging this kind of behavior.

In 2009, during congressional debates on the Affordable Care Act, opponents of the health-care law, who’d been fed a steady diet of misleading and sensationalist information, were encouraged by conservative groups like FreedomWorks and Right Principles, as well as talk show hosts such as Sean Hannity, to disrupt town hall meetings on the legislation held throughout the country. Protesters turned up at some town hall meetings armed with rifles with the apparent intention of intimidating those who, in supporting health reform, disagreed with them. In some cases, what began as nasty verbal attacks turned violent. As the New York Times then reported: “[M]embers of Congress have been shouted down, hanged in effigy and taunted by crowds. In several cities, noisy demonstrations have led to fistfights, arrests and hospitalizations.”

In 2010, as first reported by the Washington Post’s Greg Sargent, Tea Party candidate Sharron Angle, in an unsuccessful bid to unseat Senate Majority Leader Harry Reid (D-NV), suggested that armed insurrection would be the answer if “this Congress keeps going the way it is.” In response to a request for clarification by the host of the radio show on which she made her comments, Angle said:

You know, our Founding Fathers, they put that Second Amendment in there for a good reason and that was for the people to protect themselves against a tyrannical government. And in fact Thomas Jefferson said it’s good for a country to have a revolution every 20 years.

I hope that’s not where we’re going, but, you know, if this Congress keeps going the way it is, people are really looking toward those Second Amendment remedies and saying my goodness what can we do to turn this country around? I’ll tell you the first thing we need to do is take Harry Reid out.

Also in 2010, Palin, by then a failed vice-presidential candidate, created a map “targeting” congressional Democrats up for re-election, complete with crosshairs. Palin announced the map to her supporters with this exhortation: “Don’t retreat. Instead, reload!”

One of the congresspeople on that map was Arizona Democrat Gabby Giffords, who in the 2010 Congressional race was challenged by Jesse Kelly, a Palin-backed Tea Party candidate. Kelly’s campaign described an event this way:

Get on Target for Victory in November. Help remove Gabrielle Giffords from office. Shoot a fully automatic M16 with Jesse Kelly.

Someone took this literally. In January 2011, Jared Lee Loughner went on a shooting rampage in a Tuscon grocery store at which Giffords was meeting with constituents. Loughner killed six people and injured 13 others, including Giffords who, as a result of permanent disability resulting from the shooting, resigned from Congress. Investigators later found that Loughner had for months become obsessed with government conspiracy theories such as those spread by GOP and Tea Party candidates.

These events didn’t stop GOP candidates from fear-mongering and suggesting “remedies.”  To the contrary, the goading continued. As the Huffington Post‘s Sam Stein wrote in 2011:

Florida Senate candidate Mike McCalister, who is running against incumbent Sen. Bill Nelson (D-Fla.), offered a variation of the much-lampooned line during a speech before the Palms West Republican Club earlier this week.

“I get asked sometimes where do I stand on the Second and 10th Amendment, and I have a little saying,” he declared. “We need a sign at every harbor, every airport and every road entering our state: ‘You’re entering a 10th Amendment-owned and -operated state, and justice will be served with the Second Amendment.’” [Emphasis added.]

These kinds of threats by the GOP against other legislators and even the president have gone unpunished by the leadership of the party. Not a word has come from either House Speaker Paul Ryan or Senate Majority Leader Mitch McConnell decrying these statements, and the hyperbole and threats have only continued. Recently, for example, former Illinois GOP Congressman Joe Walsh tweeted and then deleted this threat to the president after the killing of five police officers in Dallas, Texas:

“3 Dallas cops killed, 7 wounded,” former congressman Joe Walsh, an Illinois Republican, wrote just before midnight in a tweet that is no longer on his profile. “This is now war. Watch out Obama. Watch out black lives matter punks. Real America is coming after you.”
Even after the outcry over his recent remarks, Trump has escalated the rhetoric against both President Obama and against Clinton, calling them the “founders of ISIS.” And again no word from the GOP leadership.
This rhetoric is part of a pattern used by the right wing within and outside elections. Anti-choice groups, for example, consistently misrepresent reproductive health care writ large, and abortion specifically. They “target” providers with public lists of names, addresses, and other personal information. They lie, intimidate, and make efforts to both vilify and stigmatize doctors. When this leads to violence, as David Cohen wrote in Rolling Stone this week, the anti-choice groups—and their GOP supporters—shrug off any responsibility.
Some gun rights groups also use this tactic of intimidation and targeting to silence critique. In 2011, for example, 40 men armed with semi-automatic weapons and other guns surrounded a restaurant in Arlington, Texas, in which a mothers’ group had gathered to discuss gun regulations. “Second Amendment people” have spit upon women arguing for gun regulation and threatened them with rape. In one case, a member of these groups waited in the dark at the home of an advocate and then sought to intimidate her as she approached in her wheelchair.
The growing resort to violence and intimidation in our country is a product of an environment in which leading politicians not only look the other way as their constituents and affiliated groups use such tactics to press a political point, but in which the leaders themselves are complicit.
These are dangerous games being played by a major political party in its own quest for power. Whether or not Donald Trump is the most recent and most bombastic evidence of what has become of the GOP, it is the leadership and the elected officials of the party who are condoning and perpetuating an environment in which insinuations of violence will increasingly lead to acts of violence. The more that the right uses and suggests violence as a method of capturing, consolidating, and holding power, the more they become like the very terrorists they claim to be against.

Culture & Conversation Human Rights

Two Years After Darren Wilson Killed Michael Brown, Police and the Media Need to Do Better

Jenn Stanley

"There are systems in place that are attacking our communities," explained Tara Tee of Hands Up United. "A lot of the things we’re doing is just rebuilding and creating plans to sustain, so that whatever this gap is doesn’t occur again.

It’s been two years since since Darren Wilson, a white police officer, shot and killed Michael Brown, an unarmed Black teenager, in Ferguson, Missouri. Caught on camera, the murder sparked weeks of demonstrations and protests, to which police responded with tear gas and rubber bullets. It garnered national attention and made Black Lives Matter a household hashtag.

Tara Tee is a Black woman from St. Louis. At the time, she was working as a project manager at a corporate tech job, but she knew she couldn’t sit back and watch.

“We’d be out in the streets until four or five in the morning. Then I would go home and try to sleep for a couple of hours and then get up at eight in time for work,” Tee recalls.

She said she noticed children as young as 10 were joining in on the protests, yelling and asking for answers, and she realized that though they wanted to be involved, the community lacked the resources to educate and organize them. So she and a group of other engaged community members and activists founded Hands Up United, a grassroots organization dedicated to “fulfilling the political void that remains from the historical archives of the Black Power Movement.”

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Tee currently serves as the director of the organization, where she puts a lot of her efforts into its Tech Institute, which teaches coding to 16-to-30-year-olds in the Ferguson/Greater St. Louis area. Hands Up United also hosts Freedom Flicks, a free social justice film series; Books and Breakfasts; and the People’s Pantry. After the organization’s efforts to get people voting in local elections, St. Louis elected its first Black circuit attorney. Tee says her day-to-day is always different, sometimes meeting with community leaders, or running the organization’s programs and events, but that her main objective is always to help rebuild her community, which she says has been broken by systemic racism.

RewireHow did you get involved with activism? And how did Hands Up United get started?

Tara Tee: I don’t necessarily consider myself an activist. I just consider myself a person who understands there are systems working against Black folks in America. I decided to do something about it, which I think most people should do in some way or another.

I went outside once I heard that the police in Ferguson had murdered someone and left his body out in the street for four-and-a-half hours, and all of the horrors that followed, including his mother not being able to approach the body, dogs being called into the neighborhood, dogs being allowed to urinate on his memorial. Just beyond the murder, everything that followed stripped someone’s humanity. It stripped humanity from Mike Brown, from his parents, and from the community.

As a Black woman in St. Louis, there’s no way that I could have not gone out to see, support, talk to, and love on people, and to let the state know that this is not OK. I just felt like it was something I had to do and there were many other people who felt the same way.

The birth of Hands Up United I would say was pretty organic, and it was a situation where it was like building the car while you’re driving it. We were out and doing things and making moves but we were just out because that’s what we felt like we needed to do. It took a while but we realized we needed to create programs to bring political education to the community.

We started thinking about, what does it look like to put something behind the nighttime action and being out in the street? What does it look like to create something that is sustainable, that is going to make a greater impact? Not that being in the street doesn’t make an impact. You and I wouldn’t be talking right now if we had not taken to the streets. You would not know Mike Brown’s name if we had not taken to the street. We have multi-level problems and we need to use every tool that we have to try to dismantle these things that aren’t working for us.

Rewire: What is Hands Up United’s mission?

TT: We’re basically just striving for the liberation of Black and brown people through education, art, advocacy, and agriculture. These are all things that are very important to us because they are all the things that are tied to these systems that are harming our communities.

Everything that we do is going to have a political education component to it, and it’s going to have an art component to it. We’re just trying to build community again. There are systems in place that are attacking our communities. A lot of the things we’re doing is just rebuilding and creating plans to sustain, so that whatever this gap is doesn’t occur again. So that, for example, the next time our neighborhoods are flooded with drugs the same things don’t occur. We ask kids to support Black businesses so that we can have a Black Wall Street, but they’re not teaching that history in school. So you’re asking someone to fathom something that they’ve never seen or heard about. So it’s important for us to create spaces and share knowledge that we have about things that are going on.

RewireIt’s clear that Hands Up United deals mainly within the community. Are you affiliated with the Movement for Black Lives, and do you think the work that’s being done nationally is helping on the ground?

TT: We support them, obviously, because our missions are similar. We’ve just picked up the fight of our ancestors. These are some of the same things that we’ve been fighting for for many, many years at this point. If you review their platform, anybody that’s for community would be for these things. It’s very similar to the ten-point platform that the Black Panthers had. These are basic rights that people shouldn’t be having to draw attention to, or be asking for. We shouldn’t have to demand basic human rights.

We are aligned with a lot of the initiatives of the Movement for Black Lives. We work with and know a lot of those folks and organizations that do very good work. We’ve worked closely with some of them, and we are in community with them for sure. If any of them call and need anything we’re coming.

But I also don’t like the whole labeling of things because it creates false narratives and problems. As far as the media is concerned, any person who is Black and has ever attended a protest is Black Lives Matter, or if they’re not they’re the Movement for Black Lives. So my stance and the stance of my organization is that we are for and with Black people, so whoever is trying to push the ball forward for Black people, that’s who we’re with.

RewireAs we approach the second anniversary of Michael Brown’s murder, what, if anything, would you say has changed?

TT: I would say nationally there’s more awareness regarding situations that are plaguing us, and these situations run the gamut from police brutality, to excessive lead in water, to food deserts, to inferior education systems.

We get the information relatively quickly when something occurs. Before, people affected were like, I don’t know if I should share this. I don’t know if anyone cares. Now people don’t hesitate to share these things, and spread this information.

So awareness, both nationally and locally, is increased. But on the ground, there’s still very much racial profiling, there’s still predatory policing, there’s still ticketing and fines aggressively directed toward poor people. We’re still seeing problems with voter rights. And so when I look at what has honestly changed—not much.

RewireHow do you think the media is doing covering what’s happened in Ferguson, and with other instances of police brutality against Black people?

TT: On a national level, I feel like it’s, for the most part, just propaganda. And then on the local level, for the most part, journalism here isn’t even journalism. There’s no investigative reporting. And so many of the stories start or end with “according to police,” or “the police said,” and it’s just like, well are you just sitting in the newsroom waiting for the police to fax over the story that you should print?

Ida B. Wells said the people committing the murders are the ones writing the reports. So it’s important to understand that the majority of the news that we are getting from the mainstream is generally not the real news.

We need nationwide media literacy. Why do [outlets] always put up a mugshot of the victim and not the cop or vigilante that shot them? It’s just not good reporting that is happening. There are some people who are doing really good work, but on the mass scale there’s just not good reporting happening.

Editor’s note: The above conversation is a lightly edited transcript of an interview between Rewire and Tara Tee ahead of the second anniversary of Michael Brown’s killing. Hear more from Tee via SoundCloud here.

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