The Pill — Lifestyle Drug or Medical Necessity?

Amanda Marcotte

On the right to contraception, pro-choicers have a slam dunk argument, right? But anti-choicers can chip away at contraceptive access without us noticing -- by redefining birth control as a luxury item, not a medical necessity.

A
recent video of John McCain unable to say that it’s unfair for insurance
companies to cover Viagra but not birth control left pro-choicers rejoicing.
  For a long time now, we’ve
been fighting to get the word out that right wing fanatics are hostile
to contraception, and now we have first rate evidence of a politician
pandering to anti-contraception forces.  Now the doubters will
have a lot less ground to work with. Now we’re that much closer
to exposing the agenda of the anti-choice  movement, which is not
just anti-abortion — but anti-contraception, anti-sex education, and
homophobic. 

On this issue, pro-choicers
should have a slam dunk, right?  Ninety-eight percent of women will use contraception
at some point in their lives, and presumably most of the men who have partnered with women who use it support that right as well.  Most advocates
for any issue wish they had that kind of broad base of support. 
When people hear that such a popular right is under attack, surely they
will swarm as one voting bloc that gives new meaning to the phrase "vast
majority" to retaliate against a narrow band of extremists, right?
I’d like to think so.  Most of the time, I do think that we have
widespread support for the right to use contraception, support that
will eagerly fight to support that right under attack from a very small
minority. 

But then I saw this video with
Bill O’Reilly defending McCain,

and I started to feel less sure of how firm the pro-choice ground is
on this issue.  O’Reilly doesn’t come right out and attack
the right to use the birth control pill.  But he does define it
as if it’s a luxury item, in fact putting it in the same category
as eating at a restaurant. (Women’s choice to have sexual intercourse,
according to O’Reilly, is a luxury, but for men, it’s a medical
necessity.  No, really.)  The double standard nauseates, but
the framing of the issue will win over a lot of people who think of
themselves as pro-choice on contraception.  The implication that
sluts have to pay for their own sinful behavior will resonate with a
lot of people, as will the idea that if you can’t afford the $30-$50
a month out of pocket for birth control pills, you don’t deserve to
have sex. 

The rule to remember with anti-choicers
is that they’re crazy but not stupid.  They know that openly
advocating for a ban on contraception won’t work, but they do believe,
with good reason, that they can chip away at the right to use contraception
slowly so that people don’t even see it coming.  After all, they’ve
had a lot of practice doing this to abortion rights, which also enjoy
the support of the majority.   

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Most people see that Roe v.
Wade hasn’t been overturned outright and feel secure with the right
to abortion.  Little do they know that the incremental chipping
away at abortion rights has, for a lot of women, meant that Roe doesn’t
exist in any practical way.  If you live far away from an abortion
clinic, or can’t afford an abortion, or have to go through waiting
periods and other forms of legal harassment, the amount of effort and
money you put into getting an abortion doesn’t differ from what you’d
have to put out if abortion was illegal.  For them, the difference
between legal and illegal abortion is a technicality on paper, not a
lived experience.  But with it being technically legal, most Americans
are complacent on the issue. 

Anti-choicers fully intend
to use the same strategy to chip away at your right to contraception,
getting rid of it in practical terms for many women while the rest of
us rest on our laurels, unaware of how much ground we’ve lost. We
know their methods, because of the abortion rights war.  Target
vulnerable populations first, people with little political power, such
as young women, women of color, and poor women.  Redefining hormonal
birth control not as a medication necessary for a healthy life, but
as a luxury that should only be available to those who can pay for it,
is a big step in targeting the young and poor. Age restrictions on
things like emergency contraception also play a role. Young women,
who are the least likely to have adequate experience using condoms (leading
to breakage), and are the most likely to be raped, have the greatest
need for emergency contraception, but if they’re under 18, they’re
out of luck, thanks to anti-choice tactics.  They’ll have to
get that abortion instead, in  many cases.  But they don’t
have much political power, so they need the rest of us to stand up for
them. 

Rural women and poor women
are the main targets of "conscience clauses," which aren’t about
religious freedom as advertised, but about restricting access to birth
control pills, one judgmental horror show of a fundamentalist Christian
pretending to be a professional pharmacist at a time.  For urban
women with a decent amount of money, going to the next pharmacist who’s
willing to do his damn job doesn’t take much effort.  But for
women living in isolated areas, or who don’t have the time or travel
range in the city because of poverty, being refused service in a pharmacy
could mean the difference between getting the pills and not.  

Unfortunately, I can easily
see a huge number of Americans who technically support the right to
contraception rolling over for the incremental strategy.  We are
indeed frogs sitting in pots of water on this issue.  Anti-choicers
aren’t going to turn the heat up to 10 right away, but will gradually
turn it up a little (deprive teenagers and poor women of their access
and then their rights) so that we don’t notice it, until it’s too
late and we’re all boiling in water.  But it doesn’t have to
be that way.  With pro-choicers out there spreading the word and
making the links between things like this John McCain video and the
crazies who are out to take away your birth control pills, maybe we
can turn down the heat. 

News Politics

Missouri ‘Witch Hunt Hearings’ Modeled on Anti-Choice Congressional Crusade

Christine Grimaldi

Missouri state Rep. Stacey Newman (D) said the Missouri General Assembly's "witch hunt hearings" were "closely modeled" on those in the U.S. Congress. Specifically, she drew parallels between Republicans' special investigative bodies—the U.S. House of Representatives’ Select Investigative Panel on Infant Lives and the Missouri Senate’s Committee on the Sanctity of Life.

Congressional Republicans are responsible for perpetuating widely discredited and often inflammatory allegations about fetal tissue and abortion care practices for a year and counting. Their actions may have charted the course for at least one Republican-controlled state legislature to advance an anti-choice agenda based on a fabricated market in aborted “baby body parts.”

“They say that a lot in Missouri,” state Rep. Stacey Newman (D) told Rewire in an interview at the Democratic National Convention last month.

Newman is a longtime abortion rights advocate who proposed legislation that would subject firearms purchases to the same types of restrictions, including mandatory waiting periods, as abortion care. Her district includes the University of Missouri, which ended a 26-year relationship with Planned Parenthood as anti-choice state lawmakers ramped up their inquiries in the legislature.

Newman said the Missouri General Assembly’s “witch hunt hearings” were “closely modeled” on those in the U.S. Congress. Specifically, she drew parallels between Republicans’ special investigative bodies—the U.S. House of Representatives’ Select Investigative Panel on Infant Lives and the Missouri Senate’s Committee on the Sanctity of Life. Both formed last year in response to videos from the anti-choice front group the Center for Medical Progress (CMP) accusing Planned Parenthood of profiting from fetal tissue donations. Both released reports last month condemning the reproductive health-care provider even though Missouri’s attorney general, among officials in 13 states to date, and three congressional investigations all previously found no evidence of wrongdoing.

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Missouri state Sen. Kurt Schaefer (R), the chair of the committee, and his colleagues alleged that the report potentially contradicted the attorney general’s findings. Schaefer’s refusal to confront evidence to the contrary aligned with how Newman described his leadership of the committee.

“It was based on what was going on in Congress, but then Kurt Schaefer took it a step further,” Newman said.

As Schaefer waged an ultimately unsuccessful campaign in the Missouri Republican attorney general primary, the once moderate Republican “felt he needed to jump on the extreme [anti-choice] bandwagon,” she said.

Schaefer in April sought to punish the head of Planned Parenthood’s St. Louis affiliate with fines and jail time for protecting patient documents he had subpoenaed. The state senate suspended contempt proceedings against Mary Kogut, the CEO of Planned Parenthood of St. Louis Region and Southwest Missouri, reaching an agreement before the end of the month, according to news reports.

Newman speculated that Schaefer’s threats thwarted an omnibus abortion bill (HB 1953, SB 644) from proceeding before the end of the 2016 legislative session in May, despite Republican majorities in the Missouri house and senate.

“I think it was part of the compromise that they came up with Planned Parenthood, when they realized their backs [were] against the wall, because she was not, obviously, going to illegally turn over medical records.” Newman said of her Republican colleagues.

Republicans on the select panel in Washington have frequently made similar complaints, and threats, in their pursuit of subpoenas.

Rep. Marsha Blackburn (R-TN), the chair of the select panel, in May pledged “to pursue all means necessary” to obtain documents from the tissue procurement company targeted in the CMP videos. In June, she told a conservative crowd at the faith-based Road to Majority conference that she planned to start contempt of Congress proceedings after little cooperation from “middle men” and their suppliers—“big abortion.” By July, Blackburn seemingly walked back that pledge in front of reporters at a press conference where she unveiled the select panel’s interim report.

The investigations share another common denominator: a lack of transparency about how much money they have cost taxpayers.

“The excuse that’s come back from leadership, both [in the] House and the Senate, is that not everybody has turned in their expense reports,” Newman said. Republicans have used “every stalling tactic” to rebuff inquires from her and reporters in the state, she said.

Congressional Republicans with varying degrees of oversight over the select panel—Blackburn, House Speaker Paul Ryan (WI), and House Energy and Commerce Committee Chair Fred Upton (MI)—all declined to answer Rewire’s funding questions. Rewire confirmed with a high-ranking GOP aide that Republicans budgeted $1.2 million for the investigation through the end of the year.

Blackburn is expected to resume the panel’s activities after Congress returns from recess in early September. Schaeffer and his fellow Republicans on the committee indicated in their report that an investigation could continue in the 2017 legislative session, which begins in January.

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.

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