HHS Sec. Leavitt Blogs Again, Avoids Contraception Again, Still Ignores Ab-Only

Scott Swenson

HHS Secretary Michael Leavitt blogs again about the proposed HHS regulations that redefine contraception as abortion, without mentioning the word contraception. But he demonstrates he knows how to play the game of far-right ideological abortion politics.

Health and Human Services Secretary Michael Leavitt acknowledges in his second blog post on the issue, that traffic has increased on his blog as people respond with concerns to the HHS proposal that redefines contraception as abortion.

Readers will recall that when the draft regulation was first leaked, Rewire experienced our highest traffic weeks, Speaker Nancy Pelosi’s web site actually crashed, and many sites saw increased readership.
In his first post on the topic last week, Leavitt attempted to redirect the conversation away from contraception, claiming a redefinition of contraception as abortion was not his or the draft regulations’ intent.

In his second blog on the issue, posted yesterday, the word contraception doesn’t even appear. As is often the case with anti-choice politicians, Leavitt only wants to talk about abortion to stir people’s emotions.
Leavitt quotes Mary Jane Gallagher, President of the National Family Planning and Reproductive Health Association, writing:

So, according to Ms. Gallagher’s ideology, if a person goes to medical school they lose their right of conscience. Freedom of expression and action is surrendered with the issuance of a medical degree.

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No Secretary Leavitt, what Ms. Gallagher was talking about was medical ethics, not ideology. In my post last week, I quoted Jon O’Brien, President of Catholics for Choice:

While some have pointed to Catholic teaching to
support the imposition of ever-more restrictive refusal clauses, they
do not reflect the Catholic position. Catholic teaching requires due
deference to the conscience of others in making decisions–meaning that
health-care providers must not dismiss the conscience of the person
seeking care. If conscience truly is one’s "most secret core and his
sanctuary [where] he is alone with God, whose voice echoes in his
depths," as the Catechism states, how can anyone, or any institution
for that matter, justify coercing someone into acting contrary to her
or his conscience?

The
goal of any reasonable conscience clause must be to strike the right
balance between the right of health-care professionals to provide care
that is in line with their moral and religious beliefs and the right of
patients to have access to the medical care they need. Within the field
of medical ethics, the accepted resolution to a conflict of values is
to allow the individual to act on their own conscience and for the
institution (the hospital, clinic or pharmacy) to serve as the
facilitator of all consciences.

 

The question, Sec. Leavitt, is not about people checking their beliefs at the door. Medical ethics and morality dictate that it is the patient, the person in need of help, sometimes in crisis, whose conscience and beliefs matter in the moment they are seeking health care services. Medical professionals who have a problem dispensing contraception should not choose professions where they will be asked for contraception, or as a commenter on another blog wrote, "if this is about people living their religious convictions, then they should have enough faith not to choose work that conflicts with their convictions." There is plenty demand for medical professionals in fields in which practitioners will never come in contact with people seeking contraception.

But this isn’t about any individual’s right to refuse service, as the Secretary suggests. As Leavitt demonstrates in his second blog, the politics of abortion are not new to him, he knows how to play the game. Congress won’t be taking up any more legislation of significance, and the clock is ticking on the Bush Administration. The only thing left for the Bush Administration to do on abortion will be done from HHS through rules and regulations. Leavitt knows it, knows how to play it, and is spinning wildly without addressing the very serious threats to preventing abortion through access to contraception that these regulations pose.

One would think that recent reports of the high rate of abortion in New York, linked to that fact that too many women do not have the information about how to obtain access to contraception, would underscore the importance of contraception as a means of reducing unintended pregnancy. But by genuflecting to ideology over prevention in order to allow a medical professional who believes contraception terminates, rather than prevents, a pregnancy, to refuse services to a couple who want to use contraception to plan their family — Leavitt demonstrates clearly that the anti-choice movement is not about preventing abortion.

The only thing a refusal clause does is elevate one set of beliefs over another, and allow that judgment to be delivered in a medical setting where one person is seeking help from another who has received special training in science. The patient did not come to the pharmacist seeking spiritual counseling, and likely has her own place of worship. The patient/customer did not come for a scolding from a stranger, or to be stigmatized. She came for a prescription, and unless the pharmacy is operated and advertised as "Preacher Bill’s Pharmacy, where we pick and choose which medical science we believe in," then there is a reasonable expectation that any physician’s prescription should be honored.

In parts of the country in which Catholic hospitals have taken over small rural hospitals and there aren’t any others around for hundreds of miles, concerns about the availability of emergency contraception for rape victims and others in crisis has already been raised. From Princeton’s web site on emergency contraception:

It can be difficult, if not impossible, to get emergency
contraceptive pills
(sometimes called “morning
after pills
” or “day after pills”) at a Catholic
hospital in the United States. That’s because the medical care
in these facilities is governed by the Ethical and Religious Directives
for Catholic Health Care Services
, guidelines developed by the
United States Conference of Catholic Bishops based on Church teachings
that prohibit using artificial contraception. As a result, the Directives
essentially ban Catholic hospitals from providing emergency
contraception
to a woman whose birth control failed or who didn’t
use contraception during consensual sex.

If you have been raped, however, a Catholic hospital might be able
to provide emergency
contraceptive pills
to help you prevent pregnancy. Directive 36
seems to allow providing emergency
contraception
to “a female who has been raped to defend
herself against a potential conception from the sexual assault . .
. if, after appropriate testing there is no indication she is pregnant.”
It does not say how to determine if conception has occurred and, since
emergency contraception might
sometimes prevent implantation of a fertilized egg
(which happens
after conception), Catholic hospitals still have to interpret the
Directives and decide if they can provide emergency
contraceptive pills
to a woman who has been raped. In one recent
survey, roughly one-third of the Catholic hospitals in three states
were not complying with state laws that require making emergency
contraception
available to women who have been raped.
(You can get more information about Catholic hospitals and contraception
from Catholics
for a Free Choice
, which commissioned the survey.)

 

After a woman has been raped Catholic hospitals "might" help.

If there is that much doubt about how to help a person in crisis, even at a Catholic hospital where beliefs are supposedly rock solid (and should default to helping the woman in crisis), how in the world do we expect HHS bureaucrats to write a clear regulation for Americans of all beliefs?

In situational medical ethics, it is the person in crisis or need of specialized service whose conscience takes precedence. Pacifists do not volunteer to serve in the military, they live their convictions by living a peaceful life. War rages on. Vegans do not eat or wear anything that has ever been alive, they live their convictions with the choices they make every day; beef and leather goods are still chosen by others and only a radical few will make a fuss about that. Monks and other religious seekers take vows that require them to constantly come up against the parts of the material world that others have chosen for themselves, not to condemn others, but as a spiritual test for the path the monk chose, the life s/he is pledged to, the journey her/his soul is on.

That is conviction. That is conscience. No one refusing or renouncing anything other than for themselves and the choices they are making for their lives. Most people of faith believe they should use their lives as an example for others to follow, not as a bludgeon to beat people down with.

People must recognize the world as it is and that each person here gets to make their own choices. What Sec. Leavitt is doing has nothing to do with operating in the real world — it is about using what time he has left in office to elevate one person’s ideology over another’s choice, and to further divide the nation by using the issue of abortion and ideology, as opposed to working together on education, prevention and accepted medical science.

 

Question Two

Now that Sec. Leavitt has engaged his blog on substantive issues of the day, I’m hoping he will take time to answer part two of the question I asked him in person at the Kaiser Family Foundation forum on health care blogging. Because the two were bound together, I’ll restate the entire question here, hoping he will soon blog about the end run his department is attempting on Title V abstinence-only grants.

 

Mr. Secretary, thank you for being here and sharing
your thoughts about blogging. I’m hoping you’ll engage a policy
question to give us something to blog about. Within the past two weeks,
two highly charged issues have surfaced from HHS: a leaked memo
redefining some contraceptive devices as abortion; and a waiver of the
annual application for Title V abstinence-only programs.

The former will substitute an ideological and political
definition of when pregnancy begins for the medical judgment of the
American Medical Association and the American College of Obstetricians
and Gynecologists. The latter will, for the first time, ignore
Congress’ reluctance to make abstinence-only programs permanent — they
have had 19 short-term extensions, and Speaker Pelosi said last week
that with a stronger majority in Congress it will end. This effort
potentially ties the hands of the next administration and promises
states money that has not been authorized.

1) Will it be HHS policy that the 98% of Americans who use
contraception at some point in their lives are terminating rather than
preventing pregnancy?

2) Can you explain why this grant period should be treated
differently than the previous 19 short-term extensions for
abstinence-only programs?



Looking forward to your reply, Mr. Secretary.

Read all of Rewire’s coverage on the HHS draft regulations on contraception here!

News Law and Policy

Supreme Court Rejects Challenge to Washington Law Requiring Pharmacies to Stock Plan B

Jessica Mason Pieklo

On Tuesday the Roberts Court turned away a challenge by a pharmacy-owning family who claimed a Washington state law that requires pharmacies to stock Plan B or other emergency contraception violated their religious beliefs.

The Supreme Court on Tuesday refused to hear a challenge by a pharmacy owner who claimed religious objections to a Washington law requiring pharmacies to stock and dispense Plan B or other emergency contraception.

In 2007, the Washington State Board of Pharmacy adopted rules governing the mandatory stocking and delivery of emergency contraception. The rules do not require any individual pharmacist to dispense medication in conflict with their religious beliefs. Instead, if a pharmacy employs a pharmacist who objects to dispensing emergency contraception for religious reasons, the pharmacy must keep on duty at all times a second pharmacist who does not object to dispensing those drugs.

The Stormans family—who own a local grocery store and pharmacy in Olympia, Washington—challenged the rules in 2012, arguing that the rules required them to violate their religious beliefs. Those beliefs, they said, include a conviction that life begins at conception; therefore, emergency contraception acts as an abortifacient, which they also object to providing.

The medical community does not consider emergency contraception to be an abortifacient.

A district court agreed with the Stormans that the rules could force them to violate their religious beliefs by stocking the medication. But in 2015, the U.S. Court of Appeals for the Ninth Circuit reversed and rejected the Stormans’ claim.

On Tuesday the Supreme Court let stand that Ninth Circuit ruling. However, Chief Justice John Roberts and Justices Samuel Alito and Clarence Thomas dissented from that decision. Writing for the dissenting justices, Alito called the case “an ominous sign” for religious liberties protections in the country.

“There are strong reasons to doubt whether the regulations were adopted for—or that they actually serve—any legitimate purpose,” wrote Alito. “And there is much evidence that the impetus for the adoption of the regulations was hostility to pharmacists whose religious beliefs regarding abortion and contraception are out of step with prevailing opinion in the State. Yet the Ninth Circuit held that the regulations do not violate the First Amendment, and this Court does not deem the case worthy of our time,” continued Alito.

“If this is a sign of how religious liberty claims will be treated in the years ahead, those who value religious freedom have cause for great concern,” he continued.

American Civil Liberties Union Deputy Legal Director Louise Melling disagreed with Justice Alito’s assessment of the case. “The court properly refused to take this case,” Melling said in a statement following the order. “When a woman walks into a pharmacy, she should not fear being turned away because of the religious beliefs of the owner or the person behind the counter. Open for business means opens for all,” said Melling.

“Refusing someone service because of who they are—whether a woman seeking birth control, a gay couple visiting a wedding catering company, or an unwed mother entering a homeless shelter—amounts to discrimination, plain and simple. Religious freedom is a core American value and one that we defend, but religious freedom does not mean a free pass to impose those beliefs on others,” Melling wrote.

Meanwhile, Alliance Defending Freedom Senior Counsel Kristen Waggoner, who represented the plaintiffs in the case, expressed disappointment in the decision. “All Americans should be free to peacefully live and work consistent with their faith without fear of unjust punishment, and no one should be forced to participate in the taking of human life,” said Waggoner in a statement after the denial. “We had hoped that the U.S. Supreme Court would take this opportunity to reaffirm these long-held principles.”

Commentary Sexual Health

Don’t Forget the Boys: Pregnancy and STI Prevention Efforts Must Include Young Men Too

Martha Kempner

Though boys and young men are often an afterthought in discussions about reproductive and sexual health, two recent studies make the case that they are in need of such knowledge and that it may predict when and how they will parent.

It’s easy to understand why so many programs and resources to prevent teen pregnancy and sexually transmitted infections (STIs) focus on cisgender young women: They are the ones who tend to get pregnant.

But we cannot forget that young boys and men also feel the consequences of early parenthood or an STI.

I was recently reminded of the need to include boys in sexual education (and our tendency not to) by two recent studies, both published in the Journal of Adolescent Health. The first examined young men’s knowledge about emergency contraception. The second study found that early fatherhood as well as nonresident fatherhood (fathers who do not live with their children) can be predicted by asking about attitudes toward pregnancy, contraception, and risky sexual behavior. Taken together, the new research sends a powerful message about the cost of missed opportunities to educate boys.

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The first study was conducted at an adolescent medicine clinic in Aurora, Colorado. Young men ages 13 to 24 who visited the clinic between August and October 2014 were given a computerized survey about their sexual behavior, their attitudes toward pregnancy, and their knowledge of contraception. Most of the young men who took the survey (75 percent) had already been sexually active, and 84 percent felt it was important to prevent pregnancy. About two-thirds reported having spoken to a health-care provider about birth control other than condoms, and about three-quarters of sexually active respondents said they had spoken to their partner about birth control as well.

Yet, only 42 percent said that they knew anything about emergency contraception (EC), the only method of birth control that can be taken after intercourse. Though not meant to serve as long-term method of contraception, it can be very effective at preventing pregnancy if taken within five days of unprotected sex. Advance knowledge of EC can help ensure that young people understand the importance of using the method as soon as possible and know where to find it.

Still, the researchers were positive about the results. Study co-author Dr. Paritosh Kaul, an associate professor of pediatrics at the University of Colorado School of Medicine, told Kaiser Health News that he was “pleasantly surprised” by the proportion of boys and young men who had heard about EC: “That’s two-fifths of the boys, and … we don’t talk to boys about emergency contraception that often. The boys are listening, and health-care providers need to talk to the boys.”

Even though I tend to be a glass half-empty kind of person, I like Dr. Kaul’s optimistic take on the study results. If health-care providers are broadly neglecting to talk to young men about EC, yet about 40 percent of the young men in this first study knew about it anyway, imagine how many might know if we made a concerted effort.

The study itself was too small to be generalizable (only 93 young men participated), but it had some other interesting findings. Young men who knew about EC were more likely to have discussed contraception with both their health-care providers and their partners. While this may be an indication of where they learned about EC in the first place, it also suggests that conversations about one aspect of sexual health can spur additional ones. This can only serve to make young people (both young men and their partners) better informed and better prepared.

Which brings us to our next study, in which researchers found that better-informed young men were less likely to become teen or nonresident fathers.

For this study, the research team wanted to determine whether young men’s knowledge and attitudes about sexual health during adolescence could predict their future role as a father. To do so, they used data from the National Longitudinal Study of Adolescent Health (known as Add Health), which followed a nationally representative sample of young people for more than 20 years from adolescence into adulthood.

The researchers looked at data from 10,253 young men who had completed surveys about risky sexual behavior, attitudes toward pregnancy, and birth control self-efficacy in the first waves of Add Health, which began in 1994. The surveys asked young men to respond to statements such as: “If you had sexual intercourse, your friends would respect you more;” “It wouldn’t be all that bad if you got someone pregnant at this time in your life;” and “Using birth control interferes with sexual enjoyment.”

Researchers then looked at 2008 and 2009 data to see if these young men had become fathers, at what age this had occurred, and whether they were living with their children. Finally, they analyzed the data to determine if young men’s attitudes and beliefs during adolescence could have predicted their fatherhood status later in life.

After controlling for demographic variables, they found that young men who were less concerned about having risky sex during adolescence were 30 percent more likely to become nonresident fathers. Similarly, young men who felt it wouldn’t be so bad if they got a young woman pregnant had a 20 percent greater chance of becoming a nonresident father. In contrast, those young men who better understood how birth control works and how effective it can be were 28 percent less likely to become a nonresident father.9:45]

Though not all nonresident fathers’ children are the result of unplanned pregnancies, the risky sexual behavior scale has the most obvious connection to fatherhood in general—if you’re not averse to sexual risk, you may be more likely to cause an unintended pregnancy.

The other two findings, however, suggest that this risk doesn’t start with behavior. It starts with the attitudes and knowledge that shape that behavior. For example, the results of the birth control self-efficacy scale suggest that young people who think they are capable of preventing pregnancy with contraception are ultimately less likely to be involved in an unintended pregnancy.

This seems like good news to me. It shows that young men are primed for interventions such as a formal sexuality education program or, as the previous study suggested, talks with a health-care provider.

Such programs and discussion are much needed; comprehensive sexual education, when it’s available at all, often focuses on pregnancy and STI prevention for young women, who are frequently seen as bearing the burden of risky teen sexual behavior. To be fair, teen pregnancy prevention programs have always suffered for inadequate funding, not to mention decades of political battles that sent much of this funding to ineffective abstinence-only-until-marriage programs. Researchers and organizations have been forced to limit their scope, which means that very few evidence-based pregnancy prevention interventions have been developed specifically for young men.

Acknowledging this deficit, the Centers for Disease Control and Prevention and the Office of Adolescent Health have recently begun funding organizations to design or research interventions for young men ages 15 to 24. They supported three five-year projects, including a Texas program that will help young men in juvenile justice facilities reflect on how gender norms influence intimate relationships, gender-based violence, substance abuse, STIs, and teen pregnancy.

The availability of this funding and the programs it is supporting are a great start. I hope this funding will solidify interest in targeting young men for prevention and provide insight into how best to do so—because we really can’t afford to forget about the boys.