Condemning Contraceptive Condoms

Carolina Austria

Despite the Philippine President's lack of support for universal access to contraceptives, an official of the Department of Health recently criticized the Roman Catholic Church's position against condom use.

Despite the Philippine President’s
lack of support for universal access to contraceptives and her stated
opposition to reproductive health policy, an official of the
Department of Health (DOH) recently criticized the Roman Catholic Church’s
position
against
condom use.

According to Undersecretary
Mario Villaverde, the opposition against condom use by the Catholic
Church has had detrimental effects on the government campaign to prevent
the spread of HIV AIDS. Alleging that the use of condoms in HIV/AIDS
prevention was an entirely different issue from its use as contraception,
Villaverde stressed that the Department of Health supports natural family
planning, including abstinence.

While he did not really clarify
what he meant by the difference of condom use as a contraceptive and
its uses in HIV/AIDS prevention, it is tempting to infer a lot of things
from Villaverde’s statement. Indeed, the use of condoms to prevent
the spread of sexually transmitted diseases including  HIV/AIDS is not exclusive to heterosexual intercourse. In which case, he was on one level, correct to point out a
difference. On the other hand, what is more probable is confusion within
the DOH, of what their actual position vìs a vìs the condom is. In
this context, however, it is nothing new.

In July, even the local Catholic
Bishops’ Conference indicated a qualified position
on condom use
. Edwin Corros, Executive
Secretary of CBCP’s Episcopal Commission for Pastoral Care for Migrants
and Itinerant People

announced that the use of the condom "as a last resort" by married
couples, to prevent the transmission of HIV/AIDS. Corros claimed that
the Church’s position is not to endorse condom use but only to prevent
deaths. He added that married couples ought to practice abstinence and
faithfulness.

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On the other hand, the CBCP
is still aggressively blocking the passage of pending legislation on
reproductive health in which both family planning and HIV/AIDS are addressed. Responding to Villaverde’s
pronouncements
,
and contradicting the qualified position issued by its own Episcopal
Commission, Archbishop Aniceto insisted that: "It is the duty of the
DOH never to propose for general public use any prophylactic that could
increase the incidence of the disease it is supposed to prevent" and
that the "idea of safe sex (by using condoms) lulls women and men
into complacency."

The premise behind this of
course is that "morally upright" lives can only be led through "chastity"
that includes abstinence from sex outside of marriage, a part of Catholic
teaching which even members of the Roman Catholic clergy find difficult
to observe. Ethically, it would, however, be difficult to dismiss
condom use as self-serving since the protection condoms offer, depending
on the context, could be for one’s partner too.

Reported HIV/AIDS cases in
the Philippines remains relatively low compared with its closest neighbours
in the Southeast Asian region at a total of 3,061 since 1984 or less
than one percent of the population. The World Health Organization, however
has warned that the actual number of unreported cases could be higher
and the situation in the Philippine HIV AIDs situation has been described
as "hidden and growing" since 2003. In 2007, the DOH noted an increase
of 29 new cases per month from an average of 20 in the past years.

Thirty-five percent
of new cases come from the ranks of
returning overseas Filipino workers who usually get tested prior to
renewing their permits to work overseas
.
Noting cases where returning HIV positive overseas workers infected
their wives, Senator Pia Cayetano called the DOH’s attention to the
possibility and dangers of mother to child transmission. Cayetano added
that information on condom use will give the government’s information
campaign on HIV AIDs prevention a big boost.

But the mere mention of condoms
in HIV/AIDs prevention modules and sexuality education materials by
the Department of Education is still controversial in this part of the
world when the Catholic hierarchy proclaims its opposition. In fact,
even the Philippine AIDS Control and Prevention Act of 1998 contains
a curious provision that reflects this apprehension vìs a vìs the
condom. While the law mandates the Department of Education (DepEd) to
provide HIV/AIDS prevention education, it also provides that the modules
on HIV AIDS prevention and control "shall not be used as an excuse
to propagate birth control or the sale or distribution of birth control
devices." Advocates who pushed for the policy in the late nineties
attest to the contested provision of the law as the final "compromise"
to calm the Catholic opposition.

Indeed, the ideal condom given
the Roman Catholic hierarchy’s requirements seems to be the stuff
of science fiction imagination. If such a condom existed, it would only
prevent HIV transmission but not necessarily function as contraception,
and would only work for heterosexual sex between married couples. If
such a condom existed, would the Roman Catholic Church endorse its use?
Probably but consider the irony: in same sex relations, the regular
condom already gives the same amount of protection from HIV/AIDS but
does not function as a contraceptive.

News Health Systems

Anti-Choice Group Files Lawsuit Over Newly Signed Law That Protects Illinois Patients

Michelle D. Anderson

The policy, which is an amendment to the Illinois Health Care Right of Conscience Act, requires physicians and medical facilities to to provide patients upon request with information about their medical circumstances and treatment options consistent with "current standards of medical care," in cases where the doctor or institution won’t offer services on religious grounds.

CORRECTION: This piece has been updated to clarify the scope of SB 1564 and which groups are opposing it.

A conservative Christian legal group has followed through on its threat to use litigation to fight against a new state policy that protects patients at religiously-sponsored hospitals in Illinois.

The Alliance Defending Freedom (ADF) on Friday filed a lawsuit in the Circuit Court of the 17th Judicial Circuit in Winnebago County against Illinois Gov. Bruce Rauner and Bryan A. Schneider, the secretary of the Illinois Department of Financial & Professional Regulation.

Rauner, a Republican, signed the contested policy, SB 1564, into law on July 29.

The ADF, which warned Rauner about signing the bill in a publicized letter and statement in May, filed the complaint on behalf of several fake clinics, also known as crisis pregnancy centers. These included the Pregnancy Care Center of Rockford and Aid for Women, Inc. Anti-choice physician Dr. Anthony Caruso of A Bella Baby OBGYN—also known as Best Care for Women—was also named as a plaintiff.

“Alliance Defending Freedom is ready and willing to represent Illinois pro-life pregnancy centers if SB 1564 becomes law,” the group said in May. The ADF wrote on behalf of several anti-choice groups, claiming SB 1564 violated the Illinois state law and constitution and risked putting federal funding, such as Medicaid reimbursements, in jeopardy.

In February 2015, state Sen. Daniel Biss (D-Skokie) introduced the policy, which is an amendment to the Illinois Health Care Right of Conscience Act.

The revised law requires physicians and medical facilities to provide patients upon request with information about their medical circumstances and treatment options consistent with “current standards of medical care,” in cases where the doctor or institution won’t offer services on religious grounds.

The new policy also gives doctors and medical institutions the option to provide a referral or transfer the patient.

Unlike an earlier version of the legislation, the version passed by Rauner does not require hospitals to confirm that providers they share with patients actually perform procedures the institutions will not perform; they must only have a “reasonable belief” that they do, Rewire previously reported.

As previously noted by Rewire:

Catholic facilities often follow U.S. Conference of Catholic Bishops religious directives that generally bar treatments such as sterilization, in vitro fertilization, and abortion care. The federal Church Amendment and some state laws protect these faith-based objections.

The plaintiffs, which are also being represented by Mauck & Baker LLC attorney Noel Sterett, argued in a statement that the Illinois Constitution protects “liberty of conscience,” and quoted a passage from state law that says “no person shall be denied any civil or political right, privilege or capacity, on account of his religious opinions.”

Illinois Right to Life and the Thomas More Society joined the ADF in protesting the bill. The Catholic Conference of Illinois (CCI) and the Illinois Catholic Health Association (ICHA) initially protested the bill after it was introduced early last year. However, the two groups later negotiated with the ACLU to pass a different version of the bill that was introduced.

In support of the bill around the time of its introduction in early 2015, the American Civil Liberties Union of Illinois pushed its Put Patients First initiative to help stop the use of religion to deny health care to patients. The advocacy group noted that patients who are miscarrying or facing ectopic pregnancies, same-sex couples, and transgender people and persons seeking contraception such as vasectomies and tubal ligations are particularly vulnerable to these harmful practices.

A new study, “Referrals for Services Prohibited in Catholic Health Care Facilities,” set to be published in Perspectives on Sexual and Reproductive Health in September, suggested that Catholic hospitals often “dump” abortion patients and deny them critical referrals as result of following religious directives outlined by the U.S. Conference of Catholic Bishops (USCCB).

Recent figures from an ACLU and MergerWatch advocacy group collaboration suggest Catholic hospitals make up one in six hospital beds nationwide.

Commentary Contraception

The Double Standard of Military Pregnancy: What Contraceptive Access Won’t Fix

Stephanie Russell-Kraft

Unique military gender politics that make it hard for some servicewomen to ask for birth control also stigmatize them if they get pregnant—especially when that happens at an overseas post or on a deployment. Any effort to increase birth control availability can only be understood against that particular cultural backdrop.

At the beginning of May, pharmaceutical giant Allergan announced that, in partnership with nonprofit Medicines360, it would begin offering its new intrauterine device (IUD) Liletta at a reduced price to military treatment facilities and veterans hospitals across the United States. The company would also support “an educational effort to raise contraception awareness among healthcare providers treating U.S. military service women,” according to its press release.

Military personnel and medical professionals agree Allergan’s initiative represents an important step toward expanding access to the IUD, which along with other long-acting reversible contraceptives (like injections) are particularly well suited to the demands of military training and deployment schedules. But this push to increase IUD use can’t be fully understood outside the context of the unique challenges and stigmas facing women of reproductive age in the U.S. military (who numbered just under 200,000 as of 2011, the latest available data obtained via FOIA by Ibis Reproductive Health).

Despite theoretically having access to a wide variety of contraceptive options, women in the military still report higher rates of unplanned pregnancy than their civilian peers, and it remains somewhat of a mystery exactly why. What is clear is that the unique military gender politics that make it hard for some women to ask for birth control also stigmatize them if they get pregnant—especially when that happens at an overseas post or on a deployment. Any effort to increase birth control availability, including Allergan’s, can only be understood against that particular cultural backdrop.

Nearly every time a U.S. military branch changes policies to include more women, critics raise the old argument that allowing women into the service, particularly in combat roles, will lead to sex between soldiers and thereby distract from the mission. Because of that, the military generally prohibits sex during deployments between service members not married to each other (exact policies vary across the branches and across units, and some are less strict). Taken as a whole, the U.S. military’s policy basically amounts to an abstinence-only approach, with women shouldering nearly all of the risk and blame when soldiers do decide to have sex on deployment.

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Bethany Saros, who enlisted in the Army as an 18-year-old in 2002, faced this blame head-on when she became pregnant by a fellow soldier during a 2007 tour in Iraq.

Although condoms were available to soldiers at her deployment site, Saros did not use birth control. Her decision not to end the pregnancy meant her deployment was over, and Saros recalls meeting several other pregnant women in Kuwait while they all waited to get shipped back. “I felt like a pariah, and I think the other girls did too,” she said.

“It’s not like anyone does this on purpose,” Saros explained. “The fathers of these babies, they don’t get any problems, and they were screwing around just as we were.”

Across all branches of service, pregnant women are typically not allowed to serve on deployments, and, though the length of time varies by branch, women are not allowed to deploy in the six to 12 months after they give birth. According to spokespeople from each of the branches, the reasoning behind the policies is to protect servicewomen and give them the time they need to recover from birth. All of the women I spoke with for this piece told me that soldiers—both male and female—often believe a woman who gets pregnant right before or during a deployment is simply trying to avoid her work.

“The first thing someone talked about when a woman got pregnant was that she was trying to get out of a deployment,” said Lauren Zapf, a former Naval officer, mental health clinician, and fellow with the Service Women’s Action Network. “Whereas if men announce that they’re going to have a baby, there’s a lot of backslapping and congratulations.”

According to Ibis Reproductive Health’s analysis of Department of Defense data, about 11 percent of active-duty military women reported an unintended pregnancy in 2008 and 7 percent reported an unintended pregnancy in 2011—in both years, this was far more than the general population. Younger, less educated, nonwhite women were much more likely to become pregnant unintentionally, as were those who were married or living with a partner, according to Ibis. Contrary to military lore, the pregnancy rates did not differ between those women who had deployed and those who didn’t during that time, the study found.

It remains unclear why exactly military women have higher reported rates of unplanned pregnancy than their civilian counterparts, but one reason has likely been their inconsistent access to birth control and limited access to abortion services. As with most institutions, there’s a difference between official policy and what happens on a day-to-day basis on military bases and in medical exam rooms. Just because most military branches officially require routine birth control consultations doesn’t mean women will always get them, according to Ibis researcher Kate Grindlay, who is one of very few independent researchers looking into this issue.

“One of the challenges that we found [in our research] was that these things were not being done in a consistent way,” Grindlay said. “Some providers having these conversations in a routine way, some weren’t.”

Access to birth control—and the conversations that lead up to it—has improved greatly for military women in the past 20 years. Elizabeth McCormick, a former Black Hawk pilot who served in the Army from 1994 to 2001, recalled that “no one talked about birth control” in any of her pre-deployment medical events in the 1990s. By contrast, some of the women I spoke with who served more recently said they didn’t have issues getting the care they needed.

However, in a 2010 Ibis survey of deployed women, 59 percent of respondents said they hadn’t discussed contraception with a military health-care provider before deployment and 41 percent said they had difficulty obtaining the birth control refills they needed while away from home. Servicewomen also reported being denied an IUD because they had not yet had children, even though nulliparous women can use the devices.

These inconsistencies are part of the problem Allergan says it hopes to address with its education efforts for military health-care providers. The company hasn’t explicitly said what those efforts will look like.

Another part of the problem, according to former Marine Corps officer and Cobra helicopter pilot Kyleanne Hunter, might be cultural. Conversations with military medical providers likely present another major barrier to proper contraceptive care because most military doctors are not only men, but also officers, who, outside the context of a hospital exam room, can give orders that must be respected.

Young female enlisted service members who have internalized the military’s rigid power structures might be reluctant to speak honestly and openly about reproductive care, posited Hunter, who’s currently a University of Denver PhD candidate studying the national security impact of integrating women into western militaries. She said the same dynamic often prevents women from coming forward after they have been sexually assaulted by a fellow service member.

“It adds one more layer to what’s already an uncomfortable conversation,” Hunter said.

When Bethany Saros returned to Fort Lewis, Washington, after leaving Iraq for her pregnancy, a conversation with a male doctor solidified her decision to quit the Army altogether.

“I had to go through a physical, and there was a Marine doctor, and he said, ‘Was there enough room on the plane for all the pregnant ladies that came back?’” she told me, still taken aback by the incident.

Grindlay said efforts like Allergan’s to increase the use of IUDs in the military are “very beneficial” to servicewomen. She also applauded a provision in the 2016 National Defense Authorization Act to require standardized clinical guidelines for contraceptive care across the armed forces. Under the new provisions, women in the armed forces must receive counseling on the “full range of methods of contraception provided by health care providers” during pre-deployment health care visits, visits during deployment, and annual physical exams.

But there’s still work to be done in order for the military to provide full access to reproductive health care, particularly when it comes to abortion. Tricare, the military’s health and insurance provider, only covers abortions “if pregnancy is the result of rape or incest or the mother’s life is at risk,” and certain countries in which the military operates ban the procedure altogether.

In a sampling of 130 online responses for a medication abortion consultation service reviewed by Ibis in 2011, several military women reported considered using “unsafe methods” to try to terminate a pregnancy themselves, according to Grindlay. One of the women, a 23-year-old stationed in Bahrain, said she had been turned away by five clinics and had contemplated taking “drastic measures.”

According to the 2011 Ibis report, many women sought abortions so that they could continue their military tour. Others feared a pregnancy would otherwise ruin their careers.

Virginia Koday, a former Marine Corps electronics technician who left the service in 2013, said in a phone interview that women can face losing their rank or getting charged for violating military policy if they become pregnant overseas. “Getting pregnant in Afghanistan is good cause to terminate your own pregnancy without anyone finding out,” she said.

“The unspoken code is that a good soldier will have an abortion, continue the mission, and get some sympathy because she chose duty over motherhood,” wrote Bethany Saros in a 2011 Salon piece about her unplanned pregnancy.

For these women, one act of unprotected sex had the potential to derail their career. For the men, it was just a night of fun.

Kyleanne Hunter said that while she doesn’t have a “whole lot of sympathy” for women who become pregnant on deployments (they’re not supposed to be having sex in the first place, she argues), she disagrees with the double standard that allows the men involved to escape punishment.

“Both parties need to be held exactly to the same accountability standards,” said Hunter. “If the woman is punished, then whoever she is involved with should be punished a well, because it takes two. She’s not alone in it. There’s no immaculate conception going on there.”

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