An Urgent Sexual and Reproductive Health Agenda for a Pro-Choice President and Congress

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An Urgent Sexual and Reproductive Health Agenda for a Pro-Choice President and Congress

Marilyn Keefe

A supporter of reproductive health and rights will occupy the White House come January. The ranks of pro-choice legislators in the House and Senate will grow significantly. There is a lot for a new administration to do and undo on reproductive health, but it's what we voted for.

They said this would never
happen again.  They said choice was a losing issue.  They
said pro-choice Democrats should avoid the issue, and pro-choice Republicans
should hide their views.  They said this day would never again

Here it is.  One day after
an historic election and we can say, conclusively:  The naysayers
were wrong.  A supporter of reproductive health
and rights will occupy the White House come January. The ranks of pro-family,
pro-choice legislators in both the House and Senate
are slated to grow significantly. On January 20, at least five new
pro-choice/pro-family planning senators will take office along with
15 or so new choice/pro-family planning members of the House.  

Make no mistake.  The
pro-choice gains were not incidental; nobody won in spite of
being pro-choice.  The overwhelming defeat of four anti-choice
ballot measures across the country, including the key swing state of
Colorado, tells us that.  So does the fact that "right to life"
groups were as active as ever this year, and that the issue was discussed
in the last presidential debate. 

America doesn’t want to go
where President Bush wanted to take us – to a Supreme Court that overturns
Roe v. Wade
, to new and impenetrable obstacles that prevent low-income
women from getting the contraceptives they need, to tax dollars supporting
abstinence-only programs that don’t work, to the world Governor Palin
inhabits which has no grey areas, no middle ground, no room for good
people to disagree. 

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The increased support in Congress
will be critical as supporters of choice begin working to reverse the
legacy of the past eight years and press for an agenda more reflective
of the needs of women and families. President Bush did a lot to erode
the rights of women, both in this country and abroad.  He opposed
access to emergency contraception, gave lifetime appointments to two
stridently anti-choice Supreme Court justices, promoted abstinence-only
sex education programs, under-funded cost-effective family planning
services though Title X and Medicaid, and used U.S. dollars internationally
to deny women the reproductive health care they need.

But can we reasonably
ask – and realistically expect – action on sexual and reproductive health in the coming months, especially
given the record federal deficits and an economy in deep trouble?

There are reasons to be optimistic. Here’s why.

1. President-Elect Obama’s
record of support for reproductive rights

His record of support is consistent
and clear, both in the Illinois legislature and the U.S. Senate. He
has been a strong proponent of sex education, sponsoring legislation
to replace failed abstinence-only programs with comprehensive, medically
accurate curricula. He cosponsored legislation to restore birth control
discounts for low-income and college women. He cosponsored the Freedom
of Choice Act, to codify Roe v. Wade. Obama is an original co-sponsor
of Prevention First, which would expand access to contraception for
low-income women, require health insurance companies to cover contraception,
and provide a dedicated funding stream for age-appropriate, medically
accurate and honest sex education programs. He also co-sponsored legislation
to expand coverage of family planning services so that it matches Medicaid
coverage for pregnancy-related care – a bill that would help low-income
women prevent some 500,000 unintended pregnancies each year, 200,000
of which result in abortion. 

2. There’s safety in numbers:
We have more pro-choice members in Congress and some of the most vocal
opponents are gone.  Gone is ultra-conservative Colorado Republican
Marilyn Musgrave, who in 2006 called the fight against gay marriage
"the most important issue that we face today." Musgrave will be
replaced by Betsy Markey (D-CO), who is pro-choice. Gone is Rep. Tom
Feeney (FL), a "passionate pro-life" member who staunchly opposed
the Title X family planning program. In the Senate, newly elected Jeanne
Shaheen (D-NH), Mark Udall (D-CO), Tom Udall (D-NM), Mark Warner (D-VA)
and Kay Hagan (D-NC) will be replacing five senators whose records on
reproductive choice were unequivocally hostile.   

3. Inaction is
not an option.
  The unmet public health needs and the inattention
to the public health infrastructure for the last eight years make inaction
impossible.  The litany of problems facing women seeking reproductive
health care is long, and the coming action on health care reform will
bring this issue to the fore. Whether trying to avoid pregnancy or
to plan a family, access to birth control and reproductive health services
is a necessary component of basic health care. Today, nearly one-half
of pregnancies in this country are unintended at the time of conception.
By age 45, nearly half of all women will have experienced an unintended
pregnancy. Nearly half of Americans contract a sexually transmitted
infection (STI) in their lives. Our nation’s real and compelling need
to improve access to comprehensive reproductive health care services
has not been well-served by the demonization of these issues over the
last eight years.

So what’s a president to
do? Here are a few suggestions for an incoming administration. 

1.  Reverse the HHS
Refusal Rule
, which will likely be published in final form
any day now.  This ill-conceived and unnecessary rule will obstruct
access to reproductive and other health services, counseling and referrals. 
It could open the door for more widespread health service refusals. 
This rule not only ignores patients’ health care needs, it also conflicts
with accepted medical standards of health care and treatment and may
create conflicts with state laws designed to enhance access to reproductive
health services.   

2. Ensure Health
Care Reform Efforts Advance Access to Reproductive Health Care:
First and foremost, reproductive health – including coverage of abortion
and contraception – must be recognized as a
critical component of care, not an afterthought or the "third rail"
of the discussion. The public health infrastructure needs to be preserved
and expanded.  

3. Prioritize
and normalize prevention: Widespread use of birth control improves
maternal and child health and has been the driving force in reducing
unintended pregnancy and preventing STIs. Yet the cost of contraception
can be a significant barrier to accessing services, especially for low-income
and adolescent women. Investing in programs to expand access to subsidized
family planning services is a cost-effective and proven way to improve
public health.  Priority should be given to increasing funding
for the Title X family planning program and for the CDC’s program
to screen and treat sexually transmitted infections. Eligibility for
cost-effective Medicaid-funded family planning services should be expanded
so more women can access services. And instead of funding ineffective
abstinence-only education programs, we should support comprehensive
sex education that give young people the information and skills they
need to make responsible and safe choices about their reproductive health.

4. Renew U.S. support for
international family planning programs:
  U.S. investments in
reproductive health yield an array of benefits in developing countries,
including improved maternal and child health, fewer unintended pregnancies
and abortions, lower HIV rates, and higher standards of living.  Funding
should be increased for USAID’s overseas family planning and for the
United Nations Population Fund (UNFPA).
We should reverse harmful policies, including the global gag rule and
this administration’s interpretation of the Kemp-Kasten law, which
have reduced the ability of international non-governmental organizations
to provide vital preventive and life-saving health services in some
of the world’s poorest nations.  

5. End the current restrictions
on embryonic stem cell research
and supplement growing studies of
reprogrammed stem cells with renewed funding for embryonic lines, accompanied
by rigorous scientific and ethical oversight. 

Remove Barriers to Abortion Care: 

In addition to the recently proposed rule that undermines access to
reproductive health care services, long-standing bans on public funding
for abortion services have severely restricted access to safe abortion
care for women who depend on the government for their health care. These
policies disproportionately harm low income women, women in the military,
women of color, and certain immigrant women – all of whom already
face significant barriers to receiving timely, high quality health care.   

That’s a lot to do – and
undo, but it’s what the nation wants and needs.  It’s also
what we voted for.   

There’s an urgent agenda
for advocates, too, and it starts with staying active and engaged, and
continuing to fight every day to improve reproductive health care. 
Opponents will surely call our agenda radical, but we simply cannot
let them dominate the debate.  There’s nothing radical about
putting in place the programs, policies and priorities that give all
women access to the education and reproductive health care services
that can reduce teen and unintended pregnancy, stop the epidemic of
sexually transmitted infection, and help women have healthier babies.