The Prevention President: A Report Card

Cristina Page

It'd be wrong to say only pro-choice people have reason to rejoice from President Obama's stellar first hundred days.

For those in favor of women’s rights, the first 100 days of the
Obama administration has been like a honeymoon. We’ve continually been
reminded why we fell in love in the first place. Coming off an
eight-year abusive relationship (to put it mildly), none of Obama’s
kindnesses are lost on us. He seems to be the kind of guy who does what
he says he’s going to do, another relief. And his gifts have not just
been for the pro-choice movement either. Nearly all of Obama’s actions
on reproductive rights to date have focused on preventing the need for
abortion, one of his "common ground" issues. And while he’s won no fans
in traditional pro-life groups, it’s an approach the majority of
pro-life Americans want.

Here’s a report card of the Obama administration’s work on reproductive rights in the first hundred days.

International:

Obama’s first gift was global. In his first month in office, with a
stroke of his pen, Obama lifted the Global Gag Rule, a Reagan-era
policy that withheld funding from any group that referred a woman for
an abortion, most of which were family planning providers.

Lifting the funding ban will restore these NGO’s access to
USAID-supplied condoms and other forms of contraception and result in
dramatic improvements in women’s health for those living in the most
desperate regions on earth. Despite anti-abortion operatives’ claims,
the policy change will not increase abortion rates since the funding
was never used to provide abortion services in the first place. In
fact, we expect just the opposite. Johns Hopkins researchers estimate
that every million dollars spent on contraceptive care prevents 150,000
abortions, 360,000 unintended pregnancies, 11,000 infant deaths and 800
maternal deaths .

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The Stimulus Package:

There was, to continue the honeymoon metaphor, our first lover’s
quarrel too. Obama quickly folded once the Republicans picked a fight
over inclusion of a family planning provision in the stimulus package.
In Obama’s defense, passage of the package was too critical to hold up
for a minor provision that could be included elsewhere. But the
concession came easily, a little too easily. Why not stand up to the
bullies who happened also to be lying to the American public about what
the contraception provision was? Obama could have pointed out that,
despite claims to the contrary, there was no $200 million budget line
for contraception in the stimulus package. That figure represented the
projected cost savings to the states if a simple administrative,
non-budgetary proposal were adopted. It gets complicated, but sadly the
unchallenged final message was "contraception has nothing to do with
economic recovery." The last few months have certainly proven
otherwise. There’s been a surge of American’s getting contraception,
and long-acting methods at that. Clearly, pregnancy prevention has a
lot to do with individual economic stability. It’s also proven that
Republicans are deeply out of touch with what struggling Americans need
to protect themselves during tough times, as if we needed more evidence.

Appointments:

With the key positions that impact women’s health and rights most,
Obama has appointed wisely. Hillary Clinton overseeing foreign policy
will impact women’s health worldwide. She is the possibly the strongest
pro-choice advocate we’ve ever had in government and there was no
better display of her pro-choice backbone than an exchange she and
anti-abortion/anti-contraception Rep. Chris Smith from NJ had last week.

Without question, the Department of Health and Human Services (HHS)
is the most important federal agency for American women’s health
issues. That’s one reason why the chief of staff to one of Bush’s heads
of HHS, Tommy Thompson, described it as "ground zero for the
ideological wars in this country." HHS includes the FDA (approves new
reproductive health drugs), the Title X program (nation’s contraception
program for the poor), the Office of Medicaid (pays for 1/3 of all US
births and the largest health payer of contraception services for the
low-income;) and the Centers for Disease Control and Prevention,
(oversees STD prevention programs.) For this post Obama chose Governor
Kathleen Sebelius who was confirmed yesterday. During her confirmation
hearings, the anti-abortion movement, in true Rove form, attempted to
portray the exceedingly moderate Sebelius as an extremist on abortion.
Very little of what HHS does has to do with abortion rights, though, so
the charge was not only false but irrelevant. Sebelius, through her
role, is likely to make contraception more available, implement the
most effective sex education programs, and focus on preventing the
spread of STDs: all strategies the traditional anti-abortion
establishment has historically opposed. Of course, it was better for
them to say she’s an abortion nut than a prevention nut.

Common Ground:

But not all pro-lifers were opposed to Sebelius’ nominaton. One of
the most revolutionary and inspiring events to emerge from the election
of Obama’s has been real common ground partners in a growing segment of
the pro-life movement. These are people who while disagreeing on some
fundamental issues have pledged to seek points of agreement with
pro-choice activists. Catholics United is one such pro-life common ground group. Among many of their cutting edge campaigns was Catholics for Sebelius,
which defended her nomination by arguing that her policies have led to
dramatic declines in the unintended pregnancy and abortion in Kansas.
Several other pro-life groups, like Pro-Life Pro-Obama and Realabortionsolutions.org,
as well as a handful of pro-life leaders, have risen to answer Obama’s
common ground call. These groups and leaders believe that rather than
focusing on banning abortion, which has never had a significant impact
on abortion rates, Obama’s prevention policies hold the greatest
promise for those seeking tangible pro-life results.

Obama has committed his administration to finding common ground in the abortion conflict. He’s assigned his Office of Faith Based and Neighborhood Partnerships to work with his Council on Women and Girls on the task. Last month, the White House hosted its first conference call
of leaders on each side and presented a broad strokes common ground
agenda. It’s decidedly straightforward and hard to argue with from both
pro-choice and pro-life perspectives. The focus will "look at how we
support women and children, address teenage pregnancy, and reduce the
need for abortion." Both sides of the abortion debate have much to gain
from this common ground effort. If it results in any success, which is
still no certainty, the American public, particularly women, and our
political discourse will be the greatest beneficiaries.

Plan B:

One of the greatest examples of the abuses of the Bush
administration was the very transparent derailing of the Plan B,
emergency contraception (EC), over the counter application at the FDA.
Bush appointed anti-contraception ideologues to the panel reviewing the
application. The majority of the panel wound up recommending over-the
counter access to EC for all women and the application had support from
all women’s and adolescent medical groups. Still the Bush FDA denied
minors over the counter access to emergency contraception. This
decision is held up as a one of the greatest examples of Bush’s attacks
on science and the administration’s misuse of agencies for purely
ideological aims. Obama has set about restoring confidence
in our scientific agencies. One step in that direction was sending the
Plan B decision back for review and demanding the agency base it’s
decision on over-the-counter access solely on scientific evidence. In
the meantime, Obama directed the agency to establish immediate
over-the-counter access for 17 year-old women to the highly effective
contraceptive method.

Obama also restored affordable birth control for college-aged women.
After Bush removed college health centers from discounted drug
programs, contraceptive costs increased
as much as 900% for college women. Obama signed legislation to restore
access to affordable birth control for college-age women who,
statistics show, are most in need of it: they’re the demographic with
the highest rate of unintended pregnancy, the highest rate of abortion,
and little disposable income.

HHS Regulations

In the final days of the Bush administration, the Christian Right just about went looting. They tried to walk away with a regulation allowing
healthcare workers’ religious beliefs to override patient’s medical
decisions. One HHS regulation, which went into effect literally moments
before Obama took office, was so broad and would cause such chaos in
the medical establishment that even Bush’s own EEOC came out against
it. It would have allowed any healthcare worker for practically any
"conscience-related" reason to deny a patient any type of medical care.
The healthcare worker wouldn’t have had to inform the employer
beforehand of the care he or she objected to and couldn’t be fired for
refusing to provide the service. Patients did not have to be informed
of the healthcare worker’s objection or that they were being denied
information about their medical options. In the service of protecting
"conscience objectors," the regulation threw patient rights out a
window. Since ample protection already exists in law for those who
don’t want to take part in abortion services, it was widely understood
that the goal of the HHS regulations was to give cover to those who
wish to obstruct women’s access to contraception. Obama rescinded the
HHS regulations.

At the end of the Bush administration and ever since, as a result of
its mismanagement and commitment to proven-to-fail approaches, abortion
and teen pregnancy rates have been spiking. Obama has, in the first 100
days, reversed course in favor of the policies that have proven,
wherever tried, to result in dramatic declines in unintended pregnancy
and abortion rates. It’d be wrong to say only pro-choice people have
reason to rejoice from this stellar first hundred days.

News Abortion

Anti-Choice Leader to Remove Himself From Medical Board Case in Ohio

Michelle D. Anderson

In a letter to the State of Ohio Medical Board, representatives from nine groups shared comments made by Gonidakis and said he lacked the objectivity required to remain a member of the medical board. The letter’s undersigned said the board should take whatever steps necessary to force Gonidakis’ resignation if he failed to resign.

Anti-choice leader Mike Gonidakis said Monday that he would remove himself from deciding a complaint against a local abortion provider after several groups asked that he resign as president of the State of Ohio Medical Board.

The Associated Press first reported news of Gonidakis’ decision, which came after several pro-choice groups said he should step down from the medical board because he had a conflict of interest in the pending complaint.

The complaint, filed by Dayton Right to Life on August 3, alleged that three abortion providers working at Women’s Med Center in Dayton violated state law and forced an abortion on a patient that was incapable of withdrawing her consent due to a drug overdose.

Ohio Right to Life issued a news release the same day Dayton Right to Life filed its complaint, featuring a quotation from its executive director saying that local pro-choice advocates forfeit “whatever tinge of credibility” it had if it refused to condemn what allegedly happened at Women’s Med Center.

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Gonidakis, the president of Ohio Right to Life, had then forwarded a copy of the news release to ProgressOhio Executive Director Sandy Theis with a note saying, “Sandy…. Will you finally repudiate the industry for which you so proudly support? So much for ‘women’s health’. So sad.”

On Friday, ProgressOhio, along with eight other groupsDoctors for Health Care Solutions, Common Cause Ohio, the Ohio National Organization for Women, Innovation Ohio, the Ohio House Democratic Women’s Caucus, the National Council of Jewish Women, Democratic Voices of Ohio, and Ohio Voice—responded to Gonidakis’ public and private commentary by writing a letter to the medical board asking that he resign.

In the letter, representatives from those groups shared comments made by Gonidakis and said he lacked the objectivity required to remain a member of the medical board. The letter’s undersigned said the board should take whatever steps necessary to force Gonidakis’ resignation if he failed to resign.

Contacted for comment, the medical board did not respond by press time.

The Ohio Medical Board protects the public by licensing and regulating physicians and other health-care professionals in part by reviewing complaints such as the one filed by Dayton Right to Life.

The decision-making body includes three non-physician consumer members and nine physicians who serve five-year terms when fully staffed. Currently, 11 citizens serve on the board.

Gonidakis, appointed in 2012 by Ohio Gov. John Kasich, is a consumer member of the board and lacks medical training.

Theis told Rewire in a telephone interview that the letter’s undersigned did not include groups like NARAL Pro-Choice and Planned Parenthood in its effort to highlight the conflict with Gonidakis.

“We wanted it to be about ethics” and not about abortion politics, Theis explained to Rewire.

Theis said Gonidakis had publicly condemned three licensed doctors from Women’s Med Center without engaging the providers or hearing the facts about the alleged incident.

“He put his point out there on Main Street having only heard the view of Dayton Right to Life,” Theis said. “In court, a judge who does something like that would have been thrown off the bench.”

Arthur Lavin, co-chairman of Doctors for Health Care Solutions, told the Associated Press the medical board should be free from politics.

Theis said ProgressOhio also exercised its right to file a complaint with the Ohio Ethics Commission to have Gonidakis removed because Theis had first-hand knowledge of his ethical wrongdoing.

The 29-page complaint, obtained by Rewire, details Gonidakis’ association with anti-choice groups and includes a copy of the email he sent to Theis.

Common Cause Ohio was the only group that co-signed the letter that is decidedly not pro-choice. A policy analyst from the nonpartisan organization told the Columbus Dispatch that Common Cause was not for or against abortion, but had signed the letter because a clear conflict of interest exists on the state’s medical board.

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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