Pregnancy Planning and Prevention: the Big Picture

The_National_Campaign

Health reform must include pregnancy planning and prevention services, which will improve health, strengthen families, improve child well-being, enhance our workforce, and reduce taxpayer burden.

Lisa Shuger is the Director of Public Policy at the National Campaign to Prevent Teen and Unplanned Pregnancy. This piece is cross-posted from the National Campaign’s blog, Pregnant Pause.

 

Over the past several months Congress has been working at a fast
pace to get comprehensive health reform legislation to the President’s
desk before the end of this year.

Two Senate committees are working on bills which they will
ultimately merge into one and send to the full Senate for a vote
sometime before Congress adjourns for the August recess.

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Meanwhile, there are three committees in the House that are working
on health reform. The House committees are collaborating to produce one
bill, which is also expected to be voted on by the full House by early
August. Broad outlines of a "Tri-Committee" draft bill were circulated
last week.

Looking at the various draft proposals that have already been released, it is clear that Congress is making a historic effort to reform health care, as is the Obama administration.
Yet with so many "big picture" issues to grapple with, like spiraling
health care costs, access and affordability, employer mandates, taxing
benefits, and whether to include a public plan option, it’s hard to get
Congress’s attention on some of the "smaller issues," such as pregnancy
planning and prevention. However, pregnancy planning and prevention
affects the lives of most Americans who would benefit from health
reform, and therefore, is very much a part of the "big picture."

Consider this: Half of all pregnancies in the United States are unplanned. We know that family planning services are widely used and broadly supported: 98 percent
of sexually active women have used some form of family planning.
Pregnancy planning and prevention is also cost-effective. Contraceptive
use saves nearly $19 billion in direct medical costs each year. And if politics are the issue, 88 percent of voters support women’s access to contraception, and 72 percent of Republicans and Independents favor legislation that would make it easier for people at all income levels to obtain contraception.

Given the health, economic, and social consequences of unplanned pregnancy,
Congress should pass health reform that: (1) includes pregnancy
planning and prevention as an integral component of any basic benefit
package; (2) complements private sector health initiatives with strong,
publicly-financed family planning services for those individuals who do
not otherwise have access to high quality, affordable family planning;
(3) encourages responsible behavior among men and women by including
pregnancy prevention within the broader scope of prevention and
wellness; (4) strengthens the practitioner workforce through enhanced
education, including education about new long-acting reversible contraceptive methods; and (5) improves young adults’ access to affordable health insurance.

There is also the question of personal responsibility as part of health reform. At a recent town hall meeting
in Green Bay, Wisconsin, President Obama responded to questions about
how health reform would incorporate wellness and encourage people to
take more responsibility for their own health care. The President
affirmed how we all have to do our part – families, government,
employers, insurance companies and others. Although this usually comes
up in the context of smoking, diet, and exercise, the notion of shared
responsibility applies to pregnancy planning and prevention as well.
Reducing unintended pregnancy requires responsible behavior and choices
by both men and women, and responsible policies on the part of the
public and private sectors. Health reform presents an unprecedented
opportunity to make progress on this idea of shared responsibility.

Health reform that leaves out or inadequately addresses an issue
that affects most women and men and families in this country is not
real health reform. And certainly, health reform legislation that
includes women’s health, prevention, and health promotion, but does not
include access to high quality family planning services – gynecological
care, contraceptive counseling, access to all FDA-approved
contraceptive drugs and devices, and related outpatient services –
falls short of real reform.

Health reform must include pregnancy planning and prevention
services, which will improve health, strengthen families, improve child
well-being, enhance our workforce, and reduce taxpayer burden. With
fewer unplanned pregnancies there will be less poverty, more
opportunities for young men and women to complete their education or
achieve other life goals, fewer abortions, and better prospects for
this generation and the next. Isn’t that the "Big Picture?"

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.

News Law and Policy

Federal Judge Guts Florida GOP’s Omnibus Anti-Choice Law

Teddy Wilson

"For many people, Planned Parenthood is the only place they can turn to,” said Barbara Zdravecky, president and CEO of the Planned Parenthood of Southwest and Central Florida. “We may be the only place they can go in their community, or the only place that offers the screening or birth control method they need. No one should have their basic health care taken away."

A federal judge on Thursday permanently blocked two provisions of a Florida omnibus anti-choice law that banned Planned Parenthood from receiving state funds and required annual inspections of all clinics that provide abortion services, reported the Associated Press.

U.S. District Judge Robert Hinkle issued an order in June to delay implementation of the law.

“The Supreme Court has repeatedly said that a government cannot prohibit indirectly—by withholding otherwise-available public funds—conduct that the government could not constitutionally prohibit directly,” Hinkle wrote in the 25-page ruling.  

Thursday’s decision came after Republican Gov. Rick Scott’s administration decided not to pursue further legal action to defend the law, and filed a joint motion to end the litigation.

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Hinkle issued a three page decision making the injunction permanent.

HB 1411, sponsored by Rep. Colleen Burton (R-Lakeland), was passed by the Republican-controlled state legislature in March.

The judge’s ruling nixed provisions in the law that banned state funding of abortion care and required yearly clinic inspections. Other provisions of the law that remain in effect include additional reporting requirements for abortion providers, redefining “third trimester,” and revising the care of fetal remains.

The GOP-backed anti-choice law has already had a damaging effect in Palm Beach County, where Planned Parenthood was forced to end a program that focused on teen dropout prevention.

Barbara Zdravecky, president and CEO of the Planned Parenthood of Southwest and Central Florida, said in a statement that the ruling was a “victory for thousands of Floridians” who rely on the organization for reproductive health care.

“For many people, Planned Parenthood is the only place they can turn to,” Zdravecky said. “We may be the only place they can go in their community, or the only place that offers the screening or birth control method they need. No one should have their basic health care taken away.”

A spokesperson for Scott told Reuters that the administration is “reviewing” the decision.

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