Spain’s Socialist Government Approves EC Without Prescription

Angela Castellanos

Regardless of age or province of residence, all Spanish women will have access to emergency contraception pill without a prescription. It will be in pharmacies by August.

Regardless of age or
province of residence, all Spanish women will have access to the emergency
contraception pill (EC) without a prescription. It will be in pharmacies by
August.

The morning-after pill was authorized in Spain in
2001, and it is distributed for free by public health centers in some regions,
while in others, it is more difficult to obtain due to the particular ways of
implementing the national norms by the regional administrators of the health
care system.

Socialists leaders argue that
the measure will contribute to eradicating the territorial inequality regarding
the access to family planning methods.

Currently, the pill is sold in pharmacies
for 20 euros (about 27 US Dollars) with prescription. But, according to Concha
Martín, director of the Family Planning Association of Madrid, women often have
to go to several doctors before finding one who will prescribe the EC.

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That is why, for the Socialists, the
announcement is part of a package of measures promoting "the development of the
fundamental right to sexual and reproductive health for all citizens."

"The aim
is to make it available to anyone who wants it without any difficulty," said
the Ministry of Health’s Trinidad Jimenez, who made the announcement May 11th.

Jimenez underscored that EC
use is aimed to "avoid unwanted pregnancies" and "unexpected sexual relations
without protection," therefore it cannot be regarded as routine method of
contraception.

Nevertheless,
the General Secretary of the Sociedad Española de Ginecología y Obstetricia (Gynecology
and Obstetric Spaniard Society), Luis T., called the governmental measure
"frivolous." Mercé Alberto argues that there is a risk, especially among young
women, of using EC as a regular contraceptive method for occasional sexual
intercourse.

Mercé Alberto added that the
generalization of its use as conventional contraceptive "could increase the
number of unwanted pregnancies and sexually transmission diseases as well."

In addition, this measure
did not address sexuality education, which is a problem to be solved by the
school system, Mercé Alberto pointed out.

"Emergency contraceptive
pills are for emergency use only and not appropriate for regular use as an
ongoing contraceptive method because of the higher possibility of failure
compared to modern contraceptives. In addition, frequent use of emergency
contraception results in more side-effects, such as menstrual irregularities.
However, their repeated use poses no known health risks,"

According to an
official document of the World
Health Organization
.

Some associations of consumers have asked
for more information in order to avoid the use of the morning-after-pill as a
conventional contraception method.

The
conservative forces, such as the Catholic Church and the conservative
opposition, the Popular Party, have reacted by arguing that the number of
abortions will increase as a result of its implementation.

Socialist leaders said statistics in
countries that have made the pill available over the counter, such as the United States and France, show it has helped reduce the
number of abortions significantly.

According to official data of the Ministry of Health, of the 112,000 women who had
abortions in Spain
in 2007, 6,000 were minors.

For many people, sexuality education and
access to contraception are the ways to diminish unwanted pregnancies and
abortions.

A Spanish blogger stated that this measure
will reinforce sexist behaviors. "Probably many men from their male condition
will say "Thanks." Once again, the consequences of a not thought-out act can be
stopped with just a pill. I am worried because day by day it is getting harder
to explain to a daughter that a woman is equal to a man, and she deserves
respect."

So far, pharmacies have
not expressed any objection. The Ministry of Health is confident that its
managers will not argue conscience objection, since the pill is not abortive.

According to the World Health Organization, "Levonorgestrel emergency contraceptive pills have
been shown to prevent ovulation and they did not have any detectable effect on
the endometrium (uterine lining) or progesterone levels when given after
ovulation. ECPs are not effective once the process of implantation has begun,
and will not cause abortion."

"Emergency contraceptive
pills prevent pregnancy. They should not be given to a woman who already has a
confirmed pregnancy. However, if a woman inadvertently takes the pills after
she became pregnant, the limited available evidence suggests that the pills
will not harm either the mother or her fetus."

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.

Investigations Media

The ‘HUSH’ Documentary: Another Secret Recording Inside an Abortion Clinic

Sharona Coutts

HUSH relies almost exclusively on interviews with renowned anti-choice “experts” whose work has been discredited. They trot out many of the worn theories that have been rejected by medical and public health experts. The innovation of HUSH, however, is that it has reframed these discredited ideas within the construct of a conspiracy theory.

Another day, another secret recording made in an abortion clinic.

At least, that’s the very strong impression given by some of the scenes contained within the documentary film HUSH, which premiered late last year and is currently making the rounds of film festivals and anti-choice conferences in the United States and internationally, including the National Right to Life Convention that took place in Virginia last month.

The film is the creation of Mighty Motion Pictures and Canadian reporter Punam Kumar Gill, who says in the film that she is pro-choice, a “product of feminism.” It purports to tell the story of “one woman,” Gill, who “investigates the untold effects of abortion on women’s health.”

HUSH—which claims in the film’s credits to have received support from the Canadian government—attempts to cast itself as neither pro-choice nor “pro-life,” but simply “pro-information.” The producers insist throughout the film, in their publicity materials, and in private emails seen by Rewire that their film is objective and balanced.

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That’s how they pitched it to Dr. David Grimes, a highly respected OB-GYN and a clinical professor in the Department of Obstetrics and Gynecology at the University of North Carolina School of Medicine, who agreed to do on-camera interviews for the film. Grimes now says the producers and reporter misled him about their intentions.

“There was no balance,” Grimes told Rewire. “It’s a hatchet job. It’s obvious.”

Indeed, HUSH relies almost exclusively on interviews with renowned anti-choice “experts” whose work has been discredited, many of whom are featured in Rewire‘s gallery of False Witnesses. They trot out many of the worn theories that have been rejected by medical and public health experts—namely, that abortion is linked to a host of grave physical and mental health threats, “like breast cancer, premature birth, and psychological damage.”

The innovation of HUSH, however, is that it has reframed these discredited ideas within the construct of a conspiracy theory.

When Anti-Choice “Science” Goes Conspiracy Theory

As a piece of propaganda, the use of the conspiracy theory has the advantage of removing the debate over abortion’s safety from the realm of logic. In HUSH‘s topsy-turvy world, the medical establishment becomes the scare-quoted “Medical Establishment,” and the more distinguished or authoritative a person or organization, the more suspect they become.

For reasons that remain murky, the film’s thesis is that the world’s leading reproductive and health organizations—including the National Cancer Institute, the American Cancer Society, the American Congress of Obstetricians and Gynecologists, and the World Health Organization, along with all of their staff, contractors, and affiliated experts—have been hiding information about the risks of abortion.

This is most apparent when the reporter, Gill, tells the viewers that “if women have the right to abortion, they should also have the right to know” about the risks she believes she has identified.

Later, the film shows graphics highlighting the states that have various informed consent laws—some of which are literally called “A Woman’s Right to Know” acts—that force providers to give patients false information about the safety of abortion. Rather than concluding that the authority of the state has been used to mandate that doctors provide medically unsound “counseling” using the very junk science that Gill presents throughout the film, she hews to the back-to-front logic of all conspiracy theories. In her view, the existence of these laws shows that the risks are real, but that the faceless, nameless “they” still won’t let women in on the their deadly secrets.

In Gill’s world, the unwillingness of organizations to speak with her becomes evidence that they are hiding something.

The American Congress of Obstetricians and Gynecologists tells Gill that it won’t fulfill her requests by giving her an interview because the science is settled; Gill sees this as a sign of conspiracy.

“This is where I started to feel equally suspicious of those denying any link,” Gill tells the viewer, her voice floating over inky footage of the U.S. Capitol at night. Lights from the Capitol dance on the velvety surface of the Lincoln Memorial Reflecting Pool, and Gill confides: “I felt like I was digging into something much deeper and darker.”

A comical scene ensues where Gill is astonished to find that turning up with a film crew on the grounds of the National Cancer Institute does not suddenly persuade it to grant her an interview with one of its experts.

“What was going on here?” says Gill in her voiceover. “It was like they really didn’t want any questions being asked.”

In fact, the National Cancer Institute had replied to Gill’s multiple requests with links to its website, which contains the conclusive studies that have long since dispelled the notion that any link exists between abortion and breast cancer. The film shows footage of those emails.

Furthermore, Grimes provided Rewire with copies of emails he had exchanged with the film’s producers during its production, in which he gave them citations to relevant studies and warned them that the work of the anti-choice “experts” they had approached had been thoroughly debunked.

After seeing the film, Grimes emailed the producers inquiring why they hadn’t simply asked him to connect them with additional experts.

“Had you truly wanted more pro-choice researchers to speak to these issues, I could have named scores of colleagues from the membership of the Society for Family Planning and Physicians for Reproductive Health who would have been happy to help,” Grimes wrote in a note he shared with Rewire. “You did not ask. That some organizations like the National Cancer Institute did not want to take part in your film in no way implies a reluctance on the part of the broader medical community to speak about abortion research.”

It seems that Gill—whose online biographies give no indication that she is a scientist—would not have been satisfied in hearing about existing research. She tells the viewers that, in her view, “more study is needed to determine the extent of the abortion-breast cancer link,” and concludes that “to entirely deny the connection is ludicrous.”

In an interview with Rewire, Grimes noted that doing such research would be viewed as unethical by reputable scientists.

“That issue is settled, and we should not waste limited resources that should be directed to urgent, unanswered questions, such as the cause of endometriosis and racial disparities in gynecologic cancers,” he said.

Grimes made his dissatisfaction clear to the producers. He wrote to them: “My inference after viewing the film is that you are suggesting a large international conspiracy of silence on the part of major medical and public health organizations, the motivation for which is not specified.”

The corollary to the suspicion cast over the most reputable research and representative bodies is that the film transforms the marginal status of the anti-choice “experts” into a boon.

Seen through HUSH‘s conspiracy theory lens, the fact that the work of people like Priscilla Coleman, David Reardon, and Angela Lanfranchi is rejected by the medical establishment becomes proof not of the unsoundness of their ideas, but rather that a conspiracy is afoot to silence them.

Instead of presenting this small but vociferous group of discredited activists as outliers—shunned because their theories have no scientific basis, or because they lack any credentials relevant to reproductive or mental health, or because they have repeatedly mischaracterized data—HUSH paints them as whistle-blowing renegades determined to set the truth free.

A tearful Lanfranchi recounts the story of patients who came to her with aggressive breast cancer in their 30s. Lanfranchi says she strove to understand “why this was happening,” and realized that each of these young women had had abortions, which she then concluded had caused their cancer. Lanfranchi said her hopes that the public would learn of this risk were dashed over time.

“Over the years I’ve realized that, no, it didn’t matter how many studies there were,” she tells viewers. “That information was not going to get out.”

Joel Brind says that he has worked with a colleague whom he says he later discovered was pro-choice, but that their views on abortion never came up. “This is about science,” he tells Gill. “This is about the effect on women and whether or not abortion increases the risk of breast cancer. Period.”

Gill asks both Lanfranchi and Brind whether they are trying to “stop abortion,” or whether they “want abortion to go away.” Both answer that all they want is for women to be informed when they exercise their choice.

The film makes no mention of the fact that both have been anti-choice activists for decades; they have each testified in support of anti-choice laws in both legislative and judicial proceedings, and both have participated in the extreme right-wing, anti-choice, anti-LGBTQ World Congress of Families.

To the extent that HUSH acknowledges these activists’ bias, it is couched in a softer light that is linked, implicitly, to their religious views—a reality raised by Grimes in his on-camera interview, in which he notes, accurately, that the anti-choice “intellectuals” often lack the relevant medical or scientific qualifications to do the type of work they purport to do, but that they do tend to share religious convictions that lead them to oppose abortion and contraception.

That allows the producers to imply that the False Witnesses are perhaps victims of discrimination; to suggest that their work is being discounted because of the activists’ religious beliefs, and not because the work itself has been thoroughly debunked. Play the ball, not the man, appears to be the producers’ plea.

It’s a conspiracy theory twilight zone: where medical groups withhold information for reasons so cloudy that they cannot be articulated, but where people who have for years worn their beliefs on their sleeves cannot be evaluated with those political views in mind.

After asserting that she is, herself, pro-choice, Gill says she “finds validity” in the claims of the anti-choice advocates, and that she finds it “sickening” that the “media and health organizations have spent their energies closing the case and vilifying those who advocate in favor of the link, instead of investigating any and all reasons why breast cancer rates among young women have increased and women are dying.”

The producer, Joses Martin, did not answer Rewire’s questions about the experts he and his team had selected, other than to say, “We are very proud of the balanced approach that we’ve taken in this documentary that is neither anti-abortion nor pro-abortion.”

Another Instance of Secret Recordings Made in Abortion Clinics

What troubles Grimes most about the film is not so much that he was cast as the face of an international conspiracy by virtue of being the sole pro-choice physician to appear on camera, but that he may be associated with people who appear to have made secret recordings in at least one abortion clinic.

The footage and audio in question have been heavily edited, and it is difficult to discern what is real from what has been staged or spliced to give certain effects.

Early in the film, Gill is shown standing in the entry path to what the producers identify as a “Seattle abortion clinic.” As she makes her way inside, the footage swaps to guerilla-style, hidden camera shots, which capture wall artwork that appears in some Planned Parenthood clinics. Viewers see Gill’s face in the waiting room, as well as blurs of other people there. The film then swaps to audio recordings without any video footage. Gill can be heard posing as a patient, receiving counseling from a woman who is identified as a “health center manager.” This audio is used twice more during the film.

In Washington state, it is a crime to make audio or video recordings of people without their consent. Similar laws are in place in California, Florida, and Maryland, states where David Daleiden and his co-defendants from the Center for Medical Progress made their surreptitious videos of Planned Parenthood employees and members of the National Abortion Federation.

Grimes asked the producers whether they had obtained permission to make any of those recordings; Rewire asked the producers whether the recordings were in fact made in Seattle.

The producer, Joses Martin, replied to Grimes that he would “not be disclosing the name or location of the clinic or the name of the individual recorded to yourself or anyone else.”

“We have kept this information undisclosed and private both in the film and out of the film to not bring any undue burden on them. We’re certainly not implicating anyone involved of wrong doings, as was the goal in the Center For Medical Progress case,” Martin wrote in an email shared with Rewire.

In an email to Rewire, Martin did not answer our specific questions about the recordings, but asserted, “We did not break any laws in the gathering of our footage.”

Planned Parenthood had no comment on whether the crew had obtained consent to film inside its clinics, or whether Gill had misrepresented herself throughout her conversation with the counselor. Nor did the organization comment on the increasing use of secret recordings by anti-choice activists within its clinics. In a federal suit, Planned Parenthood has sued Daleiden for breaches of similar laws in California, Florida, and Maryland.

The branch of the Canadian government that the producers credited with supporting the film was less sanguine when informed about the apparent use of secret recordings made in American abortion clinics.

The film’s credits say that it was produced “with the assistance of the Government of Alberta, Alberta Media Fund,” but when Rewire contacted that Canadian province to learn why it had funded a piece of anti-choice propaganda, a spokesperson distanced the fund from the film.

“We have entered into conversations with the production company but we do not at this point have a formal agreement in place, and we were not aware that the production had been completed,” the spokesperson said. “We’re not able to comment on any funding because to date we have not funded the project. Thank you for bringing the use of our logo to our attention and we’ll be in touch with the producers to discuss.” The producers did not reply to Rewire’s question about their use of the logo.

Ironically, while the producer, Martin, did reply to emails from both Grimes and Rewire (albeit without answering specific questions), the reporter, Gill, remained silent. She never answered questions about what she knew about the backgrounds of the False Witnesses to whose work she lent such credence. She didn’t respond to our questions about whether she obtained permission to record video or audio within abortion clinics, or where those clinics were located. And she didn’t reply to our questions about the nature of her relationship with the extreme anti-choice group Live Action, who also received a credit at the end of the film.

To a reporter such as Gill, such silence would surely have been deeply suspicious.

Rewire Investigative Reporter, Amy Littlefield, contributed to this report. 

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