Roundup: A Warning About A Generic Contraceptive, Lack of Access to Contraceptives Driving Unsafe Abortion in Uganda

Jodi Jacobson

Wendy Atterberry shares her experience and a warning about her switch from a branded to a generic contraceptive; lack of access to contraceptives drives unsafe abortion in Uganda; lawmakers in Peru consider expansion of indications for legal abortion; bioethicist asserts women are being treated as a "special interest" in health care reform debate.

A warning about Tri-Lo Sprintec birth control

Writing at The Frisky, Wendy Atterberry shares her recent experience with a switch from the original prescription birth control to a generic version after her insurance company changed its coverage and her pharmacist reassured her the generic version be "the same" as the branded version.

They were not.

Earlier this year, the FDA approved a generic low-dose birth control
called Tri-Lo Sprintec. Afterward, many insurance companies — including
mine — switched coverage from the name-brand Ortho Tri-Cyclen Lo to the
much cheaper, newly approved generic brand. In July, just a few days
before my wedding, my pharmacist informed me of the switch and said
that if I wanted to continue taking the name brand, I’d now have to pay
the full cost, which would be an increase of $60 over what I’d been
paying when my insurance still covered it. After the pharmacist assured
me the formula in the two pills was “exactly the same,” I decided to
save some money and try the generic brand, Tri-Lo Sprintec. Since then,
I’ve been experiencing all kinds of unpleasant side effects.

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Atterberry writes that her "side effects increased exponentially after I
switched to the generic brand."

In fact, on OTC, they barely even
registered on my radar. In addition to the weight gain, boob growth and
uncomfortable bloating in my midsection, I’d also been experiencing
intense full-body itching — so bad, it was keeping me awake at night.
About a month ago, I even started breaking out in hives — on my face,
my neck, my elbow, my armpits. I’ve been miserable! I knew the weight
gain and my suddenly overflowing cup-size were probably results of this
new Pill, but it wasn’t until I started reading a variety of message
boards on the subject this weekend that I realized my itchy skin and
hives were a side effect as well.

After researching her experiences and searching message boards about this issue, she discovered she was not alone.

I was simultaneously relieved and appalled to learn that hundreds of
women — and probably thousands more who haven’t written reviews yet
— are experiencing exactly the same reaction to Tri-Lo Sprintec that I
am. Just like me, most of them had been on Ortho Tri-Cylcen Lo with
limited problems, but switched to the generic brand when their
insurance companies stopped coverage of OTC. Like me, they were told by
their pharmacists and doctors that the formulas were “exactly the
same,” and, just like me, many, many of them have experienced terrible
side effects from Tri-Lo Sprintec. When some of the women complained to
their doctors and pharmacists about what was happening, they were told
they were “crazy,” and that “no one else has complained.” On the
message boards, pharmacists are even weighing in saying that women who
demand the name brand over the generic are “psycho” and simply don’t
realize the two medications are comprised of the same ingredients.

"Ladies," writes Atterberry:

I want this to be a warning to you: The formulas in Ortho Tri-Cyclen Lo and the generic Tri-Lo Sprintec are not the same! The active ingredients may be similar — not the same, similar — but the inactive “filler” ingredients are different (compare here and here)
and it’s very possible that you, like me, may be allergic to whatever
fillers are used in either pill. Don’t let pharmacists or doctors
intimidate you — you’re not “crazy” or “psycho” by questioning whether
a particular prescription is right for you. You know your body better
than they do — you’re not just “confused” if you’re experiencing
unpleasant side effects on medication prescribed by your doctor, even
if you’re told the formula is “exactly the same” as whatever else you
may have taken in the past. What the FDA calls “identical” — and,
therefore, the way many doctors and pharmacists use the word
“identical” — is a legal interpretation, not literal!

Lack of access to contraceptives drives high rate of unsafe abortion in Uganda

Lack of access to modern contraceptives is one of the key factors behind high rates of unsafe abortion and maternal deaths among women in Uganda, notes AllAfrica.com in a report on the recent Guttmacher study on abortion trends worldwide.

The article quotes Dr Peter Ibembe, the National Programme Manager for
Reproductive Health Uganda, saying that "increased use of contraceptives can reduce
maternal mortality and improve women’s health by preventing unwanted
and high risk pregnancies, which usually end in clandestine abortions."

Uganda’s unmet need for family planning services currently stands at 41 percent.  Close to 270,000 induced abortions are performed every year in
Uganda, with 85,000 of the cases ending in complications and sometimes
death.

Peru’s Congress considers legislation to expand conditions for legal abortion

Approximately 370,000 illegal abortions are performed each year in Peru, notes Agence France Presse, in an article on recent efforts to liberalize Peru’s abortion laws.   A bill now before the Peruvian Congress would expand a 1924
law which currently allows abortion only when the expectant mother’s health or
life are in jeopardy.  The new bill, if passed, would expand these conditions to include rape and fetal deformity.

Strong opposition by the Roman Catholic Church and Defense Minister
Rafael Rey, who says he will resign if the bill is approved, prompted a
"technical" review of the measure. Opposition has been spearheaded by Peruvian Cardinal Juan Luis Cipriani, who calls the measure a "death
penalty" for the innocent, the church has openly lobbied lawmakers to
drop the proposed legislation.  As Congressional deliberations continued, protests have been held by both pro- and anti-choice groups.

If
the abortion bill is passed, Peru would join a small group of Latin
American nations that allow abortion only in cases of rape or to save
the life of the expectant mother.

Women’s
groups say that 22 percent of women in Lima are sexual abuse victims.  Complications of unsafe abortion are the leading cause of maternal death in Peru, which has the highest rate of maternal mortality in Latin America.

Bioethicist argues policymakers must stop treating women as a "special interest" in health care debate

Speaking at a Planned Parenthood Luncheon in Madison, Wisconsin last week, bioethics professor Alta Charo of UW Madison expressed alarm at "how women are treated
as "special interests" in the health care debate when not only do
they outnumber men in the health care system, but by age 85 women
outnumber men 2-1," writes Dave Zweifel of the Capital Times.

"Health care ought to be built around women," argued Charo, "not treat them as a special interest."

During her speech, Charo told the now-infamous story of the exchange between Senators Kyl and Stabenow that encapsulates perfectly the disconnect many male policymakers, especially conservative policymakers, have about women’s health.

Just before the Senate Finance Committee wrapped up debate
over its Sen. Max Baucus-designed health care bill, its members
debated one of Sen. Jon Kyl’s amendments, which would have cut
language defining which benefits employers are required to
cover.

Sen. Debbie Stabenow, D-Mich., argued that insurers must be
required to cover basic maternity care. (In several states there
are no such requirements.)

"I don’t need maternity care," said Kyl, R-Ariz. "So
requiring that on my insurance policy is something that I don’t
need and will make the policy more expensive."

Stabenow interrupted: "I think your mom probably
did."

The amendment was defeated, 9 to 14.

"That anecdote explains a lot about what’s been wrong with the
health care debate in Washington these past several months," Charo told her audience.  

Too many people working on health care reform don’t understand
insurance – that it should be designed to spread the risk among us
all, not to exclude certain classes of people so that policies cost
less. Kyl obviously doesn’t understand it.

"If you don’t want to cover women’s maternity care, then don’t
ask us to cover your prostate cancer treatments or, better yet,
don’t ask us to cover the costs of your Viagra prescription," the
internationally recognized bioethicist said.

The reason "women are considered a special interest is because
health care becomes a debate on moralism and politics rather than
on science – something well known to Planned Parenthood," wrote Zweifel. "The
ideologues use misinformation to get their way."

Charo added that it’s why reproductive health in the U.S. is
rotten, why we have 65 million people with incurable sexually
transmitted diseases, why we have high infant mortality rates, why
we have so many unintended pregnancies. 

"We’ve got to stop treating health care as a Sunday school
scolding," Charo said.

For example, we keep pumping millions of taxpayer dollars into
abstinence-only sex education when study after study has shown that
it doesn’t work. We lead kids to believe that they never have to
have sex and then when they do, they know nothing about birth
control. And, of course, the burden typically falls on women and
the poor.

She warned the crowd that the right to life lobby may well gets
its way on abortion in the health care debate. Several amendments
have already been proposed that would ban any health insurer from
covering an abortion if the firm gets any federal subsidy. That
would cover all insurance companies because their low-income
policyholders will be subsidized with federal funds.

In order to get health reform in the end, she worries, Congress
may give in to the abortion ban unless women and others speak
clearly and loudly to their senators and representatives.

October 21, 2009

OnMedica News: Women just as likely to use condoms as the Pill

Health Service Journal: Community contraception clinics grow in popularity

All Africa: Low Contraceptive Use Blamed for High Abortion

Arizona Republic: Judge: No prepayment for abortion transport

Loyola Phoenix: Catholic group opposes internships

Boston Globe: No patch for deepest cut

Times Online: Condom catches up with the Pill but caution still needed

October 20th, 2009

Feministing: When the personal is political – and vice versa

Kansas Liberty: Missouri-based foundation helps raise awareness of pro-life pregnancy clinics in Kansas City area

AFP: Abortion debate heats up in Peru

AP: Alito troubled by concerns over court’s Catholics

Newsday: Looking at both sides of abortion on ‘Law & Order’

LifeNews: Arizona Judge Suggests Pro-Life Group Settle Case With Arizona State University

LifeNews: Pro-Abortion Group NARAL Attacks Pro-Life Democrat Bart Stupak on Health Care

Feminists for Choice: Abortion in Ancient Rome (or Why I’m Glad I’m Living in the Present)

The Guardian: Religion, HIV and the developing world

The Frisky: A Warning About Your Birth Control

California Catholic Daily: Head of Abortion-Supporting Group to Speak at USF

Times of the Internet: Doctor convicted of attempted abortion

Tampa Bay Online: Today’s pill offers much more than birth control

October 19th, 2009

Feminists for Choice: Challenging Oklahoma’s new abortion law


 

 

News Abortion

Study: United States a ‘Stark Outlier’ in Countries With Legal Abortion, Thanks to Hyde Amendment

Nicole Knight Shine

The study's lead author said the United States' public-funding restriction makes it a "stark outlier among countries where abortion is legal—especially among high-income nations."

The vast majority of countries pay for abortion care, making the United States a global outlier and putting it on par with the former Soviet republic of Kyrgyzstan and a handful of Balkan States, a new study in the journal Contraception finds.

A team of researchers conducted two rounds of surveys between 2011 and 2014 in 80 countries where abortion care is legal. They found that 59 countries, or 74 percent of those surveyed, either fully or partially cover terminations using public funding. The United States was one of only ten countries that limits federal funding for abortion care to exceptional cases, such as rape, incest, or life endangerment.

Among the 40 “high-income” countries included in the survey, 31 provided full or partial funding for abortion care—something the United States does not do.

Dr. Daniel Grossman, lead author and director of Advancing New Standards in Reproductive Health (ANSIRH) at the University of California (UC) San Francisco, said in a statement announcing the findings that this country’s public-funding restriction makes it a “stark outlier among countries where abortion is legal—especially among high-income nations.”

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The researchers call on policymakers to make affordable health care a priority.

The federal Hyde Amendment (first passed in 1976 and reauthorized every year thereafter) bans the use of federal dollars for abortion care, except for cases of rape, incest, or life endangerment. Seventeen states, as the researchers note, bridge this gap by spending state money on terminations for low-income residents. Of the 14.1 million women enrolled in Medicaid, fewer than half, or 6.7 million, live in states that cover abortion services with state funds.

This funding gap delays abortion care for some people with limited means, who need time to raise money for the procedure, researchers note.

As Jamila Taylor and Yamani Hernandez wrote last year for Rewire, “We have heard first-person accounts of low-income women selling their belongings, going hungry for weeks as they save up their grocery money, or risking eviction by using their rent money to pay for an abortion, because of the Hyde Amendment.”

Public insurance coverage of abortion remains controversial in the United States despite “evidence that cost may create a barrier to access,” the authors observe.

“Women in the US, including those with low incomes, should have access to the highest quality of care, including the full range of reproductive health services,” Grossman said in the statement. “This research indicates there is a global consensus that abortion care should be covered like other health care.”

Earlier research indicated that U.S. women attempting to self-induce abortion cited high cost as a reason.

The team of ANSIRH researchers and Ibis Reproductive Health uncovered a bit of good news, finding that some countries are loosening abortion laws and paying for the procedures.

“Uruguay, as well as Mexico City,” as co-author Kate Grindlay from Ibis Reproductive Health noted in a press release, “legalized abortion in the first trimester in the past decade, and in both cases the service is available free of charge in public hospitals or covered by national insurance.”

Analysis Law and Policy

After a Year, What Has the Smear Campaign Against Planned Parenthood Accomplished?

Jessica Mason Pieklo & Imani Gandy

One year after David Daleiden and the Center for Medical Progress released the first of a series of videos targeting Planned Parenthood, there is still no evidence of wrongdoing by the reproductive health-care provider.

See more of our coverage on the anti-choice front group, the Center for Medical Progress here.

One year ago, David Daleiden released the first in a series of videos that he claimed proved Planned Parenthood employees were unlawfully profiting from fetal tissue donation and violating the federal “partial-birth abortion” ban. With the backing and counsel of Operation Rescue President Troy Newman and the help of a woman named Sandra Merritt, among others, Daleiden had created a front group called the Center for Medical Progress (CMP).

He then disguised CMP as a legitimate biomedical research organization—despite overwhelming evidence, including CMP’s own corporate documents, to the contrary—and used it to gain access to abortion clinics and private meetings. The organization released 11 videos by the end of 2015; in a year’s time, Daleiden and CMP had released a total of 14 videos. All have been debunked as deceptively edited and misleading.

So what have those videos truly accomplished? Here’s a summary of the fallout, one year later.

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Lawmakers Mounted Attacks on Planned Parenthood

In response to CMP’s videos, more than a dozen conservative governors launched investigations into or tried to defund Planned Parenthood affiliates in their states. States like Arkansas, Kansas, and Utah had their attempts to defund the reproductive health-care centers blocked by federal court order. The Obama administration also warned states that continuing to try and strip Medicaid funding to Planned Parenthood centers violated federal law, though that did not stop such efforts throughout the country.

Additionally, congressional Republicans began their own investigations and defunding efforts, holding at least five separate hearings and as many defunding votes. Planned Parenthood Federation of America (PPFA) President Cecile Richards provided hours of congressional testimony on the lawful fetal tissue donation option available to some Planned Parenthood patients. Other affiliates do not offer such donation programs at all.

Not a single investigation at either the state or federal level has produced evidence of any wrongdoing. Still, many continue today. To date, Congress alone has spent almost $790,000 on the matter.

Violence Against Clinics Escalated

Just weeks after CMP released its first video, there was an act of arson at a Planned Parenthood health center in Aurora, Illinois. The following month, and after the release of three more smear videos, a car fire broke out behind a locked gate at Planned Parenthood in New Orleans. Abortion clinic staff and doctors around the country reported a significant uptick in threats of violence as Daleiden and CMP released the videos in a slow drip.

That violence spiked in November 2015, when Robert Lewis Dear Jr. was arrested for opening fire at a Colorado Springs Planned Parenthood, a siege that left three dead. Dear told investigating officers his violence was “for the babies” because Planned Parenthood was “selling baby parts.” A Colorado court has so far deemed Dear incompetent to stand trial. Dear’s siege was not the last incident of clinic violence apparently inspired by Daleiden and CMP, but it has, to date, been the most lethal.

Dear’s next competency hearing is currently scheduled for Aug. 11.

A Lot of Lawsuits Got Filed

The tissue procurement company StemExpress and the National Abortion Federation (NAF) filed suits in July of last year. In January 2016, Planned Parenthood did the same, alleging that Daleiden and CMP had engaged in conspiracy and racketeering, among other things.

StemExpress Sued Daleiden and CMP

StemExpress, one company to whom Planned Parenthood was supposedly selling tissue, sued CMP, Daleiden, and Merritt in California state court. StemExpress asked the court for an injunction blocking CMP from releasing any more videos that were surreptitiously recorded at meetings the pair of anti-choice activists had with StemExpress staff. The complaint also included allegations of conspiracy, invasion of privacy, and conversion of property (based upon Daleiden’s taking confidential information from a former StemExpress employee, including accessing her StemExpress email account after she was no longer employed at the company).

Although it issued a temporary restraining order (TRO), the court ultimately declined to convert that into an injunction, citing First Amendment concerns that to do so would constitute prior restraint, or pre-publication censorship, on Daleiden and Merritt’s right to free speech. In other words, Daleiden and Merritt are free—at least under this court order—to continue releasing videos involving StemExpress employees while the suit proceeds.

The case is set for trial in January 2017.

National Abortion Federation Sued Daleiden and CMP

About the same time that CMP and Daleiden were battling StemExpress in court, NAF filed suit in federal court in San Francisco, alleging civil conspiracy, racketeering, fraud, and breach of contract, among other claims. Like StemExpress, NAF sought a temporary restraining order blocking any further release of the attack videos. Judge William Orrick issued the TRO and later, after a protracted discovery battle, converted it into a preliminary injunction. Thus, CMP is prohibited from publishing any videos of footage taken at NAF’s annual meetings, which Daleiden and Merritt infiltrated in 2014 and 2015, while the suit proceeds.

As they had in their battle with StemExpress, Daleiden and CMP claimed that prohibiting publication of the videos constituted a prior restraint on speech, in violation of the First Amendment. But unlike StemExpress, which was trying to prohibit the publication of videos detailing conversations that took place in a restaurant, NAF sought to prohibit publication of video footage secretly recorded at meetings. Judge Orrick found that Daleiden had waived his First Amendment rights when he signed a confidentiality agreement at those meetings promising not to disclose any information he gained at them.

And, as in other court battles, one of the preeminent claims Daleiden and his cohorts raised to excuse his tactics—creating a fake tissue procurement company, assuming false identities through the use of false identification cards, getting people drunk in order to elicit damaging statements from them, and signing confidentiality agreements with no intention of following them—was that Daleiden is an investigative journalist.

Judge Orrick condemned this argument in strong terms: “Defendants engaged in repeated instances of fraud, including the manufacture of fake documents, the creation and registration with the state of California of a fake company, and repeated false statements to a numerous NAF representatives and NAF members in order to infiltrate NAF and implement their Human Capital Project. The products of that Project—achieved in large part from the infiltration—thus far have not been pieces of journalistic integrity, but misleadingly edited videos and unfounded assertions (at least with respect to the NAF materials) of criminal misconduct. Defendants did not—as Daleiden repeatedly asserts—use widely accepted investigatory journalism techniques.”

In an amicus brief in the same lawsuit, submitted to the Ninth Circuit Court of Appeals in early June, 18 of the country’s leading journalists and journalism scholars noted that “by calling himself an ‘investigative journalist,’ Appellant David Daleiden does not make it so.”

“We believe that accepting Mr. Daleiden’s claim that he merely engaged in ‘standard undercover journalism techniques’ would be both wrong and damaging to the vital role that journalism serves in our society,” the journalists and scholars continued.

Daleiden and CMP have appealed the preliminary injunction order to the Ninth Circuit Court of Appeals, where the case currently sits pending a decision.

Planned Parenthood Sued Daleiden and CMP

Six months after StemExpress and NAF filed their lawsuits against the orchestrators of the smear campaign, PPFA filed a whopping one of its own in California federal court, alleging civil conspiracy, racketeering, fraud, trespass, and breach of contract, among other civil and criminal allegations. PPFA was joined by several affiliates—including Planned Parenthood of the Rocky Mountains, where Dear was arrested for opening fire in November.

Daleiden has asked the court to dismiss Planned Parenthood’s claims. The court has so far declined to do so.

David Daleiden and Sandra Merritt Were Indicted on Felony Charges

Daleiden and his allies have not fared well in the civil lawsuits filed against them. But both Daleiden and Merritt also have pending criminal cases. After an investigation into Planned Parenthood Gulf Coast sparked by Daleiden’s claims, a Texas grand jury declined to indict the health-care organization for any criminal conduct. The grand jury instead returned an indictment against Daleiden and Merritt on a felony charge of tampering with a governmental record, related to their use of false California driver’s licenses in order to gain entrance into the clinic. Daleiden was additionally charged with a misdemeanor count related to the purchase or sale of human organs.

In June, Harris County Criminal Court at Law Judge Diane Bull dismissed the misdemeanor charge. Daleiden and Merritt’s attorneys, who called the dismissal a victory for the anti-choice movement, are still trying to get the felony charged dismissed.