One year after a federal court told the FDA to revisit their age restrictions related to over-the-counter access of Emergency Contraception, we're no closer to seeing real change. The Center for Reproductive Rights has brought in the bunnies to see if they might get the FDA to "hop to it."
It’s been a year since the FDA was ordered by a judge to revisit its age restrictions related to the availability of Emergency Contraception. When the FDA (finally) granted Emergency Contraception over-the-counter (OTC) status, after years of foot-dragging and political posturing during the Bush administration, they limited access to those 17 years of age and older. The Center for Reproductive Rights (CRR) took the FDA to court and on March 23, 2009, a federal court agreed that, in fact, the FDA had:
“acted in bad faith and in response to political pressure” and ordered the agency to go back and revisit the age and behind-the-counter restrictions to emergency contraception.
In fact, says the CRR, there are no scientific grounds (even according to the FDA’s own review panel!) for denying OTC access to young women under 17 years of age. Now we’re closing in on one year later and the silence from the FDA is deafening. We are no closer to seeing a change in policy despite the federal ruling.
So the CRR has decided, as we near the Back Up Your Birth Control with EC Day (March 25th), to see if cute bunnies might persuade the FDA to make a move.
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A lot has been written about how Texas' reproductive health-care restrictions codified into law in 2013 disproportionately hit low-income women of color and Latinas in particular. What's not been covered by the media, or covered enough, is how HB 2 affects undocumented people.
Read more of our coverage of Whole Woman’s Health v. Hellerstedt here.
It has been almost three years since abortion providers filed their first challengeto Texas’ omnibus anti-abortion law. As we approach March 2, the day the Supreme Court will begin hearing oral arguments for and against Whole Woman’s Health v. Hellerstedt, a lot has been written about how the reproductive health-care restrictions codified into law in 2013 disproportionately hit low-income women of color and Latinas in particular. What’s not been covered by the media, or covered enough, is how HB 2 affects undocumented people.
HB 2 contains multiple abortion restrictions, including a 20-week abortion ban, but on Wednesday the Supreme Court will specifically hear arguments on the regulations requiring abortion providers to be affiliated with nearby hospitals and limiting abortion care to ambulatory surgical centers. The implications of the case are much larger, however. As Rewirehas reported, what’s at stake in the case is not just the future of abortion access in Texas, but the impact the Court’s decision will have on clinic shutdown restrictions in states nationwide.
There are roughly 1.5 million undocumented residents in the state of Texas, 78 percent of whom emigrated from Mexico. Despite concerns from politicians that the undocumented population is growing in the state, as the Texas Tribune reported, the Migration Policy Institute found that it has remained relatively unchanged in recent years, with more than half of the state’s undocumented immigrants having lived in Texas for more than a decade.
As Texas’ undocumented population remains fixed in place, the state legislature has fought to deny this group basic human rights, whether it’s by challenging an Obama administration executive action designed to expand temporary protection from deportation for millions of undocumented immigrants—effectively stopping Deferred Action for Parents of Americans and Lawful Permanent Residents (DAPA) in its tracks—or pushing to have the state’s family detention centers licensed as child-care facilities with reduced standards. The state’s enactment of HB 2 is yet another example of the way it has targeted one of the country’s most vulnerable communities.
As the Center for Reproductive Rights reported, it is the 2.5 million Latinas of reproductive age in Texas that are disproportionately affected by HB 2, which has closed more than half of the state’s clinics, most of them in predominately Latino areas.Though it’s unclear what percentage of those Latinas are undocumented, what is known is that immigrant women already experience significant barriers when trying to access sexual and reproductive health care and HB 2 only made things worse.
Ana Rodriguez DeFrates is on the front lines of the reproductive rights battleas the Texas Latina Advocacy Network state policy and advocacy director for the National Latina Institute for Reproductive Health (NLIRH), one of more than 40 organizations that filed an amicus brief in Whole Woman’s Health. DeFrates says that “without question,” those most affected by HB 2 are the people already adversely affected by current health-care practices and immigration laws.
“We’re a reproductive [justice] organization in Texas and we see every day that it’s the same population of people most impacted that are not invited to the conversation about the policies that impact them,” DeFrates told Rewire. “I can say that ignoring the implications of immigration status [whether a person is a citizen or undocumented] when it comes to accessing health care—especially sexual and reproductive health care—would be to paint a very inaccurate and incomplete picture of what is happening in Texas.”
Since HB 2 went into effect, the southernmost region of Texas—the Rio Grande Valley—has lost all but one abortion clinic, Whole Woman’s Health of McAllen. If the remaining clinic in the Rio Grande Valley were to shut down, the only option would be driving north to San Antonio to the nearest abortion provider, but that’s not really an option if you’re undocumented. Transportation and immigration checkpoints are just two of the hurdles undocumented people must clear under HB 2.
“There are internal immigration checkpoints that exist upwards of 100 miles north of the actual Texas/Mexico border,” DeFrates told Rewire. “If you’re undocumented, you simply couldn’t get to the heart of the state where abortion access is available. And even then, we’re assuming you can take the time off work it would require for the multiple days it now requires because of increased restrictions that now mandate increased office visits and increased wait times.”
“We’re also assuming … that you have the money and means available to travel that distance and that you have child care available to you. It assumes a lot. You cannot separate immigration from HB 2 or bigger conversations surrounding health care. They are operating together and impacting lives together,” DeFrates said.
Advocates in Texas working for organizations like NLIRH are doing more than fighting for access to abortion; they are fighting strong anti-immigrant sentiments. In the state, unions representing Border Patrol and Immigration and Customs Enforcement (ICE)work with anti-immigrant groups to undermine immigration policies and promote anti-immigrant views. As the Texas Medical Association reported, legislation from 1986 to 2013 has made it increasingly difficult for undocumented people with chronic illnesses to receive safe and affordable care, forcing them to rely on costly emergency rooms, often after their condition has worsened. Whether Texas legislators set out to target low-income people of color cannot be confirmed, but advocates say intent hardly matters when vulnerable people are suffering.
A few months ago, organizers at NLIRH met a woman who would have to walk 45 minutes from her colonia to the nearest bus stop.
“That is a long walk and she is scared to make that walk because of the increasing number of law enforcement she encounters,” DeFrates said. “She’s scared because she’s undocumented, but she needs to get to that bus because that’s her only way to her health-care appointment.”
The woman told NLIRH organizers that she would rather live with the pain in her abdomen than risk deportation or separation from her family.The woman’s circumstances and concerns call to mind Blanca Borrego, the undocumented mother of three arrested this past September when seeking treatment for a cyst that was causing abdominal pain at Texas’ Memorial Hermann Medical Group Northeast Women’s Healthcare clinic.
The staff member who called the authorities on Borrego because she provided the staff with a fake driver’s licensesaidthey were simply “enforcing the law,” the Los Angeles Times reported. Situations like this could be avoided if, like the State of California for example, Texas issued driver’s licenses to undocumented immigrants. Instead, Texas is arguing that President Obama’s deferred action executive order would cause the state to “incur significant costs in issuing driver’s licenses to DAPA beneficiaries.” If an injunction had not been placed on DAPA, Borrego would have been eligible for deferred action.
According to Texas’ attorneys, subsidizing licenses for DAPA beneficiaries would cause the state to lose a minimum of $130.89 on each license issued. But a report from the Institute on Taxation and Economic Policy found that with full implementation of DAPA and Obama’s other executive actions, Texas could see returns of nearly $59 million.
Even before HB 2, things were bad for Latinas and undocumented women,who had few places to turn for contraception and other preventive reproductive health services after 2011when Texas gutted the public family planning program. Texas invested $50 million in a new program that combines family planning with other health services, like diabetes screening; Planned Parenthood, however, was not allowed to participate. The Center for Reproductive Justice reports that Latinas have far fewer options for controlling their reproduction and are two times more likely to have an unintended pregnancy than their white counterparts.
“At best, these policies are ignorant. At worst, they are attacks on our communities,” DeFrates said. “When you look at how many Latinas are dying of cervical cancer, when you look at how many clinic closures occurred as a result of the 2011 budget cuts in Texas where two-thirds of family planning was slashed, when you look at where these communities are and who inhabits them, when it seems no one is considering the needs of low-income people of color, one has to question whether these policies are rooted in racism.”
The majority of cervical cancers are preventable, yet Latinas continue to die without adequate testing and care; they have the highest incidence of cervical cancer among all ethnic or racial groups and the second highest mortality rate. As NBC Latino reported, the situation is even worse for Latinas in Texas, whose rates are 19 percent higher than the national average and 11 percent higher than the national average for Latinas.
“There is no reason in this day and age why you should be dying from this, yet Latinas in Texas are dying at a higher rate than other people. What did the Texas legislature do in response? Instead of ensuring that not one more woman died from this very preventable disease, it cut the number of providers that can participate in the cervical cancer screening program. That directly impacts Latinas and makes it harder for undocumented women to access preventive care, and we told them that. We told them that through organizing, through public testimony at the capitol, yet they moved forward with it,” DeFrates said.
As March 2 approaches, advocates like DeFrates are trying to remain hopeful that the Court will recognize the overarching implications of HB 2 and the ways in which the law puts already vulnerable communities at greater risk. The recent normalizing of anti-immigrant sentiments espoused by those seeking the highest public office—the presidency—can understandably make it hard to remain positive, but DeFrates says it’s imperative to continue fighting.
“For us in Texas, this isn’t a short-termissue. It’s not about one case or an election or whether or not we’re in legislative session,” DeFrates said. “It’s a long-term fight. We’re going to continue centering the lives of those directly impacted because bad things happen when the voices of those most impacted aren’t heard. In Texas, this is really life or death.”
The need for emergency contraception among women who rely on the Indian Health Service is clear. Some Native American women are in rural areas where the next-closest pharmacy may be hundreds of miles away, and they may not have transportation.
The Indian Health Service (IHS) released a long overdue policy last week that will make over-the-counter emergency contraception more accessible for Native American women of all ages.
The policy comes more than two years after the U.S. Food and Drug Administration (FDA) lifted age restrictions on certain emergency contraceptive pills and more than six months after a group of U.S. senators called on the Department of Health and Human Services (HHS) to develop a policy that would ensure access for women who rely on IHS.
A 2014 survey by the Native American Women’s Health Education Resource Center found that access to emergency contraception (EC) varied widely at 69 IHS centers. Some Native American women are in rural areas where the next-closest pharmacy may be hundreds of miles away, and they may not have transportation.
EC is a high dose of the hormones found in birth control pills that can prevent pregnancy by inhibiting ovulation. EC can work if taken up to five days after unprotected sex, but the sooner it is taken, the more effective it can be. That’s why immediate access is important. It is also why advocates for access to this method of birth control fought for almost a decade to make it available without a prescription.
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In July 2009, the FDA approved one of the available versions of EC—marketed as Plan B One-Step— for over-the-counter sale, but limited the sale to women 17 and older. Younger women still needed a prescription.
The FDA in April 2013 lowered the age restriction to 15. A few months later, however, the FDA agreed to comply with a district court ruling and declared that Plan B One-Step would be available without a prescription for “all women of reproductive potential,” regardless of age.
A group of lawmakers led by Sen. Barbara Boxer (D-CA) asked HHS in March for a policy that would ensure that pharmacies run by IHS would follow the new guidelines and make EC easily available, as Rewirereported.
Though HHS promised it was working on the policy in 2013, it released nothing until this week. When Boxer and colleagues readdressed the issue earlier this year, Boxer had conducted a survey of 20 IHS pharmacies and found that some did not offer EC at all, some continued to require a prescription, and others only allowed women of certain ages to access the pills.
The need for EC among women who rely on IHS is clear. As the ACLU has noted, Native Americans face rates of sexual assault that are more than twice as high as other women in this country: One out of three Native American women will be raped during her lifetime. Access to EC is vital for rape survivors.
The policy was finally released last week and is fairly simple. It states, “It is IHS policy the Plan B One-Step emergency contraception pill is easily available through the IHS facilities’ pharmacy, Emergency Department (ED), and in health clinics that are equipped with secure medication storage areas.”
The challenge now is to make sure it is widely implemented.
“The updated policy IHS released today is a long overdue and important step toward ensuring that Native American women have equal access to emergency contraceptive care,” Georgeanne Usova, legislative counsel for the ACLU, said in a statement. “The policy must now be rigorously enforced so that every woman who relies on IHS for her health care can walk into an IHS pharmacy and obtain the services she needs and is legally entitled to.”