News Contraception

Almost Fifty Years After Griswold, We’re Still Fighting for Access to Contraception

Jodi Jacobson

Nearly 50 years after the landmark 1965 Supreme Court decision Griswold v. Connecticut, which legalized family planning and the right to individual privacy in family planning decisions, women in the United States are battling to maintain their right to access birth control.

June 7th, 2011 marks the 45th anniversary of the landmark 1965 Supreme Court decision Griswold v. Connecticut, which legalized family planning and the right to individual privacy in family planning decisions. But nearly 50 years later, women in the United States can hardly find cause for celebration, because we are engaged in a full-on battle to maintain access to contraception.

The fact that we find ourselves in this situation is astonishing to say the least, and speaks to how deeply we have succumbed to what are commonly referred to as “culture wars,” but in reality is the triumph of pure religious ideology and blibical fundamentalism (on one side) over science, public health, medicine and clinical practice, and human rights on the other. 

Family planning–the means through which people exercise their right to decide whether and when to have children, how many children to have and at what intervals–has been cited by the Centers for Disease Control and Prevention (CDC) as one of the ten great public health achievements of the 20th century because of the huge gains it yields in maternal and infant survival and in the health and survival of children ages 0 to 5 years. 

Family planning also has vast economic and social benefits. In the United States, analyses conducted by the Guttmacher Institute show that family planning services are vital to the health and well-being of poor and low-income women in general, and marginalized populations in particular.  Publicly-funded family planning programs provide:

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  • a gateway into the U.S. health care system for women who would otherwise only have a tenuous connection to medical care, or none at all;
  • a source of urgently needed contraceptive services and other sexual health care for young women in foster care, who are at high risk of unintended pregnancy; and
  • a highly successful public health program that saves billions in taxpayer dollars, and averts significant numbers of unintended pregnancies, unplanned births and abortions.

Moreover, support for family planning and contraception is widespread. Ninety-eight (98) percent of women in the United States have used birth control at some point in their lives.  Ninety-three percent of all voters believe all couples should have access to birth control. Six in ten women get health care from a publicly-funded family planning center and consider it their regular source of health care.

Results of a new public opinion poll reveal that Americans strongly believe in the importance of family planning as a basic preventive measure. “This sentiment crosses all demographic and political lines and rises to the level of a core value,” notes Celinda Lake of Lake Research Partners, the firm that conducted the polling.

Lake also found that support for maintaining access to family planning services outweighs arguments for cutting family planning funding to help address the current budget crisis.

By a margin of roughly two to one, Lake reports:

Americans side with the view that everyone has a right to safe, affordable family planning services over the opposing position that with today’s budget crisis we should not be spending taxpayer money on family planning services. This sentiment is consistent across most demographic groups.

Nonetheless, ideologues have hijacked the U.S. House of Representatives, state legislatures, the media and the public discourse around reproductive and sexual health, and there has been a barrage of legislation and other efforts to reduce access to birth control.

Earlier this year, for example, the House of Representatives voted to completely de-fund Title X (H.R. 1), the national family planning program, for the first time in the program’s history.  While the bulk of funds were restored, the Final Fiscal Year (FY) 2011 spending bill (H.R. 1473) signed into law by President Obama cut funding for Title X by $18.1 million at a time when more and more low-income women are seeking care and services from this program than ever before.

Title X Funding — FY 2011

 FY 2011 Final

FY 2010 Final

Change FY 2010 to FY 2011

FY 2012 President’s Request

FY 2012 NFPRHA’s Request

$299.4 million $317.5 million -$18.1 million $327.4 million $327.4 million

As noted by the National Family Planning and Reproductive Health Association (NFPRHA), some members of Congress are trying to cut Medicaid along with Title X:

[Medicaid] is a critical funding source for family planning and other health care for low-income and poor individuals.  [They also are trying to] undermine the Affordable Care Act. Further, an unprecedented effort is underway among states to refuse Title X funds, prohibit certain types of providers from receiving state and/or federal funds, and cut Medicaid enrollees and benefits, all of which would make it harder for low-income women to get birth control.

“De-funding the Title X program, along with cuts to many other important public health programs–especially at a time when the need is so great–is reckless and offensive,” states NFPRHA. 

Conservative activists are heartlessly going after what is often the only source of health care for the most vulnerable in our society. This is a fiscally irresponsible attack on women’s access to essential health care.

The so-called pro-life movement also has been taking advantage of “conscience clauses” and refusal clauses–those that allow pharmacists to refuse to fill prescriptions for birth control–to reduce access at the point of delivery, creating especially onerous obstacles for women in rural areas who have fewer choices from the get-go.

At the state level, there is a widespread movement by GOP- and Tea-Party dominated legislatures to de-fund family planning programs.  According to NFPRHA, patient visits are increasing, but public funding, patient fees and private fundraising have all fallen during the recession. “Many Title X-funded systems have cut hours, frozen hiring, furloughed staff, or reduced staff through attrition or layoffs in order to cope with falling revenue in the recession,” states NFPHRA.

NFPHRA notes that in addition to the 280,000 people Arizona Governor Jan Brewer (R) proposes eliminating from the state’s Medicaid rolls, she has also called for a 5 percent cut in Medicaid provider rates – which became effective in April. Providers are already struggling to meet the needs of the poor and low-income – a rate cut in the Medicaid serves only to further reduce access to care for the medically under-served.

Alongside these budget cuts, efforts to establish “personhood” laws at the state level have proliferated. So-called personhood laws would decree that life begins at conception, effectively banning both abortion and contraception.  Hormonal contraceptives can prevent a fertilized egg from implanting in the uterine lining and establishing, what is according to medical definition, an actual pregnancy. But for the personhood movement, a fertilized egg has more rights than the woman in whose body it floats, so hormonal contraception is anathema.

Attacks on family planning by extremist politicians have been met by relative silence from the Obama Administration, which has done little to challenge the misinformation put out by the far right, to change the public discourse in a more positive way, or to move the ball forward.  For one thing, the Administration punted on making birth control part of the primary care package paid for under health reform when it had the momentum behind it and instead sent the issue to the Institutes of Medicine for “review.” Now, this issue is set to be decided during the high-stakes debt-ceiling debates and at the beginning of what promises to be a cut-throat Presidential election. For another, President Obama appears to persist in believing that there is “common ground” between those who feel it is an individual’s right to act in accordance with their own moral and religious beliefs when it comes to deciding whether and when to have children, and those who seek to impose their own form of biblical law on everyone and sundry.

For the vast majority of Americans, supporting access to family planning services and contraceptive supplies is a no-brainer.  Lake’s poll shows that 84 percent of Americans view family planning, including contraceptives and birth control, as important to basic preventive health services. “Of these,” Lake states, “a full 67 percent feel very strongly [about the issue]. 

Moreover, Lake notes, “It’s an election issue.” The poll found that 40 percent of voters said they would be less likely to support elected officials who vote to defund family planning programs. [Listen to an audio briefing at which Lake and others speak on these issues]. 

But despite the evidence on the public health benefits, the polling, and the fact that close to 100 percent of the population uses contraception at some point in their lives, we are engaged in a full-blown battle for access to birth control nearly fifty years after the issue was considered settled.  Access to contraception and family planning services at the state and federal level–including under the Affordable Care Act–is far from secure.  And the fact that we are in this position is testament to the ability of a very small minority to deny literally millions of people basic health care when a larger majority take it for granted.

Commentary Politics

Why Political Platforms Must Center the Most Marginalized People

Monica Simpson

"To ensure that all people and all families have the opportunity to thrive, our political platforms must be intersectional, so that the most marginalized are centered and our whole lives are honored," said SisterSong Women of Color Reproductive Justice Collective Executive Director Monica Simpson in a recent speech.

Editor’s note: This speech was given by SisterSong Women of Color Reproductive Justice Collective Executive Director Monica Simpson before the Democratic National Convention Platform Drafting Committee on June 17. The hearing was held as part of a process to determine “what should be included in the party’s platform for the July 2016 convention in Philadelphia.” A version of the statement will be sent to the Republican National Committee. We are reprinting it here with permission from SisterSong.

So for identification purposes, thank you for saying who I am. I’m really excited to be here as a volunteer and advocate to provide information to the drafting committee about the importance of reproductive justice and to highlight how the platform might address the priorities, experiences, and struggles of women of color.

So I grew up in the rural South, in a town with only one stoplight, in a town where racial divide was blatantly drawn by railroad tracks that split the town from the haves and the have-nots. I remember being forced to sign the prom promise that locked us into abstinence-only sex education, where we were given that [information about sexual health] only over one course period. And unfortunately, this is still the case.

Also in my church, the place where most Black people in my Southern community received political education, every young woman except three of us were pregnant before graduating high school. The nearest abortion clinic for those who were strong enough to endure the shame of their community and the church was 30 miles away. There were no sidewalks, or public transportation system, to get a person there, even if they wanted to have one.

Most felt stuck within the town limits, where the jobs were basically nonexistent. The then-newly built private prison that needed to be filled was a constant reminder of the criminal justice system that separated so many young mothers from the fathers of their children.

In this story, you can see how the overlapping issues like race, economic barriers, faith, and criminal justice can make it difficult and sometimes impossible for marginalized communities to access the services that they need. This is what intersectionality looks like. And it’s because of these types of stories like mine that Black women came together to establish the reproductive justice movement, now 20 years ago.

Reproductive justice, distinct from reproductive health and rights, is a movement-building framework that envisions liberation for the most marginalized. We believe that reproductive justice will be achieved when all people have the economic, social, and political power and means to make decisions about their bodies, sexuality, faith, and family with dignity and self-determination. As you can imagine, we have a long way to go.

To ensure the health and safety of women of color, I urge you to address the formidable barriers that prevent us from getting the care we need, deny our decisions, and lead to shameful disparities. [Together], we must complete the work to ensure health care for all by expanding Medicaid nationally and passing the Health Equity and Accountability Act. This act eliminates health disparities, and the one issue [to] address most importantly to us and our work right now is the issue of maternal mortality.

Black women are dying during pregnancy, childbirth, and the postpartum period at [rates] nearly four times higher than white women. This is a public health crisis and a national shame. We must stop it in its tracks and the avalanche of state laws that push access to safe and legal abortion out of reach for people of color by those struggling to make ends meet. This isthis will be helped by ending the Hyde Amendment that puts a ban on insurance coverage for abortion, and passing the Women’s Health Protection Act which removes barriers to access.

Of course, our ability to make real decisions about pregnancy cannot be separated from the economic realities in our lives. And furthermore, everyone needs to feel safe, especially mothers and pregnant women. But unfortunately, pregnant women dealing with substance abuse are being overly criminalized in states like Tennessee. Women like Marissa Alexander in Florida [were] imprisoned for protecting [their] family and women like Purvi Patel and Kenlissia Jones were criminalized for ending their pregnancies.

The intersection of criminal justice and our reproductive lives is real and something that we cannot ignore.

Now more than ever, women of color are standing up for the issues that matter to us and demanding change, and we are voting. Change in policies, change in the political discourse, and change in leadership are needed to ensure that our communities are no longer ignored. Like the platform as a whole, this is not a one-note plan. One of my sheroes, Audre Lorde, said we cannot have single-issue movements because we do not live single-issue lives. To ensure that all people and all families have the opportunity to thrive, our political platforms must be intersectional, so that the most marginalized are centered and that our whole lives are honored.

This speech has been lightly edited for clarity.

***

Watch the full video, including the Q&A following Simpson’s speech, here:

Commentary Contraception

Zika Threat Shows Urgent Need for Better Contraceptive Access

Julie Rabinovitz

As summer approaches and global officials continue to issue warnings about Zika, U.S. federal and state officials can allocate funds and expand insurance coverage to ensure contraceptive access.

Pressure is mounting on Congress to send President Obama a sufficient spending bill to combat the Zika virus’ spread.

The House and Senate recently passed their own measures, both proposing less than the $1.9 billion the president requested. But now they must work out their differences for the sake of our public health. Currently, none of these proposals include funding for Title X, the federal program that provides low-income people with family planning services, birth control, and other preventive reproductive health services. With the potentially life-changing outcomes that can result from contracting Zika, federal and state action is urgently needed to support prevention efforts and increase access to the full range of contraception available nationwide.

There’s no time to waste. More than 600 people in the continental United States, including at least 150 pregnant women, have already been infected with Zika. This month, a New Jersey infant exposed to Zika was born with the birth defect microcephaly, where a baby’s head is smaller than expected. Many more Americans have been affected in Puerto Rico and other U.S. territories. Local transmission is expected to spike as warmer weather approaches and climate conditions become more favorable to the virus’s primary vector, the Aedes aegypti mosquito.

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The Centers for Disease Control and Prevention (CDC) have reported significant evidence showing links between Zika and adverse pregnancy and birth outcomes, including miscarriage, stillbirth, and fetal abnormalities. Brain damage in Zika-infected babies is proving to be far worse than doctors initially thought. Zika has been found to attack lobes of the fetal brain that control thought, vision, and movement. Exposure to Zika was first considered to be a threat for women in the first trimester only, but there is growing concern about the possibility of maternal-fetal transmission throughout pregnancy.

It has also been discovered that men infected with Zika can transmit the virus to their sexual partners through semen, where the virus is stored much longer than in the blood.

As more individuals learn about the potential health risks linked to the virus, many will want and need services and information to help them effectively avoid or postpone pregnancy. Extensive research already shows the public health value and taxpayer savings associated with preventing unintended pregnancy.

Now with Zika, the stakes are even higher.

Congressional leaders must act without delay to pass a comprehensive Zika funding and preparedness package that includes additional resources for Title X to expand access to reliable birth control, related services, and counseling to low-income and uninsured people. Increased funding for these essential services is needed on the ground now, especially in regions expected to be disproportionately affected by the virus. The threat is particularly worrisome in areas that experience the warmer weather that’s conducive to Zika-carrying mosquitoes.

On the state level, elected leaders across the country should require public and commercial health plans to cover all—not just some—FDA-approved birth control. After the passage of the Affordable Care Act (ACA), California was one of the first states to approve a contraceptive-coverage equity law that codified the spirit of the ACA’s contraceptive mandate, also known as the birth control benefit, by requiring health plans to cover all methods of contraception without cost sharing or restrictions. Maryland recently enacted a similar measure that also requires coverage for vasectomies, and several other states are considering legislation with the same intent. The Zika threat makes passage of these kinds of laws across the country time-sensitive. State Medicaid programs must also adopt reimbursement and coverage policies that break down barriers enrollees may face in accessing the full range of effective contraceptive methods.

Patients must be able to get the method they can use safely and consistently. That means health-care professionals across the country, including those in primary-care settings, must offer all forms of available birth control. Providers need training to support their patients in accessing the contraceptive method that is best suited for their health and reproductive life goals. Even some OB-GYNs can use training on newer methods and updated best practices.

Many unknowns remain regarding the Zika virus, which has quickly become one of the world’s greatest public health challenges. But a concerted and proactive response—that includes improved access to contraception—must be implemented before Zika becomes a national public health crisis here in the United States.

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