Analysis Contraception

Contraception: Expand Access, Not Exemptions

Jessica Arons

A broad religious exemption for contraceptive coverage would go too far, depriving millions of women of an important health benefit. Instead of expanding exemptions, we should be expanding access to affordable care.

This article is cross-posted with permission from ThinkProgress Health.

As the Obama Administration debates whether to expand an exemption to a new health insurance requirement to cover all FDA-approved methods of contraception, there are some important facts to keep in mind:

– The average woman spends five years pregnant, postpartum, or trying to get pregnant, and at least 30 years trying to avoid pregnancy.

More than 99 percent of women of reproductive age who have had sexual intercourse have used at least one method of family planning.

Appreciate our work?

Vote now! And help Rewire earn a bigger grant from CREDO:

VOTE NOW

– Contraception is the most commonly prescribed medication for women ages 18 to 44

Eighty-eight percent of voters support access to birth control

– Approximately three-quarters of Americans agree that insurance should cover contraception

Fifty-eight percent of pill users rely on oral contraception at least in part for non-contraceptive reasons

Eighteen percent of women on the pill reported inconsistent use, such as skipping doses, as a cost-cutting measure

Under the Affordable Care Act, or the ACA, women will benefit from greatly expanded access to contraception—which has been shown to improve health. But this important consumer protection is at risk of being undermined by an unreasonably expansive religious exemption.

Congress recognized that cost was a major barrier for women in accessing care. In response, it passed the Women’s Health Amendment, which required health plans to cover preventive services for women with no cost-sharing such as co-pays. Contraception was included among the comprehensive list of services deemed preventive based on an assessment of their effectiveness by the Institute of Medicine, an independent body of experts that issues unbiased, evidence-based guidance on matters of importance to public health.

Indeed, the Department of Health and Human Services asked the IOM to determine which services should be covered so that there would be no question of political interference. HHS then adopted the IOM’s recommendations in full—but with one important exception. HHS exempted from the contraceptive-coverage requirement those organizations whose purpose is to promote religious values, who primarily employ and serve persons who share their religious tenets, and who qualify for a religiously-related non-profit tax status—in sum, churches and other houses of worship, church conventions, and the religious activities of religious orders.

But this exemption was not enough for anti-contraception forces. They went on the attack and pushed for a much wider exception that would include universities, hospitals, social service organizations, and potentially any religiously-affiliated non-profit organization.

While a main purpose of the ACA was to ensure that everyone has the same guarantee of a baseline set of health care services, the number of people who work for an institution that meets the proposed exemption is relatively small. The same cannot be said, however, for the numerous religiously-affiliated organizations in our society that employ people from many different faiths, as well as those with no faith, and serve the general public. Almost 800,000 people work in Catholic hospitals alone. Religious universities employ and teach around 2 million. Then there are the hospices, nursing homes, and non-profits that help victims of trafficking, people living with AIDS, children in need of adoption, and people struggling with addiction—fields that employ high numbers of women.

All of these workers, students, and their dependents would be affected by an expanded religious exemption. Millions of women could have their consciences—that tell them using birth control is the morally right thing to do—overridden by those who privilege an institution’s tenets over an individual’s. These institutions may be guided by sincere, religiously-informed principles, but they engage in secular activities, such as providing an academic education or long-term care services, and they are sought out for those services, not for religious teachings.

It is for these reasons that the proposed HHS exemption mirrors the most common exemption in the 28 states that already require employers to offer contraceptive coverage if they cover other prescription drugs and devices. And it is for those reasons that courts have upheld challenges to those laws, finding that a neutral, generally applicable law not targeted at religion does not burden the right to free exercise of religion. In fact, there is the possibility that a broader exemption would violate the law. The Equal Employment Opportunity Commission has found that the exclusion of prescription contraception from an employer-sponsored health plan constitutes sex discrimination because it only burdens women.

The small minority in this country that opposes contraception is entitled to its opinion and should be free to preach it as often as it wants. But this very dispute belies the fact that only a fraction of followers practices what is being preached. Only 2 percent of sexually active Catholic women, for instance, have not used some form of modern contraception. Contraception opponents are resorting to coercion where persuasion has failed.

Freedom of conscience is a bedrock American principle and religious exemptions can be a useful way to protect conscience, but they must be employed judiciously. Otherwise, issues of conscience become trivialized and turn into excuses for discrimination. If religious employers are allowed to object to contraceptive coverage now, will they one day be able to opt out of covering HIV services, HPV tests, health care for transgendered people, blood transfusions, or end-of-life care? If we are not careful, claims of religious liberty could be exploited by religious organizations to justify noncompliance with laws they prefer to ignore.

President George W. Bush tried to adopt an overly expansive “conscience clause” right before he left office. The Obama Administration wisely rescinded most of that rule, “based on concerns expressed that it had the potential to negatively impact patient access to contraception and certain other medical services….” This should not be an occasion to reverse course. The pending regulation is the first to interpret and implement the Women’s Health Amendment and will establish an important precedent. Imagine where a more conservative Administration would go if we start with an expansive loophole that waters down the ACA’s important protections.

Most of us want to live in a world where all children are wanted, nurtured, and adequately cared for. Birth control enables women to plan their pregnancies and avoid being placed in the difficult position of having to decide whether to continue or end a pregnancy for which they feel unprepared. Family planning also results in better health outcomes for women and their children—a woman who has a planned pregnancy is more likely to be in better health when she gets pregnant and more likely to seek prenatal care, and children who are born at least two years apart are healthier, and possibly smarter.

A broad religious exemption for contraceptive coverage would go too far, depriving millions of women of an important health benefit. Instead of expanding exemptions, we should be expanding access to affordable care.

News Abortion

Anti-Choice Leader to Remove Himself From Medical Board Case in Ohio

Michelle D. Anderson

In a letter to the State of Ohio Medical Board, representatives from nine groups shared comments made by Gonidakis and said he lacked the objectivity required to remain a member of the medical board. The letter’s undersigned said the board should take whatever steps necessary to force Gonidakis’ resignation if he failed to resign.

Anti-choice leader Mike Gonidakis said Monday that he would remove himself from deciding a complaint against a local abortion provider after several groups asked that he resign as president of the State of Ohio Medical Board.

The Associated Press first reported news of Gonidakis’ decision, which came after several pro-choice groups said he should step down from the medical board because he had a conflict of interest in the pending complaint.

The complaint, filed by Dayton Right to Life on August 3, alleged that three abortion providers working at Women’s Med Center in Dayton violated state law and forced an abortion on a patient that was incapable of withdrawing her consent due to a drug overdose.

Ohio Right to Life issued a news release the same day Dayton Right to Life filed its complaint, featuring a quotation from its executive director saying that local pro-choice advocates forfeit “whatever tinge of credibility” it had if it refused to condemn what allegedly happened at Women’s Med Center.

Appreciate our work?

Vote now! And help Rewire earn a bigger grant from CREDO:

VOTE NOW

Gonidakis, the president of Ohio Right to Life, had then forwarded a copy of the news release to ProgressOhio Executive Director Sandy Theis with a note saying, “Sandy…. Will you finally repudiate the industry for which you so proudly support? So much for ‘women’s health’. So sad.”

On Friday, ProgressOhio, along with eight other groupsDoctors for Health Care Solutions, Common Cause Ohio, the Ohio National Organization for Women, Innovation Ohio, the Ohio House Democratic Women’s Caucus, the National Council of Jewish Women, Democratic Voices of Ohio, and Ohio Voice—responded to Gonidakis’ public and private commentary by writing a letter to the medical board asking that he resign.

In the letter, representatives from those groups shared comments made by Gonidakis and said he lacked the objectivity required to remain a member of the medical board. The letter’s undersigned said the board should take whatever steps necessary to force Gonidakis’ resignation if he failed to resign.

Contacted for comment, the medical board did not respond by press time.

The Ohio Medical Board protects the public by licensing and regulating physicians and other health-care professionals in part by reviewing complaints such as the one filed by Dayton Right to Life.

The decision-making body includes three non-physician consumer members and nine physicians who serve five-year terms when fully staffed. Currently, 11 citizens serve on the board.

Gonidakis, appointed in 2012 by Ohio Gov. John Kasich, is a consumer member of the board and lacks medical training.

Theis told Rewire in a telephone interview that the letter’s undersigned did not include groups like NARAL Pro-Choice and Planned Parenthood in its effort to highlight the conflict with Gonidakis.

“We wanted it to be about ethics” and not about abortion politics, Theis explained to Rewire.

Theis said Gonidakis had publicly condemned three licensed doctors from Women’s Med Center without engaging the providers or hearing the facts about the alleged incident.

“He put his point out there on Main Street having only heard the view of Dayton Right to Life,” Theis said. “In court, a judge who does something like that would have been thrown off the bench.”

Arthur Lavin, co-chairman of Doctors for Health Care Solutions, told the Associated Press the medical board should be free from politics.

Theis said ProgressOhio also exercised its right to file a complaint with the Ohio Ethics Commission to have Gonidakis removed because Theis had first-hand knowledge of his ethical wrongdoing.

The 29-page complaint, obtained by Rewire, details Gonidakis’ association with anti-choice groups and includes a copy of the email he sent to Theis.

Common Cause Ohio was the only group that co-signed the letter that is decidedly not pro-choice. A policy analyst from the nonpartisan organization told the Columbus Dispatch that Common Cause was not for or against abortion, but had signed the letter because a clear conflict of interest exists on the state’s medical board.

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.

Appreciate our work?

Vote now! And help Rewire earn a bigger grant from CREDO:

VOTE NOW

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.

credo_rewire_vote_3

Vote for Rewire and Help Us Earn Money

Rewire is in the running for a CREDO Mobile grant. More votes for Rewire means more CREDO grant money to support our work. Please take a few seconds to help us out!

VOTE!

Thank you for supporting our work!