Commentary Contraception

“Dr.” Sebelius’s Bitter Pill: A Case of National Malpractice

Kirsten Moore

"Dr." Kathleen Sebelius prescribed us a bitter pill when she ignored overwhelming evidence on the safety and effectiveness of emergency contraception to prohibit its sale over-the-counter.  Is this change we can believe in?  It’s certainly not a “common sense” solution. President Obama and Secretary Sebelius should listen to real doctors and the FDA Commissioner, and make this decision based on science, not politics.

See all our coverage of the Administration’s 2011 Emergency Contraception Reversal here.

This week Doctor Kathleen Sebelius prescribed us a bitter pill…

But wait, she’s not a doctor, but rather a political bureaucrat, former politician, former lobbyist for the Kansas Trial Lawyers. This week she only played a doctor, and in so doing she ended up committing national malpractice.

Despite the overwhelming recommendation of medical experts, including the American Academy of Pediatrics, the American College of Obstetricians and Gynecologists, the American Medical Association, as well as her own Federal Drug Administration (FDA) Commissioner, Not-a-doctor Sebelius decided to substitute her own medical judgment and continue to limit the accessibility of the Emergency Contraceptive Plan B One-Step.

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On the same day that FDA Commissioner Hamburg confirmed that Plan B One-Step had been carefully evaluated for more than a decade and as a result deemed safe and effective for its intended use based on scientific evidence, Secretary Sebelius formally kicked off the 2012 election by siding with the political professionals over the medical professionals.

Even though the Administration’s own FDA Commissioner along with a group of experts from the Center for Drug Evaluation and Research, which included obstetricians, gynecologists and pediatricians “reviewed the totality of the data and agreed…that Plan B One-Step should be approved” for non-prescription, over-the-counter access, Secretary Sebelius thought otherwise.

She ignored the experts, a decision that will have far reaching public health ramifications, not least of which is undermining the FDA decision-making process itself.

And remember, this comes from an Administration that vocally and quite often accused the previous administration of elevating politics over science.

Just newly elected, in March of 2009, the Obama Administration declared: “…in this new administration, we base our public policies on the soundest science…(not) politics or ideology…”

Unfortunately, this week’s decision on whether to grant over-the-counter access to Plan B One-Step confirms that President Obama’s declaration of science first may in fact be nothing but politics.

And today the Obama Administration looks a lot more like the Bush Administration it used to so openly mock for its prioritization of politics over science. And there have to be those in the Administration wondering how politically astute it is to have become Bush Lite on vital national health considerations.

But let’s not allow Secretary Sebelius’ bad advice to the President to diminish just how profound a change this would have been for America’s women.

It would have been the first new contraceptive readily available on store shelves in more than a generation. It would have been a groundbreaking step in normalizing contraception. It would have provided women greater access to safe and reliable contraception, an essential part of basic health care.

On-the-shelf access emergency contraception just makes sense, because things don’t always work out as planned. All women need timely access to a safe, effective backup method of contraception if they (or their partner) failed to use a method, or if their chosen method failed them. And for those concerned about providing emergency contraception to teenagers, the National Campaign to Prevent Unintended Pregnancy has confirmed that there is “no evidence to suggest making contraception, including emergency contraception, available to teens encourages them to begin having sex, to have sex at younger ages, or to have more sexual partners”.

Most of the nation’s medical professionals agree that Plan B One-Step should be available without prescription, just not Doctor Sebelius.

And so when presented an opportunity to take a significant step forward for women and correct the rightwing, ideologically driven decision of the Bush Administration, the Administration has taken two huge steps backward.

They took the bait that the best way to protect teens was to limit access to contraception instead of recognizing that when teens do become sexually active, the best way to protect them is to ensure they have access to safe, effective birth control, including backup methods.

Is this change we can believe in?

It’s certainly not a “common sense” solution.

And now we can only ask that President Obama do what Secretary Sebelius should have done in the first place, listen to the real doctors and the FDA Commissioner, and have this decision driven by science, public health and clinical expertise, not politics.

Because this is a bitter pill no American woman should have to take.

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Reproductive Health Technologies Project advances the ability of every woman of any age to achieve full reproductive freedom with access to the safest, most effective, appropriate and acceptable technologies for ensuring her own health and controlling her fertility.  

Commentary Human Rights

When It Comes to Zika and Abortion, Disabled People Are Too Often Used as a Rhetorical Device

s.e. smith

Anti-choicers shame parents facing a prenatal diagnosis and considering abortion, even though they don't back up their advocacy up with support. The pro-choice movement, on the other hand, often finds itself caught between defending abortion as an absolute personal right and suggesting that some lived potentials are worth more than others.

There’s only one reason anyone should ever get an abortion: Because that person is pregnant and does not want to be. As soon as anyone—whether they are pro- or anti-choice—starts bringing up qualifiers, exceptions, and scary monsters under the bed, things get problematic. They establish the seeds of a good abortion/bad abortion dichotomy, in which some abortions are deemed “worthier” than others.

And with the Zika virus reaching the United States and the stakes getting more tangible for many Americans, that arbitrary designation is on a lot of minds—especially where the possibility of developmentally impaired fetuses is concerned. As a result, people with disabilities are more often being used as a rhetorical device for or against abortion rights rather than viewed as actualized human beings.

Here’s what we know about Zika and pregnancy: The virus has been linked to microcephaly, hearing loss, impaired growth, vision problems, and some anomalies of brain development when a fetus is exposed during pregnancy, according to the Centers for Disease Control and Prevention. Sometimes these anomalies are fatal, and patients miscarry their pregnancies. Sometimes they are not. Being infected with Zika is not a guarantee that a fetus will develop developmental impairments.

We need to know much, much more about Zika and pregnancy. At this stage, commonsense precautions when necessary like sleeping under a mosquito net, using insect repellant, and having protected sex to prevent Zika infection in pregnancy are reasonable, given the established link between Zika and developmental anomalies. But the panicked tenor of the conversation about Zika and pregnancy has become troubling.

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In Latin America, where Zika has rampantly spread in the last few years, extremely tough abortion restrictions often deprive patients of reproductive autonomy, to the point where many face the possibility of criminal charges for seeking abortion. Currently, requests for abortions are spiking. Some patients have turned to services like Women on Web, which provides assistance with accessing medical abortion services in nations where they are difficult or impossible to find.

For pro-choice advocates in the United States, the situation in Latin America is further evidence of the need to protect abortion access in our own country. Many have specifically using Zika to advocate against 20-week limits on abortion—which are already unconstitutional, and should be condemned as such. Less than 2 percent of abortions take place after 20 weeks, according to the Guttmacher Institute. The pro-choice community is often quick to defend these abortions, arguing that the vast majority take place in cases where the life of the patient is threatened, the fetus has anomalies incompatible with life, or the fetus has severe developmental impairments. Microcephaly, though rare, is an example of an impairment that isn’t diagnosable until late in the second trimester or early in the third, so when patients opt for termination, they run smack up against 20-week bans.

Thanks to the high profile of Zika in the news, fetal anomalies are becoming a talking point on both sides of the abortion divide: Hence the dire headlines sensationalizing the idea that politicians want to force patients to give birth to disabled children. The implication of leaning on these emotional angles, rather than ones based on the law or on human rights, is that Zika causes disabilities, and no one would want to have a disabled child. Some of this rhetoric is likely entirely subconscious, but it reflects internalized attitudes about disabled people, and it’s a dogwhistle to many in the disability community.

Anti-choicers, meanwhile, are leveraging that argument in the other direction, suggesting that patients with Zika will want to kill their precious babies because they aren’t perfect, and that therefore it’s necessary to clamp down on abortion restrictions to protect the “unborn.” Last weekend, for instance, failed presidential candidate Sen. Marco Rubio (R-FL) announced that he doesn’t support access to abortion for pregnant patients with the Zika virus who might, as a consequence, run the risk of having babies with microcephaly. Hardline anti-choicers, unsurprisingly, applauded him for taking a stand to protect life.

Both sides are using the wrong leverage in their arguments. An uptick in unmet abortion need is disturbing, yes—because it means that patients are not getting necessary health care. While it may be Zika exposing the issue of late, it’s a symptom, not the problem. Patients should be able to choose to get an abortion for whatever reason and at whatever time, and that right shouldn’t be defended with disingenuous arguments that use disability for cover. The issue with not being able to access abortions after 20 weeks, for example, isn’t that patients cannot access therapeutic abortions for fetuses with anomalies, but that patients cannot access abortions after 20 weeks.

The insistence from pro-choice advocates on justifying abortions after 20 weeks around specific, seemingly involuntary instances, suggests that so-called “late term abortions” need to be circumstantially defended, which retrenches abortion stigma. Few advocates seem to be willing to venture into the troubled waters of fighting for the right to abortions for any reason after 20 weeks. In part, that reflects an incremental approach to securing rights, but it may also betray some squeamishness. Patients don’t need to excuse their abortions, and the continual haste to do so by many pro-choice advocates makes it seem like a 20-week or later abortion is something wrong, something that might make patients feel ashamed depending on their reasons. There’s nothing shameful about needing abortion care after 20 weeks.

And, as it follows, nor is there ever a “bad” reason for termination. Conservatives are fond of using gruesome language targeted at patients who choose to abort for apparent fetal disability diagnoses in an attempt to shame them into believing that they are bad people for choosing to terminate their pregnancies. They use the specter of murdering disabled babies to advance not just social attitudes, but actual policy. Republican Gov. Mike Pence, for example, signed an Indiana law banning abortion on the basis of disability into law, though it was just blocked by a judge. Ohio considered a similar bill, while North Dakota tried to ban disability-related abortions only to be stymied in court. Other states require mandatory counseling when patients are diagnosed with fetal anomalies, with information about “perinatal hospice,” implying that patients have a moral responsibility to carry a pregnancy to term even if the fetus has impairments so significant that survival is questionable and that measures must be taken to “protect” fetuses against “hasty” abortions.

Conservative rhetoric tends to exceptionalize disability, with terms like “special needs child” and implications that disabled people are angelic, inspirational, and sometimes educational by nature of being disabled. A child with Down syndrome isn’t just a disabled child under this framework, for example, but a valuable lesson to the people around her. Terminating a pregnancy for disability is sometimes treated as even worse than terminating an apparently healthy pregnancy by those attempting to demonize abortion. This approach to abortion for disability uses disabled people as pawns to advance abortion restrictions, playing upon base emotions in the ultimate quest to make it functionally impossible to access abortion services. And conservatives can tar opponents of such laws with claims that they hate disabled people—even though many disabled people themselves oppose these patronizing policies, created to address a false epidemic of abortions for disability.

When those on either side of the abortion debate suggest that the default response to a given diagnosis is abortion, people living with that diagnosis hear that their lives are not valued. This argument implies that life with a disability is not worth living, and that it is a natural response for many to wish to terminate in cases of fetal anomalies. This rhetoric often collapses radically different diagnoses under the same roof; some impairments are lethal, others can pose significant challenges, and in other cases, people can enjoy excellent quality of life if they are provided with access to the services they need.

Many parents facing a prenatal diagnosis have never interacted with disabled people, don’t know very much about the disability in question, and are feeling overwhelmed. Anti-choicers want to force them to listen to lectures at the least and claim this is for everyone’s good, which is a gross violation of personal privacy, especially since they don’t back their advocacy up with support for disability programs that would make a comfortable, happy life with a complex impairment possible. The pro-choice movement, on the other hand, often finds itself caught between the imperative to defend abortion as an absolute personal right and suggesting that some lived potentials are worth more than others. It’s a disturbing line of argument to take, alienating people who might otherwise be very supportive of abortion rights.

It’s clearly tempting to use Zika as a political football in the abortion debate, and for conservatives, doing so is taking advantage of a well-established playbook. Pro-choicers, however, would do better to walk off the field, because defending abortion access on the sole grounds that a fetus might have a disability rings very familiar and uncomfortable alarm bells for many in the disability community.

News Politics

Zika Response ‘Sits Squarely With Congress’ After Administration’s Last-Ditch Effort

Christine Grimaldi

“Our nation’s ability to mount the type of Zika response that the American people deserve sits squarely with Congress," HHS Secretary Sylvia Mathews Burwell wrote in a letter to House Minority Leader Nancy Pelosi (D-CA).

The Obama administration’s decision to direct $81 million toward the development of a Zika vaccine pits congressional Republicans and Democrats against each other—and leaves the country no closer to a solution.

Republicans in the U.S. House of Representatives seized on the announcement Thursday afternoon to contend that federal agencies have funds at their disposal to fight Zika. The head of the U.S. Department of Health and Human Services (HHS), however, dispelled that notion as she described shifting $34 million within the National Institutes of Health and transferring $47 million to the Biomedical Advanced Research and Development Authority, both of which would have run out of Zika funds by the end of the month.

“With the actions described above, we have exhausted our ability to even provide short-term financing to help fight Zika,” HHS Secretary Sylvia Mathews Burwell wrote in an August 11 letter to House Minority Leader Nancy Pelosi (D-CA). “Our nation’s ability to mount the type of Zika response that the American people deserve sits squarely with Congress.”

The administration in April pledged $589 million, the bulk of which came from funding to halt spread of the Ebola virus, for “immediate, time-critical activities” to combat the Zika virus. Those funds have been nearly exhausted, Burwell said in an August 3 letter to congressional Democrats on the appropriations committees.

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Congress returns September 6 after a seven-week recess in which Democrats in the House and U.S. Senate repeatedly called on lawmakers to return to Washington and get a Zika deal done. Republican leaders refused, blaming Senate Democrats for obstructing a GOP-engineered $1.1 billion plan prior to the recess. The plan underfunded the administration’s $1.9 billion target and included contraception restrictions for a virus that can be sexually transmitted.

Zika causes microcephaly, an incurable neurological disorder that impairs brain and skull growth in utero, as well as other severe fetal brain defects, according to the U.S. Centers for Disease Control and Prevention (CDC). As of August 4, the CDC reported 510 cases in pregnant people living in the United States. Another 521 infections have occurred among pregnant people in U.S. territories.

Puerto Rico Faces Disproportionate Impact

Diagnoses are increasing by the day. As of August 10, the CDC reported 1,962 cases of Zika in the United States. All but seven of those cases are due to travel. That breakdown stands in sharp contrast to Puerto Rico, home to 6,475 locally acquired and just 30 travel-associated cases—in both instances, a few percentage points shy of all the Zika infections in U.S. territories.

The contraception restrictions in Republicans’ plan would hurt the people of Puerto Rico by limiting women to obtaining such services from public health departments, hospitals, and Medicaid Managed Care clinics. Such options are few and far between in the sprawling territory.

Republicans would also prohibit subgrants to outside groups “that could provide important services to hard-to-reach populations, especially hard-to-reach populations of women that want to access contraceptive services,” according to a Democratic summary Rewire obtained last month.

Nevertheless, Republicans continue to defend their plan amid criticism from Democrats and reproductive health-care groups that they’re again waging a war on Planned Parenthood. “[T]he words Planned Parenthood don’t appear anywhere in the law,” Sen. Marco Rubio (R-FL), referring to the plan, told Politico in an interview last week.

Rubio Targets Abortion Care

From the beginning, Rubio otherwise broke with his party, supporting the administration’s $1.9 billion plan without similar conditions in recognition that Zika would reach the shores of his home state. All six of the continental United States’ locally acquired Zika cases have occurred in Florida.

At the same time, Rubio had no problem with denying pregnant people infected with Zika access to abortion care.

“Obviously, microcephaly is a terrible prenatal condition that kids are born with. And when they are, it’s a lifetime of difficulties. So I get it,” he told Politico. “I believe all human life should be protected by our law, irrespective of the circumstances or condition of that life.”

Rubio’s comments put him in league with the Susan B. Anthony List, Americans United for Life, and other anti-choice groups that have framed abortion care in the context of Zika as eugenics. Anti-choice advocates have been increasingly using this argument, which hurts people with disabilities as much as pregnant people seeking abortion care, writer s.e. smith reported for Rewire.

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