News Contraception

Oklahoma Republican: What Happened to Wanting Government Out of the Exam Room?

Robin Marty

An Oklahoma Republican wonders when supporting the prevention of unplanned pregnancies became "extremist" in the GOP.

It’s can be lonely being a moderate Republican these days, especially in very conservative states. For example, Oklahoma state Rep. Doug Cox (R-Grove) has expressed that in at least some ways his party has moved so far to the right that he does not recognize it anymore. The former medical practitioner wonders why in his own party, which sees government intrusion as anathema, it has become mainstream for legislators to attempt to deny contraceptive access.

“I cannot convince my Republican colleagues that one of the best ways to eliminate abortions is to ensure access to contraception,” lamented Rep. Cox in a letter to The Oklahoman. “A recent attempt by my fellow lawmakers to prevent Medicaid dollars from covering the ‘morning after’ pill is a case in point. Denying access to this important contraceptive is a sure way to increase legal and back-alley abortions. Moreover, such a law would discriminate against low-income women who depend on Medicaid for their health care.” He continued:

What happened to the Republican Party that felt that the government has no business being in an exam room, standing between me and my patient? Where did the party go that felt some decisions in a woman’s life should be made not by legislators and government, but rather by the women, her conscience, her doctor and her God?

Oklahoma is bucking Food and Drug Administration guidelines by requiring a prescription for emergency contraception for anyone under age 17, and has stripped funding from Planned Parenthood and other public family planning providers and given it to hospitals and health-care centers to offer contraception instead. Rather than expand access in the hopes of preventing more pregnancies, state Republicans are making contraception more difficult to obtain.

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News Politics

Progressives Notch Wins, Anti-Choice Republican Gets the Boot in State Primaries

Ally Boguhn

U.S. Rep. Tim Huelskamp (R-KS), whip of the congressional Pro-Life Caucus, was defeated after losing the support of business groups and the agricultural lobby in Kansas.

State primary elections brought major victories for progressive candidates on Tuesday and saw incumbent Rep. U.S. Rep. Tim Huelskamp (R-KS)—an anti-choice member of the extreme House Freedom Caucus—lose his seat to his primary challenger.

In Washington state, progressive candidate state Sen. Pramila Jayapal advanced to the general election in November in her bid to replace retiring Rep. Jim McDermott (D) in Washington’s 7th Congressional District.

The candidate has “been a champion for access to healthcare, and commonsense gun safety and civic engagement as well as for women, workers, students, communities of color, low-income communities, immigrants and refugees,” according to Jayapal’s website. That work earned her the endorsement of Sen. Bernie Sanders (I-VT), who solicited donations for her campaign telling supporters in an email that Jayapal is “not afraid to take on powerful special interests” and is “running her campaign with our political revolution.”

Sanders lauded Jayapal’s win Wednesday in a statement circulated by press release. “Pramila just proved that candidates can run a strong progressive campaign funded by small-dollar donors and win big,” Sanders said. “The people-powered movement that propelled our campaign to victory in states around the country is already changing how campaigns are run up and down the ticket.”

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Liberal and progressive groups praised Jayapal as news of her primary win broke.

“Pramila Jayapal winning this primary is huge for progressives,” Stephanie Taylor, co-founder of the Progressive Change Campaign Committee, said in a statement on the night’s election results. “She is a bold progressive game changer whose strong performance shows that voters are hungry for bold progressive ideas like expanding Social Security benefits, debt-free college, and a $15 minimum wage. With Pramila’s record as an accomplished activist and state senator, we are confident Pramila will be one of the strongest partners progressives have ever had in Congress and one of the strongest representatives Washington has ever had.”

Stephanie Schriock, president of EMILY’s List, called Jayapal a “a progressive leader and a tireless advocate for women and families” in a Wednesday statement. “She understands the importance of increasing economic opportunities and protecting women’s access to health care. EMILY’s List is proud to continue supporting Pramila in her historic bid to be the first Indian American woman elected to Congress.”

Elsewhere in the state, fellow progressive candidate Darcy Burner finished among the top two candidates in her race for the state’s 5th District House seat. The state’s primary system allows the top two candidates to advance to the November election regardless of party affiliation.

In Kansas, the incumbent Huelskamp lost his primary race to challenger Roger Marshall. The three-term congressman has represented the state’s 1st Congressional District since 2011, where he has carved out a place for himself among the extremist House Freedom Caucus (HFC), which has pushed ultra-conservative and anti-choice policies in Congress. Huelskamp was one of a dozen politicians backed by the HFC’s unofficial PAC, the House Freedom Fund, as Rewire reported.  

Huelskamp championed anti-choice efforts prior to being elected into office and was “active in assisting women in crisis pregnancies” during graduate school, according to his website. He continued that legacy in Congress, where he serves as the Pro-Life Caucus whip.  

Huelskamp in 2012 notoriously delivered a speech on the House floor comparing abortion care to slavery and accusing both Planned Parenthood and the Obama administration of being racist. He again used race to push his anti-choice position in 2015, tweeting that those who accepted awards from Planned Parenthood supported a “racist” agenda.

According to the New York Times, Huelskamp’s challenger Roger Marshall “won with the support of business groups and the agriculture lobby, which had turned its back on Mr. Huelskamp after Speaker John A. Boehner had him removed from the Agriculture Committee in 2012, a crucial position for a legislator from a farm state.”

During the primary race, Huelskamp released an ad questioning whether Marshall, an OB-GYN, was truly pro-life and claimed he “supports pro-abortion groups that back Planned Parenthood and Hillary Clinton.” The accusation reportedly refers to a donation from the American Congress of OB-GYNs PAC to Marshall, and a previous donation he made to the group.

Marshall’s campaign website prominently displays the Republican candidate’s “pro-life” position and touts a recommendation of his from the anti-choice American Association of Pro-Life Physicians and Gynecologists. 

Brent Robertson, Marshall’s campaign spokesperson, however, defended the candidate’s anti-choice position in a statement to the Topeka-Capitol Journal in January.

Commentary Contraception

The Double Standard of Military Pregnancy: What Contraceptive Access Won’t Fix

Stephanie Russell-Kraft

Unique military gender politics that make it hard for some servicewomen to ask for birth control also stigmatize them if they get pregnant—especially when that happens at an overseas post or on a deployment. Any effort to increase birth control availability can only be understood against that particular cultural backdrop.

At the beginning of May, pharmaceutical giant Allergan announced that, in partnership with nonprofit Medicines360, it would begin offering its new intrauterine device (IUD) Liletta at a reduced price to military treatment facilities and veterans hospitals across the United States. The company would also support “an educational effort to raise contraception awareness among healthcare providers treating U.S. military service women,” according to its press release.

Military personnel and medical professionals agree Allergan’s initiative represents an important step toward expanding access to the IUD, which along with other long-acting reversible contraceptives (like injections) are particularly well suited to the demands of military training and deployment schedules. But this push to increase IUD use can’t be fully understood outside the context of the unique challenges and stigmas facing women of reproductive age in the U.S. military (who numbered just under 200,000 as of 2011, the latest available data obtained via FOIA by Ibis Reproductive Health).

Despite theoretically having access to a wide variety of contraceptive options, women in the military still report higher rates of unplanned pregnancy than their civilian peers, and it remains somewhat of a mystery exactly why. What is clear is that the unique military gender politics that make it hard for some women to ask for birth control also stigmatize them if they get pregnant—especially when that happens at an overseas post or on a deployment. Any effort to increase birth control availability, including Allergan’s, can only be understood against that particular cultural backdrop.

Nearly every time a U.S. military branch changes policies to include more women, critics raise the old argument that allowing women into the service, particularly in combat roles, will lead to sex between soldiers and thereby distract from the mission. Because of that, the military generally prohibits sex during deployments between service members not married to each other (exact policies vary across the branches and across units, and some are less strict). Taken as a whole, the U.S. military’s policy basically amounts to an abstinence-only approach, with women shouldering nearly all of the risk and blame when soldiers do decide to have sex on deployment.

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Bethany Saros, who enlisted in the Army as an 18-year-old in 2002, faced this blame head-on when she became pregnant by a fellow soldier during a 2007 tour in Iraq.

Although condoms were available to soldiers at her deployment site, Saros did not use birth control. Her decision not to end the pregnancy meant her deployment was over, and Saros recalls meeting several other pregnant women in Kuwait while they all waited to get shipped back. “I felt like a pariah, and I think the other girls did too,” she said.

“It’s not like anyone does this on purpose,” Saros explained. “The fathers of these babies, they don’t get any problems, and they were screwing around just as we were.”

Across all branches of service, pregnant women are typically not allowed to serve on deployments, and, though the length of time varies by branch, women are not allowed to deploy in the six to 12 months after they give birth. According to spokespeople from each of the branches, the reasoning behind the policies is to protect servicewomen and give them the time they need to recover from birth. All of the women I spoke with for this piece told me that soldiers—both male and female—often believe a woman who gets pregnant right before or during a deployment is simply trying to avoid her work.

“The first thing someone talked about when a woman got pregnant was that she was trying to get out of a deployment,” said Lauren Zapf, a former Naval officer, mental health clinician, and fellow with the Service Women’s Action Network. “Whereas if men announce that they’re going to have a baby, there’s a lot of backslapping and congratulations.”

According to Ibis Reproductive Health’s analysis of Department of Defense data, about 11 percent of active-duty military women reported an unintended pregnancy in 2008 and 7 percent reported an unintended pregnancy in 2011—in both years, this was far more than the general population. Younger, less educated, nonwhite women were much more likely to become pregnant unintentionally, as were those who were married or living with a partner, according to Ibis. Contrary to military lore, the pregnancy rates did not differ between those women who had deployed and those who didn’t during that time, the study found.

It remains unclear why exactly military women have higher reported rates of unplanned pregnancy than their civilian counterparts, but one reason has likely been their inconsistent access to birth control and limited access to abortion services. As with most institutions, there’s a difference between official policy and what happens on a day-to-day basis on military bases and in medical exam rooms. Just because most military branches officially require routine birth control consultations doesn’t mean women will always get them, according to Ibis researcher Kate Grindlay, who is one of very few independent researchers looking into this issue.

“One of the challenges that we found [in our research] was that these things were not being done in a consistent way,” Grindlay said. “Some providers having these conversations in a routine way, some weren’t.”

Access to birth control—and the conversations that lead up to it—has improved greatly for military women in the past 20 years. Elizabeth McCormick, a former Black Hawk pilot who served in the Army from 1994 to 2001, recalled that “no one talked about birth control” in any of her pre-deployment medical events in the 1990s. By contrast, some of the women I spoke with who served more recently said they didn’t have issues getting the care they needed.

However, in a 2010 Ibis survey of deployed women, 59 percent of respondents said they hadn’t discussed contraception with a military health-care provider before deployment and 41 percent said they had difficulty obtaining the birth control refills they needed while away from home. Servicewomen also reported being denied an IUD because they had not yet had children, even though nulliparous women can use the devices.

These inconsistencies are part of the problem Allergan says it hopes to address with its education efforts for military health-care providers. The company hasn’t explicitly said what those efforts will look like.

Another part of the problem, according to former Marine Corps officer and Cobra helicopter pilot Kyleanne Hunter, might be cultural. Conversations with military medical providers likely present another major barrier to proper contraceptive care because most military doctors are not only men, but also officers, who, outside the context of a hospital exam room, can give orders that must be respected.

Young female enlisted service members who have internalized the military’s rigid power structures might be reluctant to speak honestly and openly about reproductive care, posited Hunter, who’s currently a University of Denver PhD candidate studying the national security impact of integrating women into western militaries. She said the same dynamic often prevents women from coming forward after they have been sexually assaulted by a fellow service member.

“It adds one more layer to what’s already an uncomfortable conversation,” Hunter said.

When Bethany Saros returned to Fort Lewis, Washington, after leaving Iraq for her pregnancy, a conversation with a male doctor solidified her decision to quit the Army altogether.

“I had to go through a physical, and there was a Marine doctor, and he said, ‘Was there enough room on the plane for all the pregnant ladies that came back?’” she told me, still taken aback by the incident.

Grindlay said efforts like Allergan’s to increase the use of IUDs in the military are “very beneficial” to servicewomen. She also applauded a provision in the 2016 National Defense Authorization Act to require standardized clinical guidelines for contraceptive care across the armed forces. Under the new provisions, women in the armed forces must receive counseling on the “full range of methods of contraception provided by health care providers” during pre-deployment health care visits, visits during deployment, and annual physical exams.

But there’s still work to be done in order for the military to provide full access to reproductive health care, particularly when it comes to abortion. Tricare, the military’s health and insurance provider, only covers abortions “if pregnancy is the result of rape or incest or the mother’s life is at risk,” and certain countries in which the military operates ban the procedure altogether.

In a sampling of 130 online responses for a medication abortion consultation service reviewed by Ibis in 2011, several military women reported considered using “unsafe methods” to try to terminate a pregnancy themselves, according to Grindlay. One of the women, a 23-year-old stationed in Bahrain, said she had been turned away by five clinics and had contemplated taking “drastic measures.”

According to the 2011 Ibis report, many women sought abortions so that they could continue their military tour. Others feared a pregnancy would otherwise ruin their careers.

Virginia Koday, a former Marine Corps electronics technician who left the service in 2013, said in a phone interview that women can face losing their rank or getting charged for violating military policy if they become pregnant overseas. “Getting pregnant in Afghanistan is good cause to terminate your own pregnancy without anyone finding out,” she said.

“The unspoken code is that a good soldier will have an abortion, continue the mission, and get some sympathy because she chose duty over motherhood,” wrote Bethany Saros in a 2011 Salon piece about her unplanned pregnancy.

For these women, one act of unprotected sex had the potential to derail their career. For the men, it was just a night of fun.

Kyleanne Hunter said that while she doesn’t have a “whole lot of sympathy” for women who become pregnant on deployments (they’re not supposed to be having sex in the first place, she argues), she disagrees with the double standard that allows the men involved to escape punishment.

“Both parties need to be held exactly to the same accountability standards,” said Hunter. “If the woman is punished, then whoever she is involved with should be punished a well, because it takes two. She’s not alone in it. There’s no immaculate conception going on there.”

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