News Contraception

Obama Administration Agrees to Comply With Court Order on Emergency Contraception

Jodi Jacobson

Public health advocates are celebrating Monday night's announcement that the Obama administration will comply with a court order to make emergency contraception available over-the-counter without age restrictions.

Public health and women’s rights advocates are celebrating Monday night’s announcement that the Obama administration will comply with U.S. District Court Judge Edward Korman’s April 2013 court order to make emergency contraception (EC) available over-the-counter without age restrictions. In a letter sent to Judge Korman by the U.S. Department of Justice (DOJ), the administration stated that it would submit a plan for complying with Korman’s order. If the plan is approved, efforts to make EC available will move forward, and the department will drop its appeal of Korman’s April ruling.

In the letter, DOJ wrote:

We write to advise the Court that the Food and Drug Administration (FDA) and the Department of Health and Human Services (HHS) have complied with the Court’s April 10, 2013, judgment in the above-referenced case by granting the 2001 Citizen Petition and making Plan B One-Step (PBOS) available over-the-counter (OTC) without age or point-of-sale restrictions as described below. It is the government’s understanding that this course of action fully complies with the Court’s judgment in this action. Once the Court confirms that the government’s understanding is correct, the government intends to file with the Circuit Court notice that it is voluntarily withdrawing its appeal in this matter.

The letter further noted that the administration will focus on plans to increase access to Plan B One-Step in keeping with the court order, which gave discretion to the Food and Drug Administration (FDA) to decide whether or not Plan B (a two-pill variation of emergency contraception) meets the same safety criteria as Plan B One-Step (a single-pill version of EC tested among adolescents and pre-teens as young as 11 years of age).

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It would be difficult to exaggerate the importance of this new development in a decade-long case of scientific and public health malfeasance. The fight over emergency contraception began under President George W. Bush, but continued into the second term of the Obama administration. First, the Department of Health and Human Services, backed up by the White House and the president himself, overruled a 2011 decision by the FDA to make emergency contraception available over-the-counter without age restrictions. Advocates found themselves in a familiar place, back in court, but facing an unfamiliar opponent, an ostensibly pro-choice and pro-science administration that sought to limit access to an indisputably safe and time-sensitive medication meant to prevent unplanned pregnancies. The administration also stepped in to appeal a 2012 ruling by Judge Korman requiring the administration to develop a plan by early April for ensuring over-the-counter access to EC. But the administration appealed that decision as well, and later lost in court, leaving them subject to Korman’s order. The one constant has been Judge Korman who, over a period of at least seven years of overseeing cases on emergency contraception, had clearly grown frustrated with the constant delays in and excuses for not making EC available in a timely manner to all who need it.

Today’s decision by the administration is being widely lauded. Senator Patty Murray (D-WA) stated, After far too long of a delay, science has prevailed. Today’s move by the Administration means the safety and effectiveness of Plan B, not politics, will dictate access. Plan B is an essential part of women’s basic health care and this letter to the court is a major step in keeping it that way.”

In a statement, Jessica González-Rojas, executive director of the National Latina Institute for Reproductive Health, said, “We applaud the administration for allowing good science and common sense to move forward. This is a decision that will benefit women across the country, especially Latinas. For too long, this important backup birth control method has been kept behind the counter and out of reach, especially for immigrant women and aspiring citizens of all ages, who are less likely to have government identification.”

Emergency contraception is for those times when unprotected sex does occur, when contraception or condoms might fail, or as a result of rape. Emergency contraception provides a safe, effective way to prevent pregnancy and reduce the need for abortion. Evidence collated by the Planned Parenthood Federation of America underscores:

  • Emergency contraception is safe for use by women of all ages and that teens have equally as successful health outcomes as adult women when using it.
  • Multiple studies have shown that teens are as likely as adults to use emergency contraception correctly and that both groups report little if any difficulty using the method.
  • Research also has shown that teens understand that emergency contraception is not intended for ongoing, regular use and that the rates of unprotected sex do not increase when they have easier access to emergency birth control.
  • Nearly half of all pregnancies that occur in the United States each year are unintended. The average age for first-time sex is 17, and roughly 750,000 pregnancies will occur among 15- to 19-year-olds each year.

The decision, however, does not include generic forms of emergency contraception, pointing to the the next front in the effort to ensure universal access to EC, as affordability of the method is critical to access.

“Now that the appeals court has forced the federal government’s hand, the FDA is finally taking a significant step forward by making Plan B One-Step available over the counter for women of all ages,” said Nancy Northup, president and CEO of the Center for Reproductive Rights. “But the Obama Administration continues to unjustifiably deny the same wide availability for generic, more affordable brands of emergency contraception.”

“We are pleased that women should soon be able to buy Plan B One-Step without the arbitrary restrictions that kept it locked behind the pharmacy counter when they needed it most urgently,” Northup continued. “But we will continue to fight for fair treatment for women who want and need more affordable options.”

The administration’s decision not to continue it’s appeal of Judge Korman’s order is not an ending but rather the beginning of the next chapter in achieving universal access to EC. Critical next steps in this long-running struggle will be to educate pharmacists and the public about the safety of emergency contraception, ensure it is made available as widely as possible, ensure that generic and affordable forms of EC are also made OTC, and ensure that merchants and cashiers understand that no identification is necessary. Because when it comes to emergency contraception, time is of the essence.

News Health Systems

Complaint: Citing Catholic Rules, Doctor Turns Away Bleeding Woman With Dislodged IUD

Amy Littlefield

“It felt heartbreaking,” said Melanie Jones. “It felt like they were telling me that I had done something wrong, that I had made a mistake and therefore they were not going to help me; that they stigmatized me, saying that I was doing something wrong, when I’m not doing anything wrong. I’m doing something that’s well within my legal rights.”

Melanie Jones arrived for her doctor’s appointment bleeding and in pain. Jones, 28, who lives in the Chicago area, had slipped in her bathroom, and suspected the fall had dislodged her copper intrauterine device (IUD).

Her doctor confirmed the IUD was dislodged and had to be removed. But the doctor said she would be unable to remove the IUD, citing Catholic restrictions followed by Mercy Hospital and Medical Center and providers within its system.

“I think my first feeling was shock,” Jones told Rewire in an interview. “I thought that eventually they were going to recognize that my health was the top priority.”

The doctor left Jones to confer with colleagues, before returning to confirm that her “hands [were] tied,” according to two complaints filed by the ACLU of Illinois. Not only could she not help her, the doctor said, but no one in Jones’ health insurance network could remove the IUD, because all of them followed similar restrictions. Mercy, like many Catholic providers, follows directives issued by the U.S. Conference of Catholic Bishops that restrict access to an array of services, including abortion care, tubal ligations, and contraception.

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Some Catholic providers may get around the rules by purporting to prescribe hormonal contraception for acne or heavy periods, rather than for birth control, but in the case of copper IUDs, there is no such pretext available.

“She told Ms. Jones that that process [of switching networks] would take her a month, and that she should feel fortunate because sometimes switching networks takes up to six months or even a year,” the ACLU of Illinois wrote in a pair of complaints filed in late June.

Jones hadn’t even realized her health-care network was Catholic.

Mercy has about nine off-site locations in the Chicago area, including the Dearborn Station office Jones visited, said Eric Rhodes, senior vice president of administrative and professional services. It is part of Trinity Health, one of the largest Catholic health systems in the country.

The ACLU and ACLU of Michigan sued Trinity last year for its “repeated and systematic failure to provide women suffering pregnancy complications with appropriate emergency abortions as required by federal law.” The lawsuit was dismissed but the ACLU has asked for reconsideration.

In a written statement to Rewire, Mercy said, “Generally, our protocol in caring for a woman with a dislodged or troublesome IUD is to offer to remove it.”

Rhodes said Mercy was reviewing its education process on Catholic directives for physicians and residents.

“That act [of removing an IUD] in itself does not violate the directives,” Marty Folan, Mercy’s director of mission integration, told Rewire.

The number of acute care hospitals that are Catholic owned or affiliated has grown by 22 percent over the past 15 years, according to MergerWatch, with one in every six acute care hospital beds now in a Catholic owned or affiliated facility. Women in such hospitals have been turned away while miscarrying and denied tubal ligations.

“We think that people should be aware that they may face limitations on the kind of care they can receive when they go to the doctor based on religious restrictions,” said Lorie Chaiten, director of the women’s and reproductive rights project of the ACLU of Illinois, in a phone interview with Rewire. “It’s really important that the public understand that this is going on and it is going on in a widespread fashion so that people can take whatever steps they need to do to protect themselves.”

Jones left her doctor’s office, still in pain and bleeding. Her options were limited. She couldn’t afford a $1,000 trip to the emergency room, and an urgent care facility was out of the question since her Blue Cross Blue Shield of Illinois insurance policy would only cover treatment within her network—and she had just been told that her entire network followed Catholic restrictions.

Jones, on the advice of a friend, contacted the ACLU of Illinois. Attorneys there advised Jones to call her insurance company and demand they expedite her network change. After five hours of phone calls, Jones was able to see a doctor who removed her IUD, five days after her initial appointment and almost two weeks after she fell in the bathroom.

Before the IUD was removed, Jones suffered from cramps she compared to those she felt after the IUD was first placed, severe enough that she medicated herself to cope with the pain.

She experienced another feeling after being turned away: stigma.

“It felt heartbreaking,” Jones told Rewire. “It felt like they were telling me that I had done something wrong, that I had made a mistake and therefore they were not going to help me; that they stigmatized me, saying that I was doing something wrong, when I’m not doing anything wrong. I’m doing something that’s well within my legal rights.”

The ACLU of Illinois has filed two complaints in Jones’ case: one before the Illinois Department of Human Rights and another with the U.S. Department of Health and Human Services Office for Civil Rights under the anti-discrimination provision of the Affordable Care Act. Chaiten said it’s clear Jones was discriminated against because of her gender.

“We don’t know what Mercy’s policies are, but I would find it hard to believe that if there were a man who was suffering complications from a vasectomy and came to the emergency room, that they would turn him away,” Chaiten said. “This the equivalent of that, right, this is a woman who had an IUD, and because they couldn’t pretend the purpose of the IUD was something other than pregnancy prevention, they told her, ‘We can’t help you.’”

News Health Systems

What Happens When a Catholic-Run Clinic Comes to Your Local Walgreens?

Amy Littlefield

“It causes us great concern when we think about vulnerable populations ... [who] may need to use these clinics for things like getting their contraception prescribed and who would never think that when they went into a Walgreens they would be restricted by Catholic doctrine,” Lorie Chaiten, director of the women’s and reproductive rights project of the ACLU of Illinois, told Rewire.

One of the largest Catholic health systems is set to begin running health clinics inside 27 Walgreens stores in Missouri and Illinois next week. The deal between Walgreens and SSM Health has raised concerns from public interest groups worried that care may be compromised by religious doctrine.

Catholic health systems generally follow directives issued by the U.S. Conference of Catholic Bishops that restrict access to an array of services, including abortion care, contraception, tubal ligations, vasectomies, and fertility treatments.

“We are concerned that the clinics will likewise be required to follow the [directives], thereby severely curtailing access to important reproductive health services, information, and referrals,” MergerWatch, the National Health Law Program, and the American Civil Liberties Unions of Illinois and Missouri wrote in a letter to Walgreens on Wednesday. They also sent a letter to SSM Health.

In a statement emailed to Rewire, Walgreens said its relationship with SSM Health “will not have any impact on any of our current clinic or pharmacy policies and procedures.”

SSM Health emailed a statement saying it “will continue to offer the same services that are currently available at Walgreens Healthcare Clinics today.” If a patient needs services “that are beyond the scope of what is appropriate for a retail clinic setting, they will be referred to a primary care physician or other provider of their choice,” the statement read.

A spokesperson for SSM Health demurred when Rewire asked if that would include referrals for abortion care.

“I’ve got to check this part out, my apologies, this is one that hadn’t occurred to me,” said Jason Merrill, the spokesperson.

Merrill later reiterated SSM Health’s statement that it would continue to offer the same services.

Catholic health systems have in recent years expanded control over U.S. hospitals, with one in six acute-care hospital beds now in a Catholic-owned or -affiliated facility. Patients in such hospitals have been turned away while miscarrying, denied tubal ligations, and refused abortion care despite conditions like brain cancer.

Catholic health systems have also expanded into the broader landscape of outpatient services, raising new questions about how religion could influence other forms of care.

“The whole health system is transforming itself with more and more health care being delivered outside the hospital,” Lois Uttley, director of MergerWatch, told Rewire. “So we are looking carefully to make sure that the religious restrictions that have been such a problem for reproductive health care at Catholic hospitals are not now transferred to these drug store clinics or to urgent care centers or free-standing emergency rooms.”

Walgreens last year announced a similar arrangement with the Catholic health system Providence Health & Services to bring up to 25 retail clinics to Oregon and Washington. After expressing concerns about the deal, the ACLU of Washington said it received assurances from both Walgreens and Providence that services at those clinics would not be affected by religious doctrine.

Meanwhile, the major urgent care provider CityMD recently announced a partnership with CHI Franciscan Health–which is affiliated with Catholic Health Initiatives–to open urgent care centers in Washington state.

“We’re seeing [Catholic health systems] going into the urgent care business and into the primary care business and in accountable care organizations, where they are having an influence on the services that are available to the public and to consumers,” Susan Berke Fogel, director of reproductive health at the National Health Law Program, told Rewire.

GoHealth Urgent Care, which describes itself as “one of the fastest growing urgent care companies in the U.S.,” announced an agreement this year with Dignity Health to bring urgent care centers to California’s Bay Area. Dignity Health used to be called Catholic Healthcare West, but changed its name in 2012.

“This is another pattern that we’ve seen of Catholic health plans and health providers changing their names to things that don’t sound so Catholic,” Lois Uttley said.

 

In the letters sent Wednesday, the National Health Law Program and other groups requested meetings with Walgreens and SSM Health to discuss concerns about the potential influence of religion on the clinics.

“It causes us great concern when we think about vulnerable populations, we think about low-income people… people who… may need to use these clinics for things like getting their contraception prescribed and who would never think that when they went into a Walgreens they would be restricted by Catholic doctrine,” Lorie Chaiten, director of the Reproductive Rights Project of the ACLU of Illinois, told Rewire.

The new clinics in Walgreens will reportedly be called “SSM Health Express Clinics at Walgreens.” According to SSM Health’s website, its initials “[pay] tribute” to the Sisters of St. Mary.

“We are fairly forthcoming with the fact that we are a mission-based health care organization,” Merrill told Rewire. “That’s something we embrace. I don’t think it’s anything we would hide.”

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