Commentary Environment

The Bipartisan Chemical Safety Reform Bill Is an Improvement—But It’s Still Not Good Enough

Elizabeth Arndorfer

Chemical safety reform presents a rare opportunity for legislators on both sides of the aisle to work together to protect the health and well-being of women and their families. Unfortunately, bipartisan does not always mean better. 

Chemical safety reform presents a rare opportunity for legislators on both sides of the aisle to work together to protect the health and well-being of women and their families. Unfortunately, bipartisan does not always mean better. 

This week two bills were introduced in the U.S. Senate to improve chemical safety in the country: one by Sens. Barbara Boxer (D-CA) and Ed Markey (D-MA) and one by Sens. Tom Udall (D-NM) and David Vitter (R-LA). Although the Boxer-Markey bill does more to combat hazardous substances in our environment, the Udall-Vitter bill is getting far more congressional support. However, the Udall-Vitter legislation does not sufficiently protect reproductive health, particularly for the most vulnerable communities. 

Mounting scientific evidence indicates that the products we use every day—as well as the air, soil, and water around us—contain chemicals that harm our reproductive health. Studies on animal subjects have linked chemicals in the environment to male and female infertility; reduced sperm count and quality; alterations in ovarian function and menstruation; endometriosis; altered prostate development; and puberty onset. In addition, researchers have linked environmental chemicals to altered fetal development, miscarriage, and preterm birth in humans.

Moreover, the harm caused by chemicals in our environment is not shared equally. Low-income communities and communities of color are much more likely than other groups to be directly exposed to harmful chemicals at work, at home, and through consumer products. Increased exposure to these chemicals puts these communities at greater risk for reproductive health problems. For instance, almost 25 percent of Black girls and 15 percent of Latina girls had breast development by age 7 in one long-term study out of San Francisco, compared to just 10 percent of white girls. 

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Both Republicans and Democrats agree that the current regulatory system is seriously flawed, providing the Environmental Protection Agency (EPA) with little power to remove even the most dangerous chemicals from the market. And while the Udall-Vitter bill improves current law by providing a health-based safety standard that must consider the impact of chemicals on vulnerable communities such as those living near a factory or pregnant women, it significantly undercuts this improvement with an overreaching preemption clause.

Preemption is the constitutional doctrine that, in certain issues of national importance, federal law must take precedence over state laws. Under the current Toxic Substances Control Act (TSCA), the preemption clause allows a state to regulate a chemical until the EPA actually imposes a restriction it—at which point the state is generally prevented from acting.

This is important because in the absence of effective federal regulations, states have stepped in to protect citizens from harmful chemicals. There are more than 150 laws in 35 states that restrict or regulate chemicals. 

The Udall-Vitter legislation departs significantly—and harmfully—from current preemption in TSCA. Under this proposed bill, states would not be able to take action after a chemical has been designated by the EPA as “high priority.” This means that before the EPA has taken any action to restrict or limit the use of a high priority chemical, states would be blocked from taking action on it. This would create what the California Attorney General called a “regulatory void” in an open letter regarding the Udall-Vitter bill. And this is bad for reproductive health.

Given the timelines outlined in the legislation, it could take the EPA at least five-to-seven years to complete a safety assessment of a chemical. Since the states’ hands are tied during this time, the chemical industry will have every incentive to stall EPA action through litigation and other shenanigans. Years could tick by with no action, with continued exposure to dangerous chemicals and with continued potential harm to reproductive health, fetal development, and fertility. And this is for “high priority” chemicals—chemicals that we have good reason to believe are harmful to our health. 

In contrast, the Boxer-Markey bill enables states to continue to protect its citizens from harmful chemicals in the absence of federal action. No loophole. No regulatory void.

The Safer Chemicals Healthy Families Coalition, a diverse coalition of 450 public health, environmental, labor, and business organizations (of which RHTP is a member), have asked the proponents of the Udall-Vitter bill to fix the preemption problem so that it would occur only after the EPA imposes restrictions on a chemical. So far, those requests have been ignored.

While there are other troubling aspects of the Udall-Vitter bill, the disingenuous interplay between the better safety standard and the much worse preemption, underscores that this legislation—despite being bipartisan—is not an improvement for reproductive health.

In the coming weeks, we urge senators who care about reproductive health, fetal development, and infertility to support the Boxer-Markey legislation or work to get much needed changes to the Udall-Vitter bill.

Commentary Abortion

It’s Time for an Abortion Renaissance

Charlotte Taft

We’ve been under attack and hanging by a thread for so long, it’s been almost impossible to create and carry out our highest vision of abortion care.

My life’s work has been to transform the conversation about abortion, so I am overcome with joy at the Supreme Court ruling in Whole Woman’s Health v. Hellerstedt. Abortion providers have been living under a very dark cloud since the 2010 elections, and this ruling represents a new day.

Abortion providers can finally begin to turn our attention from the idiocy and frustration of dealing with legislation whose only intention is to prevent all legal abortion. We can apply our energy and creativity fully to the work we love and the people we serve.

My work has been with independent providers who have always proudly delivered most of the abortion care in our country. It is thrilling that the Court recognized their unique contribution. In his opinion, after taking note of the $26 million facility that Planned Parenthood built in Houston, Justice Stephen Breyer wrote:

More fundamentally, in the face of no threat to women’s health, Texas seeks to force women to travel long distances to get abortions in crammed-to-capacity superfacilities. Patients seeking these services are less likely to get the kind of individualized attention, serious conversation, and emotional support that doctors at less taxed facilities may have offered.

This is a critical time to build on the burgeoning recognition that independent clinics are essential and, at their best, create a sanctuary for women. And it’s also a critical time for independent providers as a field to share, learn from, and adopt each other’s best practices while inventing bold new strategies to meet these new times. New generations expect and demand a more open and just society. Access to all kinds of health care for all people, including excellent, affordable, and state-of-the-art abortion care is an essential part of this.

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We’ve been under attack and hanging by a thread for so long—with our financial, emotional, and psychic energies drained by relentless, unconstitutional anti-abortion legislation—it’s been almost impossible to create and carry out our highest vision of abortion care.

Now that the Supreme Court has made it clear that abortion regulations must be supported by medical proof that they improve health, and that even with proof, the burdens can’t outweigh the benefits, it is time to say goodbye to the many politically motivated regulations that have been passed. These include waiting periods, medically inaccurate state-mandated counseling, bans on telemedicine, and mandated ultrasounds, along with the admitting privileges and ambulatory surgical center requirements declared unconstitutional by the Court.

Clearly 20-week bans don’t pass the undue burden test, imposed by the Court under Planned Parenthood v. Casey, because they take place before viability and abortion at 20 weeks is safer than childbirth. The federal Hyde Amendment, a restriction on Medicaid coverage of abortion, obviously represents an undue burden because it places additional risk on poor women who can’t access care as early as women with resources. Whatever the benefit was to late Rep. Henry Hyde (R-IL) it can’t possibly outweigh that burden.

Some of these have already been rejected by the Court and, in Alabama’s case, an attorney general, in the wake of the Whole Woman’s Health ruling. Others will require the kind of bold action already planned by the Center for Reproductive Rights and other organizations. The Renaissance involves raising an even more powerful voice against these regulations, and being firm in our unwillingness to spend taxpayer dollars harming women.

I’d like to entertain the idea that we simply ignore regulations like these that impose burdens and do not improve health and safety. Of course I know that this wouldn’t be possible in many places because abortion providers don’t have much political leverage. This may just be the part of me that wants reproductive rights to warrant the many risks of civil disobedience. In my mind is the man who stood in front of moving tanks in Tiananmen Square. I am yearning for all the ways to stand in front of those tanks, both legal and extralegal.

Early abortion is a community public health service, and a Renaissance goal could be to have early abortion care accessible within one hour of every woman in the country. There are more than 3,000 fake clinics in this country, many of them supported by tax dollars. Surely we can find a way to make actual services as widely available to people who need them. Of course many areas couldn’t support a clinic, but we can find ways to create satellite or even mobile clinics using telemedicine to serve women in rural areas. We can use technology to check in with patients during medication abortions, and we can provide ways to simplify after-care and empower women to be partners with us in their care. Later abortion would be available in larger cities, just as more complex medical procedures are.

In this brave new world, we can invent new ways to involve the families and partners of our patients in abortion care when it is appropriate. This is likely to improve health outcomes and also general satisfaction. And it can increase the number of people who are grateful for and support independent abortion care providers and who are able to talk openly about abortion.

We can tailor our services to learn which women may benefit from additional time or counseling and give them what they need. And we can provide abortion services for women who own their choices. When a woman tells us that she doesn’t believe in abortion, or that it is “murder” but she has to have one, we can see that as a need for deeper counseling. If the conflict is not resolved, we may decide that it doesn’t benefit the patient, the clinic, or our society to perform an abortion on a woman who is asking the clinic to do something she doesn’t believe in.

I am aware that this last idea may be controversial. But I have spent 40 years counseling with representatives of the very small, but real, percentage of women who are in emotional turmoil after their abortions. My experience with these women and reading online “testimonies” from women who say they regret their abortions and see themselves as victimized, including the ones cited by Justice Kennedy in the Casey decision, have reinforced my belief that when a woman doesn’t own her abortion decision she will suffer and find someone to blame for it.

We can transform the conversation about abortion. As an abortion counselor I know that love is at the base of women’s choices—love for the children they already have; love for their partners; love for the potential child; and even sometimes love for themselves. It is this that the anti-abortion movement will never understand because they believe women are essentially irresponsible whores. These are the accusations protesters scream at women day after day outside abortion clinics.

Of course there are obstacles to our brave new world.

The most obvious obstacles are political. As long as more than 20 states are run by Republican supermajorities, legislatures will continue to find new ways to undermine access to abortion. The Republican Party has become an arm of the militant anti-choice movement. As with any fundamentalist sect, they constantly attack women’s rights and dignity starting with the most intimate aspects of their lives. A society’s view of abortion is closely linked to and mirrors its regard for women, so it is time to boldly assert the full humanity of women.

Anti-choice contends that there have been approximately 58,586,256 abortions in this country since 1973. That means that 58,586,256 men have been personally involved in abortion, and the friends and family members of at least 58,586,256 people having abortions have been too. So more than 180 million Americans have had a personal experience with abortion. There is no way a small cadre of bitter men with gory signs could stand up to all of them. So they have, very successfully so far, imposed and reinforced shame and stigma to keep many of that 180 million silent. Yet in the time leading up to the Whole Woman’s Health case we have seen a new opening of conversation—with thousands of women telling their personal stories—and the recognition that safe abortion is an essential and normal part of health care. If we can build on that and continue to talk openly and honestly about the most uncomfortable aspects of pregnancy and abortion, we can heal the shame and stigma that have been the most successful weapons of anti-abortion zealots.

A second obstacle is money. There are many extraordinary organizations dedicated to raising funds to assist poor women who have been betrayed by the Hyde Amendment. They can never raise enough to make up for the abandonment of the government, and that has to be fixed. However most people don’t realize that many clinics are themselves in financial distress. Most abortion providers have kept their fees ridiculously and perilously low in order to be within reach of their patients.

Consider this: In 1975 when I had my first job as an abortion counselor, an abortion within the first 12 weeks cost $150. Today an average price for the same abortion is around $550. That is an increase of less than $10 a year! Even in the 15 states that provide funding for abortion, the reimbursement to clinics is so low that providers could go out of business serving those in most need of care.

Over the years a higher percent of the women seeking abortion care are poor women, women of color, and immigrant and undocumented women largely due to the gap in sexual health education and resources. That means that a clinic can’t subsidize care through larger fees for those with more resources. While Hyde must be repealed, perhaps it is also time to invent some new approaches to funding abortion so that the fees can be sustainable.

Women are often very much on their own to find the funds needed for an abortion, and as the time goes by both the costs and the risk to them increases. Since patients bear 100 percent of the medical risk and physical experience of pregnancy, and the lioness’ share of the emotional experience, it makes sense to me that the partner involved be responsible for 100 percent of the cost of an abortion. And why not codify this into law, just as paternal responsibilities have been? Perhaps such laws, coupled with new technology to make DNA testing as quick and inexpensive as pregnancy testing, would shift the balance of responsibility so that men would be responsible for paying abortion fees, and exercise care as to when and where they release their sperm!

In spite of the millions of women who have chosen abortion through the ages, many women still feel alone. I wonder if it could make a difference if women having abortions, including those who received assistance from abortion funds, were asked to “pay it forward”—to give something in the future if they can, to help another woman? What if they also wrote a letter—not a bread-and-butter “thank you” note—but a letter of love and support to a woman connected to them by the web of this individual, intimate, yet universal experience? This certainly wouldn’t solve the economic crisis, but it could help transform some women’s experience of isolation and shame.

One in three women will have an abortion, yet many are still afraid to talk about it. Now that there is safe medication for abortion, more and more women will be accessing abortion through the internet in some DIY fashion. What if we could teach everyone how to be excellent abortion counselors—give them accurate information; teach them to listen with nonjudgmental compassion, and to help women look deeper into their own feelings and beliefs so that they can come to a sense of confidence and resolution about their decision before they have an abortion?

There are so many brilliant, caring, and amazing people who provide abortion care—and room for many more to establish new clinics where they are needed. When we turn our sights to what can be, there is no limit to what we can create.

Being frustrated and helpless is exhausting and can burn us out. So here’s a glass of champagne to being able to dream again, and to dreaming big. From my own past clinic work:

At this clinic we do sacred work
That honors women
And the circle of life and death.

Commentary Sexual Health

‘Female Viagra’ Sounds Promising, But Might Not Be All It’s Cracked Up To Be

Amanda Marcotte

A new drug promising to help women restore lost libido has been approved by the FDA. But is it just a bill of goods? And does the marketing of this actually hurt the cause of women's sexual freedom?

After two previous rejections, Sprout Pharmaceuticals finally hit the jackpot when it got FDA approval for flibanserin, a drug that promises to relieve hypoactive sexual desire disorder (HSDD). HSDD is a recent coinage to describe a disorder in which women lose much, if not all, of their previous interest in sex. Flibanserin, which will be sold under the name Addyi, is supposed to restore that lost libido. Sprout is declaring this a feminist victory, a way to “even the score” by creating what they claim is a kind of “female Viagra.”

Sounds like a straightforward win, right? Women who want to restore a lost libido now have a way to do so. If only it were that simple. Flibanserin has been plagued by criticism, a lot of it coming from feminists. And while some of the feminist criticism is misguided, many of the objections raised legitimately call into question not just the drug itself, but how it’s marketed, both to the FDA and now to consumers.

So is this really such a feminist achievement? There’s a lot of reasons to think not.

To be clear, one of the most popular feminist objections to this pill is misguided. That’s the view being advanced by psychology professor Leonore Tiefer, who objects to the very idea that there’s a problem when a woman loses most or all interest in sex. “What’s wrong with losing sexual desire?” Tiefer asked Jill Filipovic of when interviewed about her anti-flibanserin campaign. Instead, Tiefer argued in PLOS Medicine, treating low desire as a medical issue is “a textbook case of disease mongering by the pharmaceutical industry and by other agents of medicalization.”

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“There’s no damage, there’s no harm, there’s no medical consequence [from losing sexual desire],” Tiefer continued.

“This is the great advantage of having lived a number of decades longer and having been raised in a different time with different norms,” Tiefer told Filipovic. “Having sex was not considered a mental health need. Having sex was not considered proof of being a real person, a real woman.”

Considering how much pressure there is on women to mold our sexual identities and behaviors around the desires of men, one can see the surface attraction to Tiefer’s concerns that this is just another form of trying to police female sexuality. But ultimately, her argument is condescending and unfair to women. There are plenty of good reasons, outside of being some kind of victim of an oversexed culture, for a woman to desire sex. For one thing, it’s fun. A lot of women rightly believe life is too short to simply accept the loss of something as life-affirming and good for the spirit as sexual pleasure.

Women get shamed all the time for wanting to have sex, and feminists shouldn’t add to that pile by suggesting that there’s something wrong with them if they want a libido-boosting pill. Nor is it fair to suggest that women are wrong to want sex to continue in their relationship, any more than it would be to suggest they should feel bad about wanting communication or cuddling to continue in their relationship.

So much of the feminist agenda, especially around reproductive rights, is about trusting women. We trust that women who choose contraception and abortion in order to have sex for pleasure know what they’re doing, and so we should trust that women who want to have more sexual desire know what they’re doing.

That said, one reason Sprout’s marketing of this pill as a “fix” to a “disease” is so frustrating is because it does not display that trust in women’s ability to define their own lives for themselves. Tiefer is right about one thing: By giving low sexual desire a name and suggesting it’s a disorder, that implies that there’s a “right” amount of sex to want.

But what if you have a low libido and you don’t mind? What if you’re not in a relationship or don’t want to be in one, or are in a relationship where no one wants sex and that’s fine by both of you? Women are constantly being told that their sexualities are wrong somehow—that they want it too much or too little or the wrong way or for the wrong reasons. The marketing, including the invention of HSDD, adds to this problem. Why should a woman be told she has a disorder if all she wants is a boost to her libido? Why imply, conversely, that someone who doesn’t want more sex is somehow failing?

To be fair to Sprout, it doesn’t seem like the company has much of a choice. There continues to be a lot of hostility in our culture to the idea of using drugs to enhance your life, rather than only as a way to “fix” something that’s broken. Take coffee, for instance. When I type “is drinking coffee” into Google, the top search fills out “bad for you.” The top hits are things like “13 Proven Health Benefits of Coffee” and “Health Benefits of Coffee.” It’s not enough to drink coffee because you like it and because you like the alert feeling it gives you. Oh no, Americans still feel this need to justify it for “health” reasons.

This mentality is why contraception, by the way, continues to be controversial, and why the pill keeps getting defended by articles that highlight the “medical” reasons to take it. Simply wanting to have sex for fun without the worry of getting pregnant is still seen, by many, as not good enough. We need a “medical” reason for it.

And so this new pill is being slotted into that mentality. It scares people to think women might just want more sex for its own sake, so instead we’re told that they have a “disorder” that needs fixing.

Which might be not that big a deal—hey, you can’t change a culture overnight and women need relief now—if the pill actually worked, like Viagra actually works. But the real reason that feminists should be suspicious of this pill has nothing to do with whether or not women should or should not want sex at all. It’s because this pill is being oversold. As Julia Belluz of Vox explained, this pill barely performs better than a placebo at increasing sexual desire. Only 8 to 13 percent of women saw an improvement over a placebo at all. The average bump in sexual frequency? About one more sexual encounter every two months. Considering that it’s an expensive, everyday pill that has serious potential side effects, the payoff just doesn’t seem worth it.

There’s nothing wrong with wanting to take a pill that makes you hornier. Sex is fun. Wanting sex is fun. If there was a pill out there that could make women want more sex, I’d be all for it. Just like it’s okay to drink coffee just because it wakes you up or to drink alcohol (in moderation) because it loosens you up, people should be able to take drugs, especially safe drugs, for sexual pleasure. The problem is that this drug doesn’t appear to be that drug. And feminists, regardless of our disagreements elsewhere, should be able to come together to denounce drug companies who appear to be selling women a bill of goods.