Investigations Sexual Health

The Right’s Answer to Gutting Planned Parenthood? Elementary Schools, Homeless Shelters, Jails

Sharona Coutts, Zoe Greenberg & Brie Shea

Most people would consider it unusual to pick a corrections facility if they were in the market for a breast exam. But that’s exactly what is suggested by a new website launched last month by 17 of the nation’s most prominent anti-choice groups.

The receptionist at the clinic at Washington D.C.’s Correctional Treatment Facility seemed baffled to receive a call last week from a reporter asking whether she could schedule a breast exam at the facility.

“This is a jail,” the receptionist said. The reporter asked whether people from the community could nonetheless make appointments at the facility for a breast exam, a Pap smear, or a test for sexually transmitted infections. “Ma’am, this is a jail,” she said again, before suggesting that the reporter contact doctors’ offices nearby.

Indeed, most people would consider it unusual to pick a corrections facility if they were in the market for a breast exam. But that’s exactly what is suggested by a new website launched last month by some of the nation’s most prominent anti-choice groups.

The site, GetYourCare.org, is registered to the Alliance Defense Fund, a deep-pocketed fundamentalist Christian group based in Phoenix, Arizona, now known as the Alliance Defending Freedom. Other sponsors of the site include Concerned Women for America, the Susan B. Anthony List and the Family Research Council. Together, these groups have played leading roles in either promoting or bankrolling some of the most significant anti-choice, anti-LGBTQ campaigns and lawsuits of the last few years.

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The new site was launched on September 28, the day before Cecile Richards, president of Planned Parenthood Federation of America, testified before Congress about the discredited claims that her organization profits from fetal tissue donation. The claims were made in a series of surreptitiously recorded and deceptively edited videos. Though they were the focus of a media frenzy over the summer, no evidence has been found to substantiate them, despite multiple hearings and both state and federal investigations.

Planned Parenthood serves an estimated 2.7 million people throughout the United States per year, many of them students, parents, and low-income individuals reliant on Medicaid for health care. GetYourCare.org is a not-so-subtle effort by anti-choice groups to double down on their repeated claims in Congress and the media that women’s health care would be largely unaffected if federal and state governments stripped Planned Parenthood of public funding. The site features a green map of the United States, covered in a spray of thousands of yellow dots, each of which is supposed to represent a health-care facility that could ostensibly fill the vacuum left by Planned Parenthood’s absence. The site says it draws its information “primarily from two separate lists: Federally Qualified Health Centers (FQHC) and Rural Health Centers (RHC).”

“GetYourCare.org was created to show that women have real choices when it comes to health care,” the site says. “All across America, thousands of low-cost health centers offer women and their families high-quality health care.”

A press release from the Alliance Defending Freedom claimed that the facilities listed on the map “typically offer the full range of women’s health services without all the scandal of Planned Parenthood.”

But in an investigation into the facilities, Rewire has found that these “real choices” include hundreds of elementary, middle, and high schools; clinics that provide care for homeless people; nursing homes; pediatrics centers; and even the D.C. jail. Rewire called and emailed hundreds of the facilities listed on the map, and discovered that many of their spokespeople were bewildered by the notion that women would be directed to their facilities for reproductive health services.

School officials, in particular, were confused that they would be asked to provide reproductive and sexual health services to the general population. The GetYourCare site explains that there are over 600 schools listed because they “have been identified as providing girls’ and women’s health care services at ‘school-based health centers’ on location. Thus, the school serves as a very real option for girls and young women in the area who need healthcare.”

In fact, virtually none of the 60 schools Rewire contacted from the list said they provide health care to girls and women in the community.

That includes Wearwood Elementary School, which sits nestled at the foot of the Great Smoky Mountains in Wears Valley, Tennessee. Wearwood, which teaches students from kindergarten through eighth grade, is part of a rural farming community—and not the first place you might think to go for an STI screening.

Instead, the clinic is like many other elementary school nurse’s offices, where a full-time school nurse provides limited care to the 190 students in attendance.

The nurse primarily tends to the school’s one diabetic student, the principal, Jon Manning, told Rewire in a phone interview. She can also treat scrapes, fevers, and headaches, although the district has a telemedicine program for more serious ailments.

Principal Manning described the school as “remote;” the nearest commercial district is nine miles away in Pigeon Forge, Tennessee. If women need to make an appointment for a breast exam or a birth control prescription, Wearwood Elementary is certainly not the place to go.

“We just don’t have the equipment or the staff,” Principal Manning said, when asked if women from the community could make check-up appointments there.  “What we have to offer really wouldn’t be feasible. One thing is, normally, we don’t allow strangers in during the school day for security reasons.”

Of the 60 elementary, middle, and high schools Rewire contacted across six different states, only two said they provided health services to women in the community. Both were based in Sneedville, Tennessee, and are funded by the East Tennessee State University’s college of nursing, according to a receptionist at the clinic. She said the school-based clinics provide care to students during school hours, but are open to the general public after hours and on weekends. They do provide Pap smears, breast exams and STI screenings, and they accept Medicaid patients, she said.

But many respondents at the schools were mystified by the question of providing sexual and reproductive health care.

“You called an elementary school,” a receptionist at the Heritage Hill School in Springdale, Ohio, said.

“To women?” asked a receptionist at the Delhi Charter School in Delhi, Louisiana. “No ma’am, we just do the children here that go to this school.”

“We don’t have a school-based clinic and we never have,” the receptionist at the Abiquiu Elementary School in Abiquiu, New Mexico, told Rewire.

Other types of centers explained that they did not provide services to the general population.

Rewire attempted to contact more than 20 clinics that provide health care for homeless people listed on the map. Many facilities that we contacted did not return calls or emails seeking information about the care they offered. Of those that did answer calls, several said that they did provide some type of primary health care, but in some cases those services were available only to people who met their criteria for homelessness. For a facility in El Paso, Texas, that meant providing a referral letter from a homeless shelter. For the Jessie Trice Community Health Center in Miami, Florida, a receptionist said that treatment consisted mainly of primary care for residential drug treatment patients, and not for the general public.

Similarly, the pediatrics centers we contacted were puzzled by the notion that they could offer comprehensive reproductive and sexual health services to women and girls. For instance, the receptionist at the pediatrics clinic on Marco Island in Florida—the only facility listed by the map in the area of Marco Island—confirmed that they could see girls for general pediatric complaints, but for anything involving reproductive or sexual health issues, they would need to refer patients out. She told us that the closest facility was in Naples, some 30 miles away.

It should come as no surprise that so many of these facilities do not offer comprehensive sexual and reproductive care. The official government document that explains what is included in the list that the anti-choice groups used to populate the map does not specifically mention sexual or reproductive care. Rather, it enumerates some more general forms of care—such as physician services, “other ambulatory services,” and some screening treatments—that could potentially encompass sexual and reproductive care. But the list also explicitly includes services that seem to be unrelated, such as nursing home care and diabetes self-management.

When informed of our findings, the Alliance Defending Freedom was unperturbed.

GetYourCare.org includes clinics serving different populations and demonstrates that Planned Parenthood is very rarely the only option even for the very limited services Planned Parenthood actually provides,” wrote spokesman Bob Trent in an email. “Even if Planned Parenthood were to stop providing these services, it would hardly be a blip.”

The notion that shuttering Planned Parenthood could be done without affecting access to care for those patients has been widely rejected by academics, experts, and the nonpartisan Congressional Budget Office, which concluded that 15 percent of current patients would immediately “face reduced access to care” should Planned Parenthood cease providing family planning services. That conclusion focused on “services that help women avert pregnancies,” and not the many other services, such as cancer screenings and STI testing, that Planned Parenthood provides. The CBO also concluded that the move would result in more births, and therefore greater costs to Medicaid.

But that hasn’t stopped prominent anti-choice politicians and groups from sticking to the claim.

Louisiana Gov. Bobby Jindal, who is running for the Republican presidential nomination, made that argument in court filings over his state’s efforts to strip Planned Parenthood of state reimbursements for services it provides to some 5,200 patients. When the federal judge hearing the case questioned why Jindal and his lawyers had included dentists and ophthalmologists in their list of facilities that could pick up the slack, Jindal’s administration had to back down and acknowledge that a dentist’s office is probably not the right place to go if you’re in need of a Pap smear or other reproductive health service.

The groups backing GetYourCare.org are no small-bit players. The Alliance Defending Freedom is a key architect behind legal strategies to frame anti-LGBTQ laws as protections for religious liberty. It had $35.5 million in assets, according to its 2014 public tax filings. The Family Research Council has been designated as a hate group by the Southern Poverty Law Center for its homophobic vitriol. It reported assets of more than $4 million and revenue of $13.7 million in the fiscal year ending in 2014. Concerned Women for America and the Susan B. Anthony List both clock in with around $4 million in revenue according to their most recent tax filings. Each of these groups actively campaign to end access to safe and legal abortion in the United States, as well as to restrict access to contraception. Another sponsor, Americans United for Life, generates hundreds of the model laws that have been used by state and federal legislators to further the same goal.

Based on efforts to contact hundreds of the roughly 11,000 facilities that appear to be included on the map, Rewire found that many locations did say they could provide the services we requested. Facilities in Arizona and Ohio were more likely than those in Nevada, Oklahoma, northern California, or Oregon to be able to make appointments within the next week. For those other states, wait times were typically until late December or early January. A receptionist at a facility in the northwest quadrant of Washington, D.C., said that since the clinic wasn’t taking any new patients until January, she wasn’t able to schedule appointments at this time. In Kansas and Nevada, receptionists suggested looking to facilities nearby, often more than an hour away, to schedule well-woman visits. Many voicemails and emails simply went without a reply.

Insurance coverage was also patchy. Some facilities said they accepted Medicaid and others said they charged on a sliding scale, depending on ability to pay. However, other facilities said they did not accept the types of insurance that a reporter cited.

Rewire’s reporting, though not a scientific study, strongly supported the conclusions of numerous experts who found that closing or limiting Planned Parenthood services would have a dramatic impact on women and girls—especially those in low-income communities and communities of color.

Writing in the Health Affairs Blog last month, Sara Rosenbaum, a professor and founding chair of the Department of Health Policy at George Washington University School of Public Health and Health Services, argued that defunding Planned Parenthood would be a disaster for women and girls: “Unable to access the contraceptive care they need, women would be left to pay the price, as more unintended pregnancies and abortions result.”

Rosenbaum, who is also a commissioner on the Medicaid and CHIP (Children’s Health Insurance Program) Payment and Access Commission, concluded:

[A] claim that community health centers readily can absorb the loss of Planned Parenthood clinics amounts to a gross misrepresentation of what even the best community health centers in the country would be able to do were Planned Parenthood to lose over 40 percent of its operating revenues overnight as the result of a ban on federal funding.

Based on Rewire’s reporting, not even the nation’s elementary schools, homeless shelters, and nursing homes could fill that gap.

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.

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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.

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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.

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