Visions of Sugar Plums: A Reproductive Rights Wish List

Marilyn Keefe is Interim President and CEO for the National Family Planning and Reproductive Health Association (NFPRHA).

The signs are everywhere: wreaths and lights decorate lampposts and buildings, shoppers scurry to and fro in search of gifts, the "do nothing" Congress is finally over… yes, the holidays are here and not a moment too soon. I don't think it is an overstatement to say that this was another difficult year. Once again, reproductive rights were under attack in America, from Supreme Court nominations to parental notification, from funding for the Title X family planning program to the hopefully overstated war on contraception.

Lest I seem too "Bah, humbug," however, I should point out some of the bright spots of 2006. Plan B was finally approved for over-the-counter sales, the South Dakota abortion ban was defeated, the first-ever HPV vaccine hit the market, and a handful of states turned down federal abstinence-only-until-marriage program dollars in recognition of the dangers inherent in these programs. Come this January, Democrats will have control of Congress, which we can only hope will finally bring an end to the kinds of anti-family planning, anti-choice legislative attacks that have been the centerpiece of social conservatives' agenda for the last twelve years.

Still, while the prospects of a new Congress sometimes make me as giddy as a five year-old on Christmas morning, I am left with a nagging feeling of dread at the thought of what may lie in store for 2007. Opponents of contraception – especially in the Bush Administration – remain as dedicated as ever to their cause. Yet, ‘tis the season, a time of hope and optimism and a chance to focus on new beginnings. With that holiday spirit in mind, allow me to share a few items from our wish list for reproductive rights for the new year. As John Lennon said, "Let's hope it's a good one…"

Wish 1 – The 110th Congress Goes Down in History as the "Do Something Great" Congress: Let's put all the polarizing rhetoric and playing-to-the-base behind us. There are a number of pieces of legislation out there on which all sides can come together. The Prevention First Act comes to mind. The idea behind this legislative package is simple: increasing access to contraceptive services improves women's health and reduces the need for abortion. Contraceptive use has vastly improved maternal and infant health and has been the driving force in reducing national rates of unintended pregnancies, STDs, and abortions. Prevention First capitalizes on this concept by authorizing an increase in funding for Title X (the nation's family planning program); expanding Medicaid family planning services to women with incomes up to 200 percent of the federal poverty level; and requiring private health plans to cover FDA-approved prescription contraceptives and related medical services. The bill also addresses access to emergency contraception, and in the next session should also shine a spotlight on the education side of the equation by including a provision supporting comprehensive sex ed. Prevention First isn't the only way Congress can improve women's health, but it would be a great start.

Wish 2 – Politics No Longer Trumps Science: One of the hallmarks of the Bush Administration, unfortunately, has been the advancement of political ideology over scientific fact. FDA's nearly three-year delay in approving Plan B emergency contraception is perhaps the most obvious, but not the only, example. The federal government's continued promotion of abstinence-only-until-marriage education programs – despite no solid evidence that these programs work – is yet another example. But the most recent example is the appointment of Dr. Eric Keroack as the new Deputy Assistant Secretary for Population Affairs (DASPA). In a nutshell, the DASPA runs Title X, a program committed to ensuring access to contraception and reproductive health services for low-income women. Dr. Keroack has demonstrated a sincere commitment to opposing abortion and supporting abstinence, but his public statements, writings, and professional associations leave family planning a question mark at best. In fact, the website for "A Women's Concern," the group of crisis pregnancy centers at which Dr. Keroack was Medical Director, states that the centers will not distribute, encourage the use of, or offer referrals for contraceptive drugs and devices, even calling the use of birth control degrading to women. The real point is how does someone with a questionable stance on access to birth control manage to find himself heading the nation's family planning program? How does that happen, if not for the desire to put ideology ahead of reason, politics ahead of science? In the new year, I can only hope that reason will finally emerge from the wilderness to which it has seemingly been banished.

Wish 3 – Everyone Finally Understands Why Contraception is a Critical Component of Women's Health: The benefits of family planning and access to contraception are proven. Women are more empowered to choose when to have children and how many to have. With control over this decision, women can take control over their education, finances, and health. In fact, the Centers for Disease Control and Prevention included family planning in their published list of the "Ten Great Public Health Achievements in the 20th Century." Nearly 90 percent of Americans support access to contraception. Ninety-eight percent of American women have used some form of contraception during their reproductive lives. Title X has been providing contraception, as well as fundamental health care like breast exams and cervical cancer screening, to low-income women for more than 35 years. This was a non-controversial program when it was introduced – then-Congressman George H. W. Bush (yes, George senior) was one of the bills chief advocates – and should not be controversial now. Yet somehow the far right has conflated contraception with the moral degradation of society, blaming it for everything from harming relationships between men and women to actually causing abortion. If I had just one wish, it would be that those who oppose contraception would finally wake up and smell the eggnog. Contraception is not the enemy; ignorance of the need for contraception is. Ensuring access to contraception is a mission we all can, and should, support.

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