War on Contraception and Science Going Strong

Recently the New York Times and RHRealityCheck reported
on a leaked internal proposed regulation that calls for more and
different enforcement of anti-discrimination provisions for health care
providers. The provisions are forms of conscience clauses that do not
allow discrimination in hiring or promotion of health care workers who
do not wish to perform abortion or sterilization (or indeed in the
reverse, no discrimination against those who do perform abortions or
sterilizations) in federally funded settings.

The draft regulation
(PDF) goes into detail outlining the history of the laws protecting the
conscience of health providers and entities and then outlines the
problem. It seems that the central concern is not discrimination
against those who won’t perform abortions, but that the US Department
of Health and Human Services sees a real problem with requiring health
professionals (and anyone in the healthcare workforce) to be involved
with contraception, even if it is part of the job. The majority of the
section outlining “The Problem” concerns states that have passed laws
or issued executive orders requiring pharmacies to dispence
contraception, including emergency contraception, and that require
hospitals to provide emergency contracption to rape victims.

From the regulation:

In 2005, Illinois Governor Rod Blagojevich issued
executive orders requiring “a retail pharmacy serving the general
public [… to] dispense the contraceptive, or a suitable alternative
permitted by the prescriber, to the patient or the patient’s agent
without delay,” over the objection of pharmacist groups

In May 2007, Connecticut passed a law requiring all hospitals to
distribute Plan B to rape victims, despite religious rganizations’
objections to the abortifacient nature of the drug.9
A New Jersey law requires pharmacies to fill prescriptions “despite any
conflicts of employees to filling a prescription and dispensing a
particular prescription drug or device due to sincerely held moral,
philosophical or religious beliefs.”10

Massachusetts11 and New Mexico12 have passed laws similar to the
laws and executive orders in Connecticut, Illinois, and New Jersey.

These are problems? Serious enough to issue new enforceable regulations about infringing people’s conscience on abortion?

When the Administration overruled scientific staff at FDA and
outside experts regarding bringing emergency contraception, it seemed
clear to me that we were facing an attack on all contraception. Given
that the vast majority of people in the United States support access to
safe and effective contraception, and indeed the vast majority of
people of reproductive potential have used or use contraception in some
form, this is not a subject we should be arguing about at the federal

The fact that emergency contraception was so controversial that it
took over 3 years and 3 FDA commissioners before it was even partially
approved for those 18 and older told us that those opposed to
contraception (although a small group of people) had disproportionate
influence in this government. Despite the scientific and medical
evidence, the administration still sees contraception as something to
be blocked.

When Plan B was partially approved, the first thing to notice was
that the sky did not fall. Adult women have access to another form of
contraception, another option if regular contraception failed or if the
woman was raped.

But clearly the war on contraception is not over. That same small
group of highly influential people who want to limit access to
contraception are back at work within HHS. They’ve now worked to
broaden the definition of abortion to include contraception contrary to
the definitions of the American Medical Association and the American
College of Obstetricians and Gynecologists. In part they base it on a
poll from 2001.

A 2001 Zogby International American Values poll revealed
that 49% of Americans believe that human life begins at conception.
Presumably many who hold this belief think that any action that
destroys human life after conception is the termination of a pregnancy,
and so would be included in their definition of the term “abortion.”

This strikes me as an unfounded assumption. Most people do not
think use of oral contraceptives, injectable contraceptives or an
intrauterine device (IUD) are forms of abortion, even with full
understanding of the possibility that sometimes the mechanism of action
may involve reducing the likelihood of implantation of a fertilized
egg. Most people understand that contraception acts prior to pregnancy
(as defined by implantation in the uterus) and that abortion is
termination of an established pregnancy.

The leaked draft regulation also broadens who is protected by this
new regulation. Not just providers, but anyone involved in the
process, from appointment schedulers to those who clean the instruments
in a hospital, to the hospital itself all now can refuse to be involved
with their job, with federal protection, if the facility or clinic
provides contraception.

It’s a good sign that this document was released early by someone
inside HHS, so that the public can get a head start in understanding
what is coming next from the Administration, when it comes to limiting
access to contraception. Another good sign for scientific integrity is
information that not all of the scientific and health agencies within
HHS agreed (”concurred”) with issuing this proposed regulation.

Whether or not such objections within HHS will block the release of
this regulation, it is important that the scientists and medical
experts within the Department raise their voices, and I congratulate
those who have done so. There are consequences in research and
development of new medical products and in infertility clinics if the
definition of abortion reaches back to fertilization. The scientific
and medical communities need to be heard on the impact of this change,
along with the voices of women and couples who stand to lose access to
safe and effection contraception.

This article originally published on The Pump Handle.

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  • invalid-0

    How easy it is to get mired in dogma, how easy it is to forget the human beings who are affected by this.

    The HHS proposal tries to make it easy for conservative healthcare workers (even those who are not involved in direct patient care) to respond automatically to their convictions, without thinking. They then are not forced to deal with the very personal realities of the rape victim and her family.

    One in 3 women will be raped within her lifetime. Although some will not survive this rape, most do. Women aged 16 to 19 are 4 times as likely to be raped than the general population. Women with disabilities are twice as likely to be raped as the general public.

    The personal toll is enormous. Women have been conditioned to take responsibility for other people’s behavior, and many of these victims are confused about aspects of their behavior that may, in their view and the conservative public’s view, have precipitated the rape. Depression and anxiety are ubiquitous. Suicide does happen.

    As we know, they are not responsible, and rape is not miscommunication. Most rapists are serial rapists and will strike again, wreaking the same havoc on other lives.

    According to a 1998 study, rape costs a survivor an average of $87,000 per year (Tjaden & Thoennes, National Institute of Justice, 1998). Please adjust this for inflation. Women who have been raped need medical and mental health treatment, lose productivity, and consequently lose jobs and homes. Students’ grades may plummet, having lasting consequences throughout their adult lives. On a very real level, their self-doubt and fear of relationships may have a ripple effect for generations.

    Double the trauma when these women have been raped by a family member.

    Not all women who are raped will report their victimization. Those who do deserve to be treated with the utmost care and respect. It is at this moment of their greatest vulnerability that the health care worker’s attitudes matter the most– from the physician to the pharmacy tech to the cleaning staff.

    I believe that training is necessary for anyone who will deal with rape victims. The idealogue does not allow himself/ herself to personalize this issue: what if this were my daughter, my niece, my neighbor? The human being in the idealogue’s clothing might be reachable with the right training. Such training should not be given by someone with an agenda themselves: the message will get lost.

    Emergency contraception must be part of the resources available to women who have been raped. I have personally known a few women who were forced to go ahead with a pregnancy that began with a rape. I have seen how this pregnancy diminished their potential and affected their children’s lives. I have known women who have borne children as a result of forced incest. I have known the children born of these brutal unions. Although I have not personally been a victim of rape, I would want no less than the most compassionate and medically advanced treatment to be available to anyone who has gone through such a traumatic event.

    For the record, I am a retired social worker and teacher. I have worked with delinquent girls and their families, in a community mental health center, and at a battered women’s shelter. I am happily married, with a son and a daughter in their twenties. I am committed to working toward a society that allow young people like my own kids to grow up healthy, strong, and compassionate.

  • http://www.scarleteen.com invalid-0

    I don’t mean to get all fangirl on you, but I think you’re absolutely amazing.

  • invalid-0

    Thank you so much for your comment, Anonymous. As a rape survivor, I can tell you that you really hit the nail on the head.

    The religious right’s focus on Plan B makes me wonder if a large part of the objection to this drug is based in the realization that if women who are raped deserve to use this drug, that only reiforces the fact (and so many people deny and reject this very basic fact about and definition of rape) that we were assaulted and attacked again our will.

    I live in Wisconsin. My state recently passed legislation requiring all hospitals to provide rape victims with information about the morning-after pill and to inform them of their right to request the medication. It took several contentious years for this law to pass. Why?

    I usually never ask for the anti-choice perspective, but I really wonder what kind of anti-woman hate makes a person believe that rape victims should not be allowed to prevent a pregnancy caused by rape and that any employee or healthcare worker should be allowed to discriminate against women – all while on the federal payroll. I also wonder if HHS has heard of the term ‘standard of care.’ That’s clearly optional if your patient is female.

  • invalid-0

    Thank you Susan for a great blog, and Anonymous for a great reply. As a rape victim, I know how confusing and traumatic it is to find yourself possibly pregnant or diseased through no fault of your own. I personally was so depressed and guilt-ridden afterwards that I never reported it, even though it occurred within 100 yards of a police station. I should have, and if I could go back I would, but I was shocked and scared. People underestimate the courage it takes to even get to the hospital after being violated like that. To be denied care after forcing yourself out in public to a hospital, when all you want to do is take a shower and then hide for the next year or so, would only exacerbate the psychological trauma. Few enough women report this crime. We need to stop creating more barriers between a rape victim and her medical treatment, and maybe more people will report these vicious attacks.