In the late 1990's, I applied for a job with Sister Phillipa Clinic, part of St. Mary's Hospital and Catholic Health Care West as a nurse practitioner. It sounded like a great job working on their health care van that would go to Catholic schools, including high schools, in San Francisco. I was getting burned out on a long commute everyday to San Jose and after 5 years of general practice, including helping setting up the first adult/pediatric care part of the clinics, I wanted something closer to home and to specialize in children's care, especially adolescents. But, I had one huge strike against me for even an interview.
I worked for Planned Parenthood, Marmonte, the largest affiliate of the Planned Parenthood Federation of America. But, miracles do happen and I got a call for an interview.
Having been raised a Roman Catholic, including a year in a convent in Los Angeles, I couldn't believe I got a call for an interview at the Sister Philippa Clinic at St. Mary's hospital in San Francisco. A "doubting Thomas" all the way, I thought I knew the Church pretty well, especially its all male hierarchy which appears to be stuck in a 9th century time warp when it comes to matters related to women and women's health in particular. I even remember the 3 dribble rule for Catholic girls' basketball which no matter where you were in the court of play you had to pass the ball after 3 dribbles. No wonder I hated basketball. Watching athletic nuns struggling to play irked me and it irked them too.
But the Churches current position on family planning is : You have no choices and no options other than the FAM method ( Sex when you're not fertile or Yup, you're pregnant). Forget that FAM was added because the Catholic church had to offer Catholic women something. Forget also that one of the inventors of the modern birth control pill was himself a Roman Catholic and thought the Churches' only objection to this advancement in reproductive health would have been no, natural period for women. He simply added those 7 days of placebo pills so women and the church could feel better about contracepting. But, no such luck.
When I went for the interview, I went more out of curiosity than anything else. I sat down with some wonderful doctors and nurses who explained how, they managed to work for the Catholic system even though all but one, was a practicing Catholic, and still offer their patients all the options in reproductive care.They considered themselves clinicians and patient advocates first and reminded me that not all of the patients I would see on the van would be Catholics. I was being hired as a patient care advocate, not a church advocate. When the exam room door closed, it was me and the patient, not a third party making decisions. Confidentiality and patient advocacy for what the patient wanted and needed were the only priorities that mattered, no different than the standard of care I was delivering at Planned Parenthood.
I also learned that indeed I could order birth control pills to my hearts content and help make referrals for abortion services after choice counseling. They indeed stocked a limited range of oral contraceptives, they called "period regulation pills" rather than contraception and the only thing I could not order would be abortion at the Hospital.
I respected that and as long as I did not overtly promote contraception outside of the van, then it was ok to order a wide variety of family planning and write prescriptions as my practice deemed necessary.
It was an interesting interview and although, I didn't get the job, enlightening. I had more respect for the doctors, nurse practitioners and other health care providers at their clinics because of the ban on overtly promoting contraception, yet dispensing it in the privacy of the exam room. Almost like an underground movement within the system itself.
But, that paradox is alive and well, between what publically the Church advocates and what privately clinicians are doing in exam rooms everywhere within a system that still treats women overtly, like second class patients when it comes to reproductive health care choices. This isn't about religious freedom but about the freedom to offer all options to patients who, behind the exam room door, want, need and ask for access to safe contraception. It is about the right of a clinician to practice in an honest way by the practice guidelines of their profession not the whims of a third party for political points. I am not a practicing Catholic nurse practitioner and my license to practice did not come from the Church. It came from the state of California that duly, legally licensed me to practice safe, effective care. One standard of care for all patients, like the California Nurses Association would say, where ever they were seen or treated. Equal treatment for all patients, no matter where one practices.
As I see the criticisms coming from those right wing pundits and politicians who are grandstanding on religious freedom, I' m framing this as a simple matter of the ethical and moral advocacy for women patients, including ones within the Catholic system, who have a right to expect the best medical and nursing treatment modern medicine in the 21st century has to offer.
My feeling is that health care reform with private insurance that pays for the totality of care should also include all the options for reproductive choice for women. If your Doctor/NP/PA practices in a system that discriminates against that choice, then time to change systems and clinicians to those who will.
But I also know, within these systems, while the grandstanders continue to shout and yell about not providing these optionswhile protecting the santity of religious freedom, someone, quietly, behind closed doors is providing "period regulation pills" to women who want and need these options. Someone is protecting the right to provide safe and effective care for women and the right of patient confedentiality. It is NOT about religious freedom but the right to the best care clincians can offer.
We learned , with the Susan G. Komen PR disaster that was reversed after an avalanche of negative press, that when women speak and act together, we can move mountains which can reverse the attacks on women's health and access to all options for our care. Personally, I am fed up with attacks on Planned Parenthood from small minded, largely men who carelessly assume that we women will just sit back and do nothing when lies emanating from less than Presidential candidates, like Mitt Romney, about contraception are said so easily. No, Governor Romney emergency contraception is not an abortion pill. And no matter how many times you say it, it is still not true.
The only thing that should matter in this debate is why there is a debate at all about letting American women have access to safe birth control options and allowing their providers to give them the best care their training, education and expertise can give them.