Update [2004-11-13 13:55:58 by mcjoan]: Thanks to everyone for extremely substantive discussion here. I'm going to be writing a lot on reproductive health and rights issues in the coming months, and there are so many fantastic ideas to follow up on arising from this discussion. If I didn't respond to you directly, sorry. It's kind of hard to keep up sometimes. But you've all helped me tremendously.
(
Cross-posted on liberal street fight)
Hello class. Welcome back to "Pregnancy and STD Prevention I." Today's lesson is barrier methods. Let's get started by opening your textbook to page . . . oh wait, that's not in the textbook. See, the
Texas State Board of Educators (SBOE) decided last week (subscription) that your textbook couldn't talk about contraception. And since Texas is the second-largest market for high school textbooks, well that pretty much sets the standard for all textbook publishers. You're not going to find anything about contraceptive methods in this textbook. So kids, here's what to do. Abstain. Get plenty of rest, and go out in groups rather than pairs. Oh, and respect yourself. Ok, class dismissed. Girls off to home ec, boys to shop.
The Texas SBOE decision is just one more small victory by the anti-choice coalition to limit access and education about contraception to some of our society's most vulnerable members. An area in which they are seeing increasing success is passing
"refusal clauses" at the state level (pdf) that allow health care facilities, health care providers, and pharmacists to refuse to provide information or access to reproductive health services. Abortion refusal clauses exist now in 43 states. Twelve states allow some health care providers to refuse to provide contraceptive services, including three states that explicitly allow pharmacists to refuse to dispense contraception. Those three states are Arkansas, Mississippi, and South Dakota. I'll come back to the significance of those three states in a minute.
Groups like Pharmacists for Life International (wingnuts) and the American Association of Pro-Life Obstetricians and Gynecologists (more professional wingnuts) are focusing their opposition to contraception primarily on the Pill. The basis of this stand is in the belief that in some cases the Pill acts not to suppress ovulation and prevent fertilization, but to prevent a fertilized egg from implanting and growing, something they call the "post-fertilization effect." This means that the Pill is causing an abortion. (Having fun yet?) Medically, the American College of Gynecologists have a very practical basis for determining when pregnancy begins--when it actually shows positive in a pregnancy test, which can't happen until implantation.
Never ones to let science get in the way of belief, these anti-choice proponents got their crazy ideas from a paper written by a Salt Lake City family doctor named Joseph B. Stanford, an assistant professor of family and preventive medicine at the University of Utah. In this paper, Stanford described the so-called "post-fertilization effect" and discusses his reasons for refusing to prescribe birth control pills. Oh yeah, and this is the same Dr. Stanford that was appointed to the Food and Drug Administration's Reproductive Health Drugs Advisory Committee last year. Stanford, along with other Bush appointees W. David Hager and Susan Crockett, were instrumental in the decision to kill the approval of Plan B, an emergency contraceptive, as an over the counter drug.
While the anti-choice provider community is still relatively small, it's growing. According to an excellent article in Prevention,
Hundreds of physicians and pharmacists have pledged not to provide hormonal birth control. Among them: 450 doctors affiliated with the Dayton, OH-based natural family planning group One More Soul; some members of the 2,500 doctors in the Holland, MI-based American Association of Pro-Life Obstetricians and Gynecologists; and a growing number of the 1,500-member Web-based Pharmacists for Life International.
And that brings us back to Arkansas, Mississippi, and South Dakota. Let's see, what do all of these states have in common? Hmmm . . . could it be disadvantaged, largely rural populations? Could it be women who have very limited access to health care providers, and who will be unlikely to find a doctor or pharmacist willing to provide their prescription should their regular provider suddenly decide they don't like the Pill? According to the Alan Guttmacher Institute this is a population already underserved, and most likely to resort to the most extreme contraceptive solution: sterilizations. Women who have less than a high school education, have a household income below 150% of the federal poverty level, or are black or Hispanic are far more likely to resort to sterilization--about 27 percent of the female population in child-bearing years using some form of contraception. (I was encouraged to see that a full 10% of women were lucky enough to have male partners willing to go under the knife themselves to take care of this issue. Gee, thanks for stepping up to the plate, guys.)
So why now, you might wonder, is this fringe movement of the anti-choice coalition pushing for less contraceptive availability? I'm sure that some do actually buy into the post-fertilization effect, and truly believe that the Pill might actually cause abortion. But what I think is more likely on a large scale is that these people want to see more abortions. Abortion rates actually declined, and declined significantly--17.4 percent--during the Clinton presidency. At the end of his second term, abortions were at a 24-year low. And they are rising again in this administration. Because the anti-choice coalition needs to turn the problem into a crisis in order to push their agenda more quickly. What better way to do it than to dramatically increase the need for abortion in a handful of red states? How do you do that? Make birth control harder and harder to get.
This is one we can win, folks. Sixty-four percent of the more than 60 million women in child-bearing years in this country use birth control, and almost 27 percent of them use the Pill. In a recent national survey (pdf) the vast majority of women aged 18-44 felt that prescription contraceptives should be available without a doctor's prescription and with a screening by a pharmacist. Greater access to contraceptive services is something women are calling for, and would be horrified to learn is becoming the new target of the anti-choice movement.
Let's conclude by going back to Texas, and those high school kids that can't read about how to prevent pregnancy and STD infection. Turns out that Texas has the highest birth rate in the nation for teens aged 15-17. It also turns out, according to a poll conducted in August, that 90 percent of Texans "favor teaching students age-appropriate, medically accurate information on abstinence, birth control and prevention of sexually transmitted diseases and HIV." And still in Texas, regarding the case of Julee Lacey in Forth Worth, who's local pharmacist wouldn't fill her prescription:
When a woman is denied the Pill and the incident becomes public, it triggers a loud response. Case in point: After Lacey's story appeared in the Dallas Morning News, there was an enormous outpouring of letters from readers appalled by the pharmacist's actions. "This was a huge issue in our area, and we're a conservative community," says Emily Snooks, director of media relations and communications at Planned Parenthood of North Texas. "People here are still talking about it, simply because the vast majority of people in this country believe access to birth control is a basic right."
Let's keep it that way.