America's War On Sex

Marty Klein

Part 3

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Why everyone? everyone? After all, if you think abortion is horrible, don't get one. If you think an intrauterine device (IUD) dehumanizes you, don't use one. After all, if you think abortion is horrible, don't get one. If you think an intrauterine device (IUD) dehumanizes you, don't use one.

While many Americans believe that whatever two adults do privately is their own private affair, many others disagree. For them, s.e.x is either authorized or unauthorized. And s.e.x is authorized only between legally married heteros.e.xual couples, generally limited to p.e.n.i.s-v.a.g.i.n.a intercourse. The only legitimate reasons for this s.e.x are reproduction and, according to some clergy these days, strengthening the bond of holy matrimony.3 This means that most Americans are having unauthorized s.e.x. Put another way, most of the s.e.x people have in America is unauthorized, including most religious conservatives.4 Those who war on contraception and abortion don't just want to discourage everyone from having unauthorized s.e.x. They want to prevent it, or at least make it as difficult as possible. They may call themselves pro-life, but they're really antichoice. Anti your your choice. choice.

Why do these people want all unauthorized s.e.x to stop?

They feel it pollutes their world. Obsessed by unauthorized s.e.x, they feel it degrades everyone, even those not partic.i.p.ating in it. They don't seem to have the psychological tools to ignore what others do behind closed doors.

Because they are attempting to adhere to a very strict s.e.xual standard, temptation appears everywhere. Understandably, they fear their own (generally rather ordinary) s.e.xual impulses, which they project onto others. Fearing their own s.e.xual decision-making, they mistrust others'. They even talk about "slippery slopes"-that if you think you can "get away" with, say, premarital or extramarital s.e.x, there's no limit to what else you'll do, imagining s.e.x with minors, group s.e.x, even b.e.s.t.i.a.lity as the logical conclusion of unmarried people using condoms.

Ultimately, they characterize s.e.xuality as dirty, and therefore incompatible with spirituality, which they claim is what drives them-and legitimizes their attack on your rights.

American government at the national, state, and local levels has created public policy to discourage unauthorized s.e.x and minimize contraceptive use.

This itself is a breathtakingly radical development. The policy isn't quite perfectly sealed yet: you can still buy condoms in Safeway (although Safeway can't Battleground: Reproductive Rights 31 Reproductive Rights 31 freely advertise them); most single Americans do have s.e.x (although getting birth control pills and EC is becoming harder); and abortion is still legal for some some people people some some of the time (if you aren't a teenager, are less than 18 weeks pregnant, can travel several times, and if you can find and afford a provider). of the time (if you aren't a teenager, are less than 18 weeks pregnant, can travel several times, and if you can find and afford a provider).

But these current parameters aren't the point.

The point is that your government has decided to care about what you do s.e.xually. Again. This time it isn't what you do with your eyes, mouth, or imagination, it's what you do with your genitalia. Our government cares about what you do with your genitalia way more than it cares what you do with your arms or legs. And they aren't even honest about the reasons.

FEMALE EMPOWERMENT.

There's another reason some people want to limit or eliminate access to contraception and abortion: it enables women to transcend the limited role of mother, which studies from around the world show is the gateway to more financial and psychological independence.5 Reproductive knowledge and practice has always been part of female folk culture. Birth control techniques were practiced in virtually all societies, including herbal potions, ritual infanticide, abortion, magic, withdrawal, v.a.g.i.n.al inserts, douches, and cervical caps.

The nineteenth-century bans against abortion and contraception were partly introduced to eliminate midwives, seen as compet.i.tion by increasingly professionalizing doctors, and to undermine women's emerging reproductive control. And America's industrialization and westward expan-sion led government and religious groups to desire population growth. In 1905, President Theodore Roosevelt attacked birth control and the new trend towards smaller families as decadent, a sign of moral disease-and a dangerous response to the huge influx of immigrants who were "weakening" America's gene pool.

The new contraceptive technologies of the mid-late twentieth century were seen as particularly progressive because they could potentially sever the link between s.e.xuality and reproduction. Shulamith Firestone emphasized this would free women from the "tyranny of reproduction," which dictated women's oppression.6 These technical advances were opposed by conservative and religious forces on so-called moral grounds. But their hypocrisy was exposed a few years later.

Whereas abortion and contraception challenged challenged the traditional equation of femininity and motherhood, new fertility technologies helped the traditional equation of femininity and motherhood, new fertility technologies helped fulfill fulfill the traditional female role-and were therefore approved by most Christians. Artificial ways of the traditional female role-and were therefore approved by most Christians. Artificial ways of enabling enabling reproduction were OK, whereas artificial ways of reproduction were OK, whereas artificial ways of preventing preventing it were not.7 it were not.7 As one book put it, "The use of birth control requires a [social] morality that permits the separation of s.e.xual intercourse from procreation, and is 32 32 related to the extent to which women are valued for roles other than wife and mother."8 But only a few years after the Pil and Roe v. Wade Roe v. Wade, it was no longer just contraception that disrupted the natural connection between mother and conception or fetus, it was the new kinds of artificial y aided fertility, with human eggs and embryos moving in and out of a woman's body, or even from one woman's body to another. Sperm was being geographical y manipulated as wel .

In 1984, the British government debated regulating reproductive technologies, including restricting techniques such as in vitro fertilization, egg donation, embryo donation, and artificial insemination, to stable, cohabiting heteros.e.xual couples. Such restrictions look quaint today, but they were an attempt to deal with the same question America struggles with today: who will have access to any new technology, and under what circ.u.mstances?9 Some attempt to frame this as a moral or spiritual or health question, but it isn't. It's a political political question. Perhaps this is more easily seen if the question is posed as, "Who shall be allowed to access the Internet in North Korea?" Or, question. Perhaps this is more easily seen if the question is posed as, "Who shall be allowed to access the Internet in North Korea?" Or, "Who shall be allowed to drive a car in Saudi Arabia?"

SEVERAL STRATEGIES.

The war on reproductive rights is carried out in several ways at once. The strategies are: 1. Increasing the unwanted consequences of unauthorized s.e.x.

2. Decreasing the motivation for using some or all kinds of contraception and abortion.

3. Limiting access to contraceptive and abortion equipment, technology, and information.

The churches, civic groups, and government agencies who promulgate these policies and restrict our choices uniformly claim that they care primarily about the disadvantages of various contraceptive/abortion technologies, and the personal consequences of their use. And these days, some believe that abortion is morally wrong.

But this is disingenuous. None of the disastrous results they say they're trying to protect us from are actual y supported by science. For example, the idea that abortion leads to depression, infertility, and breast cancer, or that premarital s.e.x leads to depression and suicide, are simply untrue. Scary, but not true. not true.

Besides, don't Americans deserve the chance to evaluate the costs and benefits of their own choices-and aren't we used to doing so? For example, some people think flying is dangerous, and so they don't, while others think its benefits make flying an acceptable risk. The same is true with driving on New Year's Eve, smoking cigarettes, getting a facelift, and enlisting in the Marines.

Here's how your reproductive rights are being successfully successfully challenged: challenged: Battleground: Reproductive Rights 33 Reproductive Rights 33 INCREASING THE UNWANTED.

CONSEQUENCES OF UNAUTHORIZED s.e.x.

Those who war on s.e.x depend on a simplistic hypothesis proven wrong repeatedly throughout history, that if you increase the possible dangers of s.e.xual expression, people wil stop having s.e.x. This shows such a dramatic lack of insight into their fel ow creatures, one could be forgiven for imagining they had never met another human. Fear of AIDS has not prevented Africans from having s.e.x, the risk of capital punishment has not prevented Iranian gays from having s.e.x, and the possibility of unwanted pregnancy has not prevented mil ions of American teens from having s.e.x.

And yet the fear (no statistics, just fear) of your "promiscuity" is routinely cited as justification for public policy: The belief that giving teenagers access to contraception will reduce their fear of pregnancy and STDs enough so that they'll begin to have s.e.x, or choose to have more s.e.x. The same is true about ending condom distribution in American prisons-as if fear of STDs actually stops some incarcerated men from connecting with or brutalizing others.

Or that a reduced fear of STDs would entice some inmates to start having male-male s.e.x they otherwise wouldn't.

This was the idea the government and Christian conservatives trotted out in attempting to restrict your access to EC (the "morning after pil " or Plan B).

They said they feared that the drug would lower the risks of s.e.x, thereby encouraging you to have more s.e.x with more partners. In December 2003, Dr. David Hager, one of the four Food and Drug Administration (FDA) committee members who voted against Plan B approval for over-the-counter (OTC) sale, said, "What we heard today was frequently about individuals who did not want to take responsibility for their actions and wanted a medication to relieve those consequences."10 Discouraging such behavior is a function of the family (and church), not not the government. Besides, studies show that access to the drug does the government. Besides, studies show that access to the drug does not not increase contraceptive risk-taking.11 Unfortunately, this increase contraceptive risk-taking.11 Unfortunately, this fact fact (and very positive safety data) has not influenced the antis.e.x movement's desire to discourage access to and use of the drug (for details about the government's campaign against Plan B, see below). (and very positive safety data) has not influenced the antis.e.x movement's desire to discourage access to and use of the drug (for details about the government's campaign against Plan B, see below).

The latest twist in this irrational saga is the development of a vaccine that can prevent prevent HPV-the Right's favorite STD, because it can lead to cervical cancer ("see, s.e.x kills!"). To be effective, the vaccine must be administered HPV-the Right's favorite STD, because it can lead to cervical cancer ("see, s.e.x kills!"). To be effective, the vaccine must be administered before before a girl becomes s.e.xually active. Remember, the Right is always pointing to HPV/cervical cancer as a tragedy people should avoid by abstaining from unauthorized s.e.x.12 Then it attacks this medical marvel by claiming, without any data whatsoever, that the vaccine will increase promiscuity by reducing the possible consequences of s.e.x. ("That's OK, Kevin, I'm vaccinated so I can't get HPV, which can lead to cervical cancer. Come on inside me!") Thus, they're against a girl becomes s.e.xually active. Remember, the Right is always pointing to HPV/cervical cancer as a tragedy people should avoid by abstaining from unauthorized s.e.x.12 Then it attacks this medical marvel by claiming, without any data whatsoever, that the vaccine will increase promiscuity by reducing the possible consequences of s.e.x. ("That's OK, Kevin, I'm vaccinated so I can't get HPV, which can lead to cervical cancer. Come on inside me!") Thus, they're against anyone anyone using it.13 using it.13 34.Their alternate strategy for unmarried women to avoid getting HPV when they have s.e.x? Unmarried women shouldn't have s.e.x. "Abstinence is the best way to prevent HPV," says Bridget Maher, of the Family Research Council.

"Giving the HPV vaccine to young women could be potentially harmful, because they may see it as a license to engage in premarital s.e.x."14 This clearly il ustrates that they are far less interested in supporting people's health than they are in control ing others' s.e.xual behavior. They have the right to want this, of course, but their intel ectual dishonesty about it is spectacular.

DECREASING THE MOTIVATION FOR.

USING CONTRACEPTION AND ABORTION.

Although reliable contraception is a modern marvel, waging war on s.e.x requires undermining people's motivation for using these products and procedures.

Contraceptive information is, of course, systematically withheld from s.e.x education in most American schools-often by legal requirement. Any young person who develops the habit of using contraception to prevent unwanted pregnancy will have to do so in spite of what he or she learns in school. (For more information, see chapter 2.) Antis.e.x forces lie about the effectiveness of condoms. After years of urging condom use to prevent HIV, the Center for Disease Control's (CDC) Web site suddenly doubted their efficacy until criticism forced this down in 2005.

That same year, physician Senator Bill Frist equivocated on national television about condoms' value in protecting users from HIV. A few months later, after he backed away from that, the FDA proposed requiring labels on condom packages that warn that they are probably less effective against certain STDs, including herpes and HPV, than others.15 President Bush had been lobbying for such condom labeling for years.16 It isn't only the American government that is willing to lie about condoms to discourage their use. For years, James Dobson (Focus on the Family), Jan LaRue (Concerned Women for America), and many others have been talking about how condoms don't protect people very well. In 2003, the Vatican stirred international controversy with its false claim that the HIV virus can pa.s.s through condoms, and request that governments "act accordingly."17 The "effects" of contraception and abortion have been lied about so often that the lies have acquired the patina of accepted fact. The most common lies are: * contraception and abortion encourage promiscuity in young people; * abortion leads to physical problems such as infertility and breast cancer (in Mississippi, those requesting an abortion are required to undergo "counseling," which must must include the warning that abortion may lead to breast cancer. Both the National Cancer Inst.i.tute and include the warning that abortion may lead to breast cancer. Both the National Cancer Inst.i.tute and Lancet Lancet medical journal refuted this in 2004.); medical journal refuted this in 2004.); * abortion leads to mental problems such as depression or suicide; * RU486 leads to infertility.18 Battleground: Reproductive Rights 35 Reproductive Rights 35 No one has pro- duced any scientific THE POPE ON AIDS.

evidence that these are The Catholic Church's continuing stance against true. But antis.e.x con-condoms as being somehow "immoral" extends to its servatives obviously opposition to using them to prevent AIDS. In Janu-don't trust the faith ary 2005, Pope John Paul II reaffirmed church teach-of their flock enough ing urging abstinence and marital fidelity to stop the to give them access to spread of AIDS and forbidding condoms. As Nicholas medical and scientific Kristof commented, "The worst s.e.x scandal in the Cath-truth about contracep- olic Church doesn't involve predatory priests. Rather, tion and abortion.

it involves the Vatican's hostility to condoms, which is The Right attempts creating more AIDS orphans every day. The Vatican's to discourage people ban on condoms has cost many hundreds of thousands from using abortion of lives from AIDS. Historians . . . wil count its anti-by making the process condom campaign as among its most tragic mistakes so difficult or repulsive in the first two mil ennia of its history."a that many women just give up. Increasingly, aNicholas D. Kristoff, "The Pope and AIDS, The New York The New York individual states are individual states are Times, May 8, 2005, http://select.nytimes.com/search/restricted/ May 8, 2005, http://select.nytimes.com/search/restricted/ using techniques such article?res=F10A14FD3E540C7B8CDDAC0894DD404482.

as mandatory waiting periods, forced exposure to photos or ultrasounds, and mandatory, propaganda-filled lectures.

Thirty-two states require require that women receive scripted "counseling" before receiving an abortion, something not required prior to far more dangerous procedures such as plastic surgery or heart bypa.s.s surgery. In 2004, South Dakota pa.s.sed a bil requiring that a woman be informed that abortion "wil terminate the life of a whole, separate, unique, living human being." Three states require disclosure of a supposed link between abortion and breast cancer. Three others require information on possible psychological impacts of abortion. In 2005, three states introduced bil s that would require patients to view ultrasounds of their fetus, or "unborn child," as South Dakota wants to require.19 that women receive scripted "counseling" before receiving an abortion, something not required prior to far more dangerous procedures such as plastic surgery or heart bypa.s.s surgery. In 2004, South Dakota pa.s.sed a bil requiring that a woman be informed that abortion "wil terminate the life of a whole, separate, unique, living human being." Three states require disclosure of a supposed link between abortion and breast cancer. Three others require information on possible psychological impacts of abortion. In 2005, three states introduced bil s that would require patients to view ultrasounds of their fetus, or "unborn child," as South Dakota wants to require.19 Twenty-four states currently require require a waiting period (usually 24 hours) between counseling and abortion, with bills pending in 10 other states. This ne-cessitates two separate trips to a clinic, an enormous burden for poor women or those responsible for children-especially in states where women have to travel hundreds of miles to get to an abortion provider. a waiting period (usually 24 hours) between counseling and abortion, with bills pending in 10 other states. This ne-cessitates two separate trips to a clinic, an enormous burden for poor women or those responsible for children-especially in states where women have to travel hundreds of miles to get to an abortion provider.

Three states now require women be told that the fetus may feel pain during abortion, and they must be offered anesthesia provided directly to the fetus. In 2005, 15 more states introduced requirements that informed consent materials must include the claim that the fetus can feel pain. Bills were introduced in Colorado and West Virginia that would require require fetal anesthesia fetal anesthesia regardless regardless of a patient's consent or additional risk.20 of a patient's consent or additional risk.20 36.Eleven states sel "Choose Life" government-issued license plates.21 In addition to sponsoring this religious propaganda, those states then give the government-col ected fees to antiabortion pregnancy crisis centers. In fact, states introduced two dozen bil s in 2005 to support these centers. Terrified pregnant women, often young, alone, poor, arrive there and are promised comprehensive information and choices. But they never never learn their ful range of options, and learn their ful range of options, and never never learn the truth about the safety and efficacy of early abortion. learn the truth about the safety and efficacy of early abortion.

Kansas, for example, now provides grants to organizations that encourage women to carry their pregnancies to term, and prohibits grants to groups that provide abortion. Minnesota just appropriated $5,000,000 to encourage women to carry their pregnancies to term.22 DECREASING THE OPTIONS FOR.

CONTRACEPTION AND ABORTION.

Given how clumsy and ineffective our government is in pursuing many of its goals, it has a.s.sembled an impressive array of methods to deliberately decrease our contraceptive options.

For starters, the federal and state governments are committed to reducing access to contraception, abortion, and sterilization for anyone under their legal or financial supervision. Women in prison who want legal abortions face tremendous obstacles which are not supposed to exist. Medicaid and Medi-Cal funding for contraception, abortion, and sterilization have been drastical y cut. Those on welfare-for whom unwanted pregnancy real y can be a matter of life and death- are in terrible trouble. And in 2004, Congress pa.s.sed a bil denying federal funds to women in the military seeking abortions even in the case of rape or incest. even in the case of rape or incest. 23 23 In 2005, 52 state measures were enacted that restrict access to reproductive health care.24 Early in 2006, South Dakota made it a felony for doctors to perform any abortion, except to save the life of a pregnant woman. The law was designed to challenge Roe v. Wade; Roe v. Wade; its sponsors want to force a reexamination of abortion law by the Supreme Court. According to Republican sponsor Rep. Roger Hunt, lawmakers defeated exceptions for rape, incest, or the health of the woman to maximize the law's impact on the national scene (rather than because it was best for the pregnant women of South Dakota).25 its sponsors want to force a reexamination of abortion law by the Supreme Court. According to Republican sponsor Rep. Roger Hunt, lawmakers defeated exceptions for rape, incest, or the health of the woman to maximize the law's impact on the national scene (rather than because it was best for the pregnant women of South Dakota).25 And in a dramatic restriction of contraceptive availability, Kansas has now made s.e.x between teenagers more dangerous than ever. Attorney General Phill Kline now demands that doctors, nurses, counselors, and all other care providers report, as abuse, any any s.e.xual interaction between teens under 16, even when it's consenting and there's neither injury nor complaint. He claims this is to discourage and punish child abuse, but providers are already mandated to report s.e.xual interaction between teens under 16, even when it's consenting and there's neither injury nor complaint. He claims this is to discourage and punish child abuse, but providers are already mandated to report abuse. abuse. He admits he periodically gets these reports from physicians and others, but, "I do not get them from the abortion clinics."26 So that's his goal-to continue hara.s.sing abortion providers.27 He admits he periodically gets these reports from physicians and others, but, "I do not get them from the abortion clinics."26 So that's his goal-to continue hara.s.sing abortion providers.27 Battleground: Reproductive Rights 37 Reproductive Rights 37 In the process he has made it even less likely that teens will request contraception, STD and HIV testing, or simple information about s.e.xual function and health. Quite a repulsive legacy for someone who claims to care about young people. This is a typical example of how the Religious Right's ideology of "protecting life" actually undermines it.

EXILING EMERGENCY CONTRACEPTION.

Wouldn't it be great to have a product that could minimize one of the worst heritages of rape and incest; help prevent families from self-destruct-ing; give foolish or unfortunate young people a second chance at a mature, responsible future; and in general, reduce the problematic consequences of s.e.xual intercourse?

There is such a product: emergency contraception (EC). Essentially a high dose of conventional birth control pills, it has been available in Europe and the United States for decades. It prevents pregnancy for up to 72 hours after intercourse. That's the window-72 hours. The common side effects are uncomfortable, but nothing out of any woman's ordinary experience, and certainly absolutely nothing compared to an unwanted pregnancy.

First, the government was pressured against making it available here.

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Then it was approved, but only for prescription use. Obviously, though, a person needing it needs it immediately. So it must be available OTC and kept on hand. Although there's absolutely no rational reason it shouldn't be, a few key government officials and religious leaders have successfully prevented all of America from having this access.

Faced with an application to make EC available OTC, the FDA first cited bogus safety issues. Then it created a long series of unexplained delays.

When the director of the FDA's Office of Women's Health resigned in frustration, and several senators demanded an explanation, the government and religious establishment finally admitted their objection: easier availability of EC would cause "promiscuity."

For example, Dr. David Hager, one of only four FDA committee members who voted against OTC availability, said, "What we heard today was frequently about individuals who did not want to take responsibility for their actions, and wanted a medication to relieve those consequences." And Tony Perkins of the Family Research Council said that making EC available OTC "would make the morning-after pill the new Sat.u.r.day night party favor of choice."a Americans' response should have been simple and direct- "So what?"

Concerned Women for America has trashed the drug, saying it "can lead to promiscuity; it's for the promiscuity lobby." By which, presumably, they mean al those people lined up demanding that young people ruin their lives.b (continued) (continued) 38.(continued) Those ranting that EC leads to "promiscuity"-a life of depravity which is, of course, every American's G.o.d-given right-have clearly failed to read the boring social science literature that shows conclusively that EC doesn doesn' t t increase "promiscuity."c The sad truth is that it wouldn't matter if they did, because this government and its religious allies don't trust science. They don't trust s.e.x, and they don't trust you. increase "promiscuity."c The sad truth is that it wouldn't matter if they did, because this government and its religious allies don't trust science. They don't trust s.e.x, and they don't trust you.

At a news conference on August 26, 2005, FDA Commissioner Lester Crawford announced that the agency had "completed its review of this application, as amended, and has concluded that the available scientific data are sufficient to support the safe use of Plan B as an over the counter product, but only for women who are 17 years of age and older. but only for women who are 17 years of age and older. " Although there was no reason to insert this age restriction (younger women had been taking oral contraceptives for decades), the conclusion for women over 17 would seem to be simple and positive. " Although there was no reason to insert this age restriction (younger women had been taking oral contraceptives for decades), the conclusion for women over 17 would seem to be simple and positive.

But Crawford then said the possibility of selling the drug both OTC (to consumers 17 and older) and by prescription (to consumers under 17) presented "novel regulatory issues"-which he didn't know how to solve.

And so he established a period for public input, delaying the entire matter of OTC availability again.d Later that week, Senator Orrin Hatch (R-UT) cal ed it not "a pharma-ceutical issue as much as it's a social issue."e Although most people nodded in agreement, this is a staggering admission for a modern democratic nation.

What exactly is is the social issue? It's the technological reduction of the risks of s.e.xual activity, chal enged by the desperate desire to maintain those risks. the social issue? It's the technological reduction of the risks of s.e.xual activity, chal enged by the desperate desire to maintain those risks.

Ten weeks later, Susan Wood, who had resigned as head of the FDA's Office of Women's Health in protest, said she was "very worried" that political pressure from the same conservative groups who had blocked OTC for EC would also delay availability of a new vaccine that protects against HPV, and therefore against cervical cancer. And for the same reason-that reducing one of the risks involved in s.e.xual contact could lead to "promiscuity" among young women. As we saw above, she turned out to be absolutely right. "I also worry when and if we reach an HIV vaccine," she said, "that they will raise the same argument."f ahttp://www.motherjones.com/news/update/2005/11/planb_timeline.html bhttp://www.cwfa.org/articledisplay.asp?id=7967&department=CWA&categoryid=life c Reproductive Health Technologies Project, at http://www.rhtp.org/news/media/ doc.u.ments/Factsheet-ThecaseforOTCPlanBAug05.doc d http://www.fda.gov/bbs/topics/news/2005/NEW01223.html; http://www.alertnet.

org/thenews/newsdesk/N16618935.htm eNew York Times, 9/2/05 fhttp://www.alertnet.org/thenews/newsdesk/N16618935.htm Battleground: Reproductive Rights 39 Reproductive Rights 39 ABORTION TRAINING AND AVAILABILITY.

The number of abortion providers in the United States fell from 2,400 in 1992 to 1,800 in 2000,28 while our population increased by nearly 50 million.

Meanwhile, * in 1996, 86 percent of all counties in the United States lacked an abortion provider; 32 percent of all American women aged 1544 live in those counties;29 * one out of every four women must travel more than 50 miles to obtain an abortion;30 * three states have only one one abortion provider. abortion provider.

At the same time, fewer and fewer medical residents are receiving training in reproductive health services. Only 20 percent of the nation's OB-GYN residency programs require first- and second-trimester abortion training. More than a third of chief residents in family practice receive no training to fit a cervical cap, fit a diaphragm, or insert an IUD. In Maryland, 97 percent of family practice residents and 36 percent of OB-GYN residents had no experience in elective termination of pregnancy in the first trimester. Of their family practice residents, half had never inserted an IUD, 43 percent had never inserted an implant, over a third had never prescribed emergency contraceptive pills, 30 percent had never fitted a diaphragm, 90 percent had never fitted a cervical cap, and 83 percent had no experience with tubal sterilization.

Keeping medical professionals ignorant or biased isn't the only way to limit reproductive choice. Even if a woman can get a prescription for EC, retailers are being successfully lobbied against stocking it. When a woman can't get her prescription filled at Wal-Mart or Target for example, she might have to drive hours for it-which for some people is just impossible.

CATHOLIC HOSPITALS.

American hospitals affiliated with the Catholic Church are the nation's largest single group of nonprofit medical facilities. They operate some 600 hospitals, almost 400 nursing homes, and dozens of healthcare systems managing so-called public facilities.

These inst.i.tutions provide some of America's finest health care. Their beliefs and regulations about s.e.xuality, however, conflict with the needs of many patients. The National Conference of Bishops' "Ethical and Religious Directives for Catholic Health Care Services" unambiguously forbids: forbids: * abortions; * providing contraceptive information and devices; * issuing or providing information on EC; * voluntary sterilizations; * disseminating AIDS and other STD information involving condoms.

40.And indeed, a 2002 study showed that over 50 percent of Catholic hospitals refused to offer EC to patients under any any circ.u.mstances, including rape.31 circ.u.mstances, including rape.31 This is particularly onerous as Catholic hospitals buy up secular facilities across America. Of the 127 mergers involving church-run and secular facilities between 19901998, nearly half resulted in the immediate termination of some or all reproductive services. For example, a Poughkeepsie, New York hospital ended abortion services after merging with a Catholic hospital, and a Gilroy, California hospital ended sterilization and contraceptive services after such a merger. As fewer inst.i.tutions offer reproductive health care, the elimination of a single facility can add hours or even days to the task of getting legitimate services.32 Health care at Catholic colleges is similarly compromised. Of 133 Catholic colleges responding to a 2002 survey, only 16 made contraceptives available to students.33 TIMELINE: YEARS OF DELAYING OTC.

APPROVAL OF PLAN B.

May 1960 FDA approves oral contraceptives by prescription. It becomes common for doctors to prescribe a combination of oral contraceptive pills for off-label use as EC.

July 1999 FDA approves Plan B as prescription contraceptive.

February 2001 Seventy medical and public health organizations including the American Medical a.s.sociation pet.i.tion the FDA to make Plan B available OTC.

May 2001 The Journal of Adolescent Health publishes a study showing that teens who receive advance provision of EC do not use condoms less.

February 2003 A study published in the Journal of Adolescent Health shows that teenage girls with increased access to EC were not more likely to have unprotected s.e.x.

April 2003 Makers of Plan B apply for OTC status, with 15,000 pages of data and research from 39 clinical studies.

December 2003 Forty-three Republicans in Congress, including Majority Leader Tom DeLay, send letters to the FDA urging it to reject OTC status for Plan B.

December 2003 Two scientific panels of experts at the FDA vote 234 to recommend Plan B for OTC sales.

February 2004 FDA postpones its decision on Plan B's OTC status for 90 days.

(continued) Battleground: Reproductive Rights 41 Reproductive Rights 41 (continued) May 2004 FDA bows to political pressure and denies the application to switch Plan B to OTC status, citing concerns about adolescent use ("promiscuity" and STDs).

January 2005 FDA delays its decision on Plan B again.

July 2005 Secretary of Health and Human Services, Michael Leavitt, promises Senators Hillary Clinton and Patty Murray that the FDA will rule on Plan B by September 1, 2005.

August 2005 FDA announces it will miss its deadline for the third time. Susan Wood, Director of the FDA Office of Women's Health, resigns in protest against FDA Commissioner Lester Crawford's unprecedented interference in agency decision-making.

September 2005 FDA announces it wil invite public comments on whether it can approve the OTC application, and whether it could enforce any regulation stopping girls under 17 from buying it.

November 2005 Government Accountability Office (GAO) report confirms the FDA's decision process denying Plan B OTC status is "unusual," and cites evidence of uncharacteristic high-level partic.i.p.ation and obstruction.a ahttp://www.prochoiceamerica.org/womenarewaiting_web/index.html FETAL RIGHTS LEGISLATION FETAL RIGHTS LEGISLATION In 2005, 115 fetal rights measures were introduced in almost 40 states. If pa.s.sed, many would grant a fetus the same rights guaranteed to people in state const.i.tutions. This is critical not only in criminalizing abortion should Roe v. Roe v.

Wade be overturned. It will also figure in battles over the be overturned. It will also figure in battles over the definition definition of abortion. of abortion.

For example, some legislators, pharmacists, and religious crusaders are calling EC, which prevents prevents pregnancy, an abortion drug. If a fetus has significant legal rights, a legislature could outlaw EC on the grounds that it pregnancy, an abortion drug. If a fetus has significant legal rights, a legislature could outlaw EC on the grounds that it may may harm the fetus. harm the fetus.

Indeed, a Michigan lawmaker has introduced a bill to ban over-the-counter sales of EC in his state in case the FDA legalizes it.34 In many states, killing a pregnant woman counts as killing two people. This language was conspicuous in California's 2004 Scott Peterson "double murder" trial.35 Legal recognition of fetuses' rights is not not the same thing as criminalizing abortion-it's the same thing as criminalizing abortion-it's worse. worse. Nor is it the same as declaring when life begins. It's more pervasive, with a cascade of awful effects. This is not an incremental change, it is an earth-shaking event counter to every founding doc.u.ment and principle in American history. The fact that it isn't seen this way is very dangerous. In Nor is it the same as declaring when life begins. It's more pervasive, with a cascade of awful effects. This is not an incremental change, it is an earth-shaking event counter to every founding doc.u.ment and principle in American history. The fact that it isn't seen this way is very dangerous. In 42 42 essence, law has enshrined beliefs-not facts, beliefs-into legal ent.i.ties. Law has taken moral and metaphysical beliefs and made them facts.

This can can' t t be done without compromising the rights of women, whose bodies keep fetuses alive. Mothers are always free to not get abortions, always free to treat their fetuses as if they have legal standing-say, by leaving them money in a wil . be done without compromising the rights of women, whose bodies keep fetuses alive. Mothers are always free to not get abortions, always free to treat their fetuses as if they have legal standing-say, by leaving them money in a wil . But giving a fetus legal standing diminishes the rights But giving a fetus legal standing diminishes the rights of the mother in whose body it of the mother in whose body it' s growing. s growing. This is a radical step which places an unfair burden on any pregnant woman (and her partner and any other children). This is a radical step which places an unfair burden on any pregnant woman (and her partner and any other children).

As the Feminist Women's Health Center says, "The life of a fetus cannot be separated from the life of the pregnant woman. [Doing so] is unique in medicine and law. No one can create a set of medical or legal principles giving a right to life to the fetus, because doing so inevitably limits the woman's rights."36 And this is no abstraction. Both pro-choice and antichoice thinkers have discussed the possibility of jailing pregnant women for behavior deemed detrimental to their fetuses. Lynn Paltrow, founder of National Advocates for Pregnant Women, had to file a federal civil rights challenge to a South Carolina hospital policy of searching pregnant women for evidence of drug use and giving the information to police. In 2001, the Supreme Court agreed that this policy violates Fourth Amendment protections against unreasonable searches and seizures.37 The antichoice movement clearly cares far more for fetuses than for babies, although babies are at least at least as human as fetuses, thus deserving equal protection. as human as fetuses, thus deserving equal protection.

But control ing how people treat already-born babies doesn't help the religious community in their project of control ing s.e.xuality. So we should not be surprised that Mississippi has the most stringent restrictions on abortion in the country, and and the highest infant-mortality rate. So much for the moral, "pro-life" culture of which they are so proud. the highest infant-mortality rate. So much for the moral, "pro-life" culture of which they are so proud.

EXAMPLE: INVENTING THE RIGHT TO REFUSE.

In response to the legalization of abortion in 1973, federal and state poli-cymakers started enacting "refusal clauses." These laws al owed doctors to refuse to perform or a.s.sist in abortions, and hospitals to refuse to al ow abortions on their premises. It was a creative and effective way to circ.u.mvent the new law.38 Since then, refusal clauses have spread to an ever-expanding group of workers and activities-always involving s.e.x. Last year, for example, a Wisconsin pharmacist refused to fil , and actual y confiscated, a single woman's prescription for birth control pil s. An Il inois ambulance worker refused to transport a patient suffering severe abdominal pain to a clinic for an emergency abortion.

Now some hospital workers are refusing to clean surgical instruments or handle paperwork they believe tied to abortion.39 Battleground: Reproductive Rights 43 Reproductive Rights 43 MANIPULATING SCIENCE VIA COMMITTEES.

Slightly less visibly, but no less importantly, President Bush has been stack-ing various reproductive science advisory and research positions with ideologues opposed to reproductive services. Here are just a few: * Tom Coburn, cochair, Presidential Advisory Council on HIV/AIDS- pledged to "challenge the national focus on condom use to prevent the spread of HIV."

* Joseph McIlhaney, CDC Director's Advisory Committee-anticondom activist who, according to his close friend James Dobson, "rather than expecting science to solve our problems, says a better solution involves a return to the spiritual and moral guidelines that have been with us for thousands of years."

* David Hager, Reproductive Health Drugs Advisory Committee of the FDA-opposes prescribing contraceptives to unmarried women, seeks to revoke FDA approval of the RU-486 abortion pill.

* Dr. Joseph Stanford, Reproductive Health Drugs Advisory Committee of the FDA-refuses to prescribe contraceptives of any kind, because "medicine is permeated with att.i.tudes toward s.e.xuality and fertility that are incompatible with Christian values."

Comments Donald Kennedy, past president of Stanford University and editor of Science, "I don't think any administration has penetrated so deeply into the advisory committee structures as this one." Added David Michaels, professor of public health at George Washington University, "They're stack-ing committees to get the advice they know they want to hear, which is a charade." Even some Congress members are concerned. In 2003, a congressional committee on government reform noted that leading scientific journals have begun to question whether scientific integrity at federal agencies has been sacrificed to further an ideological agenda, finding "numerous instances where the administration has manipulated the scientific process and distorted or suppressed scientific findings."a aU.S. House of Representatives, Committee on Government Reform, Minority Staff Office (Washington, DC: Government Printing Office, 2003). (Cited in) The Planned Parenthood Federation of America, "The a.s.sault on Birth Control and Family Planning: Executive Summary" (New York: The Planned Parenthood Federation of America, 2003), 16.

At the moment, medical facilities in 46 states can refuse to provide abortions. This creates huge obstacles for women who can't afford (or aren't healthy enough) to travel the hundreds of miles now sometimes necessary, not to mention the problem of fol owup care. Many states now protect any inst.i.tution that refuses to mention mention EC to women who have been raped-and EC to women who have been raped-and 44 44 the federal government wants to protect this inadequate medical care national y.

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