In the past decade, so-called crisis-pregnancy centers have become an increasingly central part of the antiabortion movement. They pose as women’s health clinics and use innocuous names like “Women’s Care Center” or “Pregnancy Problem Center.” But instead of employing nurses or social workers, they’re staffed by antiabortion activists who often make patients watch gory antiabortion videos, warn them about nonexistent health risks posed by abortion, and scare them with the threat of suffering “post-abortion syndrome,” a psychiatric disorder that exists only in pro-life lore.
As of 1999, the National Abortion Rights Action League (NARAL) says, there were more than 3,200 crisis-pregnancy centers, or CPCs, in America. In New York state, they’ve been so deceptive that New York Attorney General Elliott Spitzer subpoenaed 11 of them during a February investigation. The investigation was sparked by complaints from women who’d visited the centers, but after one CPC agreed to negotiate changes to its misleading advertising and counseling, Spitzer withdrew all the subpoenas in the hopes of reaching similar settlements with the other centers. The Ohio attorney general took on the centers in the same way in 1991, with similar results.
Lawsuits against CPCs have resulted in injunctions in California and North Dakota prohibiting them from advertising themselves as women’s health clinics, and one California judge restrained a center from disseminating false information about abortion. In 1989, a Missouri woman successfully sued a CPC for intentional infliction of emotional distress after her pregnancy test was withheld until she watched a graphic antiabortion video. During a 1991 congressional hearing on CPCs, Rep. Ron Wyden, D-Ore., found that they “hold out that they are health clinics, but when the women get there, there are no medical professionals. A very strident, very aggressive antiabortion campaign is what they get.”
But in a growing number of states, the government isn’t prosecuting these places — it’s funding them. Last year, Pennsylvania’s Project Women In Need, or WIN, gave $4.3 million to antiabortion agencies, including 25 crisis pregnancy centers. Delaware and Missouri also give tax money to CPCs. The state of Florida has raised more than $650,000 for the centers by selling “Choose Life” license plates. Similar license-plate laws will soon go into effect in five other states.
Under the Bush administration, the federal government also channels money to crisis-pregnancy centers to administer abstinence-only education. For example, the Pregnancy Decision Health Centers, based in Columbus, Ohio, were awarded $585,000 to teach abstinence in 40 public schools. The group teaches that safe sex is a “myth” and uses a textbook that tells students, “Premarital sexual activity does not become a healthy choice or a moral choice simply because contraceptive technology is employed. Young persons will suffer and may even die if they choose it.”
Federal funding for abstinence education began with a $50 million appropriation in the 1996 Welfare Reform Bill. But according to a spokeswoman for Rep. Ernest Istook, R-Okla., an abstinence-funding champion, the Clinton administration was not strict in enforcing chastity-promoting criteria. The money was channeled through the states, spokeswoman Micah Swafford says, and some of it went to fund general sex education and extracurricular youth activities that were supposed to keep kids out of trouble. Unhappy with how the money was being spent, in 2000 Istook sponsored a bill creating $20 million in abstinence-only funds that would be given directly to chastity educators. That’s where most of the federal money that goes to CPCs comes from. According to NARAL, the centers received $3 million from that pot last year.
The Clinton administration tried to “undercut” the program, Swafford says, by failing to provide money to administer it. That quickly changed under Bush, who approved a dramatic increase in abstinence-only funding to $73 million next year.
Still, right now the most direct government support of CPCs comes from states, and of all the state-funded programs, Pennsylvania’s is the biggest. In fact, for the antiabortion lobby, it’s a model for federal legislation. In 1999, Pennsylvania Republicans Sen. Rick Santorum and Rep. Joe Pitts sponsored the Women and Children’s Resources Act, which, had it passed, would have given $85 million to CPCs and maternity homes. According to the National Right to Life Committee, Pennsylvania’s law was the inspiration for the bill. In February, Republican congressmen introduced bills that provide $3 million to buy ultrasound machines for CPCs, thus increasing their apparent legitimacy.
Project WIN was created in 1996 by Pennsylvania Gov. Bob Casey, an antiabortion Democrat. Under the law, all state grants to women’s health centers like Planned Parenthood — which are forbidden from using the funds to counsel about abortion, much less to perform it — are matched by equal monies for “alternatives to abortion” programs that take an active antiabortion line. In addition to CPCs, Project WIN, working through an agency called Real Alternatives, funds maternity homes and adoption agencies.
According to the work plan filed with the state government as part of its contract, Real Alternatives service providers must “maintain a pro-life mission and agree not to promote, refer or counsel abortion as an option to a crisis pregnancy.”
Of course, as a government-funded program, Real Alternatives can’t direct money to clinics that openly proselytize to their patients. They can’t, as the ACLU’s Loise Melling explains, say, “God doesn’t want you to kill your unborn baby.” But under the Supreme Court’s 1988 Bowen vs. Kendrick decision, money can be given even to “pervasively sectarian” organizations as long as programs don’t have the “primary effect of advancing religion.” Thus while government-funded counselors can’t invoke Christianity when trying to persuade their patients, they’re free to promulgate theories like post-abortion syndrome that are derived from religion if they can be said to serve some other social purpose.
Needless to say, Project WIN outrages abortion-rights activists. “These are organizations that have been successfully sued for deceptive advertising and inflicting emotional distress on their clients,” says Vicki Saporta, president of the National Abortion Federation. Saporta says her group regularly receives reports from abortion providers about patients who had “horrible” experiences at crisis centers before finding genuine clinics. “They’ve been known to give false gestational assessments,” she says — telling a woman that her pregnancy is further along than it really is. “They are ministry-based organizations designed to dissuade women from terminating an unwanted pregnancy.”
Abortion-rights groups have compiled numerous accounts by women who have felt deceived by CPCs. Most victims don’t want their names used, but one who doesn’t mind is Sean Sweet, a 33-year-old Philadelphia woman whose experience helped to politicize her — she later went to work for NARAL in Pennsylvania.
Seven years ago, Sweet was traveling through central Pennsylvania on the way home from a New Orleans road trip when she realized she might be pregnant. She looked in the phone book and found a center offering free pregnancy tests.
“I took the pregnancy test. They said, ‘We want you to wait in this room and we’re going to show you a video about abortion.’ I thought it would be about my options,” she recalls. “Instead, there were these horrible images of disfigured babies and aborted fetuses, looking very large like they were almost to term. Then there was a little segment where the woman was supposed to be thrashing around and screaming during her abortion.”
Sweet had had an abortion when she was 14, and she knew she was being lied to. She wanted to leave, but she also wanted the results of her test. It turned out she was pregnant, and though the counselors tried to stop her, she stormed out and later had an abortion. Not knowing she’d ended her pregnancy, a counselor from the center called her three times to tell her, “God loves your baby.”
When Sweet learned that her tax money was going to CPCs, she was appalled. “These are Stepford Wives hanging out waiting to pounce on somebody. There was nobody medical there. Those are lies on those tapes. That the state or the government might actually fund it, that’s outrageous to me.”
Sweet is correct that Real Alternatives counselors often don’t have any medical training — in fact, the agency’s contract with the government doesn’t specify any sort of standards or qualifications for CPC personnel. While Planned Parenthood says the money it received from the state last year allowed certified health workers to care for 260,000 patients, according to its own filings, Real Alternatives spent the same amount for a mostly volunteer staff with no medical training to counsel 11,000 women. One Real Alternatives program paid for a woman to visit pregnant prisoners and give them models of 12-week-old fetuses. According to a report filed with the state government, “The women make small cribs for the ‘babies,’ paint hair on them, and cover them with tiny blankets.”
Real Alternatives staff didn’t return numerous phone calls, and several of its affiliated pregnancy centers refused to talk about their operations. But its own publications prove that the organization promotes misinformation. The Real Alternatives Web site offers a “Sexual Health Quiz” designed to show the uselessness of condoms and other contraceptives. One true-or-false question reads, “Condoms prevent the transmission of the most common STD’s (sic).”
According to the site, the correct answer is false. “A U.S. Government study released recently reveals no proof that condoms prevent the transmission of the most common STDs, including gonorrhea, chlamydial infection, trichomoniasis, genital herpes, syphilis, chancroid, and HPV-associated diseases,” it says, citing a 2001 Department of Health and Human Services report.
That statement is deceptive — the actual report says, “Beyond mutual lifelong monogamy among uninfected couples, condom use is the only method for reducing the risk of HIV infection and STDs available to sexually active individuals.” The quiz writers twisted the report’s findings that there wasn’t enough data available to quantify how much protection condoms offered against each disease, in order to give the false impression that condoms simply don’t work.
CPCs operating under the Real Alternatives umbrella also offer medically misleading information. The Women’s Care Center, a chain of seven CPCs in Erie, Pa., that receives both direct state funding and $262,357 in federal abstinence-only funding, identifies itself as a “ministry” on its Web site. The centers warn women that abortion might result in post-abortion syndrome, and they offer counseling through a program called “Healing the Emotions of Abortion Related Trauma,” or HEART.
“In his studies, Dr. [Vincent] Rue found similarities between the post-traumatic stress syndrome experienced by Vietnam vets and post-abortion syndrome,” the Women’s Care Center Web site says. Symptoms, the site says, include depression, “psychological numbing” and flashbacks.
Rue is the foremost champion of post-abortion syndrome and a star in the pro-life movement. He’s also on the fringes of medical opinion. While most people would agree that abortion can be a terrible experience, and psychologically troubling, there’s no evidence that it does long-term psychological damage. 1997, the American Psychological Association reported that an eight-year study of 5,200 women showed that “The availability of legal abortion is not associated with long-term psychological distress in women who use it … Even highly religious women are not at significantly greater risk of psychological distress because they had an abortion.” In 1987, President Reagan ordered C. Everett Koop, his surgeon general, to document the existence of post-abortion syndrome. Koop couldn’t, and later testified before Congress that the psychological problems caused by abortion are “minuscule from a public health perspective.”
But as CPCs are religious, rather than medical, institutions, faith trumps science there. In a 1994 speech, Robert Pearson, who opened America’s first crisis-pregnancy center in 1967 and authored a manual for CPCs, was unapologetic about lying to patients. “Obviously, we’re fighting Satan,” he said. “A killer, who in this case is the girl who wants to kill her baby, has no right to information that will help her kill her baby.”
In the past, it was just scared women who paid the price when people like Pearson posed as medical counselors. Now that the government has gotten into the business of supporting these programs, we’re all paying for it.
As political dares go, this one could hardly have been more blatant. “[Republicans] say they didn’t launch a war on women,” Sen. Barbara Boxer said Wednesday, “so we’re giving them a chance to walk this back.” She added, “Personally I say it’s a war on women, and the more they protest it the more I say it.” And Sen. Barbara Mikulski channeled ”Network” (or maybe old-school feminist rage): “We’re mad as hell and we’re not gonna take it anymore.” Even Harry Reid got in on the action, saying on the floor yesterday, “Republicans deny they’re waging a war on women, yet they’ve launched a series of attacks on women’s access to healthcare and contraception this year. Now they have an opportunity to back up their excuses with action.”
What spurred such rage? Nothing so incendiary as transvaginal ultrasounds or birth control — just the Paycheck Fairness Act, which passed the Democratic House in 2009 but fell to a filibuster by two votes in the Senate in 2010. It modifies the 1963 Equal Pay Act, strengthening enforcement and creating better mechanisms for wage transparency, and authorizes new research on the pay gap and a grant program to teach negotiation skills to women and girls. And while it probably doesn’t have a prayer in the House — if it can even pass this Senate — it manages to bring feminist-friendly legislation back on the table while doubling as a political tool to force Republicans into an uncomfortable corner.
Better yet, it gets to the subject Republicans have intermittently accused Democrats of obfuscating: the economy. As Sen. Patty Murray taunted in a press conference, “To those Republicans who claim to be so concerned about the economy, now is your chance to sign on, When women are not paid what they deserve, middle-class families and communities pay the price.”
Whatever happens with the Paycheck Fairness Act (likely nothing) or the dueling versions of the Violence Against Women Act, this week also saw a bill move that, if it makes it into law, would represent a rare, if tiny, expansion of abortion access on the federal level. That would be the Shaheen Amendment, named for another female Democratic senator, which allows female servicemembers — who suffer disproportionate levels of sexual assault — insurance coverage for abortion in cases of rape and incest. (Currently, the Department of Defense offers coverage only if the woman’s life is in danger, a much more limited policy than that of other federal employees.)
The amendment passed in the Senate Armed Services Committee’s version of the National Defense Authorization Act, with three Republican votes — Sens. John McCain, Scott Brown and Susan Collins. (Democrat Ben Nelson voted against it). Of course, if it manages to get through the full Senate, it has the anti-choice House to contend with. That it would be incredibly narrow says a lot about the state of reproductive rights in this country — after all, rape and abortion exceptions are a compromise that, while reflecting American public opinion, truly jibe with neither side’s actual worldview. But you have to start somewhere, and a time of heated political rhetoric about women’s rights is as good as any other.
House Republicans seem to have learned this much in the past few months: It looks bad to turn away a woman from a hearing on women’s health. So when D.C. congresswoman Eleanor Holmes Norton was denied the courtesy of testifying at a subcommittee hearing yesterday in her district on banning abortions after 20 weeks, Chairman Trent Franks, R-Ariz., suggested a compromise of sorts.
“He said that the congresswoman could, if she desired, sit on the dais of the hearing, but she would not be allowed to speak,” Norton told Salon after the hearing. She declined an offer she said “no self-respecting member” would accept.
“I certainly didn’t give them that optic,” she said drily.
Franks was technically within his rights – per the rules, the Democratic minority was granted one witness, D.C. resident Christy Zinks, who had an abortion at almost 22 weeks after the detection of a severe fetal abnormality. Still, as Norton pointed out, “there is a long tradition that goes back more than a century of allowing members to testify on a bill that may touch upon the district.” Nancy Pelosi also condemned the move.
In the testimony she wasn’t allowed to give, Norton says the so-called Pain-Capable Unborn Child Protection Act “is the first bill ever introduced in Congress that would deny constitutional rights to the citizens of only one jurisdiction in the United States, and it is the first bill ever introduced in Congress that would ban abortions after 20 weeks of pregnancy.” Last year, House Republicans managed to strike a budget deal that would deny the District of Columbia the right to use its own Medicaid funds to pay for abortions — another byproduct of the fact that D.C. is ultimately under congressional oversight and has only partial self-governance.
Seven states have followed Nebraska in passing manifestly unconstitutional bans on later abortions without health exceptions, on the scientifically suspect notion that a fetus can feel pain after 20 weeks. So far, pro-choice organizations have declined to mount a legal challenge, for complicated reasons.
Norton called it a “stalking horse” for the overturning of Roe. “We understand we’re the vehicle, we know we’re not the object of affection,” she said. “What they want from the Congress is a federal imprimatur to continue their march in the states, to say, even the Congress has voted for a bill to limit abortion to 20 weeks.”
The National Right to Life Committee has called the bill its “top congressional priority for 2012,” and will score members based on their votes, even though it likely has no chance of getting past the Senate – or the president. “They are serious about this bill,” Norton told Salon. “They’re not playing.”
That said, she thinks that despite Franks’ zeal, other House Republicans have lost their zeal for fighting what’s still being called the war on women. An earlier Franks bill, seeking to limit race- and sex-selective abortions, didn’t make it to the floor. And on the House version of the Violence Against Women Act, fiercely opposed by the White House and women’s groups, “They keep saying that they’re working on a way to reach an accommodation, and for them, that is unusual to say,” Norton said.
“They didn’t anticipate the way the war on women, as it is called, has boiled up to the surface,” Norton said. “And they’re trying to quell it somewhat.”
It was an “anonymous informant,” Operation Rescue claimed last week, after someone slipped them the April records of 86 women who were treated at Central Family Medical. The clinic’s lawyer was blunter. “It certainly appears to me that a crime was committed,” Cheryl Pilate told the Kansas City Star. Though the clinic (which performs abortions) had already reported a break-in to a locked dumpster, Pilate said it wouldn’t have contained patient records, which are shredded. The “informant” must have gotten the documents – containing names, addresses and details of procedures – another way.
“Our concern is for the privacy of these women and for their health and safety, for which Central Family Planning has shown very little regard,” said Operation Rescue’s Troy Newman – while posting photographs of the documents, partially redacted in black marker, online.
Antiabortion activists want to create the impression that one way or another, a woman’s decision to have an abortion will be discovered and exposed. The Central Family Medical incident is only the latest skirmish in a decades-long effort to undermine the privacy of abortion patients and harass doctors. In the early ’90s, for example, at least one group of clinic protesters printed on their signs the names of women seeking abortions that day, alongside “don’t kill your baby.” Such actions, while failing to make abortion illegal, have nevertheless managed to cloak it in a stigma that belies the fact that one in three women will have an abortion before the age of 45. Now, activists are seeking new ways to shame women who seek abortions, from requiring them to hand over personal information to actually hacking into their medical records.
Kansas has been ground zero for this: Last year, the Kansas Board for Discipline of Attorneys recommended that former Attorney General Phill Kline, a hero to Operation Rescue, have his legal license suspended indefinitely for mishandling the records from murdered abortion provider George Tiller’s clinic. (The Kansas Supreme Court will make the final call.) But the zeal to keep, and sometimes steal, abortion records casts a wide net.
In Texas, the state Department of Health is trying to implement a failed legislative measure that would require abortion clinics to report far more information about their patients to the state. In Florida, voters will weigh in on a ballot measure that would exempt abortion from the privacy clause in the state constitution, with the short-term aim being to strip minors of a right to privacy that would preclude parental consent. The U.K. recently jailed a hacker who stole and intended to publish the records of 10,000 women who visited the country’s largest abortion provider.
“It promotes the idea that abortion – or your privacy, if you have any – is not safe,” says Katie Stack, a graduate student and activist who spoke out about her abortion on an MTV special, “No Easy Decision.” That put her in close contact with the “online ministry” – the name antiabortion activists have given their efforts to reach women considering abortions through the Internet.
This has been the unstated goal of many activists in the antiabortion movement — and, sometimes, the stated one. “This might sound a little strange,” said antiabortion activist Lila Rose at the Value Voters Summit in 2009, but “if I could insist, as long as they are legal in our nation, abortions would be done in the public square, until we were so sick and tired of seeing them that we would do away with the injustice altogether … maybe then we might hear angels singing when we ponder the glory of conception.”
Rose won’t get her wish any time soon, but antiabortion activists are trying to use the Internet to have a similar effect. Rose was recently on a panel at the International Pro-Life Youth Conference about social media and pro-life activism, where topics included targeting women who are seeking information about abortion online, whether through Yahoo Answers or YouTube commenters – including figuring out where they live and recommending a crisis pregnancy center nearby.
“Privacy is very important to women who have abortions,” says Kate Cockrill, program director of the Social and Emotional Aspects of Abortion project, at the University of California, San Francisco. She points out that abortion is traditionally underreported even in confidential surveys, “which is a good indication that women don’t want to be associated with abortion experience in the eyes of someone who’s gathering data, even if it’s anonymous.”
Cockrill recently conducted a survey, as yet unpublished, that seeks to measure the impact of social stigma on women who’ve had abortions. It asked 641 women who had had abortions about 61 items, including questions about the fear people would gossip about you, judge you or hurt you, or the fear that you would lose an important relationship.
So far, she’s found that the women who experienced the most stigma were worried about being judged more than they were about being hurt or harmed, that they feared loss of social status and the ruining of their public identity, that they felt isolated and guilty, and that they feared community condemnation.
But as with other abortion restrictions, which create extra burdens in the supposed service of changing women’s minds, it’s not clear that anyone’s mind is being changed.
“Lots of women who feel a lot of stigma about abortions have abortion anyway,” Cockrill says. “If it’s not doing what antiabortion people want it to do, which is reducing the number of abortions, is it doing something on the other end, [after the fact]?”
Cockrill and her team are going to be using their scale in a study next year to look at the relationship between stigma and poor coping after abortion. Given that antiabortion activists have added to their obsessions the alleged harm abortion causes to women, there’s reason to believe that this is a self-fulfilling prophecy.
Women who have abortions, Cockrill says, “have a huge range of political views.” In fact, in her survey, only 62 percent of the women identified as pro-choice. (Seven percent identified as prolife, and 18 percent described their position as “mixed or neither.”)
“A lot of women don’t experience their abortions as a political act,” Cockrill says, partly an extension of the fact that they don’t see it as constitutive of their identity.
Whether it’s political rhetoric or individual ambivalence, these women are highly sensitive about whom they tell they had abortions. Sixty-four percent of the women in the study said they’d “withheld information about my abortion to someone I’m close to,” and 45 percent said they’d “lied to someone I’m close to about my abortion.”
They may not see it as political, but that silence functions as a vicious circle that antiabortion activists happily seize upon and promote. Cockrill says, “Some people say, ‘We need to have more people come out about their abortions.’ But it’s impossible to get more women to talk about their abortions if they don’t feel supported. And it needs to be on women’s own terms.”
Here is what the state of Texas considers “irreparable harm”: Continuing to provide Planned Parenthood with federal funds for the Texas Women’s Health program, which it has done for several years. Here is what it does not find harmful: immediately denying healthcare access to tens of thousands of women who have been going to Planned Parenthood affiliates for basic health services that aren’t abortions.
On Monday, a U.S. District Court judge didn’t buy the state’s legislation defunding Planned Parenthood, putting a temporary stay on the enforcement of the law. But within a day, there was another judge who found the argument persuasive: Fifth Circuit Judge Jerry Smith, last seen obnoxiously demanding that a female Justice Department lawyer ”submit a three-page, single-spaced letter by noon Thursday addressing whether the Executive Branch believes courts have such power.” (Kevin Drum memorably compared it to “a middle school teacher handing out punishment to a student because of something her father said at a city council meeting the night before,” and you wouldn’t have to look hard to find the sexist condescension.)
The District Court judge had written 24 pages on the constitutional merits, focusing on Planned Parenthood’s First Amendment rights of association. Smith issued two sentences two hours after the state’s petition, undoing that, and apparently buying the state of Texas’ argument that Planned Parenthood’s alleged “abortion promoting” mission justified discriminating against a qualified provider of healthcare. (The clinics receiving WHP funding don’t even provide abortions, but other Planned Parenthood clinics do.)
In an election year, these posturings take on new meaning; by today, Planned Parenthood was proclaiming in a news release, “What would Mitt Romney’s America look like for women’s health care? We need look no further than Texas,” and highlighting the policy similarities of Romney and Perry on women’s health. Romney, of course, has pledged to defund Planned Parenthood, which during the primaries became a consensus Republican issue. The last federal attempt to do so, last year’s Pence Amendment, nearly shut down the entire government, though Obama held the line — as he pointed out in a recent campaign video supporting the organization.
The presidential policies matter, but as we can see from Texas, the judiciary, prompted by state legislatures that are coming off a wave of abortion restrictions, is currently wielding the most power when it comes to women’s everyday lives, and the 5th Circuit in particular has been unrepentantly hostile to reproductive rights. When they failed with Pence, right-to-lifers turned to the states, primed by the 2010 election of even more anti-choice legislators and governors. In Texas, the conservative 5th Circuit has become a brick wall, previously allowing enforcement of the most extreme ultrasound law in the country, one that requires a woman to listen to the results.
Smith is a Reagan appointee, as is his fellow 5th Circuit conservative gadfly Edith Jones, who wrote the opinion in the ultrasound case, though if they’re feeling particularly emboldened lately, you can’t really blame them. After all, the Obama administration has shown little interest in prioritizing the judiciary, even after Bush’s ambitious effort to fill federal appellate courts with movement conservatives. A January Brookings Institution report showed that Obama has nominated fewer federal trial judges than his predecessors, even as a wave of judges retires. (Unprecedented Senate intransigence is a major factor in confirmations, but doesn’t explain the nominations.) And Dahlia Lithwick has argued that “Obama, like Bill Clinton before him, has selected lower court judges more notable for their racial and gender diversity than their hard-left judicial orientation.”
All of this is to say that as long as states like Texas keep passing laws that punish women and stretch the boundaries of constitutional interpretation, to put it mildly, the buck is likelier than ever to stop at a judge like Jerry Smith.
It started around February, when Republicans were still eager to talk about contraception. The Obama administration, or so Mitt Romney charged in Colorado, was forcing religious institutions to provide “morning-after pills –in other words abortive pills — and the like, at no cost.”
It was, of course, a lie. Romney was conflating two different pills: emergency contraception, known as the morning-after pill, which prevents a pregnancy; and chemical abortion, or mifepristone, which ends a pregnancy of up to seven weeks’ gestation and isn’t covered under the new guidelines. Since both pills were marketed in the U.S. around the same time, even some pro-choicers have gotten confused. But Colorado happens to be the epicenter of people confusing them on purpose. It’s the birthplace of the Personhood movement and home to Focus on the Family, both of which have strategically called emergency contraception “abortion” on the scientifically unproven basis that they could block a fertilized egg from implanting.
There are a host of ironies here. Obama has earned the renewed support of reproductive-rights advocates by requiring health insurers to cover contraception, but the Center for Reproductive Rights is still taking him to court – with oral hearings being held this week before a New York federal court -– for overruling the FDA’s recommendation to lift the prescription requirement on emergency contraception for women under 17. That litigation has been winding its way through the system for over a decade, throughout the Bush-era politicization of the FDA, eventually resulting in a federal judge concluding that “the FDA repeatedly and unreasonably delayed issuing a decision on [the emergency contraception pill] Plan B for suspect reasons.” The FDA was ordered to explain why Plan B shouldn’t be available over the counter for girls 13 and up. When the Obama administration overruled the FDA’s recommendation to make it over the counter, U.S. District Judge Edward Korman suggested the Center for Reproductive Rights reopen its case.
“It seems to me that what we’re going through is a rerun of what happened before,” Korman remarked, referring to politics trumping the recommendations of medical professionals.
The Obama administration’s unspoken but unmistakable fear was of an election-cycle attack line that Michele Bachmann would use anyway: That teenage girls would be able to get Plan B from “the grocery store aisles next to bubble gum and next to M&Ms.” That was, in fact, an echo of the language President Obama himself used to invoke a highly unsupported bogeyman: that “a 10-year-old or 11-year-old going to a drugstore would be able to, alongside bubble gum or batteries, … buy a medication that potentially if not used properly can have an adverse effect.”
But there is another twist, so far mostly overlooked: Emergency contraception won’t be covered by insurance for everyone, since it’s available over-the-counter for those who can show I.D. proving that they’re 17 or older. They’ll still have to fork over around $50 a pop. But as long as girls 16 and younger need a prescription for the morning-after pill and they have insurance, it will be fully covered — effectively free. The same goes for women older than 17 who decide to jump through the hoops of getting a prescription, either for over-the-counter Plan B or the prescription-only generic and Ella versions.
As much as pro-choice advocates want to lift the barriers that make emergency contraception hard to get — because it’s more effective the faster you use it — one of those barriers, the prescription requirement, also mitigates another, the high cost. Said Adam Sonfield, a senior public policy associate at the Guttmacher Institute, of this catch-22, “It presents a tradeoff between cost and access.”
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Part of the reason people get confused about emergency contraception and abortion is because lots of people are confused about the basic biology of pregnancy: specifically, that it doesn’t necessarily happen instantaneously and that sperm can live in the body for several days, during which time a woman can ovulate and an egg can potentially be fertilized and implant. Regular use of hormonal contraception prevents ovulation and the chance for fertilization; emergency contraception essentially works the same way except that it’s taken after sex, by which point ovulation may have already happened. But according to recent studies, there is no evidence that taking emergency contraception after ovulation and fertilization will stop the egg from implanting.
But the misinformation and misunderstanding have created a contradictory public health picture when it comes to emergency contraception. In some ways, it’s become more accessible. In 2010, the U.S. approved a longer-acting French variant of Plan B, known as Ella, and there are scattered experiments in convenient delivery, from a birth-control vending machine at Shippensburg University in Pennsylvania to a new bike messenger service in London, both of which caused minor news sensations. The annual “Back Up Your Birth Control” campaign has been promoting the line “EC=BC,” emphasizing that emergency contraception is birth control, not abortion — just in case that is a barrier for women who are considering taking it. And the Center for Reproductive Rights’ petition did manage to lower the age restriction from 18 to 17.
But there are more disturbing suggestions that misinformation is triumphing. A recent Boston Medical Center study found that many pharmacists were still often misinformed about the age requirement and were even more likely to wrongly refuse emergency contraception to 17-year-olds in low-income neighborhoods, where the rate of unintended pregnancy is higher. In Honduras, the Supreme Court upheld the criminalization of emergency contraception, which means women who use it could be jailed. Personhood initiatives, which oppose the morning-after pill, have so far failed in Colorado, Mississippi and Oklahoma, but they’ve introduced false doubts by providing even more opportunities for pundits and candidates to say “the morning-after abortion pill.”
It’s a problem that dates back decades: When, throughout the ’90s, the U.S. considered approving a French chemical abortion pill known as RU-486, it was widely called the “morning-after abortion pill,” including, often, in the New York Times. The distinction wasn’t pressed by the pro-choice community itself. “At the time, the prevailing medical wisdom was that there is a continuum rather than a bright line between EC and mifepristone,” said Gloria Feldt, who was president of Planned Parenthood at the time, with the benefit providing more options for women who did not wish to be pregnant. “It was also assumed that a formulation of mifepristone would eventually be made for use as a true ‘morning-after’ pill.” The widespread belief, she recalled, was that a chemical abortion pill would “solve all the abortion debate problems and guarantee privacy.”
Another problem was that although doctors and non-professionals had been giving women high dosages of regular birth control pills for decades as a form of emergency contraception, the science of exactly how emergency contraception worked remained unclear. The medical definition of pregnancy remains “implantation of a fertilized egg,” but let’s say you believe, as the Catholic Church does, that fertilization itself creates a human life. Anti-choice advocates obsess over what would happen if a woman who took emergency contraception did happen to ovulate anyway and an egg potentially was fertilized, which is enough reason for some of them to call postcoital contraception “abortion.” They have claimed that hormonal contraception makes the lining of the endometrium inhospitable to a fertilized egg, constituting “murder.” Even the official packaging for Plan B, the single-step version of emergency contraception, suggests that “in addition” to blocking ovulation and fertilization, “it may inhibit implantation (by altering the endometrium).”
Except that we now know it doesn’t, even if you walk down the path of remote maybes, which requires you to believe that a zygote, which may not implant for unknowable reasons, has the same rights as a living woman who doesn’t want to be pregnant. As Princeton’s Kelly Cleland pointed out recently, “The science has evolved considerably in the last 13 years. Newer evidence, published since the Plan B label was approved, provides compelling evidence that levonorgestrel EC (LNG EC) works before ovulation, but not after.” The International Consortium for Emergency Contraception and the International Federation of Gynecology & Obstetrics also note that two new studies have shown conclusively that if a woman has ovulated and an egg has been fertilized, it’s too late for emergency contraception to work. They recommended that the language on the product labeling be changed.
Of course, scientific evidence has rarely had much place in this debate. In the meantime, even the most non-ideological news sources keep making the mistake alongside the ideologues. Last week, a furor erupted after the Associated Press reported that “Women seeking to take emergency contraception like the so-called ‘morning after’ pill would have to do so in the presence of a doctor under a bill before the Alabama legislature.” That is, until Erin Gloria Ryan from Jezebel read the actual bill and saw that it was, in fact, a law meant to limit chemical abortion, not emergency contraception. (A spokesperson for the AP said a correction was being prepared). “The confusion over this issue is probably one of the reasons emergency contraception hasn’t had as positive an impact as hoped when it comes to lowering the abortion rate,” wrote Amanda Marcotte at RH Reality Check. “If women think it is some kind of abortion-ish thing, they probably think taking it is a big deal, instead of thinking of it more like taking the pill, since it’s basically the same thing.”
But talk about moved goalposts. If ’90s-era advocates had hoped that the ability to end a pregnancy in the safety of your home with RU-486 — the actual abortion pill, not the morning-after one — would defuse the abortion debate, their more recent counterparts hoped to take it to the next technological level by providing “tele-med” abortions. They would involve doctors seeing a woman over webcam with a nurse practitioner physically present, helping women in remote areas with ever-dwindling options for safe abortions to access them. But four states have already passed requirements meant to undercut these options by forcing a doctor’s presence, and the bill the Associated Press misreported was aiming to add Alabama to the list. All in all, there have been fewer gamechangers, and more cases of one step forward, two steps back.
Jeanne Shaheen, Dianne Feinstein and Patty Murray (Credit: AP/J. Scott Applewhite) 
(Credit: Cannaregio via Shutterstock/Salon/Benjamin Wheelock) 
Jerry Smith 
(Credit: Shutterstock/Salon/Benjamin Wheelock) 
