I’m holding myself back from saying “duh” here, but this still has to be reiterated at a time when abstinence-only education that doesn’t provide detailed information about contraceptive use, except occasionally to emphasize its limits, not only persists but recently got a federal stamp of approval. As an Advocates for Youth report on the impact of abstinence-only education noted, “Proponents of abstinence-only programs believe that providing information about the health benefits of condoms or contraception contradicts their message of abstinence-only and undermines its impact. As such, abstinence-only programs provide no information about contraception beyond failure rates.” That’s how you get terrifying statistics like this one from the Guttmacher report: In the survey, “60 percent underestimated the effectiveness of oral contraceptives and 40 percent held the fatalistic view that using birth control does not matter.” Overall, “more than half of young men and a quarter of young women received low scores on contraceptive knowledge.” It’s also how you get figures like the one from the CDC that found that 31.4 percent of pregnant teens didn’t use contraception because they “thought they could not get pregnant at the time.”

There are two reasons to be optimistic that some dent can be made in these depressing figures, and they both have to do with provisions of the Affordable Care Act. Much has been made of the mandate that insurance policies cover all FDA-approved contraceptive methods, but there’s another aspect that’s been relatively overlooked: the fact that the same provision includes free education and counseling about sex and contraception, at least for the insured. The second reason for optimism is that the mandate will make it far easier for women to get longer-acting and more effective forms of contraception like the IUD — which are also more expensive and which studies have shown women would be interested in if they could afford them. Incidentally, the recent Guttmacher study found that women who were using long-acting or regular hormonal contraception tended to score higher on overall knowledge.

It will be awhile before we know if these changes will move the needle on the nation’s unparalleled rate of unintended pregnancy. The women’s health provisions only go into effect for new plans in August 2012, and older plans will be initially grandfathered and eventually phased out. And of course, there’s another big fat if – whether the Supreme Court overturns all or part of the Affordable Care Act. The Obama campaign and its allies are keen to point out how such a move — or, perhaps, a legislative repeal down the line — will hurt women above all. The Center for American Progress recently released a report on “Women and Obamacare” (the campaign having officially embraced the derisively intended term). It declares Obamacare “the greatest legislative advancement for women’s health in a generation,” which may be true for reasons more depressing than inspiring: There have been very few advancements partly because there has been so much political defense played.

In addition to the reproductive health benefits, the report points to preventive care recommendations for which cost-sharing has already been cut: mammograms, pap smears, prenatal care and so on. According to the report, “close to 9 million women will gain coverage for maternity care in the individual market starting in 2014,” currently not covered in 78 percent of plans sold on the individual market. It notes that women are more frequent users of healthcare services than men, that they’re likelier to make the household decisions on healthcare and that they’re more vulnerable to losing coverage because they’re likelier to be listed as dependents on a partner’s plan. The Affordable Care Act also makes it illegal to engage in “gender rating” – charging women $1 billion more than men on the individual market – and bans states from discriminating on the basis of gender identity in their insurance exchanges.

The report does acknowledge two ways in which Obamacare falls short for women who were “left out of the law — undocumented and recent immigrant women and women who need abortion services.” It claims that “political compromises on abortion coverage were necessary to ensure passage of the Affordable Care Act” – still a bitter loss to reproductive rights groups, who memorably described women as having been “thrown under the bus” by Democrats – “but the work to obtain abortion coverage for all women continues.” The last part is particularly debatable, at least when it comes to any momentum on the funding issue from national Democrats, while Republicans in the states and federally have spent considerable energy trying to limit abortion coverage on even private insurance plans.

Still, if the Affordable Care Act is allowed to stand, the magnitude of having an actual, proactive reproductive health access policy shouldn’t be underplayed. Maybe we’ll get closer to a saner republic where hearing “birth control doesn’t matter” from people who don’t want to get pregnant is a quaint memory.

“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.”

The controversy arose when, sometime in April, Heritage Keepers Abstinence Education was quietly added to an Office of Adolescent Health list of approved groups eligible for government funds — “the holy grail of the Administration’s commitment to a science-based approach to teen pregnancy prevention and a directive for grantees of the President’s Teen Pregnancy Prevention Initiative,” wrote four prominent sexual health experts in RH Reality Check. They accused HHS of “succumb[ing] to the political pressure of social conservatives and allowed the ideology of the right to prevail over the health and well-being of the nation’s youth.”

On April 30, over a dozen major organizations, including the ACLU and Human Rights Campaign, asked Secretary of Health and Human Services Kathleen Sebelius to explain Heritage Keepers’ inclusion. They said the program “ostracizes lesbian, gay, bisexual, and transgender (LGBT) youth; promotes heterosexual marriage as the only acceptable family structure; withholds life-saving information from sexually active youth; and uses fear-based messages to shame youth who have been sexually active and youth living in ‘nontraditional’ households.”

Like most abstinence-only programs, contraception and condoms aren’t on the agenda, nor is detailed information about sexually transmitted diseases or safe sexual behavior. Sample language from the student manual: “girls have a responsibility to wear modest clothing that doesn’t invite lustful thoughts.” Both aspects are awkward at a moment in which the president’s reelection campaign is struggling to have it both ways on gay marriage, as well as to paint itself as a champion of reproductive health.

The RH Reality Check piece also says that there is “limited evidence of effectiveness” of the Heritage Keepers program. But Christopher Trenholm, associate director of research at Mathematica Policy Research, which conducted the independent research evaluation for HHS, and whose previous work is cited as proof that the Heritage Keepers program doesn’t work, told Salon there are actually two different programs in question. The one in the 2007 Mathematica study that was found to have little impact on sexual abstinence, a complementary after-school program called Life Skills Education Component, differs from the health class curriculum that ended up on the HHS list.

This time around, Trenholm’s task was to grade the outside research that purported to back up the organization’s claims. HHS decided that every organization that got a moderate or high rating on doing what it said it did would end up on the approved list. Mathematica took a look at a 2011 study of Heritage Keepers Abstinence Education as taught to 2,215 7th- through 9th-grade students, which found that a year after participating in the program, “sexual experience” increased from 29 to 33 percent of students, compared to 43 percent of students in the control group. The study quality was deemed “moderate,” allowing Heritage Keepers to tout its HHS seal of approval on its website.

In other words, Heritage Keepers simply followed the rules of the “evidence based” system – and prevailed. The problem for supporters of inclusive and comprehensive sex education is that the HHS criteria say that studies “must measure program impact on at least one measure of sexual risk behavior or its health consequences.” That measure can be contraceptive use or fewer sexually transmitted infections, or it can be simply delaying sexual activity, as Heritage Keepers was found to do – but it doesn’t have to do both or all. And as written, it certainly does not mean that the program can’t marginalize LGBT students or shame students about their sexual behavior.

I asked Weber, the HHS spokesman, what would have to change for such groups to be left out of the program. Would the criteria simply have to be revised? “What we’re committed to is an open and transparent scientific process,” he repeated. That process appears to have been followed here – but it shows the limits of a narrowly technocratic approach.

Update. Critics respond to the HHS rationale: “HHS is being frighteningly shortsighted,” said Dr. Elizabeth Schroeder, executive director for Answer, a national sexuality education organization based at Rutgers University. “Heritage Keepers relies on fear, shame, distorted information and biases. Why are we supporting any program that discriminates against groups of students and endangers their health? How can the HHS justify putting its seal of approval on a sexist, homophobic curriculum?”

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.

Though his radio audience is larger, Fischer currently has fewer than 1,400 Twitter followers. But within a day Buzzfeed was on the case, asking for (and not getting) comment from the Romney campaign. Meanwhile, fellow “family values” conservatives like Tony Perkins and Gary Bauer were only too happy to agree that Grenell had to go, and Fischer started making the television rounds.

“The reason I was concerned is that this, I believe, was a shout-out on Governor Romney’s part to the homosexual lobby, because he knew that Grenell was a homosexual activist,” Fischer says, noting that the hire came only after several Christian right groups and the National Organization for Marriage had already endorsed Romney. “Richard Grenell could not possibly have been the only qualified individual that Governor Romney could find … If it wasn’t about homosexuality, than why did so many gay rights groups celebrate the hire?”

Upon resigning, Grenell told the Washington Post’s Jennifer Rubin, “My ability to speak clearly and forcefully on the issues has been greatly diminished by the hyper-partisan discussion of personal issues that sometimes comes from a presidential campaign.” So is Fischer, whose Twitter stream is a steady diet of anti-gay invective and Romney skepticism, convinced that he won?

“Governor Romney may not do the right thing out of political conviction, but he will do the right thing out of political expediency, and this I think would be an example,” Fischer says. “This is what I think is good for the pro-family community. … I think it’s going to be a long time before he hires another homosexual activist in a prominent position in his campaign.”

Still, Fischer isn’t on board now with Romney. The two have some history predating Grenell. Fischer, who has attacked Mormonism and blamed gays for the Holocaust, was called out by Romney at CPAC last October. “We should remember that decency and civility are values too,” Romney said at the time. “One of the speakers who will follow me today, has crossed that line, I think.” A spokesman later confirmed to Politico that Fischer was the intended target. Fischer says he took that, too, as a shout-out to the “homosexual lobby.”

Fischer never really quite gave up on Santorum, as recently as April 4 writing, “If, for the sake of argument, Romney wins the nomination, social conservatives had better shift their intense focus to taking over the Senate and the House, as we will not have a reliable ally in the Oval Office no matter who wins in November. Obama will be an in-your-face adversary on social issues, and Romney will be a splintered reed on which to lean at best. He has, of course, been saying the right things on the campaign trail, but his record (as opposed to his rhetoric) is reason for grave concern.”

Would he grant Romney an endorsement if the campaign sought it? “I think that’s about as likely as a meteor hitting your living room tonight,” he says dryly, though he adds he was “extremely encouraged” by Grenell’s resignation. But is that enough for him to drop the misgivings that Romney is actually a cultural conservative? “Do I trust him?” Fischer says. “No.”