The battle over birth control

The right has moved its war on abortion from the clinic to the pharmacy, where it now seeks to cripple the sale of contraceptives.

Published April 27, 2005 3:01PM (EDT)

One controversy over the morning-after pill is whether it prevents pregnancy or terminates it. Opponents equate the use of "Plan B," as the emergency contraceptive is called, to a chemical abortion. Supporters -- and most physicians -- counter that it does not destroy the embryo but blocks a fertilized egg from becoming implanted in the uterus. But in one sense, contraception may indeed be the new abortion -- that is, the next battleground for reproductive rights.

From conservative pharmacists refusing to dispense birth control pills to abstinence-only programs and anti-condom campaigns, access to contraception is facing tough challenges from the right. The strategy is similar to one that conservatives have used for abortion: Since overturning Roe vs. Wade looks unlikely in the near term, opponents have turned their sights on limiting access to the procedure. Now members of the religious and political right -- including the Bush administration -- are focusing on contraception, raising concern that they will succeed in curbing women's birth control choices and the ability to prevent unwanted pregnancies.

"I am deeply concerned that they have gone further than I have ever seen them. This is far past a woman's right to make decisions regarding abortion to the point now that it's about their right to make decisions on contraception," Sen. Patty Murray, D-Wash., told Salon. Murray and her Senate colleague Hillary Clinton have blocked President Bush's nominee to head the FDA, Lester Crawford, over his inaction as acting director of the agency to approve the morning-after pill for over-the-counter sale. An FDA advisory committee has given the drug overwhelming support as safe and effective, and Canada approved its nonprescription status last week. Publicly, Crawford says his indecision on the drug has nothing to do with ideology, but privately he told Murray it raises his concerns about "behavior," apparently alluding to arguments that the pill will encourage promiscuity.

There are also indications Crawford sides with those that equate Plan B with "chemical abortion." During his confirmation hearing two weeks ago, Clinton asked Crawford: "Would you clarify for the committee that emergency contraception is a method for prevention of pregnancy, not the termination of pregnancy?" Crawford responded: "I may need to confer with the experts in the FDA about exactly what the physiology of it is." Labels on Plan B, the name that its maker, Barr Laboratories, has given it, say "for the prevention of pregnancy."

Crawford's remarks troubled Murray. "We need to have confidence as consumers that the FDA approves drugs based on science and efficacy and not on ideology," she said. Murray added that Crawford's views suggest trouble for reproductive rights advocates if he is confirmed. "New contraceptives have been going on the market in the last few years and they would all be jeopardized by an FDA using ideology instead of science."

So far, Crawford's confirmation vote has not been rescheduled and his appointment has been held up on a different issue -- albeit a "moral" one. The Republican chair of the Senate Committee on Health, Education, Labor and Pensions, Michael Enzi of Wyoming, is calling for a probe into charges Crawford had a "personal relationship" with a female FDA staff member that may have led to her receiving "significant promotions." White House spokesman David Almacy would only say that Bush still backs Crawford and that "we are hopeful they will approve the nomination so he can receive a full Senate vote and ultimately confirmation."

Opposition to Plan B is just the latest and most visible drive by conservatives to curtail contraception, according to Heather Boonstra of the Alan Guttmacher Institute, a nonprofit research group for reproductive issues. "There's a constituency out there that equates all contraception with abortion, and they're organizing in concerted ways to denigrate it," she says. That constituency includes a number of social and religious groups, but the one that takes the abortion-contraception connection perhaps the most literally is the American Life League (ALL), one of the largest antiabortion lobbyists. Founded 25 years ago, it claims 300,000 families as members.

"Many forms of so-called contraception work by preventing the implantation of an already created human being, and that kills a baby in the womb, and we consider that to be an early abortion," says ALL's vice president, Jim Sedlak. He says ALL's main mission is to inform women that all hormonal birth control methods and the IUD "are actually causing abortions themselves" and to force manufacturers to put that description prominently on contraceptive labels.

ALL's STOPP International campaign also seeks to cut government funding for Planned Parenthood, which it believes misinforms women about how contraception works. Sedlak says STOPP has been successful at the city level -- closing over 100 clinics around the country in the last 10 years -- and is now targeting state funding. He pointed to the Texas Legislature's recent decision to cut Planned Parenthood's state funding as one of ALL's biggest victories. "It's not as fast as we would like, but we'll take it, and we believe it will have a snowball effect and that when people understand what they're doing we'll be closing clinics even faster."

ALL is not the only threat to Planned Parenthood's funding. In every one of his budgets, Bush has frozen funds for Title X, the 30-year-old program that pays for family-planning services for low-income women. Susanne Martinez, Planned Parenthood's vice president for public policy, says that although Congress has restored some of that money, this "assault on family planning" has crippled Planned Parenthood's contraceptive distribution -- about 95 percent of the Title X funds it receives go directly to that service. She is also concerned Bush has appointed to agencies like the FDA and Health and Human Services "people who have very publicly said they opposed the use of birth control for the unmarried. It's something [Bush] has been doing in a very strategic way."

Several other groups support ALL's views and its mission. The Family Research Council joined Republican leaders last Sunday on a national telecast blasting the Democrats for blocking appointments of conservative judges who could decide key reproductive-rights issues. And while the conservative Concerned Women for America (CFA) says it does not take a position on contraception, it does oppose abortion and has been vigorously defending the recent drive by anti-choice pharmacists to stop distributing emergency contraception, which CFA considers an "abortion pill."

One of the social conservatives' biggest victories has been the "abstinence-only until marriage" sex education programs in the public schools, according to Boonstra, of the Alan Guttmacher Institute. Those federally funded programs prohibit any discussion of contraception except in the context of failure rates -- which Boonstra says are inaccurate. An AGI survey of teachers found one in 50 schools taught abstinence-only in 1988; the number increased to one in four in 1999. That is the most recent accounting period, but the movement has clearly snowballed. The federal government has spent more than $1 billion since 1982 on those programs -- of that, $620 million has been spent in the past seven years, and President Bush is seeking an all-time high of $206 million for the 2006 budget. Some states are also moving the programs into elementary schools.

The abstinence-only programs -- which have largely replaced safe-sex education -- have not only curbed the distribution of condoms and birth control pills in school health clinics, but have entirely banned information about contraceptives and sexual health. The nonprofit Abstinence Clearinghouse, which promotes such programs, says few could argue that refraining from sex is the only sure-fire way to prevent pregnancy and sexually transmitted diseases. And it dismisses repeated studies finding that abstinence-only programs are ineffective in either delaying sexual experience among teens or protecting them from disease. So does Alma Golden, Bush's pick to head the Population Affairs department, which runs the programs. "One thing is very clear for our children, abstaining from sex is the most effective means of preventing the sexual transmission of HIV, STDs and preventing pregnancy and the emotional, social and educational consequences of teen sexual activity," she says on the Clearinghouse's Web site.

Recently, pharmacies have provided another avenue for restricting access to contraception. At least 12 states have introduced "conscience clause" laws that would allow pharmacists to refuse to fill contraceptive prescriptions on moral or religious grounds. Four states, Arkansas, Georgia, Mississippi and South Dakota, already have such laws on the books. The flap over Plan B and RU-486, which results in an abortion within seven weeks, have intensified this drive, but some pharmacists are refusing to dispense any form of birth control. The American Pharmacists Association, which represents about 52,000 pharmacists, supports a compromise that would allow pharmacists to "step away" from dispensing drugs they oppose as long as another pharmacist is on hand to fill the prescription.

Meanwhile, condoms remain on most drugstore shelves, but Boonstra says conservatives have made significant inroads on those as well. "There's been a campaign against the condom since the late 1990s to say condoms don't prevent disease," Boonstra says. She points to a chart on the government's Web site that shows that condoms are only 50 percent effective in preventing chlamydia, gonorrhea and syphilis. "There's no scientific evidence for this, and in fact, the National Institutes of Health says condoms provide an 'impermeable barrier [to disease].' Social conservatives are trying to use science to say condoms don't work, and they do work." Fewer clinics, like college health and AIDS-prevention centers, are distributing condoms now thanks to things like budget cuts. Human Rights Watch, a gay-rights advocacy group, has also charged that police have confiscated condoms from AIDS outreach programs in some areas for use as evidence of prostitution or sodomy.

Today, nine in 10 insurance plans cover contraceptive prescriptions, a considerable climb from just a few years ago, but that number could slide again. Twenty-one states mandate contraception coverage in insurance policies, stemming in part from a push by women's groups outraged that insurers covered Viagra for men but excluded birth control for women. However, about half of all Americans with workplace insurance are covered by employers who self-insure (rather than buy an insurance company plan), and the self-insured are exempt from state requirements.

Conservative groups like the Heritage Foundation and some Catholics are lobbying for plans that can also sidestep state rules. Bush backs such proposals and has made his own moves against contraceptive coverage. His 2002 budget dropped funding for contraceptive benefits in federal-employee insurance plans. Congress restored that funding -- though lawmakers have rejected a federal mandate to require contraception benefits as the states do -- and the president has since dropped the effort. But last year Illinois became the first state to allow federal employees an insurance plan that does not cover contraceptives, fertility treatment or abortions. Adam Sonfield, of the Alan Guttmacher Institute, is not surprised that the Republican-led Congress and businesses -- including conservative ones -- are unenthusiastic about such plans; they realize that pregnancy prevention is cost-effective. "There's only so far the congressional conservatives are willing to go," he says, "but sometimes they get pretty extreme."

So how far will this anti-contraception campaign go? As usual, both sides are looking to the polls and public opinion to support their cause. Sen. Murray welcomes the Plan B debate and insists that as the conservatives' contraception agenda is exposed, they'll lose ground. "I think the American public is basically outraged. People just cannot believe that access to birth control is in jeopardy. So the more they're aware, the more they'll act," she says. Murray believes she is backed by the polls, which show most Americans still support abortion rights. A New York Times/CBS News poll late last year also found 78 percent of Americans favor requiring pharmacists to fill prescriptions for birth control despite religious objections.

ALL's Sedlak agrees exposure is key -- and that his side will ultimately win over the public. He points to a survey showing that 78.6 percent of Americans believe using birth control will reduce the number of abortions. However, he says that if the public is informed of his position that most contraception actually constitutes abortion, that same majority will then oppose such birth control methods.

"We've found that once the women understand that, their whole attitude really changes," Sedlak says. Bush may also be counting on support for his anti-conception agenda from all those "moral values" voters who turned out overwhelmingly for the Republicans in the last election. A new Belcher poll commissioned by the Democratic National Committee found that in eight battleground states -- Ohio, Iowa, Virginia, North Carolina, Georgia, Wisconsin, New Mexico and Nevada -- 47 percent of the voters and 51 percent of white women said religious faith influenced their votes as much as traditional political issues.

By Gretchen Cook

Gretchen Cook is a freelance writer and public radio reporter in Washington, D.C.

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