“Inside Story” host Shihab Rattansi was well prepared for what turned into a very interesting discussion. The questions on the table included: Is women’s health being damaged by politics in the U.S.? Has the controversy over funding to Planned Parenthood for breast cancer screening underlined the extent to which conservative groups now influence women’s health access?

On the subject of Komen backpedaling on its controversial decision to stop making grants to Planned Parenthood, Nosigian said: “What we see here is a conservatizing trend in this country that I think has emboldened many … I saw the reversal of the decision simply as damage control. I do not think there has been a profound change in perspective at all.”

McGuinness made this valuable point: “This was an effort to politicize what is not a political thing … I think when it comes to women’s health, there aren’t two sides to this issue.”

Even though Komen executive Karen Handel, who drove the decision to cut off funding to Planned Parenthood, resigned this morning, the controversy is far from being closed.

Watch the discussion below.

This week, we all learned a lot about Susan G. Komen for the Cure, and Planned Parenthood, and breast cancer. Now that Komen has caved (sort of; Planned Parenthood’s response), we might start to learn what it will take to mobilize an outcry to really stop the attacks on women’s health.

As Komen was committing a huge PR failure, it became clear via Facebook, Twitter and a new Tumblr site, Planned Parenthood Saved Me, that many women value and rely on Planned Parenthood for breast cancer exams and other preventive health services. A slam-dunk week for Planned Parenthood.

We need to make it a slam-dunk month. What Komen, and the evangelicals, and Republican Rep. Cliff Stearns, who launched the pointless political inquiry, and the U.S. Conference of Catholic Bishops are really mad at Planned Parenthood about is this:

Part of what they do is help people plan. Parenthood. You know. They support birth control. In some cases, they provide it. Like your corner drugstore, but better.

And this week, the bishops are howling about it because the Obama administration refused to grant a broad religious exemption to contraception coverage.

Never mind that virtually all Catholics use birth control, that the Church itself only began to oppose it in 1968, that the Pope recently conceded that condoms are useful, and approved condom use for stopping the transmission of AIDS.

Never mind that most Catholic-affiliated hospitals, schools and charities cover birth control in their health plans — health plans that come out of the wages employees earn themselves.

Never mind that undergraduate and graduate students are fighting for coverage — and are still being denied, even for medical reasons.

Close to every cent the Church has not spent settling lawsuits against priests who sexually molested children has gone into this week’s media campaign to rile up opposition to covering birth control.

So far they’re doing a pretty effective job of it. The Obama administration is standing firm, but Congress is still on the warpath.

You can send a message that you stand against attacks on birth control and with Planned Parenthood. The organization just launched a TV ad campaign in support of contraception coverage (watch below).

And learn more about the men behind the war on women. They’re not going away anytime soon.

Ellen Shaffer is co-director of the Trust Women/Silver Ribbon Campaign, a project of the Center for Policy Analysis. Judy Norsigian is co-founder and executive director of Our Bodies Ourselves.

OBOS has received funding to make blog entries available in Spanish. We hope to expand outreach efforts in the coming year.

La secretaria del Departamento de Salud y Servicios Humanos (HHS), Kathleen Sebelius, publicó la declaración que establece el reglamento que requiere que los planes de seguro cubran el uso de anticonceptivos, sin la necesidad de un copago, un coaseguro, o un deducible.

Este servicio no siempre estuvo garantizado.  El pasado agosto, el HHS adoptó las recomendaciones del Instituto de Medicina para incluir los servicios de planificación familiar como uno de los aspectos del cuidado preventivo de la salud para las mujeres, a ser cubierto por los nuevos planes de salud, pero solo fue un reglamento provisional, sujeto a interpretaciones.

En noviembre hubo mucha preocupación sobre si la decisión de que los  anticonceptivos sean cubiertos como servicio preventivo por la Ley del Cuidado de Salud a Bajo Precio iba a sobrevivir. El Presidente Obama se reunió con obispos Católico Romanos, y uno de ellos salió de la reunión diciendo, “Salí sintiéndome un poco más en paz sobre el tema que cuando entré.”

Como se puede entender, muchas personas expresaron la preocupación de que la administración iba a abandonar los requisitos de cobertura para el control de la natalidad y a su vez ampliar el reglamento que permita el rechazo, para permitir que hospitales y universidades católicas nieguen cobertura de servicios de planificación familiar.  Pero la administración rechazó los pedidos que permitían a los empleadores optar por no cubrir anticonceptivos.  La declaración de Sebelius dice en parte:

Después de evaluar los comentarios, hemos decido añadir un elemento más al reglamento final. Los empleadores sin fines de lucro que basados en creencias religiosas no proveen cobertura para anticonceptivos en sus planes de seguro tendrán un año adicional, hasta el 1ro de agosto del 2013, para cumplir con la nueva ley.  Los empleadores que quieran aprovechar del año adicional necesitan probar que califican para la implementación retardada.  Este año adicional permitirá que estas organizaciones tengan más tiempo y flexibilidad para adaptarse a este nuevo reglamento.  Nosotros esperamos requerir que los empleadores que no ofrecen cobertura de servicio de anticonceptivos provean notificación a sus empleados, informándoles que los servicios de anticonceptivos están disponibles en lugares como centros comunitarios de salud, clínicas públicas y hospitales con ayuda basada en los ingresos.  Vamos a seguir trabajando estrechamente con grupos religiosos durante este periodo de transición para discutir sus preocupaciones.

Los científicos tienen mucha evidencia sobre los beneficios del control de la natalidad para la salud de mujeres y de sus familias.  Se ha documentado que reduce los costos de salud considerablemente, y es el medicamento tomado con más frecuencia en los Estados Unidos por jóvenes y mujeres de edad mediana. Este reglamento proveerá a las mujeres mayor acceso a los anticonceptivos por cuanto requiere la cobertura y prohíbe los costos compartidos.

It wasn’t always a sure deal. Back in August, HHS adopted the Institute of Medicine’s recommendation to include family-planning services as one of the preventive health care items for women that must be covered by newly issued health plans, but it was only an interim rule, subject to comments.

In November, there was a lot of worry about whether the decision that contraception should be a covered preventive service under the Affordable Care Act would survive. President Obama met with Roman Catholic bishops, and one of them came away saying, “I left there feeling a bit more at peace about this issue than when I entered.”

Understandably, many people expressed concerns that the administration was going to back away from birth control coverage requirements and broaden the refusal rule to allow Catholic hospitals and universities to refuse to cover family planning services. But the administration rejected calls allowing employers to opt out of covering contraception. The statement by Sebelius reads in part:

After evaluating comments, we have decided to add an additional element to the final rule. Nonprofit employers who, based on religious beliefs, do not currently provide contraceptive coverage in their insurance plan, will be provided an additional year, until August 1, 2013, to comply with the new law. Employers wishing to take advantage of the additional year must certify that they qualify for the delayed implementation. This additional year will allow these organizations more time and flexibility to adapt to this new rule. We intend to require employers that do not offer coverage of contraceptive services to provide notice to employees, which will also state that contraceptive services are available at sites such as community health centers, public clinics, and hospitals with income-based support. We will continue to work closely with religious groups during this transitional period to discuss their concerns.

Scientists have abundant evidence that birth control has significant health benefits for women and their families, it is documented to significantly reduce health costs, and is the most commonly taken drug in America by young and middle-aged women. This rule will provide women with greater access to contraception by requiring coverage and by prohibiting cost sharing.

The drug is already available without a prescription for women 17 and older, after years of political wrangling. Advocates have worked to ensure OTC access because emergency contraception is most effective when used as soon as possible, and time, distance, money, and privacy can be serious barriers to getting a prescription and obtaining the drug in time to prevent pregnancy.

The FDA’s Center for Drug Evaluation and Research (CDER) had completed a review of the issue and concluded that Plan B One-Step emergency contraception should be available OTC to younger women, which Commissioner Margaret Hamburg explains:

Based on the information submitted to the agency, CDER determined that the product was safe and effective in adolescent females, that adolescent females understood the product was not for routine use, and that the product would not protect them against sexually transmitted diseases. Additionally, the data supported a finding that adolescent females could use Plan B One-Step properly without the intervention of a healthcare provider…CDER experts, including obstetrician/gynecologists and pediatricians, reviewed the totality of the data and agreed that it met the regulatory standard for a nonprescription drug and that Plan B One-Step should be approved for all females of child-bearing potential.

That’s when Sebelius stepped in and blocked the findings of CDER from taking effect. In her letter [PDF] overruling the FDA’s findings, Sebelius objected that “The label comprehension and actual use studies submitted to the FDA do not include data on all ages for which the drug would be approved and available over-the-counter.”

That data is not available for the vast majority of over-the-counter drugs on sale to all age groups without a prescription. Many OTC drugs (like acetominophen and aspirin) can have serious, even fatal, effects if taken inappropriately because of deliberate misuse or misunderstanding the label and instructions. You will not find data on safety and label comprehension for every possible age group for these medicines, yet they are readily available OTC in adult doses to consumers of any age.

Former FDA official Susan Wood – who resigned after a previous round of political interference in emergency contraception – agrees:

“They don’t do this for pain medication, headache medication, cold medication,” she said. “That’s not part of how we assess products. Are we going to go and now do this with all products, or are contraceptives once again being singled out for this special treatment and this extra standard when we’re talking about a very safe and very effective product that can really help women?”

Change.org has a petition up urging Sebelius not to let politics trump science, and objecting to the HHS leader’s focus on very young girls who may access the drug:

The fact that the HHS and the Secretary are focusing on this extremely young age group is bizarre. Less than 1% of 11 year olds are sexually active, where over half of adolescents have had sex before their 17th birthday.

This decision is illogical and unfounded. Physicians around the country agree that Plan B is incredibly safe and effective for all ages, helping to decrease the number of unintended pregnancies.

Further reading:
This NPR coverage provides a succinct timeline and political explanation of the controversy over accessibility of emergency contraception.

Statement from Physicians for Reproductive Choice and Health stating that the Obama administration’s “put[ting] politics before science and responsible health policy…is appalling.”

Heather Corinna at Scarleteen urges young people to speak up in protest of this action.

Jodi Jacobson at RH Reality Check, who reminds us that the previous administration wasn’t the only one playing political games with reproductive rights:

…no amount of proof it seems can make up for the fact that, despite all the evidence, even President Obama and Secretary Sebelius appear to think young women are too stupid to make their own decisions or that they are just chum to be thrown to the religious right in an election year. As the saying goes, with friends like these, who needs the far right?

Norsigian talks about how the earlier “Our Bodies, Ourselves” editions demystified health and medical care, helping women to feel entitled about their right to ask questions — and get answers — from a paternalistic medical system. The book “changed the basic discourse” around women’s bodies and health, while also offering explicit information about access to birth control and abortion.

One of the ongoing health challenges, she notes, is the rate of sexually transmitted infections; women around the globe still struggle to have sex that doesn’t put their health at risk.

The video includes footage of a recent book signing for the brand new 2011 edition of “Our Bodies, Ourselves” held at Porter Square Books in Cambridge, Mass., and references the work of women’s groups in other countries that have adapted “Our Bodies, Ourselves” for their own communities.

In under 3 minutes, this interview provides one of the best historical and forward-looking assessments of the impact of “Our Bodies, Ourselves” around the world.

Visit msnbc.com for breaking news, world news, and news about the economy

Title X funds have historically gone to Planned Parenthood in Memphis; the move to give the funds to an anti-choice organization is part of nationwide efforts to defund Planned Parenthood because PP provides abortions. Existing laws already clearly prohibit Title X or other federal funds from being used for abortion services – the money goes to provide necessary services like contraception and cancer screenings.

Reports indicate that Christ Community has no intention of providing referrals to women who choose to have abortions, whether that is for personal or medical reasons. From a report by a Memphis newspaper (emphasis added):

[Christ Community CEO] Waller initially said the clinic refers patients to abortion providers if they request it, but he and Dr. Rick Donlon, a founding physician at the clinic, later called the newspaper to change that statement.

“We really try to provide women with other options and make sure they have those possibilities. And if they at the end still want a pregnancy termination, we know they know where to go,” Donlon said.

“They know where to go.” That doesn’t exactly sound like a professional provider of medical services to me. The clinic leaders obviously made a point of contacting the newspaper to make sure it was clear that they would *not* provide referrals, demonstrating a clear intent to put religious belief ahead of the medical care of women who may consider or require abortions.

Christ Community has also said it will not provide emergency contraception, only doing so through a third party. No details are available about how this will happen in practice, and how much additional time, travel and cost women may be subjected to in order to access this legal, previously available, and non-abortifacent medical care. This change clearly creates an additional burden for women seeking emergency contraception, and the women of Memphis currently have no guarantees that the third party provision will happen in a timely way, while timely administration of emergency contraception drugs is absolutely crucial for them to work.

I have not seen this discussed elsewhere, but it is also not readily apparent to me whether Christ Community would or could ever decide that any other forms of birth control are off-limits because of purely theoretical possibilities of preventing fertilized egg implantation. If we’re already providing the Title X money to a provider who can pick and choose services because of religious beliefs, I don’t see that refusing other forms of contraception is completely out of the question.

The organization also is reportedly working to install “crisis pregnancy centers” at its locations; these centers are well known for providing false and misleading information about abortion and exist to convince women not to choose abortion. Title X rules require “nondirective” counseling about abortion, and Planned Parenthood and other reputable providers who do provide abortions (using other, non-federal money) have processes and counselors in place to check whether women are certain of their decisions without pushing them in either direction.

Given the interest in installing deliberately biased in-house counseling and the stated intention to refuse to refer women out to other providers for abortion, it seems unlikely that Christ Community will be able to or has any intention of meeting the rules requiring factual, nondirective counseling. Women who cannot afford to access family planning care elsewhere will be subjected to a provider who clearly wishes to influence women’s choices, rather than providers who are committed to medical accuracy and offer women a full range of choices, supporting their right to individual decision-making about their bodies.

One woman reports that “Christ Community provides high-quality medical services, but that they sometimes come with a ‘sermon.’” She says she was told by a Christ Community provider, “If only my relationships with people and God were right, I would have fewer health problems.”

In addition to these concerns, there may be other issues with Christ Community’s administration of the Title X funds. I’m not personally familiar with CCHS’s existing health clinics and services on the ground. A Memphis local informed me Christ Community does not take appointments – patients must show up first thing in the morning and wait to be seen, and may even have to come back the next day if too many people show up. This is obviously not a good model for providing family planning services, especially when emergency contraception or other urgent services are needed or when women must take time off from jobs, school, or childcare in order to wait around for care. Although the organization’s website does have an “appointment line,” it indicates that this is to find out which clinics provide which services; I’d like to hear from others about whether this matches their experience at Christ Community clinics.

Another serious concern is that Christ Community’s proposal to provide these services clearly indicated that they would provide less care to fewer women than would Planned Parenthood. Steve Ross, of Memphis and blogging at Vibinc, has an excellent series chronicling the whole debacle, from the Tennessee state government pressuring the Memphis health department to take the funds despite their lack of capacity for family planning through to the current funding of Christ Community (parts 1, 2, 3, and 4). In part 2, he lays out the numbers and apparent relative deficiencies of the Christ Community proposal, including their lower numbers for proposed services and inconsistencies in how the proposals from Christ Community and Planned Parenthood were scored by local officials.

In Part 3, Steve points to the questions asked by the potential providers – Christ Community, Planned Parenthood, and a third non-religious applicant. Although they are unattributed, we can only assume that the following questions were asked by Christ Community, the only applicant with an explicit religious mission and on the record about refusing services because of beliefs. I think these are very telling about the intentions of the leadership of the organization that asked these questions, and how they plan to approach women’s health:

In providing information about pregnancy termination, is it sufficient to have the referral information in writing? [My interpretation: In other words, do we even have to bother to actually have a conversation with women about this?]

If the information about pregnancy termination is provided, is the contractor allowed to indicate in wiriting (NOT coerce) – on a referral sheet or in the office that it does not provide that service because of its beliefs.

If a contraceptive method is not provided on site by a provider because of the provider’s ethical beliefs, can the provider refer the client to another Title X provider who offers this method? If so, does the referring provider have to pay for the service?

The answers to these questions explicitly state that emergency contraception must be provided, the organization cannot choose not to provide forms of contraception because of its beliefs, and they are not allowed to talk about refusing abortion and referrals because of beliefs. Yet everything we’ve heard – as mentioned above – indicates that Christ Community plans to do exactly that.

As Steve writes:

To be honest, these three questions left me flabbergasted. Certainly individuals and associations of people are allowed to hold their own beliefs. Certainly, different physicians and networks of physicians have different preferred treatment plans. There’s plenty of room for this diversity out there in the private sector. However, when you choose to enter the public sector by seeking a contract for public dollars, you are bound by the requirements those public dollars place on you. If those requirements are unpalatable to you, then perhaps you shouldn’t seek them.

Honestly, I’m sure this whole thing will end in lawsuits, and I wouldn’t be unhappy if HHS would intervene. In the meantime, poor women suffer.

I will leave you with this excellent rant from Sig at DowntownMemphisBlog:

Public policy needs to be based on reason and fact, not feelings and faith. Abortion is a legal medical procedure. Any organization that aspires to hold a government contract in the area of family planning needs to present all options and perform all medical procedures, not just the ones it agrees with or likes. Not just the ones that make them feel warm and fuzzy inside. Not just the ones that fit into the narrow world view defined by their archaic religious beliefs.

See also: Aunt B

[cross-posted from Women's Health News]

Heterosexual couples in which one partner had HIV were studied in seven African countries. The participants were sexually active, not pregnant, and not on antiretroviral medicines. Women were HIV-tested quarterly and asked at those times about their contraceptive use.

The researchers found that unprotected sex and sex with other partners was more likely when women used a hormonal contraceptive, but even when they controlled for this, the risk of HIV infection was higher in women using injectable contraceptives compared to oral or no hormonal birth control. Risk of infection in uninfected men from their infected partners was also higher.

The study was limited in that it relied on women’s self-reporting of contraception use and methods. The way participants were selected could have biased the results, and condom use was also self-reported. The study did not randomize women to a birth control method, nor was it designed from the outset as a test of HIV risk and specific types of contraceptive use. It also could not clearly evaluate any risk associated with oral birth control, because there were not enough users of the pill in the study.

Despite these limitations, there is reason to be concerned about whether there is a link between Depo Provera or its generic forms and risk of HIV infection. There are several ideas about how the drugs could potentially increase risk, but the HIV question has been around since at least 1996. That year, researchers working with monkeys and implantable contraceptives published a study suggesting increased risk of a similar virus. Researchers involved with early work on this subject have responded:

How many years has it been that the non-human primate model, and other researchers, have been warning about this and being ignored? What, 15 years now? Shocking.
and
It’s not like we did our work and it was published in an obscure journal. There’s absolutely no excuse for people doing contraceptive work to not have known this, and not to have taken this forward in the late ’90s. We should have had this answered [in humans] ten years ago.

Global health programs often promote long-acting methods like Depo Provera for women in areas where access to regular medical care is difficult and maternal mortality is high. These same areas often have high rates of HIV. I find it unacceptable that the question of contraceptive use and HIV risk has been around for years, and we don’t appear to be much closer to a clear answer. As Charles Morrison wrote in an accompanying editorial:

The question of hormonal contraceptive use and risk of HIV acquisition remains unanswered after more than two decades. Active promotion of DMPA in areas with high HIV incidence could be contributing to the HIV epidemic in sub-Saharan Africa, which would be tragic. Conversely, limiting one of the most highly used effective methods of contraception in sub-Saharan Africa would probably contribute to increased maternal mortality and morbidity and more low birthweight babies and orphans—an equally tragic result. The time to provide a more definitive answer to this crucial public health question is now; the donor community should support a randomised trial of hormonal contraception and HIV acquisition.

Such a trial would require careful design in order to minimize any risk to participants and to stop as soon as any increased risk of one method is clear. It might be impossible to get funding for, but we owe it to women, who deserve clear and accurate information about the potential risks of injectable and all forms of contraception.

by Sophia Moradian

In the spring of 2009 of my freshman year at Boston College, I received an advanced study grant to travel to Armenia. As an 18-year-old of Armenian descent who had never been to the country, I had few expectations of the one month I would spend investigating small business entrepreneurship in rural Armenia.

I soon saw the links between economics, socio-cultural norms, and the status of rural women and girls, many of whom are confined to their homes. Living in disproportionate and desperate poverty, they are unable to influence or control household finances and decisions. Many of the women’s husbands work outside the country, and while this leaves their partners back home more vulnerable to sexually transmitted infections, women are unable to protect themselves or access basic health and reproductive services. I learned that more than half of rural Armenian women have never visited a gynecologist.

OBOS’s partner in Armenia, the “For Family and Health” Pan Armenian Association (PAFHA), is working to address these inequities via education, advocacy, training and service programs throughout the country. The Association has informal branches in all 10 regions of Armenia and is headquartered in the city of Yerevan.

The main areas of focus include abortion, health care access, adolescents, advocacy and HIV/AIDS.  Its work includes health clinics, one of which provides free reproductive care twice a week to women and girls, subsidized by sales of the 2010 Armenian adaptation of “Our Bodies, Ourselves.” (Tour the clinic here.)

Clinic staff undergo training at the Vernissage Reproductive Health Clinic at the St. Mary’s Family Health Centre in Yerevan, Armenia. Click the image to tour the clinic. Proceeds from the sales of the Armenian edition of "Our Bodies, Ourselves" are used to provide free reproductive health care to girls and women.

I have worked on gender and economic rights in Armenia and in the greater Middle East region and witnessed first-hand the impact of poverty on access and health in these communities. For the women and girls who cannot afford health care, PAFHA’s clinics are essential lifelines.

As the president of the Boston College Armenian club, I am an active voice in the Armenian community on campus and in the greater Boston area, organizing events on the health of rural Armenian women and the Armenian Genocide, including an annual Remembrance Day gathering on campus. These are my actions — a way for me to raise awareness about human rights and engage people on issues and injustices that affect Armenian women and girls.

PAFHA’s work in Armenia, under the leadership of Meri Khachikyan, should inspire all of us who believe women’s rights are human rights. The group’s “Women’s Manifesto,” for example, is a courageous call-to-action that will soon be submitted to the Armenian government with the endorsement of approximately 500 community leaders.

Paul Farmer, founder of Partners in Health, has called for taking up the health rights of those who cannot provide basic health services for themselves. Meri and her team are answering his call, and it is my hope that we can all do the same.

I am now applying for a Fulbright scholarship that will take me back to the Shirak province of northwest Armenia. This time I hope to build on my previous experience and further the economic rights – and ultimately the sexual and reproductive rights – of women and girls. As a young activist preparing for this assignment, and as a member of the Armenian Diaspora, I am eager to meet and listen to Meri’s experiences this October at the OBOS symposium and I hope you will join me, in person or by webcast.

Sophia Moradian is a senior at Boston College majoring in international studies with a minor in Islamic civilizations and societies. After graduation, Sophia plans to work internationally in the field of economic development and human rights.

CommonHealth, a blog at Boston’s NPR affiliate WBUR, explores this rise in the recent post “Why The IUD Is On The Rise (And You Might Want One).” The author, Carey Goldberg, suggests that one reason for the rise may be the convenience of the IUD as a long-acting birth control method that has less chance of user error (compared to birth control pills that you might forget to take, for example). She also explores a bit of the history of the Dalkon Shield and discusses safety concerns about IUD use.

OBOS’s own Judy Norsigian was interviewed about the IUD option (and Goldberg nicely mentions the new 40th anniversary edition of the book, due out this October). Judy explains that like any method, there are benefits and risks associated with IUD use:

“Like every method,” she said, “it has its downsides. There’s a remote risk of embedding and perforation, but it’s small. And some women have a lot of pain, others don’t. Some women expel the IUD, others don’t. But for most women who have very heavy periods, using the [Mirena] IUD results in lighter periods and decreased bleeding at menopause. So there are benefits as well. It’s one of those things where a woman has to weigh her own priorities about what matters most to her.”

Here’s a good fact sheet on the pros and cons. The CommonHealth blog has a follow-up piece today, “10 Reasons To Get An IUD, And 5 Downsides.”