The majority of sexually active adolescents and adults in the United States use birth control and are in favor of women being able to make their own reproductive health decisions. Despite this support, opponents of family planning and women’s rights have tried to assert themselves as the true moral voice — and have made political gains that severely threaten women’s health.

This year, as women’s health advocates celebrate the 38th anniversary of Roe v. Wade on Jan. 22, the Silver Ribbon Campaign to Trust Women for Reproductive Rights and Justice has emerged as an opportunity to show our strength and claim our rights to the legal healthcare to which we are entitled.

The Silver Ribbon Campaign is the effort of dozens of organizations — including Our Bodies Ourselves — committed to prioritizing science over ideology and offering full support for reproductive healthcare; free access to birth control; and keeping abortion legal and accessible.

You can take part by spreading the word through Twitter and Facebook and by wearing a Trust Women Silver Ribbon from Jan. 22 – Feb. 22. Make your own or make a donation to one of the participating organizations to receive a ribbon.

At OurSilverRibbon.org, you can also share your story and stay up to date on action items submitted by partner organizations, including an effort by Planned Parenthood Affiliates of California to make prescription birth control available without a co-pay. Physicians for Reproductive Choice and Health is featuring an Abortion Provider’s Declaration of Rights that you can sign to show your support for the thousands of medical professionals who perform abortions.

Ellen Shaffer, co-director of the Center for Policy Analysis, and Dr. Sophia Yen, a pediatrician and adolescent medicine specialist, wrote a piece this week at the Huffington Post that lays out how politicized the right to reproductive healthcare has become and the various ways in which both the current administration and abortion opponents have restricted access.

Most adults use or have used birth control. However, even the best birth control fails one time in a hundred. Half of all pregnancies are unplanned. At least a third of U.S. women have an abortion during their lives. Most adults believe that abortion care, a legal procedure. should be covered by health insurance as part of reproductive health services. 86% of employer-based health plans currently cover abortion. In these hard economic times, it is crucial that families have the choice whether to bring a child into the world.

But abortion has been stigmatized by a well-organized, well-funded minority movement, including extremists who provoke violent acts. Our reproductive health is used as a wedge issue, seizing on voters’ anxieties about the economy and social issues to claim support for the regressive, anti-woman, anti-self-determination ideology of the right.

We saw a pro-choice president sign laws restricting access to abortion in at least three different ways: In the health care reform law, an executive order, and a regulation on state health plans. Despite the obvious fact that contraception is prevention, the Administration felt compelled to convene a panel to determine if contraceptives count as preventive care.

87% of counties now have no abortion providers. The burden falls hardest on the most vulnerable.

In their conclusion, they note that those of us who trust women are the majority, and it’s up to us to demand our rights.

“Trust women” was a motto adopted by Dr. George Tiller, an abortion provider who was murdered on May 31, 2009 by anti-abortion activist Scott Roeder. Tiller’s strong commitment to the ability of women to make their own decisions in consult with their doctors and families is a powerful and lasting legacy. Joining the Silver Ribbon is one step toward ensuring we don’t take any more steps back.

Earlier this year, we wrote about the Center for Reproductive Rights’s efforts to bring attention to young women’s continued lack of over-the-counter access to emergency contraception, despite a lack of evidence for the current age-based cutoff.

In March of 2009, a judge ordered the FDA to extend over-the-counter access to 17-year-olds, and also to reconsider these age restrictions in general. Last week, the Center filed a motion for civil contempt against the FDA arguing that the agency has failed to reconsider the age restrictions for women younger than 17.

The Center has background materials and more information at http://reproductiverights.org/en/feature/the-center-takes-the-fda-back-to-court. The group is encouraging supporters to contact the FDA asking the agency to “respect the findings of its own scientific review panel and take immediate action to end restrictions on emergency contraception.”

[In other we're-still-waiting news, almost two years after the administration announced that they were going to review the controversial "conscience clause," we still haven't seen any action. As far as I know, the proposed public comment period never happened.]

A new study in the journal Contraception reveals the power of a simple conversation: When trained counselors at family planning clinics ask young women if they have experienced reproductive coercion, it reduces the odds of their male partners forcing them to become pregnant.

Reproductive coercion refers to abusive male behaviors to promote pregnancy, including “birth control sabotage” (interference with contraception) and/or “pregnancy coercion,” such as threatening to harm a woman if she uses birth control or if she has an abortion, and threating to leave her if she doesn’t get pregnant.

The Family Violence Prevention Fund responded enthusiastically to the results of the study:

A brief intervention was associated with a 70 percent reduction in the odds of male partner pregnancy coercion among women who recently had experienced intimate partner violence. Study participants who were asked about reproductive coercion and then counseled about harm-reduction strategies — including switching to longer-acting contraceptives and contacting domestic and sexual-assault resources — were also 60 percent more likely to report ending a relationship because it felt unsafe or unhealthy.

“There is a strong, indisputable link between domestic and dating violence and unintended pregnancy. This study is extremely important because it identifies an effective solution that can be implemented relatively easily,” said Family Violence Prevention Fund President and Founder Esta Soler. “We need to build on these results by making this intervention the norm in health care settings throughout the nation as quickly as possible.”

The study was funded by the National Institute of Child Health and Human Development; the intervention was designed by reproductive health experts, UC Davis School of Medicine, the Harvard School of Public Health, and the FVPF.

An earlier study this year, also published in Contraception, concluded that 20 percent of women experienced pregnancy coercion and 15 percent experienced birth control sabotage.

The FVPF is calling for immediate action based on this latest evidence: “This study is extremely important because it identifies an effective solution that can be implemented relatively easily,” said Soler. “We need to build on these results by making this intervention the norm in health care settings throughout the nation as quickly as possible.”

Go to FVPF’s Know More Say More website for more information and opportunities for action. The site includes resources for healthcare providers, including suggestions on how to assess for reproductive coercion [PDF], including sample scripts, and how to integrate assessments into clinical practice [PDF].

In June, we wrote about the FDA’s Advisory Committee for Reproductive Health Drugs recommendation to approve ulipristal acetate (brand name “ella”) for emergency contraception. On Friday, the FDA did approve the drug, as a prescription-only emergency contraceptive to be taken up to 120 hours (5 days) after contraceptive failure/unprotected sex. Existing “Plan B”-type emergency contraception is currently approved for use up to 72 hours.

Despite the five-day use window for this drug (and the three-day window for others), some media outlets persist in calling it a “morning-after” pill. Ahem.

At the time of our June post, a transcript of the Advisory Committee meeting – which includes the text of presentations and detailed discussion of the drug – was not yet available. That transcript is now online [PDF], including comments from representatives of Planned Parenthood and the National Women’s Health Network.

See our previous post for further discussion of the new emergency contraceptive.

Via @NLIRH, we learned that the National Latina Institute for Reproductive Health, California Latinas for Reproductive Justice and the Colorado Organization for Latina Opportunity and Reproductive Rights have teamed up for the first annual Latina Week of Action for Reproductive Justice, starting today and running until August 15th.

As part of the week, the groups are asking supporters to contact their Congressional representatives “to ask the Department of Health and Human Services (HHS) to support comprehensive family planning services that include contraception as a key women’s health service under the Women’s Health Amendment.” As with many online action campaigns, you can put in your zip code to identify your Representative and Senators and send them a letter explaining that “Latinas, immigrants, and women of color will be disproportionately affected if contraception is not made affordable and accessible.”

There is also an online conversation about Latinas and contraception happening all week, with an inaugural blog post, My-So-Called-Sex-Education, up at Nuestra Vida, Nuestra Voz (NLIRH’s blog) on the need for information about and access to contraception. Further discussion will happen on Facebook, via Twitter (#latinaRJwk), and on partnering blogs such as VivirLatino. There are in-person events taking place in a few cities; check out this page for details.

Two aspects of recent health reform legislation may help expand access to affordable contraception and family planning services. The first of these is a provision that allows states – through their Medicaid programs – to receive federal funding to cover family planning and related services and supplies for individuals not otherwise eligible for Medicaid.

This coverage would be available to individuals (women and men) who are not currently pregnant and whose income does not exceed an income eligibility level established by the state (similar to special eligibility rules for pregnant women who wouldn’t otherwise quality for Medicaid). Family planning-related services that may be covered include STI diagnosis and treatment, treatment of urinary tract infections, treatment of major complications from family planning procedures such as IUD insertion, and vaccines and other preventive services when provided as part of routine family planning visits.

States will basically have to opt in to this coverage by submitting some paperwork to the Centers for Medicare & Medicaid Services (CMS), the federal agency that oversees Medicaid. States will also set the eligibility guidelines for coverage up to a certain threshold. It is not yet clear how many or which states will be offering this coverage, which will expand access to family planning services for people who earn to much to qualify for Medicaid but who are having difficulty affording this care.

Another provision of the health care reform legislation that will take effect in late September, often referred to as the “Mikulski amendment,” requires that health plans cover preventive care and screenings (at no cost to the individual) for women. The coverage must be based on current evidence-based recommendations of the United States Preventive Services Task Force, and must includevaccines recommended by the CDC, and other care and services “as provided for in comprehensive guidelines supported by the Health Resources and Services Administration [HRSA]for purposes of this paragraph.”

What’s not clear is what guidelines the HRSA will support. Some have suggested that because HRSA doesn’t seem to have its own set of guidelines now, these will need to be created. I think another possible interpretation is that HRSA will identify an existing set of guidelines to support (such as from ACOG or another professional or governmental health organization). Whether new standards have to be created or HRSA simply designates some existing guidelines to support will determine how much room there is to advocate for services, but what will happen is not entirely clear at the moment.

A recent Guttmacher policy review has more on this issue, specifically on whether contraception might be included as preventive care. Guttmacher’s Adam Sonfield has also written about the issue for CNN, concluding:

In short, the case for ensuring family planning services are comprehensively integrated into women’s preventive care and insurance coverage is compelling. More and better contraceptive use will lead to more pregnancies that are planned and wanted, which will lead to more women who are healthy during their pregnancies and whose babies are born healthy. Who could argue with that?

The National Latina Institute for Reproductive Health is planning a “virtual cafecito” to discuss the issue of whether family planning will be included as a preventive service and to discuss strategies for ensuring that Latinas and other women have access birth control options as a preventive service. The call-in discussion will occur Wednesday, July 4 at 1pm EST; register online to participate.

by Kiki Kalkstein, Center for Health and Gender Equity (CHANGE)

Earlier this month, I attended the Women Deliver Conference in Washington, D.C ., on behalf of the Center for Health and Gender Equity (CHANGE). After a jam-packed three days of plenary sessions, chairman’s sessions, and more than 100 concurrent sessions, participants left the conference reinvigorated and ready to take action to work toward fulfilling Millennium Development Goal #5: Reduce maternal mortality and achieve universal access to reproductive health.

After speaking with hundreds of participants, one thing was made very clear to me — people not only want female condoms, but they believe that female condoms are a vital tool in decreasing maternal death, improving maternal health, and promoting sexual and reproductive health and rights.

I had countless conversations with participants from all over the world who were thrilled we were there talking about and promoting the female condom. As I shared information about the Prevention Now! Campaign (CHANGE’s initiative to increase access to existing prevention methods, especially female and male condoms), their message came through loud and clear — we want female condoms, and we want them now.

I spoke with men and women of all ages, and again and again they expressed interest in female condoms and inquired about how to increase access in their own countries. A doctor from Kenya said that women who come to his clinic consistently ask for female condoms, and he doesn’t have any to offer. A doctor from Nepal took all the information he could from our booth, and came back with his colleagues to get more. Some participants asked how they could launch a female condom program in their own countries. Female condoms are in demand.

Access to contraception is critical for preventing maternal deaths, but sometimes high-level decision makers do not make that connection. The female condom puts women in control of their own health by enabling women to delay pregnancy and space out births, all of which decrease the risk of maternal death and disability.

Effective family planning programs are not only fundamental to maternal health, they also allow women and families to better manage household and natural resources, secure education for all family members, and address each family member’s healthcare needs. Participants at Women Deliver conference acknowledged the benefits of the female condoms and recognized it as a vital tool for improving maternal health globally.

Related posts:
* Expanding the Female Condom Market
* FC2 Female Condom Available in the U.S.

Kiki Kalkstein is the program assistant at the Center for Health and Gender Equity (CHANGE). She previously designed and implemented public health education programs both domestically and internationally, including a rural community outreach program with the Uganda Village Project focused on increasing awareness around obstetric fistula. She also designed and implemented at the University of California at Berkeley “Sex and Sustainability: Reconnecting Population and Women’s Empowerment,” a campus program designed to increase awareness about unmet family planning needs in developing countries.

The FDA’s Advisory Committee for Reproductive Health Drugs yesterday reviewed a new drug application for ulipristal acetate, an emergency contraception that prevents pregnancy after intercourse. This particular drug has been available in Europe under the brand name ellaOne since May of 2009 and is intended for use up to five days after unprotected sex or contraceptive failure.

Most other emergency contraceptions sold over the counter in the United States are officially approved for use up to three days (72 hours), although it is widely accepted that these others drugs (such as versions of Plan B) are also effective for up to five days. See our previous post on the topic for further discussion of this aspect, as well as some fairly recent studies and anti-choice objections to the product.

The FDA committee voted unanimously to recommend approval; the Agency itself will now need to decide whether the drug is approved. The National Women’s Health Network released a statement [PDF] urging the FDA not to reverse the committee’s recommendation (as the FDA did in the initial, controversial Plan B decision in 2004), and commenting on anti-choice opposition, which has centered on whether the drug could be used for abortion or otherwise affect pregnancies:

As longtime drug safety advocates, NWHN would like to point out that there are hundreds, even thousands, of drugs approved by the FDA and prescribed by clinicians whose effect on pregnancy is unknown. The critics who are raising questions about ulipristal’s possible effect on pregnancy don’t raise those questions about other drugs that come before the agency, and there’s a reason for that. Their underlying agenda is to prevent women from having access to another contraceptive option by raising questions about abortion that are intended to confuse the issue. In this, they are out of step with the American public – rather than making more safe and effective options for preventing unintended pregnancy available, as the majority of people in this country would like to do, they are trying to block a new option.

A transcript of the advisory committee meeting is not yet available; we’ll update with a link when it is posted. We’ll also have discussion of flibanserin, the drug being reviewed today “for the proposed indication of the treatment of hypoactive sexual desire disorder (HSDD) in premenopausal women,” next week.

We recently wrote about the CDC’s new publication, the U S. Medical Eligibility Criteria for Contraceptive Use, 2010, which outlines specific characteristics or medical conditions that may interfere with safe contraception use. The July issue of the journal Contraception follows up on this topic, featuring articles from CDC and WHO authors on contraception use and specific medical conditions as well as current research gaps.

The authors identify the following issues as needing further research, among several others:

• Long-term effects of Depo Provera on bone mineral density and any relevant race/ethnicity factors
• Effects of postpartum oral contraceptives on infant health and breastfeeding
• Whether IUD expulsion rates vary by type of birth a woman has had (i.e., if the IUD is more likely to be come out if a woman has a vaginal or cesarean birth)
• Whether the risk of blood clots (venous thromboembolism or VTE) is greater and whether oral contraceptive efficacy is lower in obese women
• Whether use of hormonal contraceptives worsens depressive disorders (including postpartum depression)

Other issues identified as needing further research include questions about contraceptive use and efficacy in women with cervical cancer, uterine fibroids, HIV/AIDS, inflammatory bowel disease and rheumatoid arthritis.

In a commentary on the problem of gaps in the existing evidence base on contraceptive safety, CDC and WHO representatives write:

Absence of evidence regarding contraceptive safety may be equated by women or their providers with absence of safety and lead to use of less effective methods. Alternatively, absence of evidence may be equated with absence of risk, resulting in use of methods which may potentially place these women at increased risk of adverse events or complications.

Other articles in the issue review topics such as IUD use by women with uterine fibroids and contraception use among women who have had bariatric (weight loss) surgery.

The Women Deliver 2010 conference is happening in Washington DC today through Wednesday, focusing on global maternal and reproductive health and featuring great speakers from numerous U.S. and international agencies. I just listened to Melinda Gates wrap up and pledge $1.5 billion in new family planning and maternal/child health grants for next 5 years; an archive of these videos is expected to be posted as well.

The conference is streaming live at http://www.womendeliver.org/conferences/-2010-conference/webcast/. You can follow tweets using the hashtag #WD2010, which are also streaming on the webcast page. I’ve set up archives at Twapper Keeper and What the Hashtag? to save tweets with this hashtag for later review.

The CDC recently released the U S. Medical Eligibility Criteria for Contraceptive Use, 2010, adapted from World Health Organization recommendations and intended to outline specific characteristics or medical conditions that may interfere with safe contraception use.

The document is intended for use by health care providers when counseling individuals about contraceptive choices, but is freely available to the public and includes some useful tables of considerations related to numerous contraceptive methods. It also includes a table of contraceptive failure rates with perfect and typical use (i.e., what percent of women get unintentionally pregnant in the first year with each method), and how many women continue to use each method after one year.

The guide is a little bit opaque to navigate and read, putting data for each method in its own appendix and number-coding the recommendations. I’m linking directly to these appendices below – for each, the first column is the list of relevant conditions (like smoking status), and the second column, Category, gives a number code from 1-4 indicating how the risks/benefits of the method balance out for any particular condition. The third column provides any relevant explanation.

For example, use of combined oral contraceptives in those who are ≥35 years of age and who smoke ≥15 cigarettes/day is given a score of “4,” meaning “A condition that represents an unacceptable health risk if the contraceptive method is used.” The third column explains the cardiovascular risk associated with smoking and using the pill.

The guides:

• Appendix B: Combined Hormonal Contraceptives (including the pill, patch, and ring)
• Appendix C: Progestin-Only Contraceptives
• Appendix D: Emergency Contraceptive Pills
• Appendix E: Intrauterine Devices
• Appendix F: Copper Intrauterine Devices for Emergency Contraception
• Appendix G: Barrier Methods (includes male and female condoms, spermicides, and diaphragms with spermicide or cervical cap)
• Appendix H: Fertility Awareness-Based Methods (including symptom-based and calendar-based methods)
• Appendix I: Lactational Amenorrhea (i.e., breastfeeding for birth spacing/control)
• Appendix J: Coitus Interruptus (Withdrawal) (okay, looking at this topic, I can’t help giggling that the CDC has labeled all of these documents as “early release”)
• Appendix K: Male and Female Sterilization

The CDC also provides appendices summarizing the info for hormonal contraceptives/IUDs and limited data on possible interactions between hormonal contraception and antiretroviral therapies.

UPDATE: Interview got bumped for breaking news. It is scheduled to air Monday.

Our Bodies Ourselves Executive Director Judy Norsigian will be on “The Emily Rooney Show” on WGBH-FM (89.7 in Boston) today at 12 noon, discussing the 50th anniversary of the pill. You can listen live online.

Elaine Tyler May, a professor of American studies and history at the University of Minnesota and the author of “America and the Pill: A History of Promise, Peril and Liberation,” will also be on the program. Here’s an op-ed May wrote that appeared in the Washington Post this past Sunday: “The Pill: Making Motherhood Better for 50 Years,” and an interview she did recently at Feministing.

We’ll post more birth control-related stories, with comments from Judy, later today.

Monday’s episode of NPR program “On Point” focused on “The Pill’s Impact, Past and Present.” A transcript doesn’t seem to be available, but you can listen to the program online. The “On Point” site also links to a recent Time magazine piece on the topic, The Pill at 50: Sex, Freedom and Paradox.

Last Friday, “On Point” also covered the status of women in the workforce and pay equality. I haven’t heard either piece yet myself, but plan to listen soon. Let us know what you thought in the comments.

In this difficult economy, many states are struggling to balance their budgets, often resulting in controversial decisions and cuts. Last month, New Jersey Governor Chris Christie (R) released a 2011 budget plan for the state which continues to generate considerable discussion. An astute reader brought one line in particular to our attention from the proposed budget: “Funding for grants to support clinical family planning and related services is eliminated.”

A representative of the ACLU of New Jersey writes:

Without state funding next year, the centers would serve 40,000 fewer patients, leaving an already vulnerable population with even less. In the midst of a recession, these services are more critical than ever. The recently passed health care legislation may offer some assistance in the coming years, but it won’t keep the lights on in the only medical centers serving neighborhoods that need them the most.

A piece in the Daily Princetonian urges students to contact Christie about the proposed cuts, arguing that the cuts will lead to poorer health for both men and women, and already vulnerable populations, ultimately costing the state more: “These cuts are not just shortsighted, misogynistic and classist — they’re completely nonsensical. And they will result in devastating consequences for public health.”

What’s going on in your state’s budget related to women’s health? Let us know in the comments.

View all Women’s Health Heroes. Voting closes May 14. Background info here.

Entrant: Joan Z. Spade, Ph.D.
Nominee: Karen M. Hicks, Ph.D., Adjunct Professor, Lehigh University and Lafayette College

I am nominating Dr. Karen Hicks for her on-going dedication to improving women’s health and well-being, particularly as it relates to sexuality and reproductive health.

Dr. Hicks has been a sexuality educator for more than 20 years. She teaches Human Sexuality and Women’s Reproductive Health as an adjunct professor at both Lehigh University and Lehigh University.  In 1994,  Dr. Hicks authored one book on women’s health, “Surviving the Dalkon Shield IUD: Women v. the Pharmaceutical Industry,” and edited another, “Misdiagnosis: Woman as Disease.”

She started a kitchen table action grassroots action group of survivors of the Dalkon Shield IUD, which grew to 15 chapters across the United States and became the chief claimant’s voice in the courtroom during the A. H. Robbins bankruptcy case.  More than 200,000 women ultimately received modest settlements from the Dalkon Shield Trust Fund.

In 2004, she published an online Medscape CME course titled “Women’s Sexual Problems — A Guide to Integrating the New View Approach.” She also developed a successful online course titled “Ministry, Sexuality and Congregations” for the Center for Sexuality and Religion. She is currently a member of the New View Campaign, which advocates against the medicalization of women’s sexuality. She is also a member of the consortium on sexuality and aging.

Dr. Hicks is an activist, researcher and educator whose work has impacted the health and well-being of many women.  Her work on the Dalkon Shield IUD took her from the kitchen table to courtrooms and Congress. In addition to the classrooms and online courses noted above, she has also facilitated workshops on many topics related to women’s sexual well-being, including body image, teenage pregnancy prevention, menopause, and sexuality in aging and aged populations.  I believe she deserves to be called a “Women’s Health Hero.”