December 2004: The Year in Review -- Ob/Gyn & Women's Health

Ursula Snyder, PhD


January 24, 2005

Women's Human and Reproductive Rights - Reproductive Rights Threatened in the United States

Women's reproductive rights in the United States and around the world are seriously threatened. (See the recent review by the Alan Guttmacher Institute, "Top 10 Ways Sexual and Reproductive Health Rights Suffered in 2004.")

Here, I will briefly mention a few issues of particular relevance to the United States.

In December 2003, Food and Drug Administration (FDA) advisory committees had voted overwhelmingly in favor of over-the-counter (OTC) (ie, unrestricted) access to the levonorgestrel emergency contraceptive (EC) known as Plan B. In early 2004, we learned that 49 House Republicans wrote to President Bush urging him to order the FDA to reject the advisory committees' recommendation, claiming -- on the basis of no scientific evidence whatsoever -- that providing EC OTC would increase risky sexual practices by teens. On May 6, 2004, the FDA decided to delay ruling on Plan B. As former ACOG president Harry Jonas, MD, remarked, it was indeed a particularly egregious example of politics overtaking science. (See Medscape Medical News story And, as Medscape board member David Grimes, MD, said in his editorial on the issue in Obstetrics & Gynecology,[217] "The FDA's decision is poor public health practice and the antithesis of evidence based medicine." Dr. Grimes ends his editorial with this comment:

Adolescents now face double jeopardy. The current administration champions abstinence-only programs for adolescents and has invested tens of millions of dollars in these efforts. Based on ideology rather than evidence, these programs have a paradoxical effect: they increase adolescent pregnancies. Ignorance is a poor back-up method. Denying easy access to emergency contraception (that reduces unplanned pregnancies) while promoting abstinence-only programs (that increase unplanned pregnancies) seems odd, especially for an administration so opposed to abortion.

The United States leads the industrialized world in teen pregnancy and abortion. Although teen pregnancy rates have declined over the past decade, and in fact reached their lowest levels since 1946 in 2002, the decline has been in large measure due to the broader availability and use of contraception.[218] Nonetheless, there is concern that this progress could be transient. There has not been promotion and financial support of comprehensive sex education programs in schools across the country. Moreover, a report released on December 1, 2004 found that more than two thirds of the federally funded abstinence programs present distorted and false information about contraception (notably about condoms), prevention of STIs, and abortion. The Sexuality Information and Education Council of the United States (SIECUS) has also reviewed some of these programs. SIECUS supports teaching young people about abstinence, but the organization "does not support teaching young people only about abstinence -- primarily because scientific evaluations have never proven that abstinence-only-until-marriage programs are effective. In addition, SIECUS does not support any program that uses fear, shame, negative messages, or inaccurate information to control young people's behavior."

In March 2004, the Senate passed legislation to make it a federal crime to harm or kill an "unborn child," at any stage of pregnancy. Many groups involved in women's reproductive rights have charged that this legislation is an attempt to undermine Roe vs Wade. (See, for example, the NARAL report, "The 'Unborn Victims Of Violence Act' Is Not the Solution to Domestic Violence."

As of June 2004, 44 states required a young woman to obtain the consent of or notify 1 or both parents before having an abortion. The laws are enjoined or not enforced in 10 of these states.[219] On Election Day, however, that was reduced to 9 as Floridians approved a constitutional amendment allowing a parental notification law for abortions.

The "Child Custody Protection Act" that was introduced into Congress in 2003 was a topic of concern for reproductive rights groups in 2004. The legislation, if passed, would make it a federal crime for any person, other than a parent or guardian, to knowingly transport a minor across a state line to obtain an abortion, if the minor does not meet the requirements of the forced parental involvement law of her state of residence. People who assist the minor will face both civil and criminal liability, including imprisonment for up to 1 year and fines of up to $100,000, or both. To learn more about what is at stake for young women and their healthcare providers, see the report by the Center for Reproductive Rights, "The Child Custody Protection Act (CCPA): Harming Young Women Who Seek Abortions."

So what would happen if Roe vs Wade were in fact overturned? This very question was considered in a state-by-state study by the Center for Reproductive Rights. "What if Roe Fell" finds that access to safe and legal abortion would be secure in only 20 states (Alaska, California, Connecticut, Florida, Hawaii, Maine, Maryland, Massachusetts, Minnesota, Montana, Nevada, New Jersey, New Mexico, New York, Oregon, Tennessee, Vermont, Washington, West Virginia, and Wyoming).

In the 2003 "Year in Review", we discussed the passing of the "Partial-Birth Abortion Ban Act of 2003" , the first federal legislation ever enacted that bans abortion procedures. By September 2004, 3 federal judges had ruled the Act unconstitutional (California, Nebraska, New York), although the Justice Department had already launched an appeal of 1 of the decisions.

Close to the end of 2004, a budget measure was approved by the House and Senate that contained a provision denying federal financing to government agencies that "discriminate" against healthcare providers who choose for any reason to disregard state mandates to offer abortion-related services. Quoting the New York Times,[220] this provision "tells health care companies, hospitals and insurance companies they are free to ignore Roe v. Wade and state and local laws and regulations currently on the books to make certain that women's access to reproductive health services includes access to abortion...[It] represents a vast expansion of the "conscience protection" that federal law currently gives to individual doctors who do not want to undergo abortion training.'' This provision is being challenged by the National Family Planning and Reproductive Health Association and by the State of California.

The Times editorial warns: "Americans, and American women in particular, are officially on notice that post-election, the Republican war on reproductive rights has entered an ominous new phase." For readers who are interested, NARAL has issued a report: "The Price of Four More Years: Eliminating the Right to Choose and Eroding Real Choices."

Finally, this year, a woman with a history of mental illness and substance abuse was charged with the murder of her stillborn twin because she rejected the advice of her obstetrician to undergo a cesarean delivery. The murder charges were dropped in return for her pleading guilty to charges of child endangerment. This is a complex issue, but at stake are pregnant women's rights, as an article by Minkoff and Paltrow[221] in the December issue of Obstetrics and Gynecology and the accompanying editorial by Berkowitz[222] explain:

Minkoff and Paltrow eloquently point to the problems that can follow from the notion that pregnant women can be found criminally negligent for behavior that endangers their fetuses. Will we be jailing women for refusing to reduce their cigarette consumption during pregnancy or being unwilling to undergo a multifetal pregnancy reduction in a high-order multiple pregnancy that results in the birth of very premature infants?[222]

When physicians' concerns about fetal well-being are allowed to supersede both a woman's judgment about what is best for her family and her right to safeguard her bodily integrity, then there is no principled limitation on state power to police pregnancy and punish pregnant women.[221]


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