Shaping the Court—Talking Points

What’s at Stake?

A Woman’s Access to Birth Control

Availability

Widespread use of birth control continues to be a critical component of basic preventive health care for women and has been the driving force in reducing national rates of unintended pregnancies, STDs and abortion. Women who want two children will spend five years pregnant or trying to get pregnant, and nearly three decades trying to avoid pregnancy.

Importantly, contraceptive use has led to dramatic declines in maternal and infant mortality rates and has vastly improved maternal and infant health. In addition, the ability of women to control fertility has afforded women the ability to achieve educational and professional goals making women a critical component of the nation’s economic success.

Today, virtually all women (98%) aged 15-44 who have ever had sex have used at least one contraceptive method and the Centers for Disease Control and Prevention included family planning in their published list of the “Ten Great Public Health Achievements in the 20th Century.”

Six million women become pregnant each year and almost half of these pregnancies are unintended.

Today, almost 17 million women need publicly supported contraceptive care – a number which grew by 400,000 alone between 2000 and 2002.

61% of high school seniors have had sex, and four out of 10 girls in the United States get pregnant at least once by age 20 – 78% of teen pregnancies are unintended.

What is frustrating about where we find ourselves today is that it would seem logical that the services needed to prevent unintended pregnancies would be embraced by those opposed to abortion rights. It would seem logical that both opponents and supporters of the availability of abortion could unite on the issue of access to birth control. We know this isn’t crazy talk because in the past, such logic has prevailed and taken shape in successful programs like Title X and Medicaid.

For more information see the full report, “Celebrating 40 Years of Legal Access to Birth Control Support ‘Prevention First’ & Resolution Marking Griswold Anniversary”


An average woman who wants two children will spend five years pregnant or trying to get pregnant and roughly 30 years trying to prevent pregnancy.

The national family planning program, Title X of the Public Health Service Act, was established in 1970 with bipartisan support. For more than three decades, Title X has been an integral component of our public health care system, provide high-quality family planning services and other preventive health care to low-income women or uninsured women who may otherwise lack access to health care.

Title X clinic services prevent unintended pregnancies, reduce the need for abortion, lower rates of sexually transmitted diseases (STDs), including HIV, detect breast and cervical cancer at its earliest stages, and improve women’s health. For every dollar spent on publicly funded family planning, $3 is saved in pregnancy-related and newborn care cost to Medicaid.

Congress is currently considering structural changes and federal funding cuts of up to $10 billion to the Medicaid program over five years. Although it is unclear precisely how Congress will implement these changes to Medicaid, it is abundantly clear that the integrity of the Medicaid program faces an immediate and grave threat. At the very least, these financial and structural changes could severely impact access to family planning services for low-income women.

The bottom line is that any reduction in federal funding provided to states for Medicaid, when the number of uninsured is rising and states are encountering increasing difficulty paying their share of Medicaid costs, would almost certainly push states to squeeze Medicaid programs in ways that would diminish the health benefits that low-income Americans receive and further increase the numbers of uninsured.

Because women represent the majority of adult beneficiaries, they will be disproportionately impacted by program changes. Between 2001 and 2003, there was a 14% increase in the number of women age 15-44 covered by Medicaid, and a 10% increase in the number of women that age who are uninsured. One in four clients receiving services through publicly funded family planning clinics had their care paid for by Medicaid in 1999.

For more information, see the NFPRHA MEMBERS LOBBYING CHEAT SHEET

Weighing the Financial Choices

· During their childbearing years, women spend 68% more on out-of-pocket health care costs than their male counterparts

· Nearly one in four reproductive-age women rely on publicly funded family planning clinics for contraception
· More than 80% of publicly funded family planning agencies rely on Medicaid to support the cost of contraceptive services

· About three-fourths of reproductive-age women (34 million) are covered by private health insurance

· Oral contraceptives were covered by 84% of HMOs, 60% of POS plans, 41% of PPOs, and 33% of traditional indemnity plans

· Since 1998, 20 states have passed measures mandating comprehensive insurance coverage of all FDA-approved prescription contraceptives

· Legislation pending in Congress would require health plans that cover prescription drugs to include equal coverage for prescription contraceptives

For more information go to: http://www.contraceptiononline.org/contrareport/article01.cfm?art=224

· 60 million women in the U.S. are currently in their childbearing years, age 15 to 44 on average.

· Of the total number of U.S. women in their childbearing years, 42 million (or 7 out of every 10) are sexually active and do not wish to become pregnant.

· One of the major barriers to universal contraceptive access is the high cost. Costs for supplies alone can run approximately $360 per year for oral contraceptives; $180 per year for Depo-Provera; $450 for Norplant; and $240 for an IUD.

· A woman who wants two children (the average in the U.S.) will have to use contraception for more than two decades of her life.

For more information go to:
http://www.covermypills.org/facts/factsheet.asp

Vasectomy, Tubal Ligation, and Abortion

· Doctors usually perform vasectomies in an office or family planning clinic. The cost ranges from $150 to $1,200, about one-quarter of the expense of the more complicated tubal ligation surgery used for female sterilization. Most insurance policies cover at least some of the cost.

http://www.mayoclinic.com/invoke.cfm?objectid=A0FC7DEB-DAF0-49E1-9974410BCC56D5F5

· The cost of the surgery [tubal ligation] generally ranges from $1,000 to $2,500. If your procedure requires hospitalization, the cost will be greater. Some private health insurance companies cover a portion of the expense.

http://www.cnn.com/HEALTH/library/WO/00047.html

· In 2001, the average charge for a surgical abortion at 10 weeks' gestation was $468; but since most abortions in the United States are performed at low-cost clinics, women on average paid $372 for the procedure.

http://www.guttmacher.org/in-the-know/cost.html

Cost Differences
· Adoption—There is no cost to you if you choose adoption. In fact, pregnancy related expenses are paid for by the adoptive family, which often includes medical care and living expenses. Examples may include: rent, utilities, maternity clothing, food, prenatal vitamins and any other medical expenses not covered by your insurance or Medicaid. You will be able to speak with your adoption specialist about your specific needs.

· Abortion—Depending on how far along you are, the cost will range from $500-$2,000 to get an abortion. There may also be additional charges for ultrasound, morning after pill, birth control and treatment if an infection should occur. (This information was gathered from several different abortion clinics)
· Parenting—Parenting is the most expensive option. Total cost to parent a child ranges from $1,000-$2,000 monthly. This estimate may include but is not limited to: diapers, baby bottles, formula, clothing, car seat, day care, first aid supplies, blankets, crib or basinet, and hygiene products. A parent must also budget for shelter, food, transportation, and utilities to raise their child.

For more information go to http://www.americanadoptions.com/pregnant/adoption_abortion_parenting

Emergency Contraception—The Abortion Pill

· Alarmingly, there is mounting evidence that some hospitals, especially religiously affiliated hospitals, are not providing EC to sexual assault survivors. This practice is counter to the standards outlined by the American Medical Association, which state that women who have been sexually abused should be counseled about the risk of pregnancy, and offered EC (AMA, 1995).

· EC can reduce the risk of pregnancy after unprotected intercourse. Emergency contraception pills (ECPs) — the most common method of EC — contain hormones that reduce the risk of pregnancy if started within 120 hours (five days) of unprotected intercourse. The treatment is more effective the sooner it begins ("FDA Approves ... " 1999; Rodriguez, 2001; Van Look & Stewart, 1998).

For more information, see “Obstructing Access to Emergency Contraception in Hospital Emergency Rooms”
http://www.plannedparenthood.org/pp2/portal/files/portal/medicalinfo/ec/fact-032102-obstructing.xml#1097844059439::-6813410638183385624


· increasing number of pharmacists and physicians are refusing to dispense birth control or write women prescriptions for contraception. These health care professionals cite their religious, moral, ideological, and personal objections to the use of contraceptives. Prescription refusal is a disturbing trend that can jeopardize woman's reproductive health. Denying women their rights to timely access to health care is an act of discrimination that could lead to an increased number of unintended pregnancies.

· Ninety-five percent of American women use contraception at some point during their reproductive years. More than 50 percent of contracepting women use prescription methods. Approximately 27 percent use oral contraceptive pills (AGI, 2004a). Oral contraceptive pills (OCPs) and the dedicated product, Plan B, can be used for emergency contraception (EC). Emergency contraception pills (ECPs), when started within 120 hours of unprotected intercourse, greatly reduce a woman's risk of pregnancy. They are more effective the sooner a woman starts taking them. The use of ECPs could prevent an estimated 1.7 million unintended pregnancies and 800,000 abortions each year (Ellertson, et al., 2003; "FDA Approves...", 1999; Glasier & Baird, 1998; Rodrigues, et al., 2001; Van Look & Stewart, 1998).

· From 60,000 to 120,000 prescriptions for ECPs are written annually (Kaufman, 2004). However, a 2003 study about the attitudes and knowledge base of Pennsylvania pharmacists, for example, found that 65 percent had negative feelings regarding ECPs, and that 13 percent believed that ECPs are abortifacient (Bennett, et al., 2003). Misinformation about the ways in which hormonal contraception works is the primary excuse for this nationwide campaign to refuse women

· Although the total number of pharmacist refusal incidents is unknown, reports of pharmacist refusal date back to 1991 (Cantor & Baum, 2004).

· Catholic hospitals are governed by the Ethical and Religious Directives for Catholic Health Care Services. The Directives state,

· The "testing" that the Directives call for does not exist. No medical tests exist that can detect the presence of a fertilized egg. Pregnancy tests only detect established pregnancies, which begin when implantation of the pre-embryo is complete. This does not occur until about 10-15 days after vaginal intercourse (Cunningham, F. Gary, et al., 2001). At this point pregnancy is established and termination is only possible through abortion, which the Directives do not permit.

· Refusal clauses limiting access to reproductive health care were initially established in the weeks following the January 1973 Roe v. Wade decision, which legalized abortion nationwide. In 1973, Congress passed the Church Amendment to allow health care providers to cite religious grounds in order to refuse to provide abortion or sterilization. Within five years, the majority of states adopted similar refusal clauses. Over time, refusal clauses have been extended to include assisted reproductive technologies, contraception and emergency contraception, human embryonic or fetal research, in vitro fertilization, and stem cell research (Sonfield, 2004).

· Refusal clauses can apply to both medical and nonmedical individuals and institutions. These definitions include, but are not limited to, physicians, pharmacists, nurses, hospitals, clinics, universities, and insurance companies.

· Refusal clauses can cover a broad range of services including abortion, abortifacients, contraception, family planning services, and general reproductive health services. If the services are not specified, refusal clauses can be applied to other medications and procedures.

· Refusal of a service can be permitted on the basis of religion, personal conscience, moral conflict, or moral values. This broad definition permits individuals to refuse access on the basis of political ideology or bias, rather than genuine religious convictions.

· In 34 states, refusal statutes refer only to abortion. In 12 states they pertain to both abortion and contraception. Nine of these 12 states explicitly allow individuals to refuse birth control, contraception, and/or family planning. Four of these 12 states define "individual provider" broadly enough to include pharmacists (AGI, 2004b).

· Rep. Dave Weldon (R- FL) successfully tacked a so-called "Abortion Non-Discrimination Act" onto the federal government's 2005 budget. The Weldon Amendment allows health care institutions to refuse to comply with federal and state regulations regarding a range of abortion-related services, including pharmacist referrals (Feldt, 2004). This legislation, signed into law on December 8, 2004, overrides Title X guidelines that require women to be referred for abortions upon their request. As we go to press, the State of California has already taken action to challenge this legislation.




Sex Ed in America: Abstinence-Only Versus Comprehensive Curriculum

· Federally funded abstinence-unless-married education curricula contain false, misleading, and distorted information intended to scare students rather than to educate. Despite the growing reliance on this approach to sex education, much of the information that America’s youth are being taught is medically inaccurate or misleading, according to an analysis released by Congressman Henry Waxman (D-CA) on December 1, 2004.

· Examples of misinformation contained in federally funded curricula:

Condoms fail to prevent HIV transmission as often as 31 percent of the time in heterosexual intercourse.
Touching a person’s genitals can result in pregnancy; mutual masturbation can cause pregnancy.
HIV can be transmitted by tears and sweat and fifty percent of gay teens have AIDS.
A pregnancy occurs one out of every seven times that couples use condoms.
A 43-day-old fetus is a “thinking person.”
Five to ten percent of women will never again be pregnant after having a legal abortion.
Suicide is a consequence of premarital sex.

· Comprehensive sex education can help delay sexual activity and give students the tools to avoid unintended pregnancy and STDs when they do become sexually active. Research done by Douglas Kirby for the National Campaign to Prevent Teen Pregnancy shows that programs that provide teenagers with comprehensive sex education that includes a discussion of contraception in addition to abstinence can be effective in helping teens to delay sexual activity, to use contraceptives when they do become sexually active, and to have fewer partners.13 In contrast, abstinence-only messages have been shown to reduce contraceptive use among sexually active teens, putting them at risk of pregnancy and STDs, including HIV.

· Contraception is responsible for half of the recent decline in teen pregnancy. An August 2004 report from the Centers for Disease Control and Prevention (CDC) attributes 53 percent of the decrease in teen pregnancy to increased abstinence and 47 percent to increased use of contraceptives.

· Major medical, public health research groups and institutions support more comprehensive forms of sex education that includes information about both abstinence and contraception. They include the American Medical Association, the American Academy of Pediatrics, the American Nurses Association, the American College of Obstetricians and Gynecologists, the American Psychological Association, the American Public Health Association, the National Institutes of Health, and the Institute of Medicine.

· Americans support more comprehensive forms of sex education, reflecting the minimal public support for abstinence-unless-married agendas that reflects political rather than public health concerns. A January 2004 poll from NPR/Kaiser Family Foundation/Harvard Kennedy School of Government showed that a majority of parents want abstinence to be a major piece of a sex education curriculum. However, only 15 percent of parents believed that schools should teach only about abstinence from sexual intercourse and should not provide information on condoms and contraception.


For more information, see the release titled “OPPOSE FUNDING FOR DANGEROUS, FACTUALLY INCORRECT ABSTINENCE-UNLESS-MARRIED EDUCATION PROGRAMS SUPPORT FUNDING FOR “REAL” SEX EDUCATION PROGRAMS” Distributed by the National Family Planning and Reproductive Health Association (NFPRHA)

Abortion Statistics

· 49% of pregnancies among American women are unintended; Almost 1/2 of these are terminated by abortion. 24% of all pregnancies (excluding miscarriages) end in abortion.

· In 2002, 1.29 million abortions took place, down from an estimated 1.36 million in 1996. From 1973 through 2002, more than 42 million legal abortions occurred.

· Each year, 2 out of every 100 women aged 15–44 have an abortion; 48% of them have had at least one previous abortion.


· 52% of U.S. women obtaining abortions are younger than 25: Women aged 20–24 obtain 33% of all abortions, and teenagers obtain 19%.

· Black women are more than 3 times as likely as white women to have an abortion, and Hispanic women are 2 1/2 times as likely.

· 2/3 of all abortions are among never-married women.

· Over 60% of abortions are among women who have had 1 or more children.

· On average, women give at least 3 reasons for choosing abortion: 3/4 say that having a baby would interfere with work, school or other responsibilities; about 2/3 say they cannot afford a child; and 1/2 say they do not want to be a single parent or are having problems with their husband or partner.

· 54% of women having abortions used a contraceptive method during the month they became pregnant. 76% of pill users and 49% of condom users reported using the methods inconsistently, while 13% of pill users and 14% of condom users reported correct use.

Induced Abortion in the United States--The Alan Guttmacher Institute www.guttmacher.org

Impact of Supreme Court Decisions on Reproductive Rights


· The story of Griswold begins in 1961, when Estelle, then executive director of the Planned Parenthood League of Connecticut, and Dr. C. Lee Buxton of Yale University’s Medical School opened a small birth-control clinic in downtown New Haven, Conn. They intended to challenge the validity of the state’s official ban on birth control, and indeed, nine days later, they were arrested for dispensing contraceptives to a married couple. A month later they were convicted and fined $100 each.

· When their case finally reached the Supreme Court, seven of nine justices agreed that a zone of privacy safeguarding birth control inheres in what Justice William O. Douglas called a “penumbra” (a shaded rim between darkness and light) of the Constitution and the Bill of Rights. (Other justices felt it was covered by protections against search and seizure and other specific rights that could logically be extended to cover marriage.)

· In other words, although the Constitution and the Bill of Rights do not explicitly guarantee privacy rights to individuals, such rights are implicit within the documents. The landmark ruling in Griswold v. Connecticut paved the way for Eisenstadt v. Baird, the 1972 Supreme Court decision that extended these same privacy protections — and thus the right to obtain birth control — to unmarried women. It opened the door the following year to the historic ruling in Roe v. Wade, which expanded the privacy doctrine to abortion, granting women and their doctors the legal right not just to prevent, but also to terminate, unwanted early pregnancies.

· Just two years ago, the Court once again drew upon the Griswold doctrine of privacy, in the 2003 decision Lawrence v. Texas, to protect the right of consensual homosexual relations. With social conservatives again ascendant across the land — and an intense battle looming over possible Supreme Court vacancies — Griswold’s 40th anniversary this year compels us to remember just how long and hard American progressives have battled to secure reproductive-health rights in this country.

· Before birth control and abortion were legally and readily available, the average woman would become pregnant between 12 and 15 times in her lifetime. Even today in the United States, nearly half of all pregnancies remain unintended, and nearly half of those result in abortion. This is why polls show that the vast majority of Americans reject the extremism of a determined minority and do not want the Supreme Court decisions that protect their private decisions to be overturned.

For more information, see “Public Triumphs, Private Rights: Estelle Griswold and Margaret Sanger helped women gain access to birth control and abortion — but just one Supreme Court justice could take it away” by Ellen Chesler Ms Magazine. Summer 2005
http://www.msmagazine.com/summer2005/birthcontrol.asp


· On January 22, 1973, the U.S. Supreme Court announced its decision in Roe v. Wade, a challenge to a Texas statute that made it a crime to perform an abortion unless a woman's life was at stake. The case had been filed by "Jane Roe," an unmarried woman who wanted to safely and legally end her pregnancy. Siding with Roe, the court struck down the Texas law. In its ruling, the court recognized for the first time that the constitutional right to privacy "is broad enough to encompass a woman's decision whether or not to terminate her pregnancy" (Roe v. Wade, 1973).

· Roe has come to be known as the case that legalized abortion nationwide. At the time the decision was handed down, nearly all states outlawed abortion except to save a woman's life or for limited reasons such as preserving the woman's health, or instances of rape, incest, or fetal anomaly. Roe rendered these laws unconstitutional, making abortion services safer and more accessible to women throughout the country. The decision also set a legal precedent that affected more than 20 subsequent Supreme Court cases involving restrictions on access to abortion.

· In Roe, the Supreme Court found that a woman's right to decide whether to become a parent deserves the highest level of constitutional protection. The court also recognized that the right to privacy is not absolute and that a state has valid interests in safeguarding maternal health and protecting potential life. According to the court, a state's interest in protecting maternal health is not compelling until the second trimester of pregnancy and its interest in potential life is not "compelling" until viability, the point in pregnancy at which there is a reasonable possibility for the sustained survival of the fetus outside the womb. A state may — but is not required to — prohibit abortion after viability, except when it is necessary to protect a woman's life or health.

· In 1965, abortion was so unsafe that 17 percent of all deaths due to pregnancy and childbirth were the result of illegal abortion (Gold, 1999). Today, abortion is one of the most commonly performed clinical procedures, and the current death rate from abortion at all stages of gestation is 0.6 per 100,000 procedures. This is eleven times safer than carrying a pregnancy to term and nearly twice as safe as a penicillin injection (AGI, 2004; Rock & Jones, 2003; Paul et al., 1999; Gold, 1990).

For more information, see “Roe v. Wade: Its History and Impact” http://www.plannedparenthood.org/pp2/portal/files/portal/medicalinfo/abortion/fact-roe-wade-history.xml



What the Polls Say

· In 2004, 52 percent of voters identified themselves as pro-choice, 41 percent pro-life, according to Gallup Poll trend data

· A recent ABC News/Washington Post poll found that 56 percent of respondents nationwide favored keeping abortion legal in all or most cases. The survey of 1,082 adults, conducted in April 2005, showed that only 14 percent of those surveyed wanted to keep abortion illegal in all cases, with another 27 percent wanting most cases to be illegal.

· In a recent survey by The Mellman Group, 62 percent of respondents felt the government should not interfere with a woman’s access to abortion. Only 33 percent believe the government should restrict access.

· Nearly 60 percent of Americans say that, if presented with an opportunity to appoint one or more new justices to the Supreme Court, President Bush should pick individuals who would uphold Roe.

· The Associated Press/Ipsos-Public Affairs Poll, which surveyed a national sample of 1,000 adults last November, found that only three in 10 respondents (31 percent) favored nominating justices who would overturn Roe.

· Three-quarters of the respondents in a poll of 1,000 likely voters said that the Senate should examine each of the president’s nominees carefully and make its own independent judgment. Only 24 percent thought that the Senate should just confirm whomever Bush puts forward.

Voters recently surveyed by Planned Parenthood Federation of America overwhelmingly (78 percent) favor requirements that schools teach sex education, and 79 percent favor access to emergency contraception (EC) for rape and incest victims.