Women’s health advocates all over the country were stunned yesterday when Health and Human Services Secretary Kathleen Sebelius reversed an FDA request to expand access to over-the-counter emergency contraception for teenagers under the age of 17. In press releases denouncing the decision, a common theme has emerged: President Obama has followed in the footsteps of his predecessor, George W. Bush, on the heated issue of emergency contraception.

The political fight during the Bush administration over Plan B, also known as the morning after pill or emergency contraception, was a volatile one. Conservatives were dead-set against the FDA’s approval of the drug and did all they could to stall access to it once it was approved.

As feminist writer Jessica Valenti has written on the subject:

As you may remember, the concerns the FDA cited over emergency contraception were not about women’s health or the safety of efficacy of the drug. Instead, they were worried about young women getting all slutty. Dr. W. David Hager, one of the FDA committee members who voted against EC’s over-the-counter approval and a key player in making sure Plan B got held up, told The New York Times: “What we heard today was frequently about individuals who did not want to take responsibility for their actions and wanted a medication to relieve those consequences.” Some things to keep in mind about Hager: in suggested in a book he wrote that women could cure PMS with prayer, and his wife accused him of rape. So yeah, a bit scary that he was in charge of women’s health.

It later came to light that FDA medical official Janet Woodcock wrote in an internal memo that over-the-counter status for Plan B could cause “extreme promiscuous behaviors such as the medication taking on an ‘urban legend’ status that would lead adolescents to form sex-based cults centered around the use of Plan B.” It has Lifetime Original Movie written all over it. Of course this but-it-will-make-girls-slutty argument is hardly new. It’s the same excuse legislators have given when attempting to limit women’s access to birth control, and more recently, to the HPV vaccine.

Because the argument against emergency contraception wasn’t rooted in any medical or scientific argument, advocates were sure the Obama administration would uphold the recommendation. Furthermore, it was unlikely that a health secretary would publicly overrule the FDA.

According to The New York Times:

Although Ms. Sebelius had the legal authority to overrule the F.D.A., no health secretary had ever publicly done so, an F.D.A. spokeswoman said. Nor had such a disagreement been the subject of such extraordinary dueling press statements. Dr. Margaret Hamburg, the F.D.A.’s commissioner, issued a lengthy statement saying it was safe to sell Plan B over the counter, while Ms. Sebelius countered that the drug’s manufacturer had failed to study whether girls as young as 11 years old could safely use Plan B.

However, the conversation about whether to remove the barrier of a required prescription for girls under the age of 17 was about making sure emergency contraception was available to all sexually active women in an emergency. Requiring a prescription for a young girl could remove Plan B as an option altogether.

Women’s advocates also expected Sebelius and the Obama administration to protect women’s health issues, no matter the political fallout. The administration took a hit from politically powerful Catholic groups when it upheld a recommendation from the Institute of Medicine to include contraception in a list of preventive medicines to be covered without co-payments.

But in the months since the decision to include contraception in the list was made, reproductive justice advocates have been less sure that the administration will stand its ground, and they now consider yesterday’s decision a sign of things to come. Worse, advocates now see the Obama administration as continuing the politics of the Bush administration.

Nancy Keenan, the president of NARAL Pro-Choice America, wrote in a press release yesterday that the group “expected this kind of action from the Bush administration, so it’s doubly disheartening and unacceptable that this administration chose to follow this path.”

“We had a major opportunity to improve young women’s access to contraception,” Keenan said in a statement, “which is the best way to reduce the need for abortion, and the Obama administration missed the mark.”

The Center for Reproductive Rights released a statement saying, “Six years ago, we sued the Bush administration for rejecting science and playing politics with women’s health by denying emergency contraception for over-the-counter sale.”

“We are stunned to see the same behavior from the Obama administration,” said Nancy Northup, president of the Center for Reproductive Rights. ”It is unacceptable that the approval for drugs supporting women’s reproductive health is held to a completely different standard.”

One of the country’s oldest feminist groups, the National Organization for Women, aslo said in a statement that:

It is an unusual and infuriating move for the Obama administration to overrule that decision, especially at a time when rumors are flying that the president is on the brink of caving in to the U.S. Conference of Catholic Bishops by expanding religiously affiliated employers’ ability to deny contraceptive coverage to women under the Affordable Care Act.

NOW calls on the president to stop playing politics with the lives of women and girls. During the Bush years, women’s reproductive health was under constant attack. We don’t need more of the same from the Obama administration.

The Center for Reproductive Rights will be in federal court on Tuesday, according to their stament, continuing to fight for over-the-counter emergency contraception. The group filed a petition years ago, “along with attorneys Andrea Costello of Florida Institutional Legal Services and Natalie Maxwell of Southern Legal Counsel on behalf of the Association of Reproductive Health Professionals (ARHP), National Latina Institute for Reproductive Health, grassroots activists, and parents who seek over-the-counter access for their daughters.”

A federal court ordered the FDA to reconsider and rule on the petition filed by the Center in 2001. However, the FDA has yet to follow the order, the Center says.

Groups expect to hear whether Sebelius will uphold her decision to include contraception in a list of preventive services some time this week.

“I have always been committed to ensuring all our health policy decisions are grounded in sound science. The FDA’s review process was clearly extensive and thorough, and the data shared with HHS made clear that Plan B is safe and effective for its intended use,” DeGette wrote in a release. “Access to reliable and safe contraception is a fundamental component of health care and bringing Plan B from behind the pharmacy counter onto the shelves with other contraceptive methods would have been a victory for women’s health.”

DeGette looked forward to expanding access to the drug as a great victory for women’s health care and Sebelius’s move clearly came as a surprise.

Writing at the Huffington Post this week in anticipation of the decision, DeGette said expanding access to the Plan B pill to high school girls would be a great victory for women’s health.

If they approve this move, as we hope they will, it would be a great victory for women’s health care; when a woman can plan how and when she wants to have her family, there are proven health, economic and social benefits to her, her family, and indeed our society overall…

If the FDA approves this step, it will reflect the proven science of an important contraceptive innovation for American women. Access to reliable and safe contraception is a fundamental component of basic health care.

DeGette noted that, as with so much related to women’s reproductive health, the topic of the “morning after pill” was fraught. She warned against bad information.

directly in conflict with that science, many ideologues are once again trying to stand in the way of this advancement for women’s health care…

To be clear — emergency contraception is not a so-called “abortion pill.” Much like the traditional birth-control pill, Plan B One-step works to prevent fertilization, and therefore, pregnancy. Despite false declarations from extreme opponents, Plan B One-step does not work if the woman is already pregnant.

The Plan B pill is currently available without a prescription to any woman 17 or older with a photo ID. Reproductive rights advocates have long warned that this type of age restriction creates ill-advised longer wait times for young women seeking emergency contraception.

Teva Pharmaceuticals had applied to make its pill the first over-the-counter form of emergency contraception.

Secretary Sebelius explained that she thought that women as young as 11 might seek out the pill and she was unsure such young women could use the pill properly.

Although “the science has confirmed the drug to be safe and effective with appropriate use,” she said, “the switch from prescription to over the counter for this product requires that we have enough evidence to show that those who use this medicine can understand the label and use the product appropriately. ”

“I do not believe that Teva’s application met that standard. The label comprehension and actual use studies did not contain data for all ages for which this product would be available for use,” she said in a statement today.

According to her statement:

FDA has recommended approval of this application in its Summary Review for Regulatory Action on Plan B One-Step. After careful consideration of the FDA Summary Review, I have concluded that the data, submitted by Teva, do not conclusively establish that Plan B One-Step should be made available over the counter for all girls of reproductive age.

The average age of the onset of menstruation for girls in the United States is 12.4 years. However, about ten percent of girls are physically capable of bearing children by 11.1 years of age. It is common knowledge that there are significant cognitive and behavioral differences between older adolescent girls and the youngest girls of reproductive age. If the application were approved, the product would be available, without prescription, for all girls of reproductive age.

The surprise move by a member of the pro-choice Obama administration had many analysts suggesting the rejection of the FDA recommendation should be seen as political maneuvering. They said the White House might be trading access to the morning after pill for conservative support for initiatives it considers more pressing, initiatives likely tied to relieving the economic pressure of the recession.

If there’s any truth to such speculation and if the health care reform debate is any measure, analysts point to the need to win over conservative Democrats on matters related to abortion for an extension of unemployment benefits, for example.

John Tomasic contributed to this report.

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Rep. Amy Stephens

House Bill 1021 was originally weakened with amendments proposed by its sponsors when presented to the House Business Affairs and Labor Committee. At the time, McCann and Frangas reluctantly removed contraceptive coverage from the bill and diluted the language so that insurance companies merely had to offer one policy with maternity coverage. Analysts agreed that those maternity policies would be relatively expensive and so would force women into plans without the coverage, in effect reinforcing the status quo.

“I sit on Business Affairs and was very happy with the amendments and voted it out of committee. So please explain to me what you are doing with this amendment,” said Stephens on the House floor.

Frangas said the point of the amendment was to make sure women were getting maternity care in the state. He said the bill did not cover Plan B contraception and would not cover abortions.

As part of a campaign supporting the legislation, House Bill 1021, NARAL Pro-Choice Colorado submitted 250 postcards and over 350 email signatures.

In a statement, NARAL executive director Emilie C. Ailts said “Coloradans who care about healthy pregnancies are calling on our elected officials to recognize the importance of ensuring women and their families have access to the full spectrum of reproductive health care services they need to bear healthy children. Affordable access to the recommended 12-13 prenatal care visits is a critical tool to achieving healthy pregnancies and increasing the number of full-term, healthy birth-weight babies born in Colorado.

“Will the anti-abortion, anti-birth control, anti-comprehensive sex education politicians vote their purported values, which they claim are about healthy babies and healthy families? House Bill 1021 provides a clear opportunity for these anti-choice lawmakers to enact responsible policies that can reduce the need for abortion by ensuring women have access to the prenatal care they need for healthy pregnancies.”   

The bill passed easily on a second-reading voice vote.

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Democrats Rep. Diana DeGette of Denver and her upstate New York colleague Rep. Louise Slaughter have taken the lead in the U.S. House to block the controversial regulation that would allow health care workers to refuse to perform or assist in medical procedures they find religiously or morally objectionable, regardless of the patients’ needs. Twenty-three representatives have signed on as co-sponsors.

The proposed U.S. Dept. of Health and Human Services rule is largely believed to serve as a back door tactic for social conservatives to make abortion, in vitro fertilization, contraception drugs and devices, and stem cell research more difficult to obtain by women patients.

On Jan. 15, the pair filed (H.R. 570), what a press release called the “Protecting Patients and Health Care Act,” to prohibit HHS from implementing the new “conscience clause” which has been roundly criticized as unnecessary and punative since current law already requires employers to make reasonable accommodations for health care workers’ religious beliefs.

A broader strategy to kill the new rule is being employed House Democrats via the Midnight Rule Act (H.R. 34) introduced by Rep. Jerrold Nadler, D-New York. It will allow incoming cabinet secretaries “greater power to rewrite regulations issued during the final three months of the previous presidency,” writes the New York Times. Nadler’s bill is garnering interest from a motley crew of bankers, environmentalists and reproductive health advocacy groups seeking to roll back some of the more egregious 11th-hour rules pushed through by the outgoing Bush Administration.

Obama has also signaled his hostility to the last-minute regulations and has directed his transition team to explore potential executive branch repeal efforts.

Citizens opposed to the regulation also have an opportunity to get involved.

The National Family Planning and Reproductive Health Association has launched a petition calling on lawmakers to repeal the HHS rule because of its significant impact on low-income and uninsured persons seeking family planning services from its member organizations of health departments, nonprofit clinics and health providers.

According to NFPRHA spokeswoman Allison Conyers, “We really want to show that there is support from the general public to stop the regulations to limit family planning services.”

During the public comment period on the proposed regulation last summer, more than 200,000 people lodged their opposition to the HHS rule.

Beliefnet.com reports that HHS officials claim the 127-page regulation to protect health care providers of faith from violating their conscience will cost taxpayers $44 million to implement.

Follow the bill via the GovTrack widget which will automatically update throughout the legislative process:

Connecticut Attorney General Richard Blumenthal told US News and World Report that the controversial new regulation tramples on states’ and patients’ rights.

At issue are state laws requiring hospitals to provide information and, in some cases, emergency contraception to rape victims upon request. Abortion foes argue that delivering such care could violate health care providers’ religious and/or moral beliefs and have been pushing for an expansion of the “conscience clause” enjoyed by pharmacists who refuse to dispense contraception.

Reproductive health advocates worry that the rule could have far-reaching implications — beyond making an abortion more difficult to obtain — by threatening contraception, in vitro fertilization and stem cell research which are all vigorously opposed by religious conservatives.

Colorado’s 2007 emergency contraception lawcould also be at risk should the hurried U.S. Health and Human Service regulation take effect on Jan. 18, forty-eight hours before President-elect Barack Obama’s inauguration.

Presidential transition team officials have stated that Obama also opposes the HHS rule and is seeking remedies to rescind it, along with several other “midnight regulations” passed in the waning days of the Bush administration. Beliefnet.com reports that HHS officials indicate the 127-page regulation to protect health care providers of faith from violating their conscience will cost taxpayers $44 million to implement.

The anti-abortion Web site lifenews.com claims that, in addition to Connecticut, 12 other states — Arizona, Illinois, Iowa, Maine, Maryland, Massachusetts, Montana, New Jersey, Oregon, Rhode Island, Utah and Vermont — are likely to join the legal challenge since they initially voiced opposition to the rule during the public comment phase.

Nate Strauch, spokesman for state Attorney General John Suthers, told The Colorado Independent that Colorado has not been asked to join the suit and deferred further comment on its merits.

On the matter of contraception, the Centennial State has a long way to go to catch up to the efforts of its fellow intermountain west states in preventing unintended pregnancies — especially among poor women and teenagers — and reducing abortions.
_{Source: Guttemacher Institute, State Center on Reproductive Health, 2006. Methodology}

According to the Guttmacher Institute, Colorado spends a mere $33 on contraceptive services and supplies for women in financial need. In contrast, our mountain siblings Montana ($52), New Mexico ($53) and Wyoming ($112) spend far more to prevent unintended pregnancies.

So what gives in explaining Colorado’s poor performance in meeting the family planning needs of nearly 550,000 women of child-bearing age — of which 43 percent live well below federal poverty guidelines?

One explanation is that Montana, New Mexico and Wyoming have democratic governors who have not obstructed access to contraception, as Colorado’s former republican governor Bill Owens did throughout his eight year term which ended in January 2007.

Owens twice vetoed emergency contraception legislation and implemented a ban on state funding for family planning organizations linked to abortion providers among several acts — legally and rhetorically — to limit contraception access. 

The hostility toward women’s reproductive health also extends to the Colorado state legislature with a recent history of introduced, but defeated, bills to strictly define pregnancy, make performing an abortion a class 3 felony, and codify as a class 1 felony an attack on a pregnant woman that causes the death of a fetus. None of the bills made it out of committee yet lawmakers continue to push bills that promote a narrow, conservative ideological agenda. Likewise, the recently-formed Colorado for Equal Rights is circulating petitions to add a measure to the 2008 general election ballot to give state Constitutional protections to fertlized eggs. All of this in spite of majorities of Coloradans favoring pro-choice views. 

According to a 2006 Rassmussen poll, 54 percent of Coloradans oppose an abortion ban. Similarly, a 2005 SurveyUSA poll reported that Colorado is 15th in the nation for its pro-choice stance (61 percent of adults). Montana, New Mexico, and Wyoming share majority pro-choice views though at slightly lower percentages than Colorado.

Another equally plausible theory is that the other Rocky Mountain states wear their “libertarian-leanings” on their sleeves and legislate accordingly. While Colorado lawmakers tend to like to invoke small government rhetoric when it’s politically convenient, the reality is that conservative members of the state Republican Party, who dominated statehouse politics until recently, lose their libertarian “live-and-let-live” street cred when social issues arise. Reproductive health issues, in particular, strike a gong in the heads of the conservative caucus and legislative mayhem, like the bills mentioned above, quickly ensues.

The negative impact of the Colorado Taxpayers’ Bill of Rights (TABOR) — a constitutional amendment that strictly limits the amount of revenue the state can retain each year to pay its bills and support government services — also cannot be overstated in drastically slashing budget allocations to education, health care, and other important quality of life programs, including reproductive health, over the last decade and a half.

Wyoming and Montana, on the otherhand, are flush with cash thanks to a booming extractive energy industry and are able to fund state programs while stashing sizeable budget surplusses. New Mexico holds one of the largest state budget reserves in the nation. And as one of the most racially diverse among the intermountain west states, New Mexican reproductive health groups are implementing strong outreach activities to Hispanic, African American and Native American communities where contraception access tends to be low.

Whatever the explanation, Colorado has much work to do to reach the 44 percent of poor women and 51 percent of teenagers who are in need and not able to access publicly supported family planning services.

Suddenly, it’s not so funny any more that Alabama and other states — long stereotyped for clinging to antebellum views on education, race and class — are doing a much better job of serving their citizens’ needs than the state that just wasted time in the last legislative session debating the merits of “Rocky Mountain High” as the new state song.

One of the most stark contrasts in Colorado’s freefall is the mother-of-all controversial subjects: reproductive health care.

The United States has one of the highest rates of unintended pregnancy in the industrialized world. Half of the six million pregnancies that occur among American women each year are unintended; of these, 1.3 million end in abortion.

In Colorado, 92,770 of the 967,570 women of childbearing age become pregnant each year. 71% of these pregnancies result in live births, and 14% result in abortions; the remainder end in miscarriage.

Colorado has the 22nd highest teenage pregnancy rate of any state. Of the 12,130 teenage pregnancies each year in
Colorado, 62% result in live births and 23% result in abortions.

Colorado is ranked 40th overall of all 50 states and the District of Columbia on access to contraception, according to the Guttmacher Institute, one of the leading non-profit social science research, education, and public policy organizations on U.S. and global reproductive health concerns.

Alabama is ranked 4th in the nation. [PDF].

The chart, at left, is a composite of data available before November 1, 2005. Since then, the legislature has passed a long-fought bill championed by Sen. Betty Boyd (D-Lakewood) that requires hospitals to inform sexual assault victims about emergency contraception options. Gov. Bill Ritter signed SB 60 on March 15, 2007.

During the same legislative session, a non-binding joint resolution [PDF] was passed by both chambers asserting the need for the state to “consider cost-effective public policies to reduce unintended pregnancy rates based upon comprehensive data and analysis regarding the barriers and challenges to preventing unintended pregnancies.”

While the state appears to be moving in the right direction to reduce unplanned pregnancies it remains to be seen if Colorado’s low ranking on contraception issues will improve.

Especially while ballot measures are floated to bestow legal personhood on fertilized eggs as an attempt — openly admitted by Coloradans for Equal Rights — to effectively ban abortion and contraception access.

Next, we’ll look at Colorado’s relative ranking compared to its intermountain west neighbors — New Mexico, Wyoming, and Montana. When and where does western small “l” libertarian politics play a role in reproductive health?

“An American woman can decide to put her life on the line for our country in Iraq, but she can be prevented from making basic decisions about her own health here at home,” Maloney said in a press release.  “Access to birth control is a women’s health issue, a private matter and a constitutional right.  No one – not pharmacists, politicians, or religious leaders – should be able to tamper with that right.”

continued…Under the Access to Birth Control Act, pharmacists would not be allowed to object on religious grounds. The bill states: “If a customer requests a contraceptive that is in stock, the pharmacy shall ensure that the contraceptive is provided to the customer without delay.” If the pills are out of stock, pharmacists would be required to order them for the customer or refer her to another pharmacy.

Gov. Ritter signed a bill this year that requires pharmacies that don’t stock emergency contraception to post a sign saying so in order to save women valuable time waiting in line. EC, which prevents implantation of a fertilized egg in the uterus, must be taken within 72 hours of unprotected sex. But the sooner, the better.

Under the new bill, pharmacies could face a fine of $5,000 per day for violations and customers could sue pharmacies if they believe the law has been broken.

Read Colorado Confidential’s coverage of EC.

SB 60 also requires pharmacies that don’t have EC in stock to post a prominent sign saying so, thus saving women valuable time waiting in line. EC can prevent pregnancy if taken within 72 hours of unprotected sex – though the sooner the better.

EC can be dispensed at pharmacies without a prescription, but a Colorado Confidential investigation in November found that many pharmacies don’t stock it. Availability seemed to be most limited in rural areas and Colorado Springs. Catholic hospitals have objected to similar measures in past years, but SB 60 includes a right for hospital workers who object on moral grounds to opt out. All hospitals, however, would still have to find someone on staff who would talk to victims about EC.

The Senate passed the bill Jan. 30 by a vote of 25-10, and the House passed it Feb. 14 on a vote of 56-9. Rep. Anne McGihon is the sponsor in the House.

Once signed by the governor, the bill will go into effect immediately.

There was no testimony in opposition to the bill, while health professionals, reproductive rights advocates and sexual assault victims offered sometimes emotional testimony in support of the measure.

This is the fourth try for bill sponsor Sen. Betty Boyd, who introduced similar measures in past years. The closest such a bill came to becoming law was in 2005, when former Gov. Bill Owens vetoed it. Catholic hospitals have objected to similar measures in past years, but this session’s bill includes a right for hospital workers who object on moral grounds to opt out. Catholic hospitals, however, would still have to find someone on staff who would talk to victims about Plan B.

Rep. Debbie Stafford, R-Aurora, said she was previously opposed the the bill, but she was struck today by the absence of objections from Catholic hospitals. 

“It’s caused me to rethink my position,” she said.

The committee also unanimously adopted an amendment that would require pharmacies that don’t stock emergency contraception to post a conspicuous sign saying so. Plan B is available without a prescription, but pharmacies aren’t required to stock it. A Colorado Confidential investigation in November found that EC wasn’t available at many pharmacies in the state. EC can prevent pregnancy if taken within 72 hours of unprotected sex, and the amendment would save women valuable time waiting in line at pharmacies that don’t stock it.

Rep. Anne McGihon is the bill’s sponsor in the House.