Women’s health in harm’s way

AUBREY REINHARDT, who felt humiliated when she tried to get birth control, now heads a chapter of the reproductive rights group If/When/How. (Katie Falkenberg Los Angeles Times)

By Alexandra Zavis

DALLAS — It was Aubrey Reinhardt’s last year at Texas Tech University. So when things started getting serious with her boyfriend, she decided it was time to look into birth control.

Reinhardt knew that abortion foes had been trying to strip Planned Parenthood of every penny it receives from government sources. But until that momenttwo years ago, Reinhardt recalled, she didn’t appreciate what that could mean for a person like her who just needed somewhere to go for affordable contraception — without feeling she was being judged.

Planned Parenthood had to close its two health centers in Lubbock, where Reinhardt was studying, so she turned to the campus clinic. But the doctor there told her she might have a blood clotting problem, and said Reinhardt would need to get approvals from three other doctors and a hormone specialist before she would prescribe contraception.

Reinhardt, now a 22-year-old law student in Dallas, was stunned. None of her previous physicians had suggested she might have such a problem. Could the doctor be using it as an excuse? She could feel herself tearing up.

“Why are you crying?” she recalled the doctor asking. “Are you really in that big of a hurry to become sexually active?”

Humiliated, Reinhardt hurried out of the office.

In the annals of the abortion wars, the call to “defund Planned Parenthood” has become one of the most potent — and contentious — rallying cries. The organization is the largest single provider of abortions in the country and has used its political clout to protect access to the procedure.

Now with President Trump in the White House and Republicans in control of Congress and statehouses across the nation, those seeking to curtail public funding for Planned Parenthood see opportunities to achieve their long-sought goal — and they see Texas as a model to follow. But as Reinhardt’s experience shows, the effects of a successful defunding campaign can be far more extensive — and potentially damaging — than intended.

In 2011, Texas lawmakers slashed funding for family planning clinics rather than allow any of the money to go to Planned Parenthood. Because of the cuts, a quarter of the state’s clinics closed, making it harder for women of limited means to get a range of other basic health services, including contraception, breast and cervical cancer screenings, and testing for sexually transmitted infections.

Lawmakers have since attempted to repair the damage by directing more money to facilities not tied to abortion providers. But there isn’t always a facility that can readily fill the void when women are denied access to Planned Parenthood, which serves 2.4 million patients nationally each year.

Federally funded community health centers, which provide a range of low-cost primary care to poor families, are stretched thin. And family planning is not routinely offered at 40% of these facilities, according to a study by the Guttmacher Institute, which advocates for reproductive rights, including abortion.

After Reinhardt’s upsetting visit to the campus clinic, she called one such center in Lubbock. The soonest she could get an appointment was in April. It was January. She then tried facilities operated by Christian nonprofits. They didn’t offer contraception.

So she called what was left of Planned Parenthood. They could see her right away, but their nearest locations were in El Paso and Fort Worth, both four-hour drives away.

Over spring vacation, Reinhardt drove to Fort Worth and received an implant that prevents pregnancies for up to four years. But she wondered, “What about the mother that has two children, that works two jobs, that can’t take off two days to drive four hours away to a clinic and come back?”

It is already illegal to use federal dollars for abortions, except in cases of rape, incest or when the mother’s life is in danger. And Planned Parenthood says about half of its health centers don’t offer the procedure.

But the group’s opponents argue that giving Planned Parenthood public funds for non-abortion-related care allows it to spend more of its private funds on abortions. In 2016, the group received $554.6 million from government sources, about 40% of its budget.

The Republican bill to replace Obamacare, which narrowly cleared the House on May 4, would prevent Planned Parenthood from receiving reimbursements from Medicaid for a year.

That would be a big hit. Medicaid, the federal-state program that insures more than 70 million poor Americans, accounts for the majority of Planned Parenthood’s public funding, according to Congressional Budget Office estimates. Federal Title X family planning grants make up most of the rest.

The House bill, the American Health Care Act, faces an uncertain future in the Senate. And states have faced pushback from federal officials and the courts when they try to withhold federal money from Planned Parenthood themselves.

Texas, however, has found roundabout ways to chip away at the group’s funding.

Texas Republicans scored their first big win in 2011 when the Legislature reduced the two-year budget for the state’s Family Planning Program to $38 million from $111 million. It also approved a new way to allocate the funds that prioritized community health centers and county health departments over specialized family planning clinics like those affiliated with Planned Parenthood.

The argument was that women would be better served if they had their reproductive health needs addressed at facilities that could provide more comprehensive care; critics contend it was a way to squeeze out Planned Parenthood.

Texas also wanted to exclude Planned Parenthood from a separate Medicaid-funded program that offered family planning coverage for certain women who didn’t qualify for full healthcare benefits. But the Obama administration wouldn’t allow that because of a federal law guaranteeing Medicaid clients their choice of providers.

The Legislature’s solution: Forgo federal funding that had paid for 90% of the program and set up an entirely state-financed version called the Texas Women’s Health Program. That effort, launched in 2013, does not contract with clinics affiliated with abortion providers.

Texas’ actions have provided a road map for other states to follow. In May, Planned Parenthood announced it was closing four of its 12 clinics in Iowa after lawmakers there decided to set up a state-run family planning program that can legally exclude the group.

Planned Parenthood wasn’t the only organization hurt by such decisions. By 2013, 82 Texas clinics — a third of them Planned Parenthood affiliates — had closed or stopped offering family planning services, said Kari White of the Texas Policy Evaluation Project, a University of Texas initiative that studied the defunding effort. None of the clinics performed abortions.

Of those that remained open, researchers found, many had to reduce hours or begin charging for services previously offered for free.

Even when there were other clinics nearby where women could use their state benefits, White said, women would often find that they did not stock the more expensive, long-acting birth control methods available at Planned Parenthood. So women switched to less-effective methods, and a few years later, some had become pregnant.

State officials take issue with some of the conclusions because they are based on a study that sampled only patients enrolled in the Texas Women’s Health Program — expanded and rebranded last year as Healthy Texas Women — and not those who received family planning care through other programs.

Now that Trump is in the White House, the state is applying to get its Medicaid funding back for Healthy Texas Women. Since 2013, the Legislature has also committed more than $150 million in additional state funds to rebuilding the network of family planning providers and improving care for poor women — more than making up for the clinic closures, according to officials.

Although participation in the state’s women’s health programs plunged from around 359,000 in 2011 to 201,000 two years later, state figures show, the number of clients enrolled has increased since then and in 2015 was approaching 364,000.

“Texas is committed to women’s health,” Republican state Sen. Jane Nelson, who heads the Senate Finance Committee, said in an email. “The number of providers has tripled, and we are making sure that women throughout the state can access these vital services.”

Kelly Hart, a spokeswoman for Planned Parenthood of Greater Texas, acknowledged the state’s efforts to improve family planning. But she said a question lingers: “Can [those efforts] be as good as the citizens of this state deserve if you deny a major player in women’s healthcare a seat in your program?”

Planned Parenthood has 34 health centers left in Texas, four of which perform abortions.

Community health centers will try to fill the gap, but many will need to hire and train staff, reconfigure space and purchase equipment, said Jose Camacho, who heads an association of such facilities in Texas.

In the meantime, women who rely on publicly funded healthcare are still having trouble finding providers who will accept new patients and can see them in a timely manner, Planned Parenthood clinicians say. That can be critical for some patients.

Four years ago, Dayna Farris-Fisher, a mother of three from Plano, discovered a lump in her breast. She didn’t have insurance because her husband had been laid off. None of the low-cost clinics she tried could see her for at least four months.

In a panic, she called Planned Parenthood. Vivian Bigelow, a nurse practitioner at the group’s local health center, saw her the next day.

But if a patient like Farris-Fisher, now 50, walked into her exam room today, Bigelow said, she would have to refer her somewhere else. The breast and cervical cancer screening program that paid for the diagnostic testing no longer accepts claims from Planned Parenthood, another casualty of the state’s defunding efforts.

That terrifies Farris-Fisher. In the five weeks that it took to confirm a diagnosis and begin treatment, her tumor doubled in size.

“If I had had to wait for one of those other clinics,” she said, “I literally am convinced that I would be dead.”

alexandra.zavis@latimes.com

Twitter: @alexzavis

Source: Women’s health in harm’s way

Central Oregon Coast NOW Endorses the Oregon Reproductive Health Equity Act

The Board of Central Oregon Coast NOW unanimously voted to endorse the Oregon Reproductive Health Equity Act.  Several members will be going to the state Capitol on February 28 to show support for the bill.  This Act has also been endorsed by the Board of Oregon NOW.

Reproductive Health Equity Act
Leading the Nation in Progressive Reproductive Health and Justice!Thank you for signing on as endorsing organization for the Reproductive Health Equity Act (RHEA). This legislation is an important leap toward ensuring that all Oregonians have meaningful access to the care they need. The RHEA of 2017 will call upon the Oregon Legislature to:

* Close loopholes in the ACA provision that prohibits insurers from imposing co-pays, deductibles or co-insurance on preventive reproductive health services.

* Add abortion to the list of reproductive health services that commercial plans must cover at zero out-of-pocket cost.

* Establish coverage for the full range of reproductive health care, including family planning, abortion and postpartum care, for Oregonians who are categorically excluded from health programs due to citizenship status.

* Codify a nondiscrimination clause that prohibits discrimination, including discrimination on the basis of gender identity, in reproductive health coverage.

Access to reproductive health care is critical for the health and economic security of all Oregonians. That’s why everyone in Oregon, regardless of income, citizenship status, gender identity or type of insurance, needs access to the full range of reproductive health services.

In Solidarity,
Pro-Choice Coalition of Oregon: ACLU of Oregon, APANO, Family Forward, NARAL Pro-Choice of Oregon, Oregon Latino Health Coalition, Planned Parenthood Advocates of Oregon and Western States Center

 

People in Salem, Ore., protesting for women’s rights in solidarity with the march in Washington.CreditAnna Reed/Statesman-Journal, via Associated Press

If the Affordable Care Act is repealed, coverage of birth control with no co-payment is one of many benefits that Americans could lose. Now legislators in Oregon have introduced a bill intended to protect access to birth control in the state, along with a broad range of other reproductive health care services, including abortion.

The measure would require insurers in Oregon to cover all types of contraceptive drugs and devices approved by the Food and Drug Administration with no co-payment, co-insurance or deductible. It would extend the same requirement to a number of reproductive health services, including prenatal care, well-woman visits, screening for sexually transmitted infections, voluntary sterilization and abortion.

The bill also includes a provision that would prohibit insurers from discriminating against patients based on gender identity — for example, by refusing to cover gynecological exams for transgender women.

Under the Affordable Care Act, 30 million women gained co-pay-free access to preventive services like contraception, according to an estimate by the Department of Health and Human Services. An increase in the use of long-acting birth control methods has helped decrease the rates of unintended pregnancy and abortion nationwide.

By codifying the protections of the Affordable Care Act, the bill would protect Oregonians’ access to birth control and other preventive health care in the event of a repeal.

But the Oregon bill would go beyond the Affordable Care Act by establishing a comprehensive list of essential reproductive health services that must be covered without a co-payment. Its sponsors recognized that people need access to the full range of reproductive health care in order to participate fully in society and the economy. Especially for patients with high-deductible health plans, abortion can be prohibitively expensive even if it is covered.

The bill, which is expected to come up for debate in March, may serve as a model for other states. New York is already moving in the right direction, with regulations announced this month to require insurers to provide co-pay-free coverage of contraceptives and abortions deemed medically necessary by a doctor.

Oregon’s bill is a powerful defense, at the state level, of necessary reproductive health care.

President Trump’s War on Women Begins

Is Donald Trump’s Cabinet Anti-Woman?

anti-women

Spencer Platt/Getty Images

Donald J. Trump’s campaign was dogged by accusations of misogyny. Now his cabinet is shaping up to be one of the most hostile in recent memory to issues affecting women, advocacy groups for women say. Tax credits for child care and the prospect of paid maternity leave are exceptions to a host of positions that could result in new restrictions on abortion and less access to contraception, limits on health care that disproportionately affect women and minorities and curbs on funding for domestic violence, as well as slowing the momentum toward raising the minimum wage or making progress on equal pay.

Consider their positions on these issues.

Domestic violence

Jeff Sessions, Mr. Trump’s selection for attorney general; Tom Price, chosen for Health and Human Services secretary; and Mike Pompeo, the pick for C.I.A. director, all voted against reauthorizing the Violence Against Women Act in 2013, which funds shelters and services for victims of domestic violence, because of amendments extending protections to L.G.B.T. victims. The act is up for reauthorization next year.

Pay discrimination and equal pay

Senator Sessions and Representative Price also voted against the Lilly Ledbetter Fair Pay Act, which extended the statute of limitations to allow women to sue for pay discrimination.

Mr. Sessions, as well as Elaine Chao, Mr. Trump’s choice for transportation secretary, opposed the Paycheck Fairness Act, which would have strengthened federal equal pay laws for women.

Minimum wage

Ms. Chao, in her tenure as secretary of labor in the George W. Bush administration, opposed raising the minimum wage. President-elect Trump generally opposed raising the federal minimum wage during the campaign, although he occasionally contradicted himself. Eleanor Smeal, president of the Feminist Majority Foundation, points out that two-thirds of minimum-wage earners are women, who dominate fields with low-paying service jobs.

Mr. Trump, who supported the right to abortion as recently as 1999, opposed abortion during the campaign. And so do almost all of his cabinet picks, including Betsy DeVos, his nominee for education secretary; Nikki Haley, for ambassador to the United Nations; and Ms. Chao. Governor Haley signed a bill into law in South Carolina banning abortions from 20 weeks, a rollback from the medically established viability standard of 24 to 26 weeks.  Ben Carson, his nominee for Housing and Urban Development, is a longtime abortion foe.

In Congress, Senator Sessions and Representatives Price and Pompeo have consistently voted for abortion restrictions, including a ban on abortions after 20 weeks and against funding for Planned Parenthood and Title X, because abortion is included in these family planning services.

A Trump administration may well restrict funding for family planning or abortion in programs overseas to which the United States contributes.

Contraception

In Congress, Mr. Sessions, Mr. Price and Mr. Pompeo all voted against requiring employers to provide health care plans that included contraception, citing religious liberty.

In an exchange that went viral in 2012, Mr. Price scoffed at the notion that any woman could not afford contraception as part of his opposition to the Affordable Care Act, which requires contraceptive coverage without co-payments as well as a range of other preventive services for women. “Bring me one woman who has been left behind,” he said at the Conservative Political Action Conference. “Bring me one. There’s not one.”

As numerous women’s advocacy groups have demonstrated, high co-payments for birth control have been a significant deterrent for many women.

Medicare and Medicaid

Mr. Price proposes offering states lump sums, known as block grants, for Medicaid. These measures could disproportionately hurt women, particularly poor and minority women, since they would end up reducing the amount of federal money going to the states for health care. Medicaid is the main source of health care for low-income women, providing prenatal and maternity care as well as paying for nursing home care, which affects women more because they live longer. Under Obamacare, federal money to expand Medicaid has helped to narrow a longstanding gap in health care between blacks and whites.

Mr. Price has also proposed that the federal government provide a contribution that could be applied to private insurance or Medicare. Some fear those changes would hurt women because they become sicker as they age and would be more likely to exceed a fixed federal contribution.

“They will frame this as flexibility, but it’s about the federal government paying less or making it easier for states to cut back on services,” said Debra Ness, president of the National Partnership for Women and Families.

How We Changed the Conversation on Safe Sex at Our High School

September 22, 2016 by

As a Latina, I have been taught that I am more likely to have a child in high school than to go off to college. I have spent the last two years fighting this stereotype, pushing to be heard and bringing the voice of low-income women into the halls of power. At my high school, that meant fighting stigma and social norms in pursuit of a simple, but revolutionary, conversation-sparking tool: a condom machine.

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Less than 10 percent of Latinx students are enrolled in a 4-year college, but 53 percent of Latinas become pregnant at least once before age 20. I’m from San Rafael, California, where a majority of my peers are on free and reduced lunch. My school district of just three high schools has our own daycare center—but conversations about consent, safe sex and contraceptive access are scarce.

I became an Auntie at nine, when my 17-year-old brother and his girlfriend became pregnant. While everyone else around me was silent, they spoke to me about their lives as teen parents. I learned the very real barriers to contraceptive access for low-income teenagers. It made me frustrated and angry—so, like my immigrant parents, I searched for a solution.

With the help of Next Generation Scholars, I began to brainstorm ideas to create change in my community, but I needed to find out for myself what was truly accessible. I tried to get condoms, Plan B and information about birth control options at my school. After nine attempts at meeting the school nurse, I realized I needed to look elsewhere. I was directed to a local youth health program for sex-related questions, which came with its own issues—long lines, lots of paperwork and a three-hour wait.

Local stores aren’t an option, as most students don’t have extra cash, and almost all of the stores have people we know working in them. There’s a Planned Parenthood nearby to my neighborhood, but it isn’t advertised within the district because of feared community repercussions. Still I went. I found, to my surprise, that it was clean, private and free. It even offered bilingual support—yet no one was telling us about it.

I decided the only option was to lobby the school to get condom machines installed in the bathrooms. It would require a trip to the school board, which seemed simple enough. It wasn’t. The school board seemed excited by my plan, but was not able to give immediate feedback. I waited for five months and was continually denied a chance to speak. During that time, two more Latinas left my school to have children.

I took to the halls to distribute condoms from my backpack. What started as a few dozen condoms turned into hundreds. It may seem extreme to turn yourself into what my friends called a “human condom machine,” but I needed to take matters into my own hands. Next I launched a school club, held a parent meeting, surveyed students on sex and contraceptive access and interviewed teachers to build my case.

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Two years later, when I was a senior, I was finally called back to the school board to get my answer. When my proposal passed, my family and community celebrated. But—and there is always a “but”—we would have to fund the condom machines ourselves.

The resources I had relied on for the first condom donation were running out until I was connected with the National Coalition of STD Directors (NCSD). Not only did NCSD use their existing partnership with TrojanTM to donate 10,000 condoms to my school district, they enabled us to see the power of our voices. As soon as people began to find out that our school was going have access to TrojanTM condoms, the news spread like wildfire. When we filled the condom machines for the first time, they were empty within an hour. To have donations from such a well-known brand like Trojan™ was a huge contribution to the success of our project.

My school and my community are so often counted out. Like so many communities in America, we are poor, we are Brown and we are struggling to make our way in this country. To be seen, to be acknowledged, to be protected is revolutionary and transformative.

For the first time, conversations on safe sex are happening freely in San Rafael. Across campus—in two languages—the conversation about safe sex spread quickly. I created posters and used Snapchat and Instagram to spread the word, even reaching students in other districts.

I am the first in my family to attend college. Here at Wesleyan, I hope to gain the education and experience I will need to become a changemaker in this field. College is a whole new world, and my family and I will struggle to make ends meet, but after all I have gone through to get to this moment I stand ready to keep fighting for sexual healthcare access for all.

I know my story is small and that there is still work to be done—but if a 17-year-old kid can get this far, just imagine what more could be done.

 

alba-photoAlba A. Alvarado is a freshman student at Wesleyan University in Middletown, Connecticut. She is a first-generation college student. She hails from San Rafael, California where she was heavily involved in extracurricular activities, specifically community service. Her condom campaign changed countywide school policy and provided free access to students.

How We Changed the Conversation on Safe Sex at Our High School

June 2016 – Call to Action – Women Demand Control Over Our Reproduction

Women are the Experts: National Week of Action for Abortion and Birth Control
June 3-10, 2016

#thisoppresseswomen #notmyclinic #shoutyourabortion

Call to Action – Women Demand Control Over Our Reproduction

Controlling our reproduction is a basis of women’s freedom. On May 16, 2016, the Supreme Court decided Zubik v. Burwell and is expected to decide Whole Woman’s Health v. Hellerstedt next month. Whatever the outcome, the Court will change women’s access to abortion and birth control – and we’re expected to passively wait to see how our lives will be affected.

Enough already!  We demand control over our reproduction.  Join us for a Week of Action.

Speaking out is a powerful tool. In Florida and New York, we’ll host women testifying on their experiences with abortion, birth control, and pregnancy scares. We will distribute a packet on how to host a speakout- and we hope that women around the country will also organize events where women can testify on their need to control their reproduction.

Abortion rights were won by organized women- not simply given to us by the Supreme Court. In the United States, abortion rights were won by everyday women who joined together in groups and dared to tell the truth publicly about their own illegal abortions or their fears of the consequences of unwanted pregnancy.

We saw this first in New York where, on February 13, 1969, women won greater access to abortion from the state legislature after a group of radical feminists who would soon take the name Redstockings disrupted a New York City hearing on abortion reform.  The New York legislature planned to create reform based on the opinions of a panel of “experts”—consisting of 13 men and a nun. But we know that women are the experts. These feminists demandedthat the hearing members listen to the real experts–women!  Women interrupted the hearing and bravely testified about their then-illegal abortions. The women demanded what they really wanted–the repeal of all abortion laws, meaning no restrictions.  About a month later, Redstockings held its own “hearing,” an open meeting in the Washington Square Methodist Church where twelve women testified about their experiences with illegal abortion or the fear that they could be pregnant. The disruption and the hearing that followed resulted in New York becoming the first state to legalize abortion. The NY law became the model for Roe v. Wade. It was a win, but with Roe v. Wade we got reform, instead of abortion law repeal.

Their fight is still ours today. For women, the right to birth control, including abortion, is a cornerstone of women’s freedom. Women must control if and when we have children to determine the direction of our lives and be on equal footing with men. Without an organized, strong feminist movement making radical demands and keeping up the pressure, our victories have been attacked and eroded. We need to strengthen the radical movement to turn this around!

In the Zubik case, the Supreme Court was supposed to decide whether employers could completely block their employees’ access to birth control by blocking them from the Affordable Care Act’s birth control funding. The court didn’t stand with women. Instead, it ordered the government and employers back to the lower courts to find a compromise.

In Whole Woman’s Health, the Supreme Court will decide whether to permit the state of Texas to require medically unnecessary regulations that will close nearly every abortion clinic.  The Supreme Court’s decision will have reaching effects because many states have passed laws similar to the Texas law.

We are calling for a national week of speak outs for abortion and birth control, Friday, June 3rd–Friday, June 10th. Women are the experts—we know what we need and don’t need.  We don’t need additional “safety” regulations on abortion.  We don’t need employers deciding whether we get birth control. Women need unrestricted access to free birth control and abortions. Women, speak out!

http://womensliberation.org/index.php/events/324-june-2016-call-to-action

We Can—And Must—Meet Contraceptive Needs in Developing Regions

Investing $21 per user per year to meet contraceptive needs and offer quality contraceptive services in developing regions would result in 6 million fewer unintended pregnancies each year. There would be 2.1 million fewer unplanned births, 2.4 million fewer unsafe abortions and 5,600 fewer maternal deaths related to unintended pregnancies.

May 19, 2016 by

This month, the fourth Women Deliver conference—in the wake of the launch of the Sustainable Development Goals (SDGs)—focused on how to implement the SDGs so they matter most for girls and women. There was a special focus on sexual and reproductive health, in recognition of the reality that many young women—most especially those in the developing world—are being left behind.

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Today, of the 38 million adolescent women aged 15 to 19 in developing regions who are sexually active and want to avoid pregnancy, 23 million have an unmet need for modern contraceptives—meaning they are not using a contraceptive method at all, or they are using a less effective traditional method.

Meanwhile, current use of modern contraceptives by the other 15 million adolescent women prevents an estimated 5.4 million unintended pregnancies each year. (Of these pregnancies, an estimated 2.9 million would have ended in abortion, many of which would have been performed under unsafe conditions.) Current use of modern contraceptives also prevents 3,000 maternal deaths annually among adolescent women in developing countries.

These are impressive numbers, and a new study from the Guttmacher Institute—released at Women Deliver this week—adds to them. Our researchers found that improving existing contraceptive services for current modern contraceptives, as well as expanding services to the 23 million adolescent women with unmet need in developing regions, would cost only an estimated $770 million annually, or an average of just $21 per user each year.

The impact of this investment would be truly remarkable.

Investing $21 per user per year to meet contraceptive needs and offer quality contraceptive services in developing regions would result in 6 million fewer unintended pregnancies each year. There would be 2.1 million fewer unplanned births, 2.4 million fewer unsafe abortions and 5,600 fewer maternal deaths related to unintended pregnancies.

These goals are attainable and the financial investment to achieve them would have enormous long-term effects on young women’s lives: Not only would it improve adolescent women’s sexual and reproductive health, it would improve their long-term social and economic well-being. Enabling young women to avoid unintended pregnancy and childbearing until they feel ready to become mothers allows them to achieve more education, better job opportunities and healthier lives for themselves and their children. Meeting adolescent women’s unmet contraceptive needs is not only the right thing to do, but is critical to achieve the SDGs—not only the few focused on sexual and reproductive health, but all of them.

Photo courtesy of UK Department for International Development on Flickr and licensed under Creative Commons 3.0

csummersDr. Cynthia Summers joined the Guttmacher Institute as Vice President for Communications & Publications in 2012 and was named Executive Vice President in 2015. Prior to joining the Guttmacher Institute, Dr. Summers served as the Executive Director of Health Planning at the New York City Department of Health and Mental Hygiene, Director of Take Care New York and Director of Marketing and Public Affairs at Danco Laboratories. Dr. Summers received her DrPH in health policy and administration from the University of Illinois at Chicago and received their Distinguished Alumni Achievement Award in 2013. She received her MPH degree in community health from San Diego State University and her BS in biology from the University of Utah.

Justices, Seeking Compromise, Return Contraception Case to Lower Courts

WASHINGTON — The Supreme Court, in an unsigned unanimous opinion, announced on Monday that it would not rule in a major case on access to contraception, instructing lower courts to explore whether a compromise was possible.

The ruling was the latest indication that the eight-member Supreme Court is exploring every avenue to avoid 4-to-4 deadlocks, even if the resulting action avoids deciding the question it had agreed to address.

The case, Zubik v. Burwell, No. 14-1418, was brought by religious groups that object to providing insurance coverage for contraception to their female workers.

Less than a week after the case was argued in March, the court issued an unusual unsigned order asking the parties to submit supplemental briefs on a possible compromise. In Monday’s ruling, the court said those briefs suggested that a compromise was possible, but that it should be forged in the lower courts.

“Given the gravity of the dispute and the substantial clarification and refinement in the positions of the parties, the parties on remand should be afforded an opportunity to arrive at an approach going forward that accommodates petitioners’ religious exercise while at the same time ensuring that women covered by petitioners’ health plans receive full and equal health coverage, including contraceptive coverage,’” the court said, quoting from a brief filed by the government.

The Supreme Court urged the lower courts to “allow the parties sufficient time to resolve any outstanding issues between them.”

The justices stressed that they were deciding nothing.

“The court expresses no view on the merits of the cases,” the opinion said. “In particular, the court does not decide whether petitioners’ religious exercise has been substantially burdened, whether the government has a compelling interest, or whether the current regulations are the least restrictive means of serving that interest.”

Justice Sonia Sotomayor filed a concurrence, which was joined by Justice Ruth Bader Ginsburg, underscoring the limited nature of the court’s action and cautioning lower courts not to read anything into it.

“Today’s opinion does only what it says it does: ‘affords an opportunity’ for the parties and courts of appeals to reconsider the parties’ arguments in light of petitioners’ new articulation of their religious objection and the government’s clarification about what the existing regulations accomplish, how they might be amended, and what such an amendment would sacrifice,” she wrote. “As enlightened by the parties’ new submissions, the courts of appeals remain free to reach the same conclusion or a different one on each of the questions presented by these cases.”

The case was the court’s second encounter with the contraception requirement and the fourth time it has considered an aspect of President Obama’s health care law, the Affordable Care Act. It built on one from 2014, Burwell v. Hobby Lobby Stores, which said a regulation requiring family-owned corporations to pay for insurance coverage for contraception violated a federal law protecting religious liberty. Justice Samuel A. Alito Jr., writing for the majority, said there was a better alternative, one the government had offered to nonprofit groups with religious objections.

That alternative, or accommodation, was at issue in the new case. It allowed nonprofit groups like schools and hospitals that were affiliated with religious organizations not to pay for coverage and to avoid fines if they informed their insurers, plan administrators or the government that they sought an exemption.

Many religious groups around the nation challenged the accommodation, saying that objecting and providing the required information would make them complicit in conduct that violates their faith.

The groups added that they should be entitled to the outright exemption offered to houses of worship like churches, temples and mosques. Houses of worship are not subject to the coverage requirement at all and do not have to file any paperwork if they choose not to provide contraception coverage.

At arguments in March, several justices indicated that they thought the accommodation violated the federal Religious Freedom Restoration Act because it allowed the government to “hijack” the insurance plans of the religious groups that are the petitioners in the case.

Days later, the court called for more briefs in an order that asked the parties to “address whether and how contraceptive coverage may be obtained by petitioners’ employees through petitioners’ insurance companies, but in a way that does not require any involvement of petitioners beyond their own decision to provide health insurance without contraceptive coverage to their employees.”

The order sketched out how this might work, asking the two sides to address whether it would be acceptable for the groups to do no more than to buy insurance plans for their workers that do not include contraception coverage.

On Monday, the court said the unusual tactic had worked and that both sides “now confirm that such an option is feasible.”

The religious groups, the court said, quoting their brief, “have clarified that their religious exercise is not infringed where they ‘need to do nothing more than contract for a plan that does not include coverage for some or all forms of contraception,’ even if their employees receive cost-free contraceptive coverage from the same insurance company.”

“The government,” the court continued, “has confirmed that the challenged procedures for employers with insured plans could be modified to operate in the manner posited in the court’s order while still ensuring that the affected women receive contraceptive coverage seamlessly, together with the rest of their health coverage.’”

Most federal appeals courts have ruled for the government in challenges to the accommodation.

Among the religious groups challenging the accommodation are an order of nuns based in Baltimore called the Little Sisters of the Poor, which operates nursing homes around the country. The nuns object to playing any role in providing any of the forms of contraception approved for women by the Food and Drug Administration.

Other challengers only object to covering intrauterine devices and so-called morning-after pills, saying they are akin to abortion. Many scientists disagree.

The religious groups sued under the Religious Freedom Restoration Act of 1993, which says that government requirements placing a substantial burden on religious practices are subject to an exceptionally demanding form of judicial scrutiny.

The two sides differed about whether the accommodation was such a burden. The religious groups said that adhering to their faith would subject them to crushing fines in the tens of millions of dollars.

“The government wants petitioners to do precisely what their sincere religious beliefs forbid — and it is threatening them with draconian penalties unless they do so,” Paul D. Clement, a lawyer for several religious groups, told the justices in a brief.

Solicitor General Donald B. Verrilli Jr., in a brief for the Obama administration, said, “We do not question the sincerity or importance of petitioners’ religious beliefs.” But, he added, “a sincere objection to opting out of a legal requirement based on the knowledge that the government will then arrange for others to fulfill the requirement does not establish a substantial burden.”