Reproductive rights: U.S. lags behind
Despite the introduction of long-acting birth control methods and the Food and Drug Administration’s acceptance of oral contraceptives for emergency contraception, the United States lags behind other developed countries in public funding, other access issues, and method availability, say those involved with women’s health education, law, and policy organizations.
U.S. women still do not have mifepristone (RU-486) or many varieties of intrauterine devices, and they have just been given dedicated emergency contraceptives, contends Janet Benshoof, JD, president of the New York City-based Center for Reproductive Law and Policy. Indeed, the hard-fought ground won since the landmark 1973 Roe vs. Wade decision for women’s rights to reproductive autonomy may be threatened this spring if the U.S. Supreme Court hears a partial-birth abortion case, Benshoof predicts.
In hearing such a case, the court may vote to cut back on abortion rights. Thus, the court might affect interpretation of the federal constitutional law governing contraceptives, access for minors, and other issues, because all are part of reproductive privacy, she notes.
Despite the struggles, strides have been made in the provision of abortion care with the advent of early abortion procedures such as medical abortion and manual vacuum aspiration, says Susan Dudley, PhD, deputy director of the Washington, DC-based National Abortion Federation. Gains in education have been made in the Accreditation Council for Graduate Medical Educa tion’s legislation requiring abortion training for obstetrics/gynecology med ical residents and the rise of two advocacy groups, Medical Students for Choice in Berkeley, CA, and Clinicians for Choice in Washington, DC.
Two important pieces of legislation, the federal Freedom of Access to Clinic Entrances (FACE) act and the enactment of buffer zones, have offered legal remedies for abortion clinic harassment. The FACE legislation makes it a federal crime to use physical obstruction, force, or threat of force to injure, intim idate, or interfere with someone to prevent that person from obtaining or providing reproductive health services. Court-ordered buffer zones define areas, usually outside of clinics, where specific activities are forbidden or strictly limited. (Contraceptive Technology Update, April 1997, p. 41, offers more information on such legislation and how clinics can protect themselves from acts of violence.) With the Montana Supreme Court’s October 1999 decision to allow physician assistants to provide abortion care, the door may be opening for abortion services by midlevel clinicians, says Dudley.
Given those advances, however, Dudley sees the preeminent challenge as putting abortion care back into the mainstream of reproductive health care. "We’ve seen, over the years, so much stigmatization of the providers and women who get abortions so that women tend not to want to talk about an abortion experience or to own an abortion experience. That’s a very unhealthy thing in our society."
While private insurance coverage for contraception is not yet a reality in the United States, the federal government now offers such benefits for its employees. Ten states — California, Connecticut, Georgia, Hawaii, Maine, Maryland, Nevada, New Hampshire, North Carolina, and Vermont — have enacted legislation requiring coverage from private-sector employment-based health plans. (See CTU, December 1999, p. 146, for an overview of federal and state action on contraceptive coverage.) Continued support for such legislation is important if women are to have increased access to affordable contraception, says Marilyn Keefe, MPH, director of public policy at the National Family Planning and Reproductive Health Association in Washington, DC. Also key is increased funding for federal Title X family planning services, which has remained stagnant over the past few years, she notes.
The last decade has seen a greater openness on gay and lesbian issues and the proliferation of sexual information via the Internet. However, it also has also seen the curtailment of sex education for young people through the enactment of "abstinence-only" programs, according to Debra Haffner, MPH, president and CEO of the Sexuality Information and Education Council of the United States. Such programs were created following 1996 passage of federal welfare reform legislation and funded by a five-year entitlement. (See CTU, July 1997, p. 81, for a review of funding for abstinence-only programs.)
"I think that the abstinence-only-until-marriage program is going to be proven to be ineffective at increasing young people’s ability to abstain, and is going to mean that more young people are at risk because they will not have gotten information about contraception and prevention against sexually transmitted diseases," Haffner says. Because young people’s ability to acquire accurate information on sexual issues may be affected through abstinence-only programs, she says there should be more avenues of information open to them. "I think we can no longer expect the schools to play the major role. We need to be reaching out to community agencies and churches, as well as to look at the Internet potential for providing good information."
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