New Directions in Reproductive Health and Justice Advocacy: Yes We Can!

By Amy Allina

In November, the United States elected a president who campaigned by calling on all of us to believe and engage in making real change in the country. The Congressional election results – which strengthened support for abortion rights and family planning in both the House and the Senate -- also signal popular support for change. And, after eight years of an administration that has been openly hostile to women’s reproductive rights, reproductive health policy is one of the areas most badly in need of a new direction.

The attacks on women and our right to make our own decisions about how, when, and whether to have children won’t go away just because of one election, but the National Women’s Health Network and other women’s health advocates throughout the country are seizing this moment to press for bold action on a reproductive health and justice agenda that will improve women’s health and well-being. Critical reproductive health and justice priorities which advocates are focusing on include:

• Access to quality, affordable health care
• Restoration of integrity and evidence to decisions about public health
• Investment in women’s health research
• Prevention of unintended pregnancies and sexually transmitted infections
• Support for healthy pregnancies.

Guarantee access to comprehensive, quality, affordable health care for all

Through our Raising Women’s Voices collaboration, the NWHN’s key priority for the new administration and Congress will be to enact health care reform that meets the needs of diverse women. (See RaisingWomensVoices.net for more detail on this project.) By including the concerns of women from a multitude of communities in discussions about health reform, the NWHN is working to ensure that any reforms will guarantee all women access to a full range of reproductive health services. These services include contraception, maternity and abortion care, as well as patient-centered care delivered in culturally and linguistically appropriate ways.

We are also advocating for changes to the current health system that would lift barriers to safe abortion care that have been imposed on women who rely on the government for their health care. We are calling on President Obama and Congress to eliminate restrictions on public funding of abortions for Medicaid-eligible women and Medicare beneficiaries, Federal employees and their dependents, residents of the District of Columbia, Peace Corps volunteers, women who receive care through Indian Health Services, and women in Federal prisons. We also are calling for Congress to repeal the ban on abortions at U.S. military facilities, which is a significant barrier to safe abortion care for women who serve in the military or receive care through those facilities as dependents in military families. For too long, these restrictive policies have created an unjust obstacle to quality health care and inflicted disproportionate harm on women, many of whom who already face significant barriers to receiving timely, quality health care.

Regulations and procedures that make immigration status an obstacle to receiving services have also imposed unjust barriers to health care, and we are calling for the repeal of citizenship documentation requirements for Medicaid eligibility for low-income people. This requirement has limited access not only for immigrants but also for others who are eligible for Medicaid but who cannot prove they are U.S. citizens because they lack the necessary documents. The Congressional Budget Office has found that nearly all of those turned away by Medicaid because they lacked this documentation were, in fact, U.S. citizens.(1) Additionally, we hope that Congress will restore access to health care for hundreds of thousands of lawfully residing immigrant children and pregnant women by granting states the option of covering them under the State Children’s Health Insurance (SCHIP) program.

Restore integrity and evidence to decisions about public health

The government’s ability to protect and advance women’s health has been severely undermined by the politicization of science policy, and rampant disregard for medical and public health expertise. The result has been damaging policies like the medically unwarranted age-restriction on over-the-counter access to emergency contraception (EC); the exponential growth of dangerous and ineffective abstinence-only until marriage health education programs; and numerous other examples throughout the health-, environment-, and science-related agencies of the Federal government. At the Food and Drug Administration (FDA), in particular, it is essential to reestablish a standard of excellence and integrity so that women can trust that public health and medical evidence, not ideological concerns, determine how the FDA handles reproductive health. The NWHN is working to ensure that President Obama will appoint senior leaders at health agencies, including the FDA, who have demonstrated track records in their fields; knowledge of, and commitment to, the work they’re charged with leading; and experience managing scientists and public health experts with respect and integrity.

We are also calling on the President to take specific policy actions toward this goal by directing several agencies to reexamine Bush Administration policies that were based more on rigid ideology than on scientific evidence. First, we seek changes in policies that block and/or limit women’s access to EC without valid medical justification. These include the age restriction on over-the-counter EC purchase , EC’s exclusion from the military’s core formulary and the U.S. Agency for International Development’s Commodities Program, and the Department of Justice’s failure to include a discussion of EC in its guidelines for hospital treatment of sexual assault survivors. Second, we are urging the President to defund dangerous and ineffective abstinence-only-until-marriage health education programs that provide inaccurate information about sexual and reproductive health.

Third, we have asked President Obama to ensure that the information provided by the Federal government is accurate and helpful. We suggest that health officials inventory the reproductive and sexual health information available on all Federal websites and fill in gaps and incomplete statements with materials that will ensure that readers gain a full and accurate understanding of the facts and their reproductive options.

Invest in research to improve women’s health

Under President Bush, public investment in research to understand and support women in attaining full reproductive and sexual health was limited by both a constrained budget environment at the National Institutes of Health (NIH) and intense political pressures. The NWHN is advocating for a greater public commitment to research on contraceptive development and evaluation, pre-term birth prevention, pregnancy and childbirth, sexual health, and infertility prevention. Expanded funding is needed for both biomedical and behavioral research in these areas. Because these areas of research do not attract adequate private sector investment, we can only expand our knowledge about how to support people in attaining their reproductive goals and achieving healthy sexual lives by investing public resources in the work.

Additionally, we are urging President Obama to maintain the leadership he demonstrated as the lead Senate sponsor of a bill supporting microbicide development. As president, he will have opportunities to shine a spotlight of unprecedented strength on the need for research to develop safe and effective technologies that prevent sexually transmitted infections (STIs) and HIV/AIDS.

Prioritize prevention of unintended pregnancies and sexually transmitted infections

During the campaign, Senator Obama called us to come together as a country and support an agenda that prioritizes prevention of unintended pregnancy. We are advocating for his Administration to follow through on that call by increasing access to affordable reproductive health services -- including contraception and STI prevention services -- and ensuring that young people receive medically accurate and comprehensive sexuality education.

Access to contraception must be expanded by putting more money into the Title X family planning program; ensuring that family planning program guidelines are consistent with the best available evidence for clinical, educational, and counseling services; and by expanding Medicaid-funded family planning services and removing barriers to accessing these services. The Administration can improve STI services by expanding programs at the Centers for Disease Control and Prevention such as the Infertility Prevention Program and the Division of Adolescent and School Health (DASH), which both promote evidence-based interventions. In addition, we urge the Administration to tighten eligibility requirements for Federal grants to ensure that applicants that provide misleading and inaccurate information about reproductive health are not funded. And finally, a prevention agenda will not be complete without investing in accurate and age-appropriate sexuality education that helps young people protect their health and their futures.

Support healthy pregnancies

This Administration can invest resources that give real meaning to the Bush Administration’s family-friendly rhetoric by implementing policies that encourage prenatal care and by expanding funding for nutrition and other support services for pregnant and nursing women. The NWHN is advocating for the Administration to ensure affordable, high quality prenatal care is available to all. Additionally, we are urging the president to roll back the Bush Administration’s recent decision to deny Medicaid reimbursement for birth center facilities, which restricts the ability of low-income women and their families to choose this safe, cost-effective option for giving birth and to access other reproductive health services. There is also great potential to support healthy pregnancies simply by putting research findings into practice. For this reason, the NWHN urges the president to direct the Agency for Healthcare Research and Quality to conduct a systematic, evidence-based review of best practices for improving pregnancy outcomes, and to make recommendations based on this evidence for how to improve the quality of maternity care and birthing practices for all women. We also seek a review of research findings on fertility services and pre-term labor prevention.

Finally, we seek to advance the health of both women and their families by expanding support for substance abuse treatment programs for pregnant and parenting women, and to end the practice shackling pregnant women in custody during transport, labor, delivery, and immediately after delivery. We are advocating for increased funding for family treatment programs and for the president to direct all Federal departments and agencies responsible for the custody or control of pregnant prisoners and detainees to end the dangerous practice of shackling.

Yes we can

Fueled by the promise of change and the excitement of watching a national surge of support for new leadership, this election has raised many hopes. During the campaign, then-Senator Obama said, “I’m asking you to believe not just in my ability to bring about change. I’m asking you to believe in yours.” The NWHN is committed to working with the Obama Administration and the new Congress to bring about the changes described here – to lift the restrictions and eliminate the barriers that have made it hard for so many underserved women to get the reproductive health services they need, and to put protections and policies in place that will advance women’s health and rights in the future. To keep up on NWHN’s work on these issues, visit www.nwhn.org and sign up for our E-alerts. To learn about new directions in international reproductive health and justice issues, visit the Center for Health and Gender Equity at www.genderhealth.org.

REFERENCE

1. Letter from Peter Orszag, CBO Director, to Cong. Nancy Pelosi regarding CBO estimate of SCHIP reauthorization bill, H.R. 3963, October 25, 2007, cited in Kaiser Commission on Medicaid and the Uninsured, Key Facts: Citizenship Documentation in Medicaid, (March 2007), http://www.kff.org/medicaid/upload/7533-02.pdf (accessed September 25, 2008).

Amy Allina is the NWHN Director of Programs.