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news release

Rebecca Wind

For Immediate Release: Monday, December 20, 2004


Note to Editors: Sexual and reproductive health was the focus of heightened controversy at the local, national and global levels in 2004. Given developments during the past year, there are grounds for real concern that sexual and reproductive health worldwide will be further undermined in the coming year. Here, The Alan Guttmacher Institute takes a look back, as well as a look forward to what we might find in 2005.

1. Health Professionals Allowed to Deny Women Their Contraceptive Prescriptions

A recent wave of state and federal legislation has expanded the ability of health care providers (including pharmacists), institutions and insurers to refuse to offer or cover sexual and reproductive health services. This means that patients are not always able to access critical health information and services, including fulfillment of prescriptions for emergency contraceptives and birth control pills. In 2004, seven states introduced, and Mississippi enacted, restrictive legislation allowing health care providers to refuse to provide services, including referrals. Look for more state legislatures to take such action in 2005. For more information, click New Refusal Clauses Shatter Balance Between Provider “Conscience,” Patient Needs, and to review the current policy in your state, click

2. Government-Sponsored Ignorance Putting Young People at Risk

Since 1996, nearly $1 billion in state and federal funds have been spent on abstinence-until-marriage education that denies young people vital information about the effectiveness of condoms and other contraceptives, which puts teens at increased risk of unintended pregnancy and sexually transmitted infections (STIs). Another $170 million in federal funds is slated for FY 2005, despite a lack of evidence supporting the effectiveness of this approach. When President Bush issues his budget for FY 2006 in February, keep an eye out for his request for additional abstinence-only education funding. For the latest research and analysis on sex education in the United States, see Sex Education: Needs, Programs and Policies.

3. Gag Rule Imposed on Health Care Providers Overseas

On his first day in office, President Bush reinstated, and has since continued to impose, the Global Gag Rule, which requires nongovernmental organizations outside the United States to forego use of their own funds to provide abortions or abortion counseling, or to engage in any advocacy related to their country’s abortion laws, in order to be eligible for U.S. family planning assistance. Many organizations in poor countries, desperate for funding, have succumbed to the policy--sacrificing their freedom to speak out as well as their ability to meet all their patients’ needs. The impact of this decision will continue to unfold during 2005, as poor women suffer the health consequences of a lack of contraceptive, prenatal and abortion services. Click U.S. Global Reproductive Health Policy: Isolationist Approach in an Interdependent World for more information.

4. Multilateral Family Planning Efforts Defunded

Overruling the recommendation of the administration’s own investigative team, President Bush has, for three consecutive years, withheld $34 million that Congress appropriated for the United Nations Population Fund (UNFPA), an organization that provides voluntary family planning assistance to women in more than 140 countries. UNFPA estimates that this loss of funding will result in two million unwanted pregnancies per year, nearly 800,000 abortions, 4,700 maternal deaths and 77,000 infant and child deaths. Stay tuned next summer to see if the money appropriated by Congress is released to UNFPA or is withheld for a fourth year. Click The President’s Overseas Reproductive Health Policy: Think Locally, Act Globally to learn more about U.S. funding for international family planning.

5. Medicaid Support for Family Planning in Jeopardy

More than one in three low-income women of reproductive age depends on Medicaid for health care. The program pays for nearly one in four births in the United States each year and is the largest funder of subsidized family planning services and supplies nationwide. Yet the Bush administration has been open about its desire to sharply reduce benefit guarantees under Medicaid. Watch the President’s FY 2006 budget proposal for further attempts to reduce federal spending on Medicaid and to balance the budget on the backs of poor families. For more information about the administration’s attempts to reduce Medicaid spending at the expense of low-income women, click Different Paths, Same Goal: End Medicaid as We Know It.

6. Timely Access to Emergency Contraception Blocked

Emergency contraceptive pills can stop a woman from getting pregnant, but they must be taken as soon as possible after unprotected sex has occurred--which is why the U.S. Food and Drug Administration’s (FDA’s) Reproductive Health Drugs and Nonprescription Drugs Advisory Committees overwhelmingly recommended that the pills be made available over the counter rather than by prescription only. Yet the FDA overruled the recommendation of its own expert advisory panel, thus making it harder for women and couples to avoid unintended pregnancies and abortions. The FDA is expected to reconsider early in 2005 whether emergency contraceptive pills can be made available over the counter to some women, though perhaps not to teenagers. For more information, click FDA Rejects Expert Panel Recommendation, Blocks OTC Switch for Plan B Emergency Contraception.

7. Family Planning Clinics Passed Over in Allocation of HIV/AIDS Funds

Reproductive health providers are a major source of preventive health care and are important entry points for HIV prevention for millions of individuals who are now at the center of the global HIV pandemic. Yet despite an existing client base and the knowledge and skills to implement prevention efforts, these providers’ current and potential role on the front line of HIV prevention is largely untapped. U.S. global HIV/AIDS spending commits the majority of available funds to services for people living with HIV and to the promotion of sexual abstinence. In 2005, keep an eye on the priorities in U.S. funding and the impact these decisions will have on women in particular. For more information about , click here.

8. Insurance Coverage for Contraception Stalled

Although federal employees are guaranteed insurance coverage for contraception, many women in the United States still have to pay for birth control out of pocket. Half of all U.S. women live in the 30 states that do not require insurance coverage for contraception, and about half of all Americans with employer-based insurance coverage obtain that coverage from employers who are exempt from state coverage requirements. In the past year, however, 21 states have introduced legislation mandating that many employers provide insurance coverage of contraception. Look to the states for more action in 2005 and to the federal government for movement on a national mandate. For more information about insurance coverage of contraception, see New Study Documents Major Strides in Drive For Contraceptive Coverage.

9. Condoms Under Attack

In the process of promoting abstinence until marriage for our nation’s youth, social conservatives in Congress have continued to disparage the effectiveness of condoms in preventing common STIs; these claims misrepresent scientific evidence and contradict the advice of mainstream public health prevention experts. Undermining confidence in condom effectiveness decreases the likelihood that people will use condoms when they do have sex, which puts them at increased risk for a range of health problems. Newly available federal data show a decline in the number of people using condoms. In 2005, look for a discussion of what this trend means for public health. For more information on attacks on condom efficacy, see Public Health Advocates Say Campaign to Disparage Condoms Threatens STD Prevention Efforts.

10. Ideology Trumps Scientific Evidence

Over the last four years, the Bush administration has distorted scientific evidence and gone against the recommendations of mainstream prevention experts on a wide range of public health issues. Examples include the politicization of the scientific advisory committee appointment process and the replacement of medically accurate information on government Web sites with misinformation. Putting ideology ahead of science threatens the government’s--and the public’s--ability to rely on the expertise and independence of the scientific community in shaping health information and policy. Next year will bring many new policies and programs on a variety of sexual and reproductive health issues. For the sake of our nation’s health, we will work to ensure that scientific evidence will win out over ideology as the basis for this critical decision making. For more information, see Critics Charge Bush Mix of Science and Politics Is Unprecedented and Dangerous.

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