The War On Women

Earlier this month, the Ninth Circuit Court of Appeals rejected a Planned Parenthood request to delay implementation of a new Trump administration rule forbidding Title X recipients from making abortion referrals. The ruling allowed the policy to take effect while lawsuits from states, medical groups and reproductive rights advocates continue.

The following Monday, Planned Parenthood exited Title X, forfeiting millions of dollars in federal grants. Planned Parenthood serves nearly half of the approximately 4 million low-income women covered by Title X, providing free and subsidized birth control, STD  and breast cancer screenings and other health services.

There has rarely been a better illustration of why “pro life” people are anything but pro-life.

Numerous observers have pointed to the disconnect between the movement’s obsessive concern for zygotes and fetuses, on the one hand, and its utter lack of interest in the health and welfare of poor children who are already born on the other. Others have noted that activists’ zealous efforts to ban abortion aren’t accompanied by even tepid efforts to ban assault weapons. But this attack on the health of over two million poor women is an even more compelling example of the movement’s deep hypocrisy.

In order to impose a gag order on medical personnel working at family planning clinics–in order to ensure that they don’t utter the word “abortion” or tell women where they might obtain one–these “pro-lifers” are perfectly willing to deny women access to lifesaving breast cancer screenings, STD treatments and other medical services totally unconnected to abortion.

In addition, it’s hard not to notice that the “pro life” movement has moved beyond its purported emphasis on preventing abortion to an all-out effort to limit access to birth control. (Logic tells us that increased access to birth control reduces the incidence of abortion. If reducing the number of abortions was really the focus of “pro-life” efforts, you would expect these activists to be dispensing birth control pills on street corners.)

To be fair, there are undoubtedly some among these single-issue zealots who genuinely believe that a fertilized egg is equivalent to a human being, and that the rights of that fertilized egg take precedence over the rights of the human woman who carries it. I have trouble with that viewpoint, but some people–for whatever reason–really do hold it, and they are obviously entitled to do so.

However, it has become abundantly clear that a far greater percentage of those who label themselves “pro life” are actually “anti choice.” These are people (mostly men, but some women) who would deny women the personal autonomy that men in our society have always enjoyed. They fear the loss of “traditional values,” by which they mean the continued dominance of White Christian males.  If a few thousand women need to die from an undetected cancer in order to preserve their privileged status, they consider that a perfectly reasonable tradeoff.

I still recall a conversation with a partner in the law firm I joined immediately after graduation from law school. I was the first woman hired by that firm–which had over 50 lawyers at the time. The partner attributed the growing number of female law students to the (then-relatively-new) birth control pill; thanks to that pill, women were no longer hostages to reproduction. They could plan their pregnancies. Consequently, they were better able to enter and thrive in the workforce, and less dependent upon a man to support them and their (often-unplanned) children.

Both he and I thought that was a good thing.

Obviously, there are a lot of people who disagree, and who find a woman’s ability to control her own reproduction existentially threatening. If denying them access to healthcare is the only way to prevent women from exercising autonomy and controlling their own destinies, they’re more than willing to make that trade.

You can call such people many things, but “pro-life” isn’t one of them.

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We Aren’t Going Back

Friday night, I spoke at a local synagogue about women’s rights. They were very nice to me. Here’s my talk. (Apologies for the length.)

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I don’t know how many of you remember when it was considered tactful to refer to older women as “women of a certain age.” I’m one of those women, having attained and then passed that “certain age,” and I’ve seen a significant evolution in women’s rights in my own lifetime. Not too long ago, someone asked me if I had experienced discrimination because I’m a woman. I responded that I’ve really been lucky; I’ve been able to do pretty much anything I wanted to do. But when I began to think about it, I realized that my entire life has played out against the restrictive laws and patriarchal social expectations of the times. A number of options that were available to males simply weren’t options for me. As noted, some of those options were legally unavailable, but many other limitations were products of prevailing, deeply-rooted social attitudes. To the extent women accepted those attitudes, we didn’t see discrimination—we just saw “the way things are.”

My mother—who was born the year women finally got the vote–didn’t work, although she was a woman who would definitely have been much happier pursuing a career. But for middle-class women, participation in the workforce was seen as evidence that one’s husband  wasn’t an adequate breadwinner—so it wasn’t an option.

When my sister and I were in grade school and high school, there were no women’s sports. Girls were cheerleaders, boys played team sports. When I went to college, my parents wanted me to choose a profession I could “fall back on” if my eventual husband died. I could choose among the three professions suitable for women—I could be a teacher, a nurse or a secretary. Three times in college, I switched into the school of Liberal Arts, and three times my father switched me back into the School of Education. (I get nauseated at the sight of blood, and I was never a good typist—so voila—I was a teacher!).

When I got married the first time, women still couldn’t get credit or establish a credit rating separate from that of their husbands. Later, when I went to law school, my sister’s brother-in-law told me I should be ashamed that I was taking the place of a man who would actually practice law. A cousin who was a lawyer was more supportive; he told me that if I really excelled, I would probably get hired, but the only lawyer job I could expect would be in the “back room” of a large firm, doing research. I wouldn’t be allowed to work directly with clients. A “friend” told me that my selfish decision to go to law school meant that my children would end up being drug addicts.

When I was interviewing for my first job as a lawyer, the EEOC was only a few years old, but lawyers at the firm knew that certain questions were off-limits. I had three small children, a fact disclosed by my resume, so I volunteered my childcare arrangements. (It seemed reasonable.) One of the lawyers was so visibly relieved that I evidently wasn’t going to burn a bra then and there that he blurted out “Not that there’s anything wrong with being a woman! We hired a man with a glass eye once!”

When Bill Hudnut appointed me Corporation Counsel, I was the first woman to head the city’s legal department. That deviation from the norm evidently triggered a lot of speculation. The Indianapolis Star identified me as a “divorcee” and the Indianapolis News ran a “gossip” item, asking “Did a city official just appoint his most recent honey to a high city position?” Evidently, the notion that a woman might be a good lawyer never crossed their minds.

When I ran for Congress in 1980, I was told by a number of people that they wouldn’t vote for a woman with young children, because my place was at home with those children. (I don’t need to remind you that men with young children are never the subject of similar sentiments—nor do I need to share my strong suspicion that they wouldn’t have voted for any woman, with or without small children.) When I joined a small law firm after losing that election, one of the partners suggested that I stick to wills and divorces, which were areas deemed appropriate for women lawyers. That actually represented progress, since by that time there were at least some limited areas in which it was acceptable for women to be lawyers …

Virtually all of these examples seem ridiculous today, when girls excel at sports and law school classes are more than 50% female. So there has been progress—actually, a lot of progress.  I am always bemused when female students assure me that they aren’t feminists—a word that some of them evidently associate with beefy women who don’t shave their legs.  The young women who don’t think of themselves as feminists simply take for granted that they will get equal pay for equal work, that they won’t have to “put out” for the boss in order to get that promotion, that they can choose the number and spacing of their children, and that there might even be a pediatrician whose office hours don’t reflect the assumption that mom is home all day.

As the commercial says, we really have “come a long way, baby.” But as the “me too” movement, the persistence of the glass ceiling, and depressing statistics about earning discrepancies all attest, we still have a long way to go.

And that long way to go was before the hard-won gains for women’s equality came under sustained attack. At the Women’s March, an elderly woman carried a sign saying “I can’t believe I’m still having to protest this shit.” A lot of us old broads feel that way.

The unremitting attacks on Planned Parenthood are particularly troubling, because women owe an enormous amount of our progress to the availability of reliable birth control. Only when we are able to plan our families, only when we are able to be more than baby factories, is it even possible to talk about having both a family and a career. Once women were in control of their reproduction, they entered the labor market in huge numbers, and became less economically dependent upon their husbands. A woman with a decent job could leave an abusive or unfulfilling relationship and support herself. Economic independence is the first step toward equal treatment, and the ability to decide for ourselves the number and spacing of our children is what makes economic independence possible.

That independence is also what has triggered the backlash we are experiencing from insecure men and especially from the Christian fundamentalists who believe that God made women to be submissive to men. Let me be very clear: there are sincere and admirable people who have principled objections to abortion—but anyone who believes that the anti-Choice movement and the assaults on Planned Parenthood are really about abortion is naïve. The real focus of this attack is on access to birth control and self-determination. It is an effort to deny the equal moral status of women. Let me share just one illustrative example—there are many, many others.

In 2009, the Susan Thompson Buffett Foundation donated over $23 million to the Colorado Family Planning Initiative. That was a five-year experimental program offering low-income teenage girls in the state long-acting reversible contraceptives—IUDs or hormonal implants—at no cost. These devices, which require no further action once inserted and remain effective for years, are by far the best method of birth control available, with less than a 1 percent failure rate. (The failure rate for the Pill is higher.) One reason more women don’t use these devices is cost: While they save the patient money over time, the up-front price can be as high as $1,200.

The results were staggering: a 40 percent decline in teen births, and a 34 percent decline in teen abortions. And for every dollar spent on the program, the state saved $5.85 in short-term Medicaid costs, in addition to other cost reductions and the enormous social benefit of freeing low-income teens from unwanted pregnancies and what too often follows: dropping out of school, unready motherhood, and poverty.

When the original grant ran out, the state legislature had to decide whether to continue funding the program. Now, you would think continued funding for so successful a program would be uncontroversial–but you would be wrong. The bill continuing funding for the program passed the Democrat-controlled House, but the Senate Republicans killed it.

And what were the highly principled reasons for refusing to continue a program that reduced teen pregnancies, reduced the number of abortions, and saved money? According to one Republican State Senator, using an IUD could mean “stopping a small child from implanting.”

Another said, “We’d be allowing a lot of young ladies to go out there and look for love in all the wrong places.”

If these lawmakers were really “pro-life,” they would support programs that substantially and demonstrably reduce the incidence of abortion. As the travesty in Colorado clearly shows, however, their real objective is to deprive women of self-determination. If necessary, at taxpayer expense.

A full list of the ongoing assaults on birth control and reproductive rights, from the Hobby Lobby decision to   Mike Pence’s effort to require funerals for miscarried fetuses to the constant efforts of state legislators around the country to outdo each other’s transvaginal probes and other punitive measures would take hours. Just in Indiana, the ACLU is currently challenging at least three anti-choice laws. I want to believe that what we are seeing is a last convulsion of old men who are frantic to retain their male privilege…but the jury is still out.

The ferocity of the pushback against women’s autonomy and reproductive rights is particularly dangerous to those of us in the Jewish community, because it represents the belief that fundamentalist Christian dogma should be the law of the land—that government should favor the beliefs of one segment of the Christian community over the theologies of other religions and other Christians.

One reason that the United States has been hospitable to Jews—and Muslims and Sikhs and other minority religions—is that the Bill of Rights not only separates Church from State, but forbids government from making decisions that are properly left to individual citizens. As I tell my students, the Bill of Rights is essentially a list of things that government doesn’t get to decide. The American constitution and legal system are based upon respect for personal autonomy and the primacy of the individual conscience—not upon conformance with majoritarian religious beliefs. I don’t think it is an accident that so many of the “family values” politicians who seem intent upon keeping women barefoot and pregnant are also anti-Semites who insist that the United States is a Christian nation.

Opponents of measures requiring equal pay for equal work, pundits who excuse predatory sexual behavior in the workplace (or by the occupant of the Oval Office), voters who reject female candidates for public office simply because they are female, and the politicians and public figures who talk about “making America great” like in the “good old days”—want to take us back to a time when women’s voices were discounted and our aspirations ignored. They want to go back to the “good old days” when women were second-class citizens—a time when being a straight white Christian male conferred automatic social dominance.

I lived through those “good old days.” They are the days I described at the beginning of this talk. They aren’t the reality I want my granddaughters—or my grandsons—to inhabit. We all deserve better.

Thank you.

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Meanwhile, Behind The Scenes….

Every day, a “Presidential” tweet or administrative outrage occupies the attention of the media and citizens who follow current affairs.

We are mesmerized by the slow train-wreck that Trump and his Keystone Kops are engineering, and for good reason. We rarely have a chance to catch our breath, or to wonder–as my husband often darkly does–what the truly vile people we don’t hear about are doing while our attention is  diverted by the ongoing public clown show.

Recently, my cousin the cardiologist (to whom I sometimes refer) sent me an example.

I have just been made aware that WomensHealth.gov has deleted much of its breast cancer web pages. But why?

It seems there has been a great reduction of breast cancer content on the website of the Office on Women’s Health (OWH) of the US Department of Health and Human Services (HHS), leaving just a single page with rudimentary information on mammograms and breast cancer. Most of the previous, seven-page content is gone.

The removal appears to reflect what my cousin calls “a broader agenda from the current administration.”

For example, under the auspices of the Affordable Care Act, breast cancer screening is offered free of charge for women meeting certain financial criteria, but that information has been deleted from WomensHealth.gov. Now, the information must be accessed on the site via a link to the Centers for Disease Control and Prevention website, which, in turn, requires a click through to yet another link.

Also, the “Government in Action” section of WomensHealth.gov previously contained information on federal programs that provide free or low-cost cancer screening, including clinical breast exams and mammograms. Known as the National Breast and Cervical Cancer Early Detection Program, the entity offers screening to all “low-income, uninsured, and underinsured women.” That entire section of the site is now removed.​This information cannot be found elsewhere on the OWH website, or anywhere on the HHS site, despite the agency’s contention that it has been integrated into other parts of the HHS website.

Apparently, most of the breast cancer content on WomensHealth.gov has been deleted.

“Because breast cancer is the most common cancer for women in the US, affecting 250,000 annually resulting in 40,000 deaths a year, it is astonishing that important information about risks, prevention and treatment of breast cancer has been eliminated from the Office on Women’s Health site,” said Joyce Bichler, deputy director of Breast Cancer Action in San Francisco, California.

According to a report from the Sunlight Foundation, a national, nonpartisan, nonprofit government watchdog, the government’s justification for this removal was  “lack of use.” This is transparent bullshit; WomensHealth.gov was visited nearly three quarters of a million times in one recent month. An HHS spokesperson told ThinkProgress that the “pages were removed… because content was not mobile-friendly and very rarely used. Before we update any of the information…we engage in a comprehensive audit and use analysis process that includes reviewing other federal consumer health websites to ensure we are not duplicating efforts or presenting redundant information.”

More bullshit.

The spokesperson directed users to WomensHealth.gov/cancer, which presumably contained the “duplicated” material, but doesn’t even have a dedicated section for breast cancer. The same spokesperson said “sister HHS agencies…have the same information in a much more user-friendly format on their websites.”

This isn’t the first time that important health information has vanished without notice or explanation. The removal of breast cancer information is part of what the Sunlight Foundation calls “wider changes to the OWH website that include the removal of resources related to lesbian and bisexual health, minority women’s health, and other topics.”

“The specificity of these removals adds more evidence to a growing concern: that public information for vulnerable populations is being targeted for removal or simply hidden,” says Sunlight.

Bottom line: Important information intended to assist low-income individuals and people of color access healthcare has been removed from the website–even though the most common cancer in women is breast cancer–and at the same time, the administration is ramping up its assault on Planned Parenthood, an important provider of breast cancer screenings.

Don’t tell me that “war on women” is hyperbole.

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Why Government Loses Public Trust–Indiana Version

Most of us would avoid patronizing a butcher shop where the butcher routinely put his thumb on the scale.  We would take our business elsewhere.

When our state government lies to us, however, most of us can’t simply move elsewhere. Worse, we may not even find out that we have been misled.

I don’t know how it is in other states, but here in Indiana, we are most likely to encounter biased information when the people running the state are religious zealots. Mike Pence was uninterested in the nitty-gritty of governing, but he was intensely focused on imposing his religious beliefs on Hoosiers–he saved his real enthusiasm for his anti-gay, anti-woman efforts.

I had a much better impression of current Governor Holcomb, who has seemed refreshingly free of the urge to sermonize and actually appears to be tending to the issues facing Indiana. But then I came across this report.

Indiana ranks as one of the worst states in the nation when it comes to its infant mortality rate. In his state of the state address earlier this month, Gov. Eric Holcomb (R) called attention to this crisis and announced the goal of improving the state’s status in the coming years. As part of that process, in November 2017 the Indiana State Department of Health (ISDH) launched a new mobile app for its existing statewide campaign aimed at improving Indiana’s infant mortality rate. The app, Liv, was developed with state funding and includes pregnancy and parenting guidance.

It also provides users with contact information for health and service providers, along with basic descriptions of what the users can expect from those providers. But the app’s resource list excludes evidence-based family planning clinics and centers, such as Planned Parenthood and All-Options Pregnancy Resource Center (PRC), while including crisis pregnancy centers (CPCs): fake clinics that do not provide medically sound reproductive health care and actively lie to people seeking services.

Public health research shows that access to comprehensive family planning programs and services can help reduce infant mortality. Nonetheless, continuing the legacy of former Indiana Gov. Mike Pence (R), this app—and ISDH’s larger infant mortality initiative—promotes ideology over evidence.

Infant mortality is the result of a combination of factors, including poverty and lack of prenatal care. But research shows that comprehensive contraception and family planning help reduce infant mortality rates.

For example, as research from the Guttmacher Institute shows, access to contraception gives women the tools to space their births: “By allowing women to time and space the number of children they want, contraception prevents unintended, often high-risk pregnancies—too close together, too often, too early or too late in life—that can lead to maternal and child death and injury.” Additionally, addressing unintended pregnancies by increasing access to contraception and family planning services also contributes to increased prenatal care provision by establishing connections between patients and providers.

When policymakers allow ideology to trump evidence, and erect barriers to access for family planning services, you get the results we have been seeing in Indiana. In 2011, only 68 percent of infants in the state were born to women who had received prenatal care in their first trimester–and nearly half of all pregnancies in Indiana are unintended.   

Using taxpayer dollars to direct vulnerable women to crisis pregnancy centers, while omitting information about high-quality health services available through Planned Parenthood, is worse than irresponsible. Crisis pregnancy centers are purveyors of dogma, not medically-accurate information. They have no place on a state-run registry.

Women using the app don’t have to go to Planned Parenthood. But they are entitled to know that it is an option. For state government to omit a medically-appropriate service from a directory it has created and disseminated while including a “service” that offers dishonest “counseling” is unforgivable.

It certainly isn’t the way to cultivate public trust.

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Texas Tells Heidi To Go Yodel

I do love Texas. Whenever I need examples of really stupid government behavior for classroom use, I can count on the Lone Star State to supply them.

A recent example, courtesy of the AP: Texas has been an enthusiastic participant in the war against Planned Parenthood, and in 2011 it banned the organization from a women’s health program meant to provide low-cost breast exams, contraception and cancer screening. Instead, the state contracted with inexperienced providers, notably the Heidi Group, an evangelical nonprofit started in the 1990s and best known for promoting alternatives to abortion.

The Heidi Group fell well short of serving the 70,000 women it had promised to reach, and for which it had been paid 1.6 million dollars. Its failure to perform under that contract, however, paled in comparison to its failure to meet the goals in a much larger state contract under which it was to provide family planning services.

More than $5 million in taxpayer funds pledged to the Heidi Group was for family planning services. But the small nonprofit hasn’t met their goals and now plans to serve only a fifth of the nearly 18,000 women originally projected, said Carrie Williams, a spokeswoman for the Texas Health and Human Services Commission.

Texas has now reduced the contract from $5 million to $1 million. That will save some tax dollars, but it won’t provide needed health services to Texas’ women.

According to the AP, “The Heidi Group is led by Carol Everett, a prominent anti-abortion activist and influential conservative force in the Texas Legislature.”

Most sentient people have figured out that the unremitting assault on Planned Parenthood is part of a larger war being waged against women’s autonomy–our right to control our own reproduction and make our own moral and medical decisions. That broader assault is usually veiled by rhetoric against abortion (which is a tiny percentage of the services Planned Parenthood provides).

So how is Texas doing? Is the legislature’s willingness to deny poor women life-saving pap smears and breast exams translating into fewer abortions?

Not so much.

With the goal of eliminating abortion, Texas Republicans have stripped Planned Parenthood of funding and steadily obstructed patient access to care over the past few years. Turns out, their ideological, anti-choice crusade is having the opposite effect. A new study shows abortion rates have jumped since Planned Parenthood was blocked.

During the three years after the Texas legislature defunded Planned Parenthood, teen abortions increased 3.1% and teen births spiked by 3.4%  The legislature shuttered more than 80 family planning clinics altogether, action which not only decreased access to preventive women’s health care and low-cost contraception, but led to a spike in unintended pregnancies, especially among teens, and substantial increases in Medicaid expenditures.

Packham reports that 2,200 teens would not have given birth if the Legislature hadn’t cut family planning, slowing the overall progress of a decreasing birth rate. With an average taxpayer cost of $27,000 per birth, the price tag of the cuts total an estimated $80 million, outweighing the funds saved by the drastic cuts – a figure self-avowed fiscal conservative Republicans may want to heed. Other research bolsters Packham’s work: Last year, the UT-based Texas Policy Evaluation Project found that in East Texas’ Gregg County, abortion rose by a whopping 191% in the two years after the county lost 60% of its family planning funding. Similar results appeared in neighboring counties.

Will anyone who thinks Texas legislators learned anything from their Heidi experience please yodel?

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