Rachael, I somewhat agree with you that the Choice USA ad was ill-advised in using a character that looked like she's eight months pregnant.  It's not because I disagreed with their point—it's true that pregnant women are only legally treated like two people if it's being used to take away women's rights—but because showing someone so far along in her pregnancy could mislead the public about what Prop 62 in Colorado is about.  Prop 62 doesn't deal at all with women that far along in their pregnancy.  It's actually an assault on women in the earliest stages ... or women who aren't even pregnant at all.

It's not just that seven- or eight-month—and four- and five-month—fetuses already have a great deal of legal protection that encroaches on a woman's right to choose abortion at that stage, which is largely uncontroversial because few to no women actually wake up when they're 8 months pregnant and say, "You know, I changed my mind."  Only 1.5 percent of abortions are performed after 21 weeks (five months), and those are generally done for medical reasons.  Prop 62 is about defining a fertilized egg as a rights-bearing person.  That is more directly an attack on the vast majority of abortions—the 62 percent that are performed before nine weeks.

But it's oh so much more than that.  For one thing, this law has the potential to restrict the rights of women who aren't pregnant or have pregnancies that have absolutely no hope of coming to term. In the latter category, you have women with molar pregnancies, ectopic pregnancies, or incomplete miscarriages.  According to the American College of Obstetricians and Gynecologists, Prop 62, if passed, could severely restrict a doctor's ability to provide health- and life-saving medical care to women who have pregnancies that have gone wrong.  This isn't an overreaction on their part, but based in a long history of what happens to women when you consider a zygote the equivalent of a 5-year-old.  Catholic hospitals, for instance, will not perform emergency care to remove an incomplete miscarriage as long as the fetus is still technically alive, which leaves a woman quite likely to get an infection that could render her infertile or even kill her.  These are called "ambulance cases" in gynecological jargon, because women who are in the throes of a miscarriage and have the misfortune to go to Catholic hospitals are usually put in an ambulance and rushed to a place that isn't religion-bound to let her die before they perform the necessary procedures.  You see similar issues when it comes to ectopic pregnancies—in Nicaragua, the personhood status of zygotes means ectopic pregnancies can't be removed until the fallopian tube bursts, which is one of the main causes of maternal mortality in the country.

There's a gap between when an egg is fertilized and when it implants, which is what triggers the hormones that indicate that you're actually pregnant. Considering that 30 percent to 50 percent of fertilized eggs never even implant, one has to conclude that proponents of Prop 62 are arguing that every tampon is potentially the gravesite of a teeny-weeny human corpse.  Despite the fact that using the pill actually means you're murdering fewer of your itty-bitty "babies", because you're not ovulating in the first place, many proponents of this law hope to use it to ban the birth control pill by claiming, incorrectly, that it works by killing fertilized eggs.

So, yes, it's a shame to see Choice USA fall for the anti-choice bait and switch, where images of hugely pregnant women and well-developed fetuses dominate, but the proposed laws actually target early pregnancies and women who aren't really pregnant at all.  And while I'm always up for a joke, I have to say that the threat Prop 62 represents to the well-being, health, and even lives of pregnant women is something that extends far beyond their access to singles tennis courts.

Tags: birth control, Choice USA, colorado, personhood amendment, prop 62

Debra, I appreciate some of the points you made about the No Wedding No Womb campaign, but I do want to quibble with one point. When you say "Aren’t condoms easier?" I have to point out that the answer to your question is all too often, "No." Some folks are talking up personal responsibility, some are talking about the social context that causes some young women to have children before they're really ready, but barely anyone's talking about the fact that no, contraception isn't that easy.

The lack of focus on the role contraception plays in all this is one reason I agree with Monica Potts that this whole campaign moved more into the direction of shaming women over their sexuality than actually speaking realistically about ways to improve women and children's well-being. Sixty-nine percent of black women's pregnancies are unintended, compared with 40 percent of white women's and 54 percent of Hispanic women's. The result? It's not just that black women give birth while unmarried more (though, as Ta-Nehisi Coates pointed out, the birthrate for unmarried black women is actually dropping), but black women also have a much higher abortion rate. The problem isn't really an education gap—sex education in this country is poor, but it's equally poor across different race categories. As this new widespread survey from researchers at Indiana University shows, condom use is actually higher amongst black and Hispanic men than white men.

But more doesn't mean always. I suggest that the most underdiscussed factor in all this is that the demand for female-controlled contraception like the pill—which is easier to be consistent with than condoms—isn't being met. Debra, you suggest that young women living in poverty should delay child-bearing while working through their low-paying jobs and trying to save some money. But delaying childbirth in and of itself costs money. I just recently renewed my birth-control prescription, and even thought I have insurance, it's now costing me $50 a month to be on the pill. Condoms are cheaper, but still, a box of 36 can run you $25. The current minimum wage is $7.25 an hour, and few who make that have employers who provide them full-time jobs. Contraception is so expensive it's no wonder some women try to wing it, and why so many of them find themselves pregnant unexpectedly. According to the Guttmacher Institute, 18 percent of low-income pill users surveyed skipped pills because they couldn't afford them, and 24 percent of low-income women put off a visit to the gynecologist to save money. Just last year alone, 1.3 million women were added to the rolls of the uninsured, so this particular problem is likely only to get worse.

I don't think we can even talk about the various methods—pushing personal responsibility, talking about systemic pressures, looking for middle ground between the two—of encouraging young women to delay childbirth unless we're willing to start looking at contraception. The "why" is an important aspect in this debate, but it shouldn't overshadow the basic question of "how."

Photograph of oral contraceptives by Matthew Bowden for Wikimedia Commons.

Tags: black families, contraception, No Wedding No Womb

The good news this week is that—as this stream of local news stories can attest—HHS has started handing out the $55 million in Personal Responsibility Education Program (PREP) grants. These grants go toward sex-education programs that have met evidence-based standards for reducing teen pregnancy and STI transmissions, which is a fancy way of saying that they teach kids about contraception. The bad news is that this doesn't mean the end of abstinence-only education.

In all the melee over health care reform, the baby-splitting compromise over sex education went understandably under-reported. In the grab bag of goodies being tossed at conservative Democrats and Republicans to get them to support health care reform, $50 million in grant money for abstinence-only programs was added to the $55 million for PREP. States can choose which money they'd like to apply for. Quietly, Congress instituted a form of red state/blue state balkanization of the sort that fed up people on both sides of the aisle are increasingly demanding, at least over cocktails, when, should politics come up amongst like-minded people, someone is bound to say, "Why can't the red states and blue states just go their separate ways already?" Well, on sex education, it looks like a looming possibility.

Should the "go your own way" strategy with sex education really take root, it will likely grow the already-existing inequalities between sexual health outcomes in red and blue states. As Naomi Cahn and June Carbone demonstrated in their book Red Familes v. Blue Families, more conservative states generally have higher teen pregnancy rates. There are complex reasons for this, but lack of social support for contraceptive use for sexually active teenagers is a major factor. Having the federal government help fund contraception-positive messages in blue states and contraception-negative messages in red states can only make this situation worse.

The good news is that red states aren't (yet) all completely in the thrall of the anti-sex league. There comes a breaking point for many where teen pregnancy rates get so high they're willing to start taking another look at those condom thingies. Arkansas quietly added contraception education to its health programs that used to be anti-contraception. For them, the breaking point was 62.3 births for teenagers out of 1,000 live births, 48 percent over the national average. Of course, some states, like Mississippi, will probably be building maternity wards in their high schools before they start to think that maybe it's not the worst idea if sexually active teenagers wrap it up.

Illustration about promoting abstinence by Adrignola for Wikimedia Commons.

Tags: abstinence-only education, comprehensive sex education, health care reform

Finally, the day has come when all new insurance plans are required to cover preventive health care without any co-payments or deductibles. But despite reassurances from Congress and the White House that birth control would be covered under health reform, it didn’t make the list of essential preventive services. Instead, all anyone could promise was a future “study.”

Comissioned by Kathleen Sebelius, the Secretary of Health and Human Services, the study is supposed to determine whether contraception is, in fact, a preventive health service. Allowing a year for the research, which is due next August, then additional time to issue new regulations, and, after that, a year in which insurers will have to comply with new regulations, it’ll be at least 2012 before women can get birth control without a hefty co-pay. 2013 is more likely.

Women’s health advocates have sent a letter urging Sebelius to shorten, or better yet, eliminate the delay. “There’s no need to study for an entire year whether birth control is a preventive services,” says Lois Uttley, co-founder of Raising Women’s Voices, one of the more than 60 organizations that signed the letter. “They can come to a conclusion on that issue in a matter of weeks by simply reviewing the existing scientific and medical evidence.” Alternatively, she suggests, they could simply add birth control to the list with no further ado.

But quick resolution doesn’t look likely. In a move that’s brought unpleasant flashbacks to last Winter and Spring, the Catholic Church is waging its own campaign. According to a letter the U.S. Conference of Catholic Bishops sent to HHS last week, contraceptives and sterilization should not be considered preventive services. “To prevent pregnancy is not to prevent a disease,” the bishops’ letter explains, going on to argue that the interim list, which doesn’t include birth control, should be made permanent.

And then, of course, there’s the debate about abortion, which will be as bitter as it was last time around. Though the final law included abortion language that was less restrictive than the total ban that had been proposed by anti-choice Democrat Bart Stupak, the same Stupak-like language that enraged abortion rights supporters less than a year ago has returned. And this time, the White House and HHS apparently inserted it themselves. After complaints from the National Right to Life Committee this summer, the administration announced that its temporary health plans for high-risk adults could only offer abortion coverage in cases of rape, incest, or life endangerment.

Meanwhile, congressional members who wanted an out-and-out ban on abortion during the first health reform go-round have re-introduced legislation that would, like the old Stupak amendment, ban private insurers from covering abortions.

While their chances of passing the “No Taxpayer Funding for Abortion Act” may be slim, they have a healthy shot at rehashing bitter debates. And, as we’re already seeing with birth control, that can delay access to services, or even prevent them forever.

Photograph of birth control pills by Ceridwen for Wikimedia Commons.

Tags: birth control, coverage for birth control in health care reform, health care reform

—Christine O'Donnell's former employee helped the Senate nominee rail against gay rights—until he came out. He was abandoned by O'Donnell, but her lesbian sister helped him accept his sexuality. [The Daily Beast]

—Wall Street firm Goldman Sachs is being sued by three women who used to work at the company for what they say is rampant gender discrimination that unfairly favors men in pay and promotions. [AP]

—A new government report released on Wednesday revealed that although almost all U.S. teens have had formal sex education, only about two-thirds have been taught about birth-control methods. [Washington Post]

— Christine O'Donnell’s victory on Tuesday indicates that Sarah Palin's "political war machine" strategy works. [The Daily Beast]

—Elle magazine is being criticized for one of its 25th anniversary covers. Plus-size Gabourey Sidibe of Precious is the only subject shot close-up, while the other three cover girls appear in full-body shots. [BuzzFeed]

Photograph of Christine O'Donnell by Mark Wilson for Getty Images.

Tags: birth control, christine o'donnell, elle magazine, gay rights, Goldman Sachs, Sarah Palin

Tags: birth control, christine o'donnell, elle magazine, gay rights, Goldman Sachs, Sarah Palin

At first glance, it appears that Ella, the new emergency contraception pill developed by HRA Pharma, could make Plan B, the first “morning-after pill” in the United States, obsolete. Ella works for five days after unprotected sex occurred; Plan B must be taken within 72 hours. Plus, studies show that it may be more effective than Plan B at preventing pregnancy.

So when I talked to James Trussell, director of the Office of Population Research at Princeton University and one of the most well-known pro-choice advocates in the country, I was surprised to hear him say that the didn’t think it would make much of a difference.

He thinks Ella is a great new drug and said (in theory) that he would recommend it to his own daughter if he had one. But since Plan B was approved for over-the-counter status by the Food and Drug Administration in 2006, use has skyrocketed. In the first year it was available OTC, sales doubled. And since then, obtaining emergency contraception has become as easy (for women over 17), as say, buying cigarettes: go to the pharmacy, show proof of age, pay for purchase.

But Ella’s manufacturer, HRA Pharma, didn’t even apply for over-the-counter approval because ulipristal acetate, Ella’s chemical name, is a completely new chemical entity. “Women … are not going to go to their doctor looking for emergency contraception, so how will they ever find out about it?” Trussell asked. “They’ll just go to CVS and buy Plan B one-step.”

Frugal women may take the extra step for Ella: Insurance companies that cover other forms of contraception are likely to cover emergency contraception as well, which may make a prescription drug cheaper in some cases, according to Adam Sonfield, a senior public policy associate at the Guttmacher Institute.

Even if Ella doesn’t become a blockbuster prescription drug, a new emergency contraception option, especially one that works for five days, is a big victory for reproductive health advocates. The extra two days can mean a lot for a woman if she doesn’t have easy access to a pharmacy or her pharmacist refuses to dispense emergency contraception.

And if Ella does get FDA approval, it will have one more major challenge: marketing the vague name. We call emergency contraception “Plan B" for a reason.

Photograph of Plan B courtesy of Getty Images.

Tags: birth control, Ella, emergency contraception, Plan B

If they can just get men past the words "a blast of ultrasound to the testes," researchers at the University of North Carolina may have finally hit on a method of birth control that's most appealing to the people it's meant to interest: men. That ultrasound blast is quick, painless and effective for up to six months, and would free both men who might actually have the opportunity to accidentally father a child and men who only hope things go that well from worrying about whether they've accidentally hit the bull's eye. The ultrasound treatment also sounds great for couples in between kids or as a back-up plan.

What it wouldn't do, of course, is prevent diseases or offer any real reassurance to the girl who's willing to risk an STD but not pregnancy. But then, no form of birth control other than condoms offers full protection to both parties without taking anything on trust. If researchers can get ultrasound birth control out of clinical trials and approved for the masses, the big question will be the same old, same old ask. Women are willing to subject ourselves to various indignities and procedures in order to keep from bearing children; men, historically, have been somewhat less willing to shoulder the burden of not fathering them. Can even the simplest technology change that?

Tags: birth control, Male birth control

—Few recognize that the emergence of the birth control pill spawned a revolution in pharmaceutical regulation. [New York Times]

—What happens when fighting over a guy goes national. [Jezebel]

—The galling absurdity of Iran’s claiming a spot on both the U.N. Human Rights Council and Commission on the Status of Women. [Washington Post]

—Primatologists claim that chimpanzees use sex toys, too. [New York Times]

—Obama Administration torn on fighting the new Arizona immigration law after discovering that Janet Napolitano created one of its tougher provisions. [Politico]

Tags: arizona, birth control, human rights, immigration, iran, Islam, Janet Napolitano, mean girls, monkeys, Science, we're talking about

History professor Elaine Tyler May has a new book out about the birth control pill, and a New York Times op-ed to go with it. In it, May dismisses the argument made by both proponents and detractors alike, that the pill ushered in the sexual revolution. That was a long process that depended more on changing attitudes than technological advances. Instead, she concludes that the pill had its biggest impact on women's growing independence, allowing women the ability to walk through the doors that feminism opened for them.

In its first decade, it seems the pill didn't do much for unmarried women at all, since most were afraid to ask for it. But for a lot of married women, it meant the difference between going to work or not, or being able to leave a bad marriage or not. Obviously, in the decades since, the pill and widespread contraception use in general has had the same impact for unmarried women, pushing the average age of first birth up from 21.4 in 1970 to 25 in 2009. The data make it obvious, however, that the widespread use of contraception came after the sexual revolution, and that people were pulling and praying for literally decades before unmarried women using contraception became normalized.

Whether the pill had more of an impact on the sexual revolution or on women's access to education and employment may seem like hair-splitting to most people, and it would be a purely academic exercise in a society that wasn't plagued by a powerful anti-choice lobby. Unfortunately, we live in a country where the House minority leader thinks it's appropriate to attack contraception access as immoral, where religious groups still pressure schools into teaching kids misinformation about contraception, and where anti-choice groups use pseudo-science in an effort to create legal arguments to ban the pill. This hostility to contraception is ostensibly based on a belief that contraception provokes "immoral" behavior. But the evidence suggests that this isn't the case, and that contraception is mainly useful for protecting women's lives from unintended pregnancy.

Of course, if anti-choicers are motivated by wanting to limit women's lives and preserve inequality between men and women, they'll keep on keeping on in face of this new evidence. If I were a gambling woman, I'd go all in on the bet that they'll continue to act as if they're morally offended by women's access to education and employment.

Tags: feminism, the pill, women’s history

—Since her infamous shopping sprees during the presidential campaign, money has been an issue with Sarah Palin. She may no longer be a governor, but she is getting by just fine with her new gig: making a brand of herself. [New York]

—The Wasington Post is hosting a discussion today: Can religion handle sex? [Washington Post]

—It seems finding child-care on the Hill may actually be harder than getting Republicans and Democrats to agree. There are waiting lists for Hill staffers hundreds of names long. [Politico]

—After 50 years, what promises has the pill kept, and what expectations did it fail to meet? It supposed to change the world—did it? [New York Times]

Photograph of Sarah Palin by Christian Petersen/Getty Images.

Tags: birth control, childcare, craft, Etsy, regretsy, religion and sex, Sarah Palin, the hill, the pill