PREVENTING UNINTENDED PREGNANCY
STATE FUNDING FOR FAMILY PLANNING SERVICES
In 2008, the statewide family planning provider network served over 300,000 low-income women and men, of these patients 96,000 were uninsured (Family Planning Council of Southeastern PA, 2009). Family planning services include screening for conditions such as diabetes, high blood pressure, sexually transmitted infections and cancers (including breast and cervical cancer), as well as a variety of birth control methods. By preventing unintended pregnancies, government subsidized family planning services prevent 25,000 abortions in Pennsylvania each year (Alan Guttmacher Institute [AGI], 2009). Family planning also allows women to plan their pregnancies. Women who utilize family planning services seek prenatal care earlier and have healthier babies.
These services save taxpayers money. Often, an unintended pregnancy will cause a woman to lose her job and precipitate an episode of welfare dependency. A national study published in 2008 by the Journal of Health Care for the Poor and Underserved (Frost, Finer, and Tapales) found that for every $1 spent on family planning services, $4.02 was saved on maternity and infant care costs.
Currently, subsidized family planning services are supported by federal grants, limited state funds, patient fees, and private donations. A “Medicaid Waiver”, known as SelectPlan for Women, expands eligibility for coverage of family planning services to more low-income women in PA. The present network of providers is still, however, unable to totally meet the current need.
Federal grants support confidential family planning services to teens. The effectiveness of these services in reducing teen births and abortions has been demonstrated over twenty years, as has their effectiveness in preventing and treating sexually transmitted infections among youth. According to the AGI, without family planning services, the number of teenage pregnancies would likely increase by 20 percent. In Pennsylvania, 46 out of 1,000 teenagers become pregnant each year. The American Academy of Pediatrics supports the provision of confidential family planning services for teens without requiring parental consent, as does state and federal law. The Journal of Pediatrics has noted that 85% of teens said they would not seek care for a sexually transmitted infection if parental consent or notice were required. Although reports have noted a decline in teen pregnancy, a recent study by AGI found that 80% of this decline is attributable to an increased use of more effective methods of birth control.
COMPREHENSIVE SEX EDUCATION
"Abstinence-only-until-marriage" sexuality education programs teach a "just say no" approach to sexuality and exclude information about birth control and safe sex practices. In Pennsylvania, there is no standard for sexuality education and nationally at least 1 in 4 girls have a sexually transmitted infection (Center for Disease Control and Prevention, 2008). Comprehensive approaches to sexuality education include discussions of abstinence, work to build self-esteem and enhance refusal skills, and provide age-appropriate information about the prevention of pregnancy and sexually transmitted infections. Recent studies have repeatedly shown that quality, comprehensive sex education helps teens delay sexual activity, prevent unintended pregnancy, and prevent the spread of sexually transmitted infections. In a 2007 Susquehanna Research and Polling survey of Pennsylvania voters, 83% supported the teaching of responsible, age-appropriate, medically-accurate sexuality education, including information about both abstinence and contraception, in public schools.
REFUSAL CLAUSES: A THREAT TO REPRODUCTIVE RIGHTS
Alarmingly, an increasing number of pharmacists and physicians are refusing to dispense birth control or write women prescriptions for contraceptives. These health care professionals cite their religious, moral, ideological, and personal objections to the use of contraceptives. Prescription refusal is a disturbing trend that can jeopardize women's reproductive health. Denying women their rights to timely access to health care is an act of discrimination that could lead to an increased number of unintended pregnancies.
EMERGENCY CONTRACEPTION ACCESS
Emergency contraception (EC) can prevent pregnancy after unprotected sexual intercourse. EC can be used if the primary form of contraception fails, if you have unplanned sex, or if you are forced to have sex. It is often known as “the morning after pill,” but this name is misleading because EC can prevent pregnancy up to 120 hours (five days) after unprotected sex. However, the sooner it is taken, the more effective it is. Emergency contraception does NOT interfere with an already established pregnancy as defined by American College of Obstetricians and Gynecologists and the U.S. Department of Health and Human Services.
Women who have been sexually assaulted have a particularly compelling need for swift and easy access to EC. More than 300,000 women are sexually assaulted each year in the U.S. Of these, an estimated 25,000 will become pregnant as a result. About 80% of these pregnancies could be prevented if all women who were raped used EC (Stewart & Trussell, 2000).
More than 20% of hospitals in PA are not routinely providing EC to sexual assault survivors (PCAR and Clara Bell Duvall Reproductive Freedom Project, 2009). This practice is counter to the standards outlined by the American Medical Association, which state that women who have been sexually abused should be counseled about the risk of pregnancy and offered EC.
INSURANCE COVERAGE FOR BIRTH CONTROL
Nearly half of all pregnancies in the United States are unintended, and nearly half of those unintended pregnancies end in abortion. Contraceptives have a proven track record of enhancing the health of women and children, preventing unintended pregnancy, and reducing the need for abortion. Although contraception is basic health care for women, many insurance policies exclude this vital coverage.
According to a 2002 AGI study, 86% of U.S. insurance plans covered the then-leading contraception medications in their prescription plans (AGI, 2002). In addition, 27 states require insurers that cover prescription drugs to provide coverage of the full range of FDA-approved contraceptive drugs and devices (AGI, 2010). However, Pennsylvania has no such requirement (AGI, 2010) and therefore women of reproductive age spend 68% more out-of-pocket for their health care then men do. The U.S. Equal Employment Opportunity Commission and one federal district court have ruled that not providing for equitable contraceptive coverage is a violation of federal anti-discrimination laws. A national study published in 2008 states that for every $1 spent on family planning services, $4.02 was saved on maternity and infant care costs (Frost, Finer, & Tapales).
SAFE, LEGAL ABORTION
Planned Parenthood believes in access to family planning and reproductive healthcare and choice. We believe that every woman – regardless of income, age or marital status – has the fundamental right to decide when and whether to have a child. It is government's role to support personal childbearing decisions by making available medically accurate reproductive health information, comprehensive sexuality education, access to contraception, and safe, legal abortion.
RIGHT TO CHOOSE ABORTION
In 1973, the Supreme Court Roe v. Wade decision established a framework to regulate the provision of abortion services in the United States. Roe and subsequent Supreme Court decisions stated that government may not ban abortion before the point of fetal viability. After the point of fetal viability, Roe allowed the government to prohibit abortion except when it is necessary to preserve the life or health of the woman. In a 2007 Susquehanna Polling and Research survey of Pennsylvania voters, 67% agreed that Pennsylvania’s current restrictions on abortion are sufficient, that government interference in private, personal medical decisions should be limited and politicians should instead focus their efforts on pregnancy prevention programs.
ABORTION METHOD BAN
Anti-choice organizations have tried to erode the Supreme Court’s Roe v. Wade decision (which ensures a woman’s constitutionally protected right to choose) by banning specific abortion procedures. Abortion method bans interfere with a physician's ability to choose the safest method when abortion must be performed to protect a woman's life or health. This type of legislation also interferes with a woman's right to choose, in consultation with her physician, the method of abortion that will best protect her life and preserve her health. The Pennsylvania Abortion Control Act already prohibits all methods of abortion at 24 weeks of pregnancy or later while providing exceptions to preserve the woman's health and life.
PENNSYLVANIA'S ABORTION CONTROL ACT
Pennsylvania's Abortion Control Act, which was designed to restrict and limit access to abortion, went into effect in March of 1994. Since the first year of implementation, women, hospitals, and reproductive health care providers reported an increase in the number of adult and teenaged women who left the state in order to choose abortion and an increase in the number of women unable to exercise their right to choose at all.
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Mandatory 24-Hour Delay and State-Mandated Lecture
Pennsylvania's Abortion Control Act requires a woman to receive a state-mandated lecture and then delay her decision at least
24 hours before having an abortion. There is no public health rationale for these restrictions, which were designed solely to
make abortion more difficult to obtain. The mandatory 24-hour delay often causes a wait of up to a week that can result in riskier procedures.
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Mandatory 24-Hour Delay and State-Mandated Lecture
Pennsylvania's Abortion Control Act requires a woman to receive a state-mandated lecture and then delay her decision at least 24 hours
before having an abortion. There is no public health rationale for these restrictions, which were designed solely to make abortion more
difficult to obtain. The mandatory 24-hour delay often causes a wait of up to a week that can result in riskier procedures.
STOP CLINIC VIOLENCE
In recent years, a campaign of violence, intimidation, and harassment has been waged against reproductive health providers, patients, and their families. Planned Parenthood believes that all levels of government should take an aggressive role in enacting and enforcing laws to deter these illegal acts, and in prosecuting the perpetrators of such acts.
FETAL PERSONHOOD
Legislation and regulations have been introduced that would elevate the status of a fetus, at any stage of development, to that of an adult. This is an effort to establish fetal “personhood” to create a conflict with a woman's right to choose.
MANDATORY ULTRASOUND
Ultrasounds are routinely provided as an integral part of thorough and standard medical practice in abortion services, including the option to view the screen and receive a printout of the image. Legislation in Pennsylvania and other states seek to impose extensive and demeaning requirements meant to impede access and shame women who seek abortion care. Such requirements include that the ultrasound is performed 24 hours in advance of an abortion, that the screen of the ultrasound machine is in the woman’s line of view so she must avert her eyes if she does not want to view the image and that she must also personally receive and transfer the ultrasound images to the physician performing the abortion. These efforts are not only unnecessary given standard ultrasound practices today, but are a cruel and malicious misuse of government power.
REFERENCES
AGI (2002).
http://www.guttmacher.org/pubs/psrh/full/3607204.pdf
AGI (2010a).
http://www.guttmacher.org/statecenter/spibs/spib_ICC.pdf
AGI (2009).
http://www.guttmacher.org/pubs/NextSteps.pdf
Center for Disease Control and Prevention (2008).
http://www.cdc.gov/stdconference/2008/press/release-11march2008.pdf
Family Planning Council of Southeastern PA (2009). The Facts on Pennsylvania’s Family Planning Network for 2008.
J.J. Frost, L.B. Finer, & A. Tapales (2008). Journal of Health Care for the Poor and Underserved, 19(778–796).
PCAR and Clara Bell Duvall Reproductive Freedom Project (2009). Provision of EC in PA Hospitals.
Stewart & Trussell (2000). American Journal of Preventive Medicine, 19(4).
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