An Urgent Sexual and Reproductive Health Agenda for a Pro-Choice President and Congress

They said this would never happen again.  They said choice was a losing issue.  They said pro-choice Democrats should avoid the issue, and pro-choice Republicans should hide their views.  They said this day would never again come. 

Here it is.  One day after an historic election and we can say, conclusively:  The naysayers were wrong.  A supporter of reproductive health and rights will occupy the White House come January. The ranks of pro-family, pro-choice legislators in both the House and Senate are slated to grow significantly. On January 20, at least five new pro-choice/pro-family planning senators will take office along with 15 or so new choice/pro-family planning members of the House.  

Make no mistake.  The pro-choice gains were not incidental; nobody won in spite of being pro-choice.  The overwhelming defeat of four anti-choice ballot measures across the country, including the key swing state of Colorado, tells us that.  So does the fact that "right to life" groups were as active as ever this year, and that the issue was discussed in the last presidential debate. 

America doesn't want to go where President Bush wanted to take us - to a Supreme Court that overturns Roe v. Wade, to new and impenetrable obstacles that prevent low-income women from getting the contraceptives they need, to tax dollars supporting abstinence-only programs that don't work, to the world Governor Palin inhabits which has no grey areas, no middle ground, no room for good people to disagree. 

The increased support in Congress will be critical as supporters of choice begin working to reverse the legacy of the past eight years and press for an agenda more reflective of the needs of women and families. President Bush did a lot to erode the rights of women, both in this country and abroad.  He opposed access to emergency contraception, gave lifetime appointments to two stridently anti-choice Supreme Court justices, promoted abstinence-only sex education programs, under-funded cost-effective family planning services though Title X and Medicaid, and used U.S. dollars internationally to deny women the reproductive health care they need.

But can we reasonably ask - and realistically expect - action on sexual and reproductive health in the coming months, especially given the record federal deficits and an economy in deep trouble?

There are reasons to be optimistic. Here's why.

1. President-Elect Obama's record of support for reproductive rights:

His record of support is consistent and clear, both in the Illinois legislature and the U.S. Senate. He has been a strong proponent of sex education, sponsoring legislation to replace failed abstinence-only programs with comprehensive, medically accurate curricula. He cosponsored legislation to restore birth control discounts for low-income and college women. He cosponsored the Freedom of Choice Act, to codify Roe v. Wade. Obama is an original co-sponsor of Prevention First, which would expand access to contraception for low-income women, require health insurance companies to cover contraception, and provide a dedicated funding stream for age-appropriate, medically accurate and honest sex education programs. He also co-sponsored legislation to expand coverage of family planning services so that it matches Medicaid coverage for pregnancy-related care - a bill that would help low-income women prevent some 500,000 unintended pregnancies each year, 200,000 of which result in abortion. 

2. There's safety in numbers: We have more pro-choice members in Congress and some of the most vocal opponents are gone.  Gone is ultra-conservative Colorado Republican Marilyn Musgrave, who in 2006 called the fight against gay marriage "the most important issue that we face today." Musgrave will be replaced by Betsy Markey (D-CO), who is pro-choice. Gone is Rep. Tom Feeney (FL), a "passionate pro-life" member who staunchly opposed the Title X family planning program. In the Senate, newly elected Jeanne Shaheen (D-NH), Mark Udall (D-CO), Tom Udall (D-NM), Mark Warner (D-VA) and Kay Hagan (D-NC) will be replacing five senators whose records on reproductive choice were unequivocally hostile.   

3. Inaction is not an option.  The unmet public health needs and the inattention to the public health infrastructure for the last eight years make inaction impossible.  The litany of problems facing women seeking reproductive health care is long, and the coming action on health care reform will bring this issue to the fore. Whether trying to avoid pregnancy or to plan a family, access to birth control and reproductive health services is a necessary component of basic health care. Today, nearly one-half of pregnancies in this country are unintended at the time of conception. By age 45, nearly half of all women will have experienced an unintended pregnancy. Nearly half of Americans contract a sexually transmitted infection (STI) in their lives. Our nation's real and compelling need to improve access to comprehensive reproductive health care services has not been well-served by the demonization of these issues over the last eight years.

So what's a president to do? Here are a few suggestions for an incoming administration. 

1.  Reverse the HHS Refusal Rule, which will likely be published in final form any day now.  This ill-conceived and unnecessary rule will obstruct access to reproductive and other health services, counseling and referrals.  It could open the door for more widespread health service refusals.  This rule not only ignores patients' health care needs, it also conflicts with accepted medical standards of health care and treatment and may create conflicts with state laws designed to enhance access to reproductive health services.   

2. Ensure Health Care Reform Efforts Advance Access to Reproductive Health Care:  First and foremost, reproductive health - including coverage of abortion and contraception - must be recognized as a critical component of care, not an afterthought or the "third rail" of the discussion. The public health infrastructure needs to be preserved and expanded.  

3. Prioritize and normalize prevention: Widespread use of birth control improves maternal and child health and has been the driving force in reducing unintended pregnancy and preventing STIs. Yet the cost of contraception can be a significant barrier to accessing services, especially for low-income and adolescent women. Investing in programs to expand access to subsidized family planning services is a cost-effective and proven way to improve public health.  Priority should be given to increasing funding for the Title X family planning program and for the CDC's program to screen and treat sexually transmitted infections. Eligibility for cost-effective Medicaid-funded family planning services should be expanded so more women can access services. And instead of funding ineffective abstinence-only education programs, we should support comprehensive sex education that give young people the information and skills they need to make responsible and safe choices about their reproductive health.

4. Renew U.S. support for international family planning programs:  U.S. investments in reproductive health yield an array of benefits in developing countries, including improved maternal and child health, fewer unintended pregnancies and abortions, lower HIV rates, and higher standards of living.  Funding should be increased for USAID's overseas family planning and for the United Nations Population Fund (UNFPA). We should reverse harmful policies, including the global gag rule and this administration's interpretation of the Kemp-Kasten law, which have reduced the ability of international non-governmental organizations to provide vital preventive and life-saving health services in some of the world's poorest nations.  

5. End the current restrictions on embryonic stem cell research and supplement growing studies of reprogrammed stem cells with renewed funding for embryonic lines, accompanied by rigorous scientific and ethical oversight. 

6. Remove Barriers to Abortion Care:  In addition to the recently proposed rule that undermines access to reproductive health care services, long-standing bans on public funding for abortion services have severely restricted access to safe abortion care for women who depend on the government for their health care. These policies disproportionately harm low income women, women in the military, women of color, and certain immigrant women - all of whom already face significant barriers to receiving timely, high quality health care.   

That's a lot to do - and undo, but it's what the nation wants and needs.  It's also what we voted for.   

There's an urgent agenda for advocates, too, and it starts with staying active and engaged, and continuing to fight every day to improve reproductive health care.  Opponents will surely call our agenda radical, but we simply cannot let them dominate the debate.  There's nothing radical about putting in place the programs, policies and priorities that give all women access to the education and reproductive health care services that can reduce teen and unintended pregnancy, stop the epidemic of sexually transmitted infection, and help women have healthier babies.