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Redefining the Pill: Bush Administration Calls Contraception “Abortion”

Today's blog post is from Carole Joffe, author of Doctors of Conscience: the Struggle to provide Abortion before and after Roe v Wade (Beacon Press, 1996) and a professor of sociology at the University of California, Davis.  She is currently at work on a book about contemporary abortion provision.

Joffee Fans of Jewish folklore are familiar with tales from the town of Chelm, the legendary center of foolishness. Chelm's citizens unfailingly choose actions guaranteed to achieve the opposite of what was desired. The children need more milk? Buy a billy goat! The synagogue needs a new roof? Build a new floor! There has been much about the eight long years of the George W. Bush presidency that has made one think s/he was living in Chelm (remember how we were told the U.S. invasion of Iraq would be greeted by Iraqis bearing flowers and sweets?). Now, in the waning days of this presidency comes a move that would no doubt earn special respect from the people of Chelm because of its tortured logic. Draft regulations now circulating in the Department of Health and Human Services would redefine many forms of contraception (including most birth control pills) as "abortions."

So an administration that has done everything in its power to oppose abortion–making sure its appointments to the Supreme Court and other key positions are reliably anti-abortion, signing a bill banning a rarely used but sometimes medically necessary abortion procedure and so on–now goes after the main thing that can prevent unwanted pregnancies? In true Chelm-like fashion, this Administration is proposing a policy that virtually assures there will be more abortions.

Specifically, the proposed rule advocates a dramatically broadened interpretation of the Weldon Amendment, a 2004 measure which prohibits recipients of federal funds from "discriminating" against individuals or institutions who refuse to provide abortion services or be otherwise involved in abortion care, including referrals. Here is the wording from HHS [pdf]: "the Department proposes to define abortion as any of the various procedures– including the prescription and administration of any drug or the performance of any procedure or any other action–that results in the termination of the life of a human being in utero between conception and natural birth, whether before or after implantation."

This definition of when pregnancy begins– and therefore what constitutes an "abortion" – is at odds with a longstanding consensus within the medical community which defines pregnancy as beginning with implantation into the uterine wall, and not fertilization. Jessica Arons, in an excellent posting on Science Progress, points out a number of compelling scientific reasons why implantation is the medical marker for pregnancy: there is actually no way to know if a woman is pregnant prior to implantation; fertilization itself is a process that can take up to 24 hours, and anywhere from one third to one half of all fertilized eggs never begin or complete implantation.

But this HHS proposal of course is not about science, but about politics. This proposal, if implemented, could potentially wreak havoc with the country's family planning programs for low income women and teens, dissemination of Emergency Contraception in hospital ERs, and the ability of women in various places to pick up their monthly packet of birth control pills at their local pharmacy, to name just a few. The proposal very cleverly speaks to two main policy objectives of the Religious Right: to change the cultural– as well as bureaucratic– understanding of contraception, and to further the cause of "health worker refusals"– the growing movement of individuals who withhold access to various medications and procedures with which they have political disagreement.

How did we arrive at such a surreal and backward turning moment in public policy, nearly 50 years after the discovery of oral contraception– an invention, in the words of Economist magazine, that "defined a century"– and more than 40 years after the Supreme Court, in the Griswold decision, legalized birth control? Not so long ago, contraception was seen by many politicians as "common ground" between the supporters and opponents of abortion. One of the most enthusiastic supporters of Title X (the leading government program that funds family planning services for low income women and teens) when the program was established in 1970, was George H.W. Bush. Then a Congressman from Texas, he was nicknamed "rubbers" because of his promotion of contraception.

But this common ground approach did not last long after the election of Ronald Reagan in 1980, and the rise of the Religious Right as a powerful force in the Republican Party. Rightwing extremists began to reframe contraception as "supportive of the abortion mentality," and not as something that actually might reduce the need for abortions. Opposition to publically funded family planning, as well as abstinence-only sex education (programs that are forbidden to even mention birth control methods, except to give misinformation about their effectiveness) joined abortion as key domestic targets of these religious conservatives. The elevation of contraception to actual abortion status was a logical next step in a presidential administration that has often shown contempt for scientific findings when they are inconvenient. (Think of the Bush administration's record on climate change).

Meanwhile, just in the last few days, the highly respected Guttmacher Institute, which specializes in reproductive health issues, issued a report stating that without the publically funded contraceptive services currently provided to seven million women each year, the number of unintended pregnancies and abortions in the U.S. would be 50% higher. In other words, 1.4 million pregnancies and 600,000 abortions are averted each year because of these programs.

The Religious Right for years has tried to get rid of Title X altogether, and has managed to keep the program greatly underfunded. The HHS proposal, if it went into effect, offers a new line of attack: Title X sites would quite likely be faced with an orchestrated campaign of applications by religious conservatives who would invoke their newfound right to refuse to dispense contraception.

It is not clear, as of this writing, what will be become of the HHS draft proposal. Predictably, the reproductive health community is appalled and the Religious Right is thrilled with the prospect of it becoming policy. The Bush administration could order this regulation to be implemented– which would not require Congressional approval. The next president, if he is so inclined, could overturn it. Barack Obama has joined with lawmakers from both parties in a letter of outrage to HHS. John McCain, on the other hand, has "declined to comment" on the matter. One hopes that the 98% of heterosexually active women who have used at least one contraceptive method will note these differing positions. Chelm is charming as folklore, not as reality.

Carole Joffe previously posted on Beacon Broadside about the Republican candidates' abortion views and the politics of abstinence-only sex education. She also contributes blog posts to RHRealityCheck.org.