Put Women's Health Back in the Picture

The Global Gag Rule withheld critical funds from organizations abroad which provided legal, voluntary abortions, counseled women about abortion, and engaged in advocacy for abortion rights.
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By rescinding the Global Gag Rule, President Obama has stood up for reproductive rights, for individual dignity and autonomy, and for the simple proposition that women's health should be the central concern of women's health policy. For the last eight years, and for almost a decade during the Reagan and George H.W. Bush administrations, the Global Gag Rule withheld critical funds from organizations abroad which, using separate funds, provided legal, voluntary abortions, counseled women about abortion, or engaged in advocacy for abortion rights. The imposition of this ideologically motivated rule reduced access to basic reproductive health services and information, and undermined women's health around the world.

In addition to the Global Gag Rule, the Bush administration derailed women's health services internationally by refusing to contribute to the United Nations Population Fund, as instructed by Congress. The fund estimated the contribution would have prevented 2 million unwanted pregnancies, nearly 800,000 induced abortions, 4,700 maternal deaths, nearly 60,000 cases of serious maternal illness, and over 77,000 infant and child deaths each year. But citing rumors linking the organization to coercive abortions in China -- rumors debunked by a US government panel -- the Bush administration blocked the contribution seven years in a row.

Placing politics over women's health was the Bush model for domestic women's health policy as well. The Food and Drug Administration's interference with access to emergency contraception is a prime example. In 1999, the FDA approved prescription distribution of "Plan B," a medication used for emergency contraception. In 2003, the makers of the drug applied for permission to dispense it over-the-counter, as many women cannot see a doctor to seek a prescription within the short timeframe required for the drug to be effective. The American College of Obstetricians and Gynecologists and the government's own panel of scientific advisors overwhelmingly supported this application.

The FDA rejected the application, and delayed approval of a revised application until August 2006. Susan F. Wood, FDA assistant commissioner for women's health and director of the Office of Women's Health, resigned in protest in 2005, telling her colleagues that she could "no longer serve as staff when scientific and clinical evidence, fully evaluated and recommended for approval by the professional staff here, has been overruled." A Government Accountability Office study concluded that the consideration of the application had indeed been irregular, involving an unusual amount of input from the higher ranks.

Efforts to erase women's health considerations from women's health policy achieved a considerable victory in April 2007, when the Supreme Court for the first time upheld a federal law banning an abortion procedure that contained no exception for its use when necessary to protect a woman's health. The nationwide ban, championed by President Bush, was largely identical to a Nebraska law that the Supreme Court had declared unconstitutional in 2000 because it contained no such exception. When the federal ban came before Congress, the debate ignored concerns about its impact on women's health. As a federal court noted in 2004, "[N]one of the six physicians who testified before Congress had ever performed [the procedure]. Several did not provide abortion services at all; and one was not even an obgyn... . [T]he oral testimony before Congress was not only unbalanced, but intentionally polemic."

Given the 2000 Supreme Court precedent, the lack of a health exception in the federal ban should have sealed its constitutional fate. However, since the 2000 case, President Bush appointed two justices whose records on women's health and rights issues raised considerable concern. With a 5-4 majority, the new Court declared a health exception unnecessary, despite the wealth of evidence that the procedure is in some cases the safest option.

In mid-December, the Department of Health and Human Services (HHS) sneaked in yet another regulation jeopardizing women's health. The so-called "provider conscience rule" permits health care workers to deny patients access to services they find objectionable. They may even refuse to refer the patient to someone else who will provide the service.

By the government's own estimates, the rule will affect hundreds of thousands of clinics across the country. While the regulation is broad enough to impede access to almost any health service, it poses a particular danger to access to basic reproductive health services, including access to abortion and contraceptives. Nonetheless, HHS did not discuss the rule's impact on women's health in its proposal and dismissed thousands of comments raising women's health concerns out of hand, notwithstanding its responsibilities to review them.

President Obama marked a new day for women's health around the world with the decision to rescind the global gag rule. The importance of this single act cannot be overstated. However, after eight years of policies that ignore women's health, many more days like this will be needed to redress the harms to women's health caused by US health policy.

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