Dr. Sophia Yen’s 5 Key Facts You Should Know About EC.

Emergency Contraception Will Be Available Over The Counter Without Age Restrictions Soon

1. It should be taken ASAP – do not wait ”until the morning after”!

2. It CAN be taken up to 5 days after unprotected sex. It just depends where a woman is in her cycle. If she is ovulating now, she has seconds if anything to use EC. If she is ovulating in 5 days, she has 5 days. (In my clinical practice with adolescents, unfortunately, they often seem to have sex right at ovulation, probably because hormones are driving them.)

3. Men and women and can buy it and should. I recommend any sexually-active heterosexual man and any fertile woman regardless of her sexual orientation have a pack; condoms break and women can be raped, respectively. Women should educate their male partners about it because otherwise they might not speak up when a condom breaks.

4. Levonorgestrel is not an abortifacent - If you are pregnant, it doesn’t end the pregnancy. It does nothing. Its main mechanism of action is that it blocks ovulation (the egg from coming out). JAMA 2006 Davidoff and Trussell, report that “virtually no evidence supports the ability of Plan B to interfere with implantation, and some evidence contradicts it.”

5. Levonorgestrel is not teratogenic – It doesn’t cause a growing embryo/fetus to mutate, grow an extra arm/leg, etc.

There are other EC options that are more effective but are NOT over the counter—ulipristal acetate (a pill, namebrand Ella) and copper IUD. If my daughters needed EC, I would give them ulipristal acetate.

Dr. Yen’s TedX Bay Area Women video with info on EC from 2010 (start at2:22go to8:19):

http://bit.ly/10cvKTk

Sophia Yen, MD MPH is an adolescent medicine specialist whose research interest is Emergency Contraception knowledge, awareness and practices of adolescents and physicians. She is a co-founder of the Silver Ribbon Campaign to Trust Women, and an Assistant Professor at the Stanford School of Medicine and works at Lucile Packard Children’s Hospital in their Teen and Young Adult Clinic. She is board certified in pediatrics and in Adolescent Medicine. She is the immediate past president of the N. CA Society for Adolescent Health and Medicine. Her goal in life is to prevent all teenage pregnancies – “No teenager should want to get pregnant – she should have better things to do during her teen years and no teenager should get pregnant (she should have access to comprehensive sex education and confidential reproductive health care).”

She adds: Thank you Judge Korman for siding with science and calling out the politics that blocked access to backup birth control!

Great Resources on EC:

http://ec.princeton.edu/  – website on emergency contraception – has basic information and if you enter your zip code, where you can get it.

General IUD resource: http://maybetheiud.org/

http://www.acog.org/~/media/For%20Patients/faq114.pdf?dmc=1&ts=20130611T1754589001 ACOG fact sheet on EC

http://www.acog.org/Resources%20And%20Publications/Committee%20Opinions/Committee%20on%20Health%20Care%20for%20Underserved%20Women/Access%20to%20Emergency%20Contraception.aspx ACOG committee opinion on EC 2012

http://trustwomen.civicactions.org/twsilverribbon/all_women_need_ready_access_to_emergency_contraception

 Comments on Notice of Proposed Rulemaking (NPRM) on Coverage of Certain Preventive Benefits Under the Affordable Care Act, File code CMS-9968-P, published in the Federal Register on Feb. 6, 2013 (Vol. 76, No. 25), issued by the Department of the Treasury, Department of Labor, and Department of Health and Human Services.

The Affordable Care Act requires insurance plans to cover preventive health care services including contraception without the additional expenses of out-of-pocket copayments and deductibles.  This builds on the recommendations of the scientists and other experts at the independentInstituteofMedicineto the Department of Health and Human Services, designating contraception as a preventive service that helps keep women healthy and should be covered without a co-pay or deductible. In fact, nearly 99% of all women have relied on contraception at some point in their lives, but more than half of all women between the ages of 18 and 34 have struggled to afford it. Inadequate access to contraception is a key reason why 50% pregnancies in theU.S.are unintended.

The regulation proposed in this NPRM would grant a wide range of religiously-affiliated employers the right to deny their employees coverage for contraception on the same terms as any other preventive health care benefit. The NPRM thus codifies special treatment for opponents of contraception, and discrimination against women.

The Departments issuing the NPRM define two types of religious employers, and request comments on several issues. Nonprofit churches would be exempt from covering contraception. Other religiously affiliated employers would enjoy an accommodation: the employer would be required to notify employees about their individual coverage for contraception without copayments and deductibles, but the employer would be shielded from paying directly for that particular benefit.

The Departments ask whether the proposed definitions unduly expand the universe of exempt employers, compared with an earlier definition promulgated in 2012; whether the proposed procedures are the best way to accomplish the goals of providing coverage and accommodating the employers’ views; and whether the proposed accommodations are as effective as possible at assuring that employees nevertheless receive coverage.  But there are other essential considerations.

If implemented, the rules would allow women’s choices to be governed by their bosses’ beliefs about sex and reproduction.

Equally importantly, these proposed concessions stigmatize birth control, discouraging access.

The accommodation would mean that at least 1.1 million employees at Catholic hospitals, charities, primary schools and secondary schools, along with more than 930,000 students at Catholic universities and colleges, would be left to wonder if they will receive the same access to contraception as everyone else.

In opposition to the exemption

The NPRM elaborates on the Administration’s proposal of 2012 to entirely exempt churches, synagogues and mosques from the requirement to cover contraception for their employees.  However, it retreats from the definition of these entities proposed in 2012.  Those definitions asserted in part that employees of these institutions could be presumed to share the same faith as their religious employer, and its tenets. By the accounts of the institutions themselves, as reported in the Federal Register (p. 8459), they “may not know the religious belief of those they serve or hire, and … employment discrimination laws may prohibit them from inquiring about the religious beliefs of their employees.” As suggested above, abstinence from contraception is in any case neither a shared belief nor a shared practice by the vast majority of Americans regardless of religious affiliation.

The Departments ask whether the remaining definition, referring to the tax code, unduly expands the universe of employers who would have the right to an exemption.  It might.

More pertinent, the new definition makes it crystal clear that the determination to exempt religious employers from the coverage requirement privileges the discriminatory, minority views of certain religious employers over the known preferences of employees, and is thus a violation of employees’ autonomy and right to equal treatment.

Religious employers should not enjoy the legal right to deny or interfere with coverage for contraception.  To the extent that they do now, it is time stop providing the privilege to deny others their rights.

In opposition to the accommodation

The NPRM also expounds on the definition of another category of religiously-affiliated institutions such as schools and hospitals, which are to be offered an accommodation requiring their employees to receive contraceptive coverage, while shielding the employers from the allegedly contaminating activities of financial transactions associated with effectuating such coverage.

Extending legal protection for segregating contraception coverage puts employees’ rights at the mercy of their employers’ discriminatory views.  Every person who depends on health insurance through employment has the right to personal autonomy, and to equal treatment under the law.  The financial relationship between a person and her employer does[asa1]  not compromise her rights or autonomy.  The fact that religious institutions, when acting as employers, distribute funds earned by employees to pay for health benefits does not grant them the power to impose their doctrinal beliefs upon those employees, or to put those employees at risk for less effective coverage. In fact. the funds were earned by and belong the employees, who should direct their disposition.

Requiring employers to notify employees about their benefits, but not to transfer funds to pay for those benefits, is a complication without a fundamental purpose. The employer would be required to cooperate with actions to inform employees that the coverage is available. The arrangement would have to involve the employer, though to a minor extent, while placing a potentially cumbersome barrier to employees receiving the benefit of coverage.

Subsequent rounds of regulations are slated to determine how these employees can gain access to individual contraception coverage through a convoluted system relying on insurers and other third parties to pick up the tab. But inevitably, some women will lose out[asa2] .

Opposition by religious employers to covering contraception is discriminatory and violates the affected employees’ 14th Amendment rights to personhood and autonomy.

Opposition to contraception is discriminatory, and contradicts public health principles regarding sexual health.  Imposing that opposition on employees, particularly on those who do not share that view, abridges their rights to autonomy.  It is the wrong choice.

For these reasons, legal precedents by and large do not support exemptions from contraceptive coverage for religious employers. However, any legal precedents that may suggest separate treatment for the financial assets of religious institutions on this matter should not be perpetuated.

Polling by the National Latina Institute for Reproductive Health found that women and men of all races and religions spoke out overwhelmingly in the recent election, through votes and in opinion polls, rejecting attacks on reproductive health care.

On Jan. 21, 2013, President Obama in his inaugural address paid respects to Seneca Falls, Selma, and Stonewall, key fights for the rights of women, African Americans, and LGBTQI people. This recognition should be backed by policies that respect all of our rights.

Ellen R. Shaffer PhD, Director Sophia Yen MD, Co-Founder Silver Ribbon Campaign to Trust Women ershaffer@twsr.org

Joseph E. Brenner MA, Co-Director Center for Policy Analysis joeebrenner@gmail.com

Mona Sarfaty MD MPH Professor, Jefferson University Mona.Sarfaty@jefferson.edu

Arlene Ash PhD UMass Boston arlene.ash@umassmed.edu

Lin Wang, MD Albert Einstein College of Medicine, Doctors for America linfanw@gmail.com

Rosalind Hinton rosalindhinton@me.com

Somer Loen, President San Francisco National Organization for Women somer@pocketgems.com

TWSR on NPRM contraception coverage 4-2013

We’ve won some shifts in policy in 2013: We forced Congress to enact an improved and expanded Violence Against Women Act.  It’s great to hear the Administration speak approvingly of pay equity, and the basic human right to choose “whom we love.”

But the sex and gender-based attacks have continued almost without missing a beat. Arkansas is just the latest state to hurl breath-taking restrictions at abortion services,  and to ban funding for Planned Parenthood.

The Obama Administration has proposed a regulation on birth control that treats us like the property of our employer.  We need to help them to a more respectful posture.

The Affordable Care Act covers preventive health care services without co-payments and deductibles. Scientists and other experts at the independent Institute of Medicine have recommended to the Department of Health and Human Services (HHS) designating contraception as a preventive service that helps keep women healthy. In fact, nearly 99% of all women have relied on contraception at some point in their lives, but more than half of all women between the ages of 18 and 34 have struggled to afford it.

The proposed rule would grant a wide range of religiously-affiliated employers an exemption from this rule, and the right to deny their employees coverage that is identical to what they’d get in any other health plan.  The latest round of the proposed regulations specifies different categories of religiously-affiliated employers.

Subsequent rounds of regulations are slated to determine how these employees can gain access to individual contraception coverage through a convoluted system relying on insurers and other third parties to pick up the tab.  Inevitably, though, some women will lose out.

Equally importantly, this concession continues to stigmatize both women, and birth control.

Few groups would take this fight head-on last year, when the gravest threat came from a party united behind overturning Roe v Wade entirely.  It’s time to stop dancing a minuet with the Administration, and determine how to shield employees of all faiths or none who happen to work for a tax-exempt religiously affiliated university or hospital from the delusional patriarchal fantasies of their employers about human reproduction and biology.

The opposition enjoys the sway of many people’s emotional ties to religious organizations that have in fact lurched to the right in recent decades. It’s important to seek a path that distinguishes respect and reverence for the institutions, from allegiance to discriminatory beliefs and practices There is also ample corporate funding. There are more deceptive “crisis pregnancy centers” in the U.S. than there are abortion providers.

But these views challenge women’s ability to be full, equal, constitutional persons in the United States of America.

Comments for regulations on this issue are due on April 8.  Sign our petition here, or write your own.

It’s time to stand and fight. Fair and equal coverage for birth control must be our next victory of 2013.

The rules would permit religiously-affiliated non-profit organizations like hospitals, universities and charities, as well as churches, to withhold coverage for contraception.  They can self-declare that they are religious institutions that oppose providing coverage for contraception. Employees would be issued individual insurance plans that cover contraception at no additional cost.

The proposed rules continue to stigmatize contraception, which is widely used and accepted, but too often inaccessible, especially to lower-income women. They would leave millions of women – and their families – subject to as-yet poorly defined financial and administrative arrangements, dependent on the compliance and goodwill of private health insurance plans.

* If link does not work, copy and paste into your bowser:

 http://www.ofr.gov/OFRUpload/OFRData/2013-02420_PI.pdf

From Catholics for Choice:

“The Obama Administration did the right thing the wrong way. According to the proposed rule, some women whose employers have a religious objection to providing contraception will still be able to get access through a  third party provider.

“That’s the good news, but the proposed rule’s expansion of which employers can be exempted from providing comprehensive preventive healthcare, including contraception, is appalling.  Women who work at Catholic schools, hospitals and social service agencies are wondering whether they’ll be able to get the same coverage as millions of other women, or if their healthcare just isn’t as important to the president as their bosses’ beliefs about sex and reproduction.

“It’s obvious that once again, the administration listened to the lobbyists for the Catholic bishops and their big business interests, instead of Americans of every faith and of none who support the separation of religion and state and believe that public policy should not impose or privilege any religious viewpoint. Allowing such a wide exemption gives religious extremists carte blanche to trump the rights of others, based merely on the assertion of a belief about contraception even if that belief runs contrary to science or the widely-held convictions of co-religionists.

“While protecting contraceptive access under the ACA is a win for women, the administration’s caving in to lobbying from conservative religious pressure groups is a loss for everyone. American Catholics who support contraceptive coverage, who believe in the separation of church and state and who were hoping for change in Washington are disappointed today.”

In addition:  NLJ Home > News > Seventh Circuit stays contraception insurance mandate in second case

Seventh Circuit stays contraception insurance mandate in second case. A federal appeals court has issued a second ruling staying the health care reform law’s requirement that health insurance plans cover contraception and related services.

From the Obama Administration:  Women’s Preventive Services Coverage and Religious Organizations

Thanks to the Affordable Care Act, most health plans cover recommended women’s preventive services, including contraception, without charging a co-pay or deductible.  The scientists and other experts at the independent Institute of Medicine provided recommendations to the Department of Health and Human Services (HHS) regarding which preventive services help keep women healthy and should be covered without cost-sharing. The IOM recommended covering contraception without a co-pay or deductible because there are tremendous health benefits for women that come from using contraception. In fact, nearly 99% of all women have relied on contraception at some point in their lives, but more than half of all women between the ages of 18 and 34 have struggled to afford it.

Today, the Obama Administration moved forward to continue to implement provisions in the health care law that would provide women contraceptive coverage without cost sharing, while taking into account religious objections to contraceptive services by certain religious organizations. The Notice of Proposed Rulemaking (NPRM) released today reflects the public feedback from comments on the Advance NPRM issued in March 2012.

Today’s proposals build on the ideas we laid out last year to provide women with coverage for recommended preventive care, including contraceptive services, without cost sharing, while also ensuring that non-profit organizations with religious objections won’t have to contract, arrange, pay, or refer for insurance coverage for these services to their employees or students.

Details on these proposed policies are outlined below.  The Administration is seeking comment on these proposals and welcomes feedback from all Americans through April 8, 2013.

Exemption for Religious Employers
Group health plans of “religious employers” are exempted from having to provide contraceptive coverage, if they have religious objections to contraception.

Today’s NPRM would simplify the existing definition of a “religious employer” as it relates to contraceptive coverage.

The NPRM would eliminate criteria that a religious employer:

1. have the inculcation of religious values as its purpose;
2. primarily employ persons who share its religious tenets; and
3. primarily serve persons who share its religious tenets.

The simple definition of “religious employer” for purposes of the exemption would follow a section of the Internal Revenue Code, and would primarily include churches, other houses of worship, and their affiliated organizations, as defined by Section 6033(a)(3)(A)(i) or (iii)

This proposed change is intended to clarify that a house of worship would not be excluded from the exemption because, for example, it provides charitable social services to persons of different religious faiths or employs persons of different religious faiths.  The Departments believe that this proposal would not expand the universe of employer plans that would qualify for the exemption beyond that which was intended in the 2012 final rules.

Creating Accommodations for Non Profit Religious Organizations

Consistent with the Advance NPRM, the NPRM proposes accommodations for additional non profit religious organizations, while also separately providing enrollees contraceptive coverage with no co-pays.  An eligible organization would be defined as an organization that:

1. opposes providing coverage for some or all of any contraceptive services required to be covered under Section 2713 of the PHS Act, on account of religious objections;
2. is organized and operates as a nonprofit entity;
3. holds itself out as a religious organization; and
4. self-certifies that it meets these criteria and specifies the contraceptive services for which it objects to providing coverage.

Under the proposed accommodations, the eligible organizations would not have to contract, arrange, pay or refer for any contraceptive coverage to which they object on religious grounds.

In addition, under the proposed accommodations, plan participants would receive contraceptive coverage through separate individual health insurance policies, without cost sharing or additional premiums.  The issuer would work to ensure a seamless process for plan participants to receive contraceptive coverage.

With respect to insured group health plans, the eligible organization would provide the self-certification to the health insurance issuer, which in turn would automatically provide separate, individual market contraceptive coverage at no cost for plan participants.  Issuers generally would find that providing such contraceptive coverage is cost neutral because they would be they would be insuring the same set of individuals under both policies and would experience lower costs from improvements in women’s health and fewer childbirths.

With respect to self-insured group health plans, the eligible organization would notify the third party administrator, which in turn would automatically work with a health insurance issuer to provide separate, individual health insurance policies at no cost for participants.  The costs of both the health insurance issuer and third party administrator would be offset by adjustments in Federally-facilitated Exchange user fees that insurers pay.

The NPRM also proposes that an eligible religious non profit organization that is an institution of higher education that arranges for student health insurance coverage may avail itself of an accommodation comparable to that for an eligible organization that is an employer with an insured group health plan.

The NPRM on women’s preventive services coverage is available here: http://www.ofr.gov/inspection.aspx.

For more information on women’s preventive services coverage, visit:  http://www.healthcare.gov/news/factsheets/2011/08/womensprevention08012011a.html.

OBOS is taking part in Trust Women Week to urge policy makers to support reproductive justice and access to contraception and abortion. You can add your name to a petition that will be sent to legislators. In San Francisco, sign up to Celebrate Women, Life and Liberty this Saturday Jan. 26 starting at 10 a.m. at Justin Herman Plaza.

Trust Women Week partners, including NOW, the National Women’s Health Network, and ACT for Women and Girls, are mobilizing and informing our communities.

In honor of the 40th anniversary of Roe v. Wade, we are proud to offer the documentary Voices of Choice: Physicians Who Provided Abortions Before Roe v. Wade, online, in full, for the first time.

A 25-minute film created by PRCH in 2003, Voices of Choice documents the experiences of physicians involved in abortion care and reform prior to the landmark Supreme Court Roe decision in 1973. Their stories remain fascinating, moving, and profound—a record of the horror of illegal abortion and the social and historical ramifications of a time when health care providers worked to save the lives of women who suffered needlessly.

Voices of Choice preserves the legacy of older physicians and figures in the reproductive rights movement who witnessed the effects of illegal abortion, including:

• Curtis Boyd, MD, who has provided abortions since 1965
• Bylle Avery, founder of the National Black Women’s Health Project, who prior to Roe was a leader in the underground abortion referral network
• Mildred Hanson, MD, who saw the tragic results of illegal abortion as a young gynecologist in the years before Roe
• The late Reverend Howard Moody, who helped found the Clergy Consultation Service on Abortion in 1967, an extensive network of clergy members and abortion providers
• The late George Tiller, MD, who was murdered in 2009 for providing abortions

Watch the full video, and follow the links below to read transcripts from individual interviews. To request an interview with one of the physicians featured in the Voices of Choice video, please contact Alexandra Ringe at 646-649-9907 or email alexandra@prch.org.

Women won historic numbers of seats in Congress in the November election. Voters across the political spectrum supported women’s reproductive  health, rights, and justice, and defeated candidates who trivialized  women’s safety. Florida rejected a ballot measure that would outlaw  public funding for abortions.

But many state legislatures and members of Congress continue to attack  access to birth control and abortion care, and cut funds for health care providers like Planned Parenthood. In Mississippi, state regulators plan to force  the last clinic that provides abortions to close. These  restrictions most severely affect low-income women and women of color,  and women in certain geographic areas.

Threats continue to women’s long-term economic and social security and safety.

Trust Women Week partner organizations are joining together to express the  powerful voices of the majority of women, men, children, families and  communities who uphold traditional American values of democracy, independence, fairness, progress, innovation and pragmatism.

See www.oursilverribbon.org to find an event near you – or create one and post it!

Messages to Congress

1.      I Trust Women and I Vote
Women can make our own decisions about our reproductive health, and we did and will vote to enforce that right.

2.      Her decision, her health
We extend respect and compassion to individual women facing decisions about a pregnancy.

3.      Keep abortion safe and legal, and make it accessible and affordable

4.      Stand up and be counted for the human right to reproductive health and justice.
Reproductive justice and rights call on us to create the  conditions necessary for health, recognizing that we must take action to overcome disparities based on social factors including race, gender,  and income. 

5.      Contraception is Prevention
Contraception must be included in preventive health care benefits in all public and private health insurance programs

6.      Fix the economy and stop the attacks on women’s health.
We call on the government and our elected officials to help improve our lives and create the conditions to be healthy.
7.      U.S. Out of My Uterus
Politicians should stop interfering in women’s personal health decisions, especially related to reproductive biology and sex.