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Politicizing Birth Control

by Carole Joffe

"Crass commercialization and distribution of birth control is demeaning to women, degrading of human sexuality, and adverse to human health and happiness."

Although the 98 percent of heterosexually active women in the United States who have used birth control would likely take issue with the above statement, this is America, after all, the land of free speech. People and organizations are entitled to their opinions, however unpopular.

But the statement takes on a special meaning when we find out it appears on the website of A Woman's Concern, a fleet of so-called "Crisis Pregnancy Centers" in Boston, whose major function is discouraging women from having abortions. Eric Keroack, the medical director of A Woman's Concern, has just been named deputy assistant secretary of population affairs by the Bush administration. The "DASPA" is the government official who is in charge of federal family planning programs. This official oversees the Title X program which currently disperses some $283 million to clinics for contraceptive supplies and information, as well as breast and pelvic exams, pregnancy diagnosis and counseling and screenings for sexual transmitted infections. Title X funds are targeted toward low-income persons.

So how did we get to this Orwellian situation where the person in charge of helping poorer Americans obtain birth control thinks the major service his office provides is "demeaning and degrading?" In fact, though Keroack's record of opposition to contraception is unmatched by previous DASPAs, the position has long been used by Republican presidents as a relatively pain-free way to reward their extreme rightwing base. The position does not require confirmation by Congress, and thus has served as an ideal "stealth" appointment—one to which most Americans do not pay attention.

By making such a clearly inappropriate—if not bizarre—appointment, President Bush is following in the steps of his father, George H. W. Bush. The DASPA during the latter's presidency was William Reynolds Archer III, an obstetrician gynecologist who publicly and proudly proclaimed himself sexually abstinent at the age of 37. He was famously quoted in the press as saying that "when it became possible for women to buy contraceptives on their own, men lost their manhood."

In contrast, the DASPA who followed Archer, in President Clinton's administration, was the late Felicia Stewart, a highly respected physician whose major achievement in that office was to convince the FDA to rule on the safety of emergency contraception. EC is a higher than normal dose of oral contraception that, if used within a certain time frame after unprotected sex, is very effective in preventing pregnancy. This finding in turn led to the approval of a dedicated product for EC, now known as "Plan B." In short, Dr. Stewart did what one would expect someone in this position to do—determined the safety and efficacy of contraceptive options and worked to make them more available to the public.

The irony in all this is that, while Archer and Keroack were selected for their long involvement with anti-abortion groups, and Dr. Stewart was a supporter of abortion rights, it was her work as DASPA that actually led to fewer abortions. The highly respected Guttmacher Institute, a private organization that studies reproductive health, estimated recently that some 50,000 abortions per year are averted because of EC. The recent approval of over-the-counter status for EC (for women 18 and over) will presumably increase this number.

Dr. Keroack assumes his post at a time when low-income women are losing ground in their ability to obtain birth control. The Guttmacher Institute recently reported that about half of all poor women who need birth control are unable to afford it. The $283 million now allocated to Title X has not been raised in several years and is not enough to meet the need. If the funding were doubled, the experts at Guttmacher say, that would prevent some 244,000 unintended pregnancies, 116,000 unplanned births and about 98,000 abortions annually. But meeting such contraceptive need is hardly likely to happen on our new DASPA's watch.

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