Preventing Unwanted Pregnancy
January 24, 2005 — NYS Family Planning Providers, New York City
Thank you all very much for having me. I am so pleased to be here two days after the 32nd anniversary of Roe v. Wade, a landmark decision that struck a blow for freedom and equality for women. Today Roe is in more jeopardy than ever, and I look forward to working with all of you as we fight to defend it in the coming years. I’m also pleased to be talking to people who are on the front lines of increasing women’s access to quality health care and reducing unwanted pregnancy — an issue we should be able to find common ground on with people on the other side of this debate.
We should all be able to agree that we want every child born in this country and around the world to be wanted, cherished, and loved. The best way to get there is do more to educate the public about reproductive health, about how to prevent unsafe and unwanted pregnancies.
My own views of family planning and reproductive rights are heavily influenced by my travels as First Lady. I saw firsthand the costs to women when the government controls their reproductive health decisions.
In pre-democratic Romania, they had a leader named Ceausescu, a Soviet style Communist dictator, who decided it was the duty of every Romanian woman to bear five children so they could build the Romanian State. So they eliminated birth control, they eliminated sex education, and they outlawed abortions.
Once a month, Romanian women were rounded up at their workplaces. They were taken to a government-controlled health clinic, told to disrobe while they were standing in line. They were then examined by a government doctor with a government secret police officer watching. And if they were pregnant, they were closely monitored to make sure you didn’t do anything to that pregnancy.
If a woman failed to conceive, her family was fined a celibacy tax of up to 10 percent of their monthly salary. The terrible result was that many children who were born were immediately abandoned, and left to be raised in government-run orphanages.
Now go to the other side of the world and the opposite side of this debate. In China, local government officials used to monitor women’s menstrual cycles and their use of contraceptives because they had the opposite view — no more than one child. If you wanted to have a child in China, you needed to get permission or face punishment. After you had your one allotted child, in some parts of China, you could be sterilized against your will or forced to have an abortion.
So whether it was Romania saying you had to have children for the good of the state, or China saying you can only have one child for the good of the state, the government was dictating the most private and important decisions we make as families and as women. Now with all of this talk about freedom as the defining goal of America, let’s not forget the importance of the freedom of women to make the choices that are consistent with their faith and their sense of responsibility to their family and themselves.
I heard President Bush talking about freedom and yet his Administration has acted to deny freedom to women around the world through a global gag policy, which has left many without access to basic reproductive health services.
This decision, which is one of the most fundamental, difficult and soul searching decisions a woman and a family can make, is also one in which the government should have no role. I believe we can all recognize that abortion in many ways represents a sad, even tragic choice to many, many women. Often, it’s a failure of our system of education, health care, and preventive services. It’s often a result of family dynamics. This decision is a profound and complicated one; a difficult one, often the most difficult that a woman will ever make. The fact is that the best way to reduce the number of abortions is to reduce the number of unwanted pregnancies in the first place.
As many of you know, I have worked on these issues throughout my career and I continue to work on them in the Senate. One of the most important initiatives I worked on as First Lady and am proud to continue to champion in the Senate is the prevention of teen pregnancy. I worked alongside my husband who launched the National Campaign to Prevent Teen Pregnancy in the mid-1990s. This organization, which has proven to be a tremendous success, was really was born out of my husband’s 1995 State of the Union address, which declared teenage pregnancy to be one of the most critical problems facing our country. We set a national goal of reducing unwanted pregnancies by one-third over the decade. We knew, though, that this goal could not be reached with a government-only effort. That’s why we invited private sector sponsors to join the board and use their organizations to send a powerful message to teens to be responsible about their futures.
Now back when the National Campaign was getting off the ground, I actually came to New York City and gave a speech before high-profile members of the media — essentially challenging the media to embrace this issue and use its power to send strong, clear messages to teenagers to be responsible. Back then I used the phrase “teenage celibacy” over and over. Of course, no one talks about “teenage celibacy” anymore, but the message remains relevant and necessary today. I think it’s a synonym for abstinence.
The good news is that the National Campaign, which has nourished many new and fruitful partnerships like those with Time Warner and with the faith community, has helped achieve the goal that my husband set in his State of the Union in 1995. Between 1991 and 2003, the teen birth rate fell 32.5 percent to a record low. The National Campaign has also conducted and disseminated some critical research on the important role that parents can play in encouraging their children to abstain from sexual activity.
So I’m very proud of the work of the National Campaign. We’ll be celebrating its 10th anniversary this yearand I will continue working with them to keep the number of unwanted pregnancies among our teenagers falling until we get to zero. But we have a long road ahead.
Today, even with the recent decline, 34% of teenage girls become pregnant at least once before their 20th birthday, and the U.S. has the highest teen pregnancy rate of any industrialized country. Children born to teen moms begin life with the odds against them. They are more likely to be of low-birth weight, 50 percent more likely to repeat a grade, and significantly more likely to be victims of abuse and neglect. And girls who give birth as teenagers face a long, uphill battle to economic self-sufficiency and pride. Clearly we do have our work cut out for us.
Research shows that the primary reason that teenage girls abstain is because of their religious and moral values. We should embrace this – and support programs that reinforce the idea that abstinence at a young age is not just the smart thing to do, it is the right thing to do. But we should also recognize what works and what doesn’t work, and to be fair, the jury is still out on the effectiveness of abstinence-only programs. I don’t think this debate should be about ideology, it should be about facts and evidence — we have to deal with the choices young people make not just the choice we wish they would make. We should use all the resources at our disposal to ensure that teens are getting the information they need to make the right decision.
We should also do more to educate and involve parents about the critical role they can play in encouraging their children to abstain from sexual activity. Teenagers who have strong emotional attachments to their parents are much less likely to become sexually active at an early age.
But we have to do more than just send the right messages and values to our children. Preventing unwanted pregnancy demands that we do better as adults to create the structure in which children live and the services they need to make the right decisions.
A big part of that means increasing access to family planning services. I have long been a strong supporter of Title X, the only federal program devoted solely to making comprehensive family planning services available to anyone interested in seeking them. Each year, approximately 4.5 million people receive health-care services at Title X-funded clinics. Nearly two-thirds of Title X clients come from households with incomes below the poverty level. And just to remind you, the poverty level is currently set for a family of three at $15,620. So where do these two-thirds of Title X clients go to receive the services they need? Unfortunately, despite the Clinton Administration working to obtain a 58% increase during the 1990s, the Bush Administration proposed level funding for Title X at $265 million for the 2003 and 2004 budgets, and Congress appropriated only $275 million in 2003. So even as our population has grown and the need has increased, the funding has remained stagnant. In fact, if Title X funding had increased at the rate of inflation from its FY 1980 funding level of $162 million, it would be at approximately $590 million now, but because its been held flat and we don’t even know yet what the next budget holds for Title X funding. Title X cannot keep pace with basic services, let alone meet the growing cost of diagnostic tests and new forms of contraception.
It’s also important that private insurance companies do their part to help reduce unwanted pregnancies. That is why I am a proud co-sponsor of the Equity in Prescription Insurance and Contraceptive Coverage — the so-called EPICC. The legislation would require private health plans to cover FDA-approved prescription contraceptives and related medical services to the same extent that they cover prescription drugs and other outpatient medical services. This bill simply seeks to establish parity for prescription contraception. Thanks to so many of the people in this room and the advocates, the EPICC law is now in effect in New York State having been passed and signed in 2002. It’s a real role model for the nation. And it’s about equal rights and simple justice. After all, if insurance companies can cover Viagra, they can certainly cover prescription contraceptives.
Contraception is basic health care for women, and the burden for its expense cannot fall fully on all women, many who after all live below that poverty rate, and in many instances above it, but not by very much and have a hard time affording such prescriptions. Just think, an average woman who wants two children will spend five years pregnant or trying to get pregnant, and roughly 30 years trying to prevent pregnancy. As I said earlier, and you know so well, the U.S. has one of the highest rates of unintended pregnancy in the industrialized world. Each year, nearly half of the six million pregnancies in this country are unintended, and more than half of all unintended pregnancies end in abortion.
The use of contraception is a big factor in determining whether or not women become pregnant. In fact, this is a statistic that I had not known before we started doing the research that I wanted to include in this speech, 7% of American women who do not use contraception account for 53% of all unintended pregnancies. So by preventing unintended pregnancy, contraception reduces the need for abortion. Improving insurance coverage of contraception will make contraception more affordable and reduce this rate of abortion. And expanding coverage and resources for Title X will do the same.
Another form of family planning that should be widely available to women is “Plan B,” Emergency Contraception. I agree with the scientists on the Food and Drug Administration’s Advisory Panel who voted overwhelmingly that Plan B is safe and effective for over the counter use. And I worked to launch a GAO investigation into the process of denying Barr Laboratories’ application because I believe the decision was influenced more by ideology than evidence.
I am hopeful that the FDA will come to its senses and announce a new policy making Plan B available. Information about Plan B should be available over the counter, which is exactly what the FDA’s Advisory Committee recommended. It should also be made available —automatically — to women who are victims of sexual assault and rape. I have to confess that I never cease to be surprised but last week, I joined with 21 of my colleagues in sending a letter to the Director of the Office on Violence Against Women — that’s the name of the office at the Department of Justice — urging the Director to revise the newly-released first-ever national protocol for sexual assault treatment to include the routine offering of emergency contraception. Right now, this 130-page, otherwise comprehensive document fails to include any mention of emergency contraception, a basic tool that could help rape victims prevent the trauma of unintended pregnancies, avoid abortions, and safeguard their reproductive and mental health. Every expert agrees that the sooner Plan B is administered, the more effective it is. Once a woman becomes pregnant, emergency contraception obviously will have no effect.
Yet nowhere does the DOJ Protocol mention emergency contraception or recommend that it be offered to sexual assault victims. According to the Alan Guttmacher Institute, there are 15,000 abortions a year from rape. How is it possible that women who have been so victimized by violence can be victimized again by ideology? And how can we expect to reduce the number of unwanted pregnancies if we lose this most obvious opportunity to help women who may have had an unwanted pregnancy physically forced upon them?
I hope that whatever one believes or whatever side of the aisle one is, in either the NY State Legislature or the Congress, or anywhere in our country, we all at least agree that the Department of Justice must immediately revise its protocol to include strong recommendations about emergency contraception.
And the final building block of our effort to increase women’s health includes ensuring that once women become pregnant, they have access to high-quality pre-natal care so that they can bring healthy children into the world.
One bill that provides a comprehensive approach to the problem of unintended pregnancies encapsulates many of these efforts. It’s called “The Putting Prevention First Act.” It provides a roadmap to the destination of fewer unwanted pregnancies – to the day when abortion is truly safe, legal, and rare. The Putting Prevention First Act, which I was proud to co-sponsor in the last Congress, increases funding for Title X; expands Medicaid family-planning services to provide access for more low-income women; ensures that health plans that cover prescription drugs also cover prescription contraceptives; funds emergency contraception public-education campaigns for doctors, nurses and women; ensures that hospital emergency rooms offer emergency contraception to victims of sexual assault; and establishes the nation’s first-ever federal sex-education program.
A very similar version of the Putting Prevention First Act is being introduced today, one of the first bills introduced by Minority Leader Harry Reid, to lay out the Democratic plan for women’s reproductive healthcare. I am proud to be a co-sponsor of this bill and I will work very hard to see that it is enacted. Because I know we can make progress on these issues; the work of the Clinton Administration and so many others saw the rate of abortion consistently fall in the 1990’s. The abortion rate fell by one-fourth between 1990 and 1995, the steepest decline since Roe was decided in 1973. The rate fell another 11 percent between 1994 and 2000, from about 24 to 21 abortions for every 1,000 women of childbearing age.
But unfortunately, in the last few years, while we are engaged in an ideological debate instead of one that uses facts and evidence and commonsense, the rate of abortion is on the rise in some states. In the three years since President Bush took office, 8 states saw an increase in abortion rates (14.6% average increase), and four saw a decrease (4.3% average), so we have a lot of work still ahead of us.
I think it’s important that family planning advocates reach out to those who may not agree with us on everything to try to find common ground in those areas where, hopefully, emergency contraception, more funding for prenatal care and others can be a point of common ground.
As an advocate for children and families throughout my life, as a lawyer who occasionally represented victims of sexual assault and rape, as a mother, as a wife, as a woman, I know the difference that good information, good education, and good health care can make in empowering women and girls to make good decisions for themselves.
So in addition to the work that lies ahead of us here at home I would just put in a word for the work that weshould be doing around the world. It has been tragic to see so much of the good work that provided family planning assistance and resources to physicians and nurses to deliver to women in places where there was no family planning, where in fact abortion was the only means of contraception. But during the 90’s we reached out to women and girls in other parts of the world. When my husband rescinded the global gag rule we began to work on behalf of women’s health, though the infant mortality and maternal mortality rate is way too high in so many parts of the world. When I was in Afghanistan last year, I met with a group of women and their number one plea was what can the United States Government do to help save the lives of Afghan women who have one of the highest rates of maternal mortality in the world? Is there some way that more education could be brought in so that women could possibly have more control over their own lives? In places I’ve traveled I’ve cut the ribbons on clinics — that were partially funded by money from our government and money from private givers in our country — that for the first time would provide the full range of health services to women and girls. Because of the reinstatement of the global gag rule under President Bush that work has stopped. Those resources have dried up. The lives of so many women and girls have been put at risk. We can do better not only here at home but around the world.
Yes we do have deeply held differences of opinion about the issue of abortion. I for one respect those who believe with all their hearts and conscience that there are no circumstances under which any abortion should ever be available. But that does not represent even the majority opinion within the anti-abortion community. There are exceptions for rape and for incest, for the life of the mother. Those in the pro-choice community who have fought so hard for so many years, not only to protect Roe v. Wade and the law of the land, but to provide the resources that would effectuate that constitutional right, believe just as strongly the point of view based on experience and conscience that they have come to. The problem I always have is what is the proper role of government in making this decision? That is why I started with two stories about Romania and China. When I spoke to the conference on women in Beijing in 1995 — ten years ago this year — I spoke out against any government interfering with the reproductive rights and decisions of women and families.
So we have a lot of experience from around the world that is a cautionary tale about what happens when a government substitutes its opinion for an individual’s. There is no reason why government cannot do more to educate and inform and provide assistance so that the choice guaranteed under our constitution either does not ever have to be exercised or only in very rare circumstances. But we cannot expect to have the kind of positive results that all of us are hoping for to reduce the number of unwanted pregnancies and abortions if our government refuses to assist girls and women with their health care needs, a comprehensive education and accurate information.
So my hope now, today, is that whatever our disagreements with those in this debate, that we join together to take real action to improve the quality of health care for women and families, to reduce the number of abortions and to build a healthier, brighter more hopeful future for women and girls in our country and around the world.
Thank you very much.