Consequences of Planned Parenthood Defunding

This is way more important than soccer kits, even insultingly patronizing ones. Go right now and read about one Texas woman's attempt to find low-cost well-woman care in the new world Republicans are trying to create. Then call your senators.

And Here We Go

Not sure how this slipped past me the first time, but, um, pardon me; are you one of the people who thinks physician and pharmacist conscience clauses aren't a big deal because you can just go to some other pharmacy, some other hospital? Yeah, sometimes the Catholic Church takes over the only hospital in town, as it did in Sierra Vista, Arizona, and it suddenly becomes a very big deal.

Southern Arizona's Carondelet Health Network is about to join forces with Sierra Vista Regional Health Center.

The two health-care providers will execute an "integrative network agreement" April 17, which will allow them to share resources, officials from both say.

Trustees with Sierra Vista Regional Health Center say one of the major concerns has been a prohibition on sterilization procedures that will occur at the hospital as a result of the agreement. They say the prohibition is part of the Ethical and Religious Directives for Catholic Health Care Services used by Carondelet, a Catholic, nonprofit network.

And there you have it. Well, maybe it's not all that bad, right?.

On Sunday, the Sierra Vista hospital ran an advertisement in the Sierra Vista Herald that says the only services that will be discontinued are direct sterilization procedures and IUD insertion, except for directly therapeutic purposes.

The hospital will continue to treat ectopic pregnancies and will still use Plan B (the morning-after pill) for rape victims, says the advertisement, which was signed by hospital President and CEO Margaret Hepburn and board of trustees chair Larry Kope.

Abortion for ectopics and Plan B for rape is great, although I'm not sure why I should be turning handsprings for legal procedures and medications remaining accessible to women who need them, but abortion and emergency contraception for people in different circumstances? It's difficult to conclude otherwise that the level of specificity in the hospital's statement is intentionally exclusive. And that's just fabulous news for the women of Sierra Vista who don't have the means or time to drive the hour and a half to Tucson.

It's a two-year agreement. Maybe the economy will improve enough in that time to allow the Sierra Vista hospital to get back on its own feet and go back to operating under a general humanist code of ethics, not one dictated by the Catholic Church./p>

Arizona Legislature Notices Janet Napolitano is no Longer Governor, Crams Every Previously Vetoed Abortion Restriction into Single Law

The new Arizona law that massively restricts access to abortion and emergency contraception is scheduled to kick in at the end of this month. The first lawsuits were filed yesterday. Most of the provisions were included in bills vetoed at least once by former governor Janet Napolitano, although at least one rather audacious restriction was tossed in for good measure, just because they can.

Among other things, the new law includes a provision that prohibits nurse practitioners from performing abortions, a move expected to shrink services in Southern Arizona to a level at which women will be forced to go to Phoenix for the procedure, said Patti Caldwell, the chief operating officer of Planned Parenthood Arizona. It also allows health-care and pharmacy employees to refuse to take part in any way in abortions or to fill related prescriptions if they have moral or religious objections. [...]

Other provisions of the new law require that minors provide notarized parental consent for an abortion and that a woman make a face-to-face visit with the abortion provider within 24 hours before the procedure or emergency contraception such as the "morning-after pill" can be prescribed.

That last bit is the one that made me choke on my Kashi this morning. A mandatory 24-hour waiting period before EC can be prescribed? When it's a nonprescription medication? Hmm. Nancy Barto says "expanding the law to cover the morning-after pill simply updates existing laws covering abortions," cheerfully continuing to falsely conflate emergency contraception with abortion, which it most assuredly is not. A reading of the text of the House bill suggests the Daily Star got the bit wrong about a waiting period before acquiring EC, since there is no mention of it either there or in the Senate version (although the conscience clause exemption specific to pharmacists not wanting to hand it over still stands). But hang on, there's still more than enough bullshit to go around.

Rep. Nancy Barto, R-Phoenix, the legislation's sponsor, said all the provisions are good policy to protect the health of women as well as being legally sound. Barto defended the 24-hour waiting period — and specifically the requirement for face-to-face counseling — rather than allowing a woman to get the information over the phone and avoid having to make a second trip.

"This ensures that they get the information that they need and the attention that they get for their own health," she said.

Because lord knows the primary societal effect of the Information Age has been limiting the delivery and comprehension of information to face-to-face interactions. Phone? Internet? It's a wonder people can even order a pizza any more with the intervention of these confounded electrical instruments, much less raise the local constabulary! But wait! It gets even better, where "better" means "completely assfucked sideways with a chainsaw and no lube."

The requirement, however, does not stop there. The law says certain information can be given to women only by the physician who will perform the abortion and not a nurse or other staffer.

Shade your eyes. This one really requires shouting. Because LORD KNOWS THE ONLY DOCTOR CURRENTLY PROVIDING ABORTION SERVICES IN ALL OF SOUTHERN FUCKING ARIZONA FOR PLANNED PARENTHOOD HAS NOTHING BETTER TO DO WITH A 16-HOUR DAY THAN HOLD FACE-TO-FACE COUNSELING SESSIONS. Can Cathi Herrod, chief harpy of the Center for Arizona Policy, clear this up for us? Of course she can.

"Finally, Arizona is taking care of the needs of women facing the abortion decision, as well as parents and health-care professionals," said Cathi Herrod, president of the Center for Arizona Policy, which lobbied for the legislation.

Finally. Up, down. Black, white. Charlie Weis, football genius. Arizona, taking care of women's needs. How nice to be taken care of like this. Throw enough roadblocks up between a woman and one of her options in "the abortion decision" and the decision pretty much makes itself for her, doesn't it? Which, unfortunately, is exactly the point.

The hearing on Planned Parenthood's requested injunction is scheduled for next week. Can you feel the optimism from BoltCorner? Me neither.

As Expected, Arizona Restricts Access to Abortion

Governor Jan Brewer signed a few highly annoying abortion restrictions into law yesterday, including a required 24-hour waiting period, a reiteration of the ban on intact dilation and extraction, a redundant requirement that women seeking an abortion be informed of its risks and alternatives, strengthened parental consent requirements for minors, and a self-righteousness conscience clause exempting healthcare workers from participating in an abortion or even dispensing emergency contraception.

Because nothing should give a fundamentalist pharmacist a bigger hard-on than denying Plan B to a woman who may then end up seeking an abortion as a result.

None of this is surprising, as all of these measures had wound up on former governor Janet Napolitano's desk at one time or another over the past few years, only to be vetoed. Despite Brewer's unexpected rational thinking about state taxes in the face of a monster deficit, her social conservaservaSERVAtism is as unchanged as ever.

Curiously, I find myself more frustrated by the emergency contraception clause than by the restricted access to actual abortion this time around. Maybe it's because the exemption betrays a continuing ignorance of how Plan B actually works, which, if you're a medical professional--and particularly if you're a pharmacist--is inexcusable. I've flogged this to death on this blog, in comments on other blogs, in letters to the newspaper, and to random people I meet in the grocery store, but it apparently bears repeating: Plan B is not an abortifacient. Plan B does not interfere with conception or implantation. Plan B functions only to inhibit ovulation for the length of time that sperm are viable after ejaculation. Plan B does not cause abortions. It has been hypothesized that in a very small number of cases, Plan B might prevent implantation, but this is both highly unlikely and untestable, as there is no test for conception prior to implantation. So demanding that scientists prove that Plan B does not interfere with implantation is on the same level as demanding they prove that eating Twinkies or staring at the sun or hopping on your right foot five times while chanting nobabynobabynobaby does not interfere with implantation. You can't prove a negative, but you can predict with pretty good certainty that a drug that acts to maintain the uterine lining will not make the uterine wall a hostile environment to a zygote.

So science is trumped by hysteria, and Arizona women woke up this morning to find that the barricades between them and a still-legal medical procedure have been piled even higher with razor wire and old tires, and some of the tires have started to be set on fire. How's that DHS job treating you, Janet?

Governor Notices Arizona Only Ranks 5th in Nation on Teen Birthrates, Acts Accordingly

Arizona's teens are currently getting their collective birth-giving asses handed to them by the kids in Mississippi, New Mexico, Texas, and Arkansas, so Governor Jan Brewer is springing into action by opening the floodgates to the federal abstinence-only funding that her rational predecessor, Janet Napolitano, said uh, no to.

"This governor believes that abstinence education is the right path to take," said gubernatorial spokesman Paul Senseman. He said the fact the program won't cost the state anything only bolsters Brewer's belief that it makes sense.

See? It's free! What's not to like? Oh.

Napolitano, in refusing to take more federal funding last year, cited a study by the U.S. Department of Health and Human Services. It found that teens in abstinence-only programs "were no more likely than youth who were assigned to the 'services as usual' control group to have abstained from sex."

Acting state health director Will Humble (no relation to state environmental quality "commissioner" Benjamin Grumbles) likes the abstinence-only curriculum because it promotes self-esteem and decision-making for teenagers, at least when that decision is to not have sex. Interestingly, while Humble thinks pairing those inarguably important skills with actual information about contraceptive would be a good idea, he's not even inching out onto that limb when it comes to his official job of, I don't know, safeguarding kids' health.

Humble also said he personally believes that birth control "probably should" be part of a high school curriculum. None of these funds, however, can be used to tell those teens who are going to be sexually active how to prevent pregnancy or avoid sexually transmitted diseases.

Yeah, "probably." But with contraception off the table, what kinds of things, then, will the federal dollars allow teachers to tell Arizona children?

Federal regulations say the dollars can be used only for programs teaching that abstinence from sex outside of marriage is the "expected standard for all school-age children." Programs also must teach that sex outside of marriage "is likely to have harmful psychological and physical effects..."

In other words, the federal funding cannot be used to provide factual information about preventing pregnancy and life-threatening diseases, but it can be used to tell kids lies. Because nothing prepares kids for healthy adult sexual relationships like instilling the belief that a gold ring will magically protect them from whatever viruses their spouses might have picked up before the second or third time they renewed their virginity by making yet another purity vow, or will miraculously transform an abusive or exploitative relationship into the stuff dreamed by rainbow unicorns who breathe whipped cream with sprinkles. And, honestly, the greatest part of that funding by necessity will have to go toward busy-work modules that can be stretched to cover an entire semester's worth of classtime, since abstinence education can be boiled down to "no sex before marriage because it will make you insane and then kill you; the end," which can be communicated in just about as much time as it took you to read the sixteen words between the quotation marks there. Even allowing an extra second's dramatic pause there to accomodate the semicolon, it leaves an awful lot of instructional time to fill. And when you can't talk about things like biology or contraception, well, worksheets all around! Don't color outside the lines, kids!

The state of Illinois is re-evaluating abstinence programs this week too, with, not surprisingly, the same sets of arguments and data at loggerheads there as well, with the difference that sex-ed curricula are determined by local school districts rather than being standardized by the state education department. Roughly 40 percent of Illinois students get the abstinence-only classes, and the patchwork of lessons taught in middle schools makes high school health teachers pull their hair out.

Joliet Central High School teacher Susan Cailteux is reminded of how varied the sex education curriculum is at the elementary and middle school level every time she begins a unit with a 25-point quiz on the reproductive system.

"I'll get kids with a 5. They don't even get the uterus right," said Cailteux, who teaches high school sophomores about both abstinence and contraception. "It's very frustrating at times because you expect them to know the basics, but the basics have not been taught."

Sophomore Tim Nemec, 16, of Joliet acknowledged that he never learned much about reproduction or the risk of infections until he took the health course required of all sophomores at Joliet Central. After that, he noticed a shift in some classmates' attitudes.

"There were some kids who went in like, 'I don't care. I'll do what I want,' " Nemec said. "But after a while, they were sort of like, 'Wow, I don't know if this person is clean or not,' or, 'I could actually get someone pregnant.' "

In a country where two-thirds of high school seniors report being sexually active, with one in five of those reporting more than three partners, the need for universally taught, accurate information would seem to be self-evident, but too many people favor the fingers-tightly-in-ears, eyes-closed, la-la-la-I-can't-hear-you approach to their kids' *shudder* sexuality.

Abstinence-only advocates contend that, just as adults drill teens not to drink and drive, educators should teach them to avoid risk by maintaining celibacy until marriage.

They have their metaphors slightly out of focus. Providing accurate data about biology and contraceptives is not. the. same. as tossing your 16-year-old the car keys and a fifth of Jack. No, we don't want kids driving drunk. So we tell them not to drink, but we also tell them that if they do drink, or if the person they're riding with drinks, that they can call us for a ride home with no questions asked. We put a cab company's number in their cell phones and give them a twenty to keep in their wallets so they'll have a safe way out if they get into that situation. That in no way equates to saying well, I know you're going to drink anyway, so go ahead and take the Mustang! Driving drunk does not equate to having sex, but it does equate to having unprotected, stupid sex you're not mature enough to handle. So we do tell our kids that the only surefire way to avoid pregnancy is to keep penises far, far away from vaginas, and the only surefire way to avoid every STD is to not touch anyone ever, but then we also equip them with knowledge and the means to protect themselves when reality asserts itself. Because to do otherwise is to willfully punish them for their humanity by letting their lives get really fucked up by unwanted pregnancies and unwanted viruses, whether they're married at the time or not. And no amount of federal freebies--or the prospect of Arizona being NUMBER ONE!--can ever make that a good bargain.

More on the Arizona Abortion Bill: Tiny Conversations with Steve Farley

Steve Farley (D-28th) is the representative for my Arizona state congressional district. I e-mailed him after the Frank Antenori kerfuffle for his side of the Arizona Health & Human Services Committee hearing on HB 2564, which was introduced to further place restrictions and impediments in the paths of women seeking not only abortion but also emergency and other contraception in the state. He was kind enough to respond the same day and provided a little more information than I'd had before.

Steve doesn't sit on the HHS committee, so he wasn't present at the hearing the Democrats and their healthcare-providing allies decided to walk out of last month, nor did he discuss the strategy with them prior to the meeting. He suspects the intention was to prevent giving the Republicans a bigger platform than they were already going to have for what by many accounts was a predetermined outcome. He also provided a link to the debate over the bill and the amendment he offered when it came to a floor vote so that, as he said, I would be able to form my own opinion of it rather than simply getting his, and would be able to quote participants directly. The Farley amendment would have exempted women who are the victims of sexual assault (of both the incestual and non-incestual varieties) from the waiting period and doctor's script-reading requirement, and would have eliminated the pharmacist conscience clause for emergency and conventional contraception.

Dr. Matt Heinz's (D-27th) testimony in favor of the Farley amendment focused on the language in the bill defining pregnancy as beginning with conception, as well as on the conscience clause. It served up a simply stated bit of scientific information for people who believe that pregnancy starts at conception. Unfortunately, it's not clear that anyone who believes otherwise and had already decided to vote for the bill was listening.

As a medical professional myself, I'm very concerned, first of all that we're discussing this at all. But as the bill is written at this time it appears to actually redefine some accepted medical terminology, which is something I believe we should try to avoid as the Legislature. What I’m referring to in particular, which I’ll begin with, is a viable, clinically diagnosable pregnancy. Now, I understand that the bill defines this as the union of a sperm and ovum. However, fertilization, as I hope everyone knows, occurs at the ends of the fallopian tubes, which are attached to the uterus—forgive me for not bringing my uterus model—and that’s not where a pregnancy occurs or even could be defined necessarily as a viable intrauterine pregnancy. That [pregnancy] is where the ovum, the conceptus, that has been fertilized travels through the fallopian tubes, which takes seven to twelve days, and then there’s implantation in the endometrium, in the wall and lining of the uterus, and blood vessels supply the developing embryo in that situation, and that—that is what a pregnancy is, a clinically diagnosable, viable pregnancy. So I’m a little bit unclear as to what we’re trying to do with that language.

Next, I’m very concerned about how, um, about how this bill is going to affect the provision of healthcare, especially to women… Pharmacists being allowed to refuse any sort of medication ordered by a licensed physician is very disturbing to me, especially in regards to emergency contraception, where there’s not exactly a lot of time available for the patient to go to another place. There’s also no requirement that I see in the bill that says that the pharmacist who is refusing for moral reasons or for a conscience has to refer the women to somewhere where they can obtain this urgently needed medical attention or device or prescription. So I don’t like that at all.

And I do believe this is beyond the pharmacist’s scope of practice because then, again in this bill, the way things are defined even with the Barto amendment, it is unclear to me if this could also possibly prohibit certain other types of hormonal therapy which may not be used for birth control at all, to control excessive uterine or vaginal bleeding. A pharmacist should not be authorized to refuse these medications when prescribed by an appropriate licensed physician.

Nancy Barto--one of the original sponsors of the bill--came up with a rebuttal on the conscience issue that is a work of art, if by "art" we mean "flinging every can of paint I can find at the canvas in hopes something will stick."

The fact of the matter is that emergency contraception is not hard to get these days. In fact, it’s available over the counter. And it’s available online, there are websites to deliver it. You can get it through the mail. And so this does not deal with emergency contraception availability. This merely protects the right of conscience. If you have an opportunity to go, to receive emergency contraception, shouldn’t an ab- a pharmacist have an opportunity to keep his job and protect his faith, live by his faith and belief? Both rights are important. This bill makes sure those rights are protected.

Jesus. One more time! If you have the opportunity to go request a legal and necessary medication from the only middleman licensed and authorized to dispense it to you within the timeframe required for the medication to be effective, shouldn't that middleman have the opportunity to refuse to perform his job, at no risk to his continued employment? I'm not sure which is more disturbing to me--that Rep. Barto considers both of those "opportunities" to be "rights"--guess which of the two does not really fit into the "rights" category--or that she can say with a straight face that the bill protects the rights of women to obtain something that is legal.

Because despite her statement that both rights are important, it's only the rights of certain pharmacists that are really being protected here. And while emergency contraception is indeed "available over the counter," which simply means "without a prescription," if it were really as easy to lay hands on EC as on peanut M&Ms, then pharmacists wouldn't be its gatekeepers and their consciences would not be at issue either way. The simple fact that Barto's fighting to give some pharmacists the ability to bar all women from obtaining the medication is the proof that the only way to buy the stuff in a store is through a transaction with a pharmacist. You can't get it from the lady at the cosmetics counter or the guy in the liquor department. Yes, you can have EC delivered through the mail if you order it online, but good luck having it show up on your doorstep within your 72-hour window of opportunity (and remember that the further your timer ticks away from hour one toward hour 72, the chances of it working drop off precipitously, because if you ovulate before you can take the pill, you're screwed again). No computer or internet access? Too bad, so sad--but you can always comfort yourself with the knowledge that you've at least kept your pharmacist's delicate sensibilities from being injured.

As an interesting side note, Steve pointed out in his e-mail that the House Republicans had promised smart-as-a-whip Assistant Minority Leader Kyrsten Sinema (D-15th) that they wouldn't bring the bill to a floor vote until she was back from an overseas trip. And as soon as she was gone they hustled it to the floor because, Steve says, "they did not want her brilliant strategic mind to get in the way of their show." This is the same group that illegally shut off a Democrat's microphone to stop a filibuster that was intended to kill the no-gay-marriage constitutional amendment before it could come to a vote. They later admitted they broke the rules on that one, but hey, it was officially too late to do anything about it. It isn't too late to hammer your state senator now with arguments against this piece of crap bill.

Object Lesson

On the same day that we find out about George Bush's on-the-way-out-the-door proposed rule preventing federally funded medical facilities from firing or otherwise disciplining employees who refuse to perform the parts of their jobs involving abortion, sterilization, or contraception as long as they play the conscience card--and making de facto reproductive choices for people unlucky enough to be depending on them in the process--a co-worker forwarded this picture taken in Uganda by her international public health worker sister:

This is the Bush reproductive healthcare legacy in action. Good luck with your adult lives, kids. And especially you, little girl.

Why I Want Hillary to Be Our Lioness in the Senate

This is why. Like, for the next thirty years.

Last month, the Bush administration launched the latest salvo in its eight-year campaign to undermine women’s rights and women’s health by placing ideology ahead of science: a proposed rule from the Department of Health and Human Services that would govern family planning. It would require that any health care entity that receives federal financing — whether it’s a physician in private practice, a hospital or a state government — certify in writing that none of its employees are required to assist in any way with medical services they find objectionable...

The rule would also allow providers to refuse to participate in unspecified “other medical procedures” that contradict their religious beliefs or moral convictions. This, too, could be interpreted as a free pass to deny access to contraception.

Many circumstances unrelated to reproductive health could also fall under the umbrella of “other medical procedures.” Could physicians object to helping patients whose sexual orientation they find objectionable? Could a receptionist refuse to book an appointment for an H.I.V. test? What about an emergency room doctor who wishes to deny emergency contraception to a rape victim? Or a pharmacist who prefers not to refill a birth control prescription?

Maybe it feels like a crap-ass consolation prize after being denied a run at the White House. But Jesus, she could stay in the Senate forever and fight for us there in a very effective, very important way. I don't know if four or eight years of a bully pulpit would have the same effect, especially as people inevitably start ignoring years six through eight except for monumental fuckups. But I do know that she's the first woman senator to be loudly and continuously vocal about the HHS situation, and if we've finally found someone to carry that banner, well, I hope she doesn't give it up any time soon.

The Boltgirl Coupon Clipper: Contraception

Read this, print it, clip it out, laminate it, and keep it in your pocket to thrust in the face of the next conscientious pharmacist, HHS employee, or severely Catholic great-aunt who bleats at you that birth control = abortion.


















Clip 'n' save 'n' quote frequently.

This is the relevant portion of the abstract of a peer-reviewed paper (meaning here: actual science) from the American Journal of Obstetric Gynecology that was designed to evaluate the familiar claim of the anti-contraception camp that oral contraceptives prevent the implantation of the fertilized egg in the uterus, and thus are nothing more than little abortion 21-packs. This is the "reasoning" behind the new Health and Human Services proposal that all healthcare workers receiving federal monies be allowed to refuse to administer said contraception under an expanded and even more insidious conscience clause than we've already had to deal with regarding pharmacies.

The one little problem with the "pills kills babies" argument is that it's patently false. As Christina Page explains over at HuffPo, the pill works by preventing ovulation, and on the very small chance that an egg manages to wriggle out of the ovary despite a hormonal bombardment that will keep it lodged in there 'til the cows come home, secondary hormonal safeguards are in place to make it very difficult for sperm to slog their way to the egg through thickened mucous on the vaginal walls, and then, if an exhausted sperm or two stagger up to the egg more exhausted than salmon whose ladders up the falls have been removed for painting, the lining of the egg itself will refuse to cooperate with them. In other words, if you use the pill there will almost certainly be no egg, and if there is an egg it won't get fertilized.

But, the anti-contraceptioneers will whinge, what if three individually statistically unlikely events all happen, even more statistically unlikely, all at the same time and there is an egg and there is a sperm and they hook up and create a zygote? Well, if all that happens, it's probably going to implant at the same rate as any other fertilized egg, which is roughly 50% of the time. Progestin acts to maintain the endometrium, which is the exact opposite of a hostile environment for the egg, so if those three unlikely events all occur (four if you count the even odds of a fertilized egg burrowing into the uterine wall and sticking), there's no evidence to suggest that implantation will be hindered at all.

Plan B, the morning-after pill, works exactly the same way because it's exactly the same hormone, simply at a higher dosage. PZ Myers explains in detail here. Plan B is a wing and a prayer because it only works if you haven't already ovulated. If an egg is lurking in the vicinity of your fallopian tubes when a load of semen gets dumped into your vagina, Plan B will not keep the egg from getting fertilized, and will not keep it from implanting in your uterine wall and setting you off on the exciting adventure of deciding what next.

In neither case does the oral contraceptive in question come close to creating an abortion. The anti-choice camp's refusal to let go of their cherished folk belief that fertilized egg = fully formed human being ==> birth control = abortion is now threatening to corrupt public health policy at the highest level. Don't let people continue to cling to fears that have no basis in science.

The Inevitable Next Step Comes a-Trip-Trappin' Down the Hall

Don't worry about that little Conscience Clause thing, they told us. It only protects the delicate sensibilities of fundamentalist pharmacists who don't want to hand you certain kinds of perfectly legal and prescribed medications. After all, you're an American, right? You like freedom of religion, right? So don't think of your inability to get contraception when you ask for it as the elevation of one person's religious beliefs over your own, or your lack thereof. Just reframe it as a constitutional celebration and you'll be fine! Would you like some pre-natal vitamins instead? I would be happy to give you those. What? You still want those birth control pills? Well, then maybe you should have thought about going to pharmacy school and opening your own abortifacient candy shop before you had sex, you stupid slut. Now step aside. The guy behind you needs his Viagra and has been waiting four full minutes while you've been here whinging.

Predictably, now the conscience meme has spread beyond the initially promised narrow spectrum of pharmacists, nurses, and doctors to the entire range of healthcare funded by the federal government. The Department of Health and Human Services, perhaps bolstered by the growing tendency of state education departments to decide "science" means "whatever we damn well say it is," has taken the mind-bending step of basing crucial biological definitions on public opinion polls. Zogby polls. Which typically have an error in the +/- four million percent range.

In a spectacular act of complicity with the religious right, the Department of Health and Human Services Monday released a proposal that allows any federal grant recipient to obstruct a woman's access to contraception. In order to do this, the Department is attempting to redefine many forms of contraception, the birth control 40% of Americans use, as abortion. Doing so protects extremists under the Weldon and Church amendments. Those laws prohibit federal grant recipients from requiring employees to help provide or refer for abortion services. The "Definitions" section of the HHS proposal states,

Abortion: An abortion is the termination of a pregnancy. There are two commonly held views on the question of when a pregnancy begins. Some consider a pregnancy to begin at conception (that is, the fertilization of the egg by the sperm), while others consider it to begin with implantation (when the embryo implants in the lining of the uterus). A 2001 Zogby International American Values poll revealed that 49% of Americans believe that human life begins at conception. Presumably many who hold this belief think that any action that destroys human life after conception is the termination of a pregnancy, and so would be included in their definition of the term "abortion."

Something like 40% of Americans also believe in the Genesis creation story and eschew evolution, so I expect HHS to make the administration of medications based on evolutionary biology optional as well. Enjoy your camphor oil, people, and be sure to close up your windows tight so you don't get the night vapors!

Jesus. Why does this matter? It matters because of this:

Up until now, the federal government followed the definition of pregnancy accepted by the American Medical Association and our nation's pregnancy experts, the American College of Obstetricians and Gynecologists, which is: pregnancy begins at implantation. With this proposal, however, HHS is dismissing medical experts and opting instead to accept a definition of pregnancy based on polling data. It now claims that pregnancy begins at some biologically unknowable moment (there's no test to determine if a woman's egg has been fertilized). Under these new standards there would be no way for a woman to prove she's not pregnant. Thus, any woman could be denied contraception under HHS' new science.

Any woman could be denied contraception by HHS. If your employer-provided health plan continues clinging to a slender thread, you'll be okay, provided, of course, you have access to a pharmacy whose employees are required to do their jobs rather than proselytize. If you rely on federally funded clinics--in other words, if you tend disproportionately to be low-income and/or a woman of color--you're screwed. Twice.

All together, please. Science is indeed a consensus, but it's not a democracy. Public opinion is lovely but has exactly no relevance to the definitions portion of the program. Against abortion? Don't have one. Really super duper against it? Don't go into healthcare.

Thanks to Top!Secret G-woman for the tip, and for starting my day on a very stabby note.

Mmmmmmaddow.

Still catching up on several years of journal reprints and data tables I'm sure are important for something, because otherwise I never would have stacked them in teetering piles all over my office. And whilst doing the re-stacking today I am also catching up on a week's worth of Rachel Maddow guest hosting Countdown, so in lieu of anything resembling a thoughtful post, I give you Maddow's presentation of John McCain on reproductive freedom:

Oh, Goody

And here I thought it was just the fundamentalist fringe in Colorado pushing the fertilized-egg-as-full-person legislation. No. No, no, no. Five other states (Georgia, Montana, Oregon, Mississippi, Michigan) are considering similar ballot measures to give two-day-old, non-implanted fertilized eggs the same legal standing as you and me. More importantly to the walking incubators housing them, the two-four-eight-sixteen-cell clusters would have legal standing trumping the autonomous personhoods of the living, breathing women housing them.

Not surprisingly, the host of murky legal ramifications are being dismissed with a sniff by the pro-blastocyst contingent.

Any contraceptive that interfered with the ability of a fertilized egg to implant in the womb could be considered person-destroying and banned, reproductive rights groups suggested. Examples include intrauterine devices and birth-control pills, which may affect implantation in some cases.

Also, the entire enterprise of in-vitro fertilization — which involves creating embryos in laboratories for couples trying to conceive — could be brought to a halt if these embryos were deemed to be persons with legal rights, others suggest.

In Colorado, Kristi Burton, the driving force behind the proposed “personhood” initiative, shrugs off questions about these potential impacts, calling them “pretty much scare tactics.” Referring to critics of her initiative, she says that “they realize this issue is simple and they don’t have an answer for it. They cannot say when this (embryo) becomes a person. We do.”

Hmmm. The cautions sounded by reasonable people following the proposed legislation to its logical conclusion are being pooh-poohed as "scare tactics" designed to discourage support for the referendum. Where have I heard that before? Ah, yes, I heard it in the runup to the 2006 ballot measures intended to ban same-sex marriage. When the reality-based community pointed out that the proposed constitutional amendments would prevent state, county, and municipal governments and institutions from extending healthcare benefits to the domestic partners of their employees (and any children in those relationships not legally related to the employees), the conservatives accused them of engaging in, yes, scare tactics to erode support for the anti-gay amendments. It's just about the sanctity of marriage, they tutted, and nothing else.

Except that it wasn't.

Shortly after the amendments passed, conservative groups filed lawsuits forcing states to rescind benefits to the domestic partners of state employees. The ink was barely dry on the freaking paper. Well, they said, after looking at it a little closer the new law really doesn't leave us any choice but to bring these suits. Who knew? Sorry.

And they expect us to believe that this will be any different? Learn to love condoms, y'all, since that's just about all you'll have left. Until, that is, sperm and unfertilized eggs are declared full persons too, which will put condoms squarely in dutch with the First Amendment's right to free association.

Emergency Contraception and Pharmacists, Again

Skimming the Daily Star this morning...

Court: Washington State Druggists May Refuse to Prescribe "Morning-After" Pill

In an injunction signed Thursday, U.S. District Judge Ronald Leighton said pharmacists can refuse to sell the morning-after pill if they refer the customer to another nearby source. Pharmacists' employers also are protected by the order.

Two pharmacists and a drugstore owner sued the state in July over the new rule, saying it violates their civil rights. They asked the judge to halt forced Plan B sales while the lawsuit is in play.

Many critics consider the pill tantamount to abortion, although it is different from the abortion pill RU-486 and has no effect on women who are already pregnant.

In other words, many critics are fucking idiots. All together now, please. Emergency contraception. Does NOT. Cause. Abortion.

EC works, instead, by preventing ovulation. If you've already ovulated in the 72 or so hours prior to unprotected sex, EC will not help you, just as if you're already pregnant, EC will not terminate that pregnancy and will, in fact, probably give that pregnancy a helping hand by maintaining the richness of the uterine lining. If you have not ovulated, EC keeps your ovaries from releasing an egg into the hordes of sperm stampeding up your fallopian tubes for a few days until all the little buggers are dead.

That is not abortion. That is not the destruction of a fertilized egg. That is not even the frustration of an egg and sperm gazing at each other all moon-eyed through a veil of latex, because EC keeps the egg from being there in the first place. Sperm get to do their spermy thing, swimming in circles and snapping each other's butts with their flagellae and standing in the street looking wistfully up at the ovary and yelling yo, you coming down or what, but the egg stays snug up in the ovary reading Katha Pollitt with a cup of tea and says, no thanks, I'm busy tonight.

Not that it matters to the pharmacists trying to exercise what's pathetically titled a conscience clause. You know damn well they understand the physiological mechanism the EC pill triggers (considering that they got through pharmacy school and all), and that it's not even vaguely related to abortion. They are not attempting to escape being involved in an abortion. They're simply flexing a newly created muscle that allows them to intercede in a woman's life when she deigns to have sex in a context they disapprove of. That is, any context not precisely equal to married and desirous of producing children.

Pharmacy is not simply another service industry sector. The license required by state regulators does not simply indicate competence but grants pharmacists a quasi-monopoly on drug transactions. Because the only way people in this country can legally acquire the controlled medications they need is by (1) getting prescriptions from their doctors and then (2) having medications dispensed by a licensed pharmacist, pharmacists have an absolute duty to fill all prescriptions brought to them in a timely manner, and to stock all drugs that can be reasonably expected to be required by the populations they serve, particularly medications that respond to acute needs. Like nitroglycerine, or asthma inhalers, or emergency contraception.

The fact that EC may now be purchased without a prescription doesn't change this basic argument, because, while no prescription is needed, the drug still must be dispensed from behind the pharmacy counter.

The pharmacist's job is to check dosages and potential drug interactions the physician may have missed, and to make sure the patient is informed about use instructions and side effects. It is not to increasingly interfere in people's lives under the banner of morality, or to make value judgments predicated solely on the medication prescribed or sought without the context of the life of the person seeking the medication. RU-486 opened the gate to pharmacists who were able to make an accepted argument against being required to participate in abortion, and now that gate is in danger of being flung wide open by those who would us the RU-486 precendent as justification for refusing to dispense any medication to be used in circumstances that run afoul of their own personal standards of conduct. That alone is cause enough for concern. But when the focus is consistently narrowed down from any morally ambiguous circumstances to those specifically and exclusively relevant to sexually active women, and adjudicated on the basis of one particular strain of one religious sect, it's completely unacceptable and abhorrent.

More Anti-Choice Machinations in Arizona

A Republican state senator from the Phoenix area (Thayer Verschoor, R-Gilbert) has introduced a bill that would greatly expand the personal information doctors are required to collect from women obtaining abortions.

But in addition to a woman's age, race and marital status — which the state health department already collects — it would mandate that doctors collect and report information such as the reason for the abortion, who referred the woman to the clinic, the weight of the aborted fetus and other intimate personal information about the woman.

Funny, but when I had two invasive surgical procedures over the past four years, I don't recall the state being interested in why I was choosing to have tissue excised from my body, who referred me to the surgeon, or how much the removed shreds of meniscus weighed. Lucky for me that the kneecap isn't subject to the same level of scrutiny as the uterus, despite my knees' much greater potential for long-reaching health effects (a year after the second surgery I'm still not walking right).

But wait, it gets better:

A potentially bigger effect of SB 1550 is that it would require doctors to report the same information not just for surgical abortions but when a pregnancy is terminated with drugs such as RU-486 — something state health officials say they don't track now.

Verschoor acknowledged that it might even require reports to be filed when a woman uses the "morning-after" pill. That's because the legislation would define a fetus as any organism beginning at fertilization, and there is some medical evidence that the pill prevents a fertilized egg from implanting.

At least they're being upfront about throwing science completely out of the room. Hell, science is being slammed face-down on the cement and frisked before it can even get close to the building. Setting aside the "life begins at conception" argument for a few seconds, whatever spriritual investment you want to ascribe to that diploid cell, it ain't a fetus. "Fetus" applies only to developing offspring that have acquired the major structural characteristics of the adult animal, and that doesn't happen in humans until after week 8. Hell, even calling the blastocyst or embryo an organism is a bit of a stretch, given its inability to function independently of the gestating woman. And finally, of course, given our species' shoddy successful implantation rate of roughly 50%, pregnancy does not begin until the fertilized egg implants in the uterine lining. Under this bill's logic, sexually active women might as well be required to wring out their tampons into a cup on a scale, because about half the time there very well may be a Verschoor-style "fetus" in there.

Clearly, this bit of legislation from a recognized "long term abortion foe" is designed to throw up even more roadblocks in the path of a still-legal medical procedure, this one by raising the paperwork bar in the hopes that at least a few doctors will throw up their hands and stop providing abortions altogether.

Verschoor acknowledged half that point. He said any new information obtained by the state about who has abortions, even in aggregate form, could be used to create programs targeted at certain groups.

"The hope here is that we can find alternatives to abortion where they choose the life of the child instead of abortion," he said, citing adoption as an alternative.

Here's a clue for Mr. Verschoor: women who do not wish to be pregnant in the first place have abortions. Some of them get pregnant because they're ignorant about reproductive physiology and contraception. Some get pregnant because they and their partners are careless. Some get pregnant because they're sexually abused. Adoption is certainly a wonderful choice for some of these women. For most, it isn't. And rather than expending all of your energy in creating programs intended to convince their target audience of unintentionally pregnant women to give birth, you would do far more to end abortion by advocating thorough and accurate education, as well as effective, affordable, accessible contraception.

Anti-contraception Movement... the Groundwork

On Monday I posted about the Christian Right’s coming battle against contraception (shorter version: none for anyone ever) and mentioned my grudging admiration for the morality brigades’ perseverance and dedication to to their mission, abhorrent as I personally find it. Part of the strategy has been to crank out the kids like bunnies, homeschool them, send them to evangelical colleges, and groom them to enter public life so as to influence legislation at every level, toward the ultimate goal of crafting laws reflecting conservative Christian values (or Biblical literalism, depending on how pessimistic you’re feeling at any given moment).

The articles in the Chicago Tribune and LA Times mentioned the intent to chip away at the availability of contraceptives, following the manner in which abortion access has been steadily constricted, in large part by enacting state laws giving pharmacists the right to refuse to dispense medications that violate their own personal consciences.

Four States (Arkansas, Georgia, Mississippi, and South Dakota) have passed laws allowing a pharmacist to refuse to dispense emergency contraception drugs. Illinois passed an emergency rule that requires a pharmacist to dispense FDA approved contraception. Colorado, Florida, Maine and Tennesee have broad refusal clauses that do not specifically mention pharmacists.

California pharmacists have a duty to dispense prescriptions and can only refuse to dispense a prescription, including contraceptives, when their employer approves the refusal and the woman can still access her prescription in a timely manner.

Given the increasing presence of evangelicals in legislatures of all levels over the past decade or so, I wondered if they might be stacking the pharmaceutical deck as well. So it came as little surprise that the Christian Pharmacists Fellowship International has established student chapters in 30 pharmacy schools out of the 89 or so institutions granting at least a B.S. in pharmacy across the country, including at major players such as Purdue, North Carolina, and Florida.

The CPFI position on the “conscience clause” is as follows (emphases mine):

Pharmacists have the moral and legal responsibility to refuse to dispense a prescription that, in the pharmacist's judgment might be harmful to the patient, either directly or indirectly. Therefore, the Board of Directors of CPFI supports the right of all pharmacists to refuse to dispense a prescription that goes against their moral conscience.

No regulatory authority should be allowed to force a pharmacist to dispense a prescription against his/her best judgment or refer a patient to another healthcare provider. Likewise, a pharmacist should not engage in any activity that impairs a patient from seeking care from another provider.

Furthermore, the Board acknowledges the responsibility of Christian pharmacists to follow Biblical principles including the sanctity of life and life begins at the time of conception. Therefore, CPFI supports the right of Christian pharmacists, based upon Biblical principles and their moral convictions, to exercise their conscience within the realm of professional practice.

The “either directly or indirectly” phrase is quite vague, and it’s difficult to think that was unintentional. Indirect harm to a patient covers a troublingly wide expanse of territory, including that nebulous realm of the patient’s eternal soul—presumably the target of the conscience clause refusals. The insistence that pharmacists shall not be compelled to refer the patient to the other, non-evangelical pharmacist at Walgreen’s or to the CVS down the street is troubling. And the “responsibility” of Christian pharmacists to insist that life begins at conception is the grand finale, the big cake topper.

To be fair, CPFI maintains chapters at only slightly more than a third of the major pharmacy schools in the US (I did not consider associate-degree-only colleges and technical schools in this compilation), and most of these schools support a variety of student organizations. The faculty advisors don’t mention CPFI prominently in their online profiles, if at all, and there is no evidence that the organization is exerting undue influence within the respective colleges of pharmacy. Nor are hard membership numbers readily available.

In that sense, this posting may reflect more paranoia than imminent threat to freely accessible contraception in the US. However, given the numbers of students in the programs where CPFI is present*, it is an unavoidable fact that pharmacists who are very likely to invoke a conscience clause (or push for such legislation in states where it has not yet been enacted) are being churned out at a steady rate. Additionally, ample anedotal evidence exists documenting instances in which individuals have encountered absurd, near-Atwoodian barriers to acquiring emergency contraception. It is imperative that we remain vigilant as one segment of this society seeks to impose its own version of morality on all people, regardless of their personal belief systems. Find out where the candidates in your local races stand on conscience clauses and keep their asses out of office if they are even remotely conciliatory to the idea.

* sample numbers of students:

University of Arizona: 77-81 admitted annually

University of Florida (Gainesville): 450 pharmacy students plus 100 graduate/postdocs enrolled annually

University of Iowa: 108 students admitted annually to six-year program

University of North Carolina (Chapel Hill): 500 professional students and 100 graduate students, postdocs, residents, and fellows enrolled annually.

Nationwide, 7,488 professional degrees were reported awarded in 2003.

Tap Tap Tap... Straight Folks? You're Next.

The evangelical wing will never be content demonizing only us urine-drinking, rectum-intromissing sodomites and the wicked, hedonistic liberals who get abortions at every opportunity. Now they're coming after anyone who uses contraception--yep, even the 91 percent of people who believe married folks should be able to decide when or if they're going to have a baby.

The new strategy, as summarized in the Chicago Tribune, was unveiled at an anti-abortion meeting in sunny Rosemont yesterday:

Experts at the gathering assailed contraception on the grounds that it devalues children, harms relationships between men and women, promotes sexual promiscuity and leads to falling birth rates, among social ills.

Oh, but this takes me back to what passed for freshman theology in high school, particularly the semester-long "Reverence for Life" curriculum that left me alternately snoring and indignant. The ability of a man and woman to have sex without fearing an unwanted pregnancy--even if they're married--somehow means they're not selflessly sharing themselves with each other. Sex for pleasure rather than brusque, businesslike reproduction means you're selfishly closing yourselves off from God's gift of life (conveniently left out of this line of reasoning is why God's additional gifts in the nether region department included the clitoris, glans penis, and G-spot).

It's the let-them-eat-cake mentality, the same one we've seen endlessly applied to the poor (you can't afford health insurance? why, go out and get a second--or third--job!), to the hurricane-smacked (you didn't have a car to evacuate with? why, you should have just walked to Texas!), to HIV-infected women in Africa (you didn't want to get sick? why, you should have stopped having sex with your husband!). Now it's being applied to people who want rational family planning (you can't afford a[nother] child? why, just don't fuck!).

Commenters in the Trib article speculate that the no-BC'ers will push not for across-the-board contraception bans, but rather another creepy war of attrition similar to that waged against abortion rights over the past decade:

What's more likely, experts suggest, is an ongoing "chipping away" at access to contraceptive services. This could entail cuts to federal programs that pay for birth control. Likely it also would involve a state-by-state push to allow pharmacists to refuse to fill birth-control prescriptions for reasons of "conscience."

You gotta hand it to these folks. They have been very patient, taking years to groom candidates for entry in local-level public office with designs on hopping up the legislative ladder one level at a time. Now that the groundwork has been laid, with various states enacting the pharmacists' right of refusal laws, how many bible colleges will start adding pharmacy programs? Nothing like a little point-of-sale control to get the practitioners of your ideology firmly entrenched in the front lines.

And if you do not personally subscribe to this particular strain of Christian thinking that teaches birth control is unacceptable under any circumstances because it befouls the couple's relationship with each other and with God? If you perhaps think you should not be subject to religiously derived moral rules about a highly personal matter that do not proceed from your own beliefs? Well, tough shit, pal.

Not Much Else Going On, So How About Some Abstinence Talk?

Aimee Short (of the BreakDown abstinence Shorts, as ABB might say) is back. She left a lengthy comment while I was away, so I've not gotten around to responding until now. I'll give her this much; she's persistent.

Now about the blog posted on June 18th in response to my comment. It is encouraging to know that the blogger is not heartless and has the ability to step away from her strong opinions and see not just the values of another person, but the PERSON behind those values. It's easy to put another person into a box that they do not deserve when you know very little about them or what they really do. I have been guilty of that myself from time to time. But, I do not, nor does BreakDown as an organization fit into the "abstinence" box.

There is one major difficulty that I have with this blog. It is stated as a fact that "Ms. Short offers no solution beyond don't have sex." Now how would you know that? Have you been to a high school classroom with me anytime over the last 6 years while I am teaching a 5 hour course on sex, abstinence and relationships? How can you be so sure that I say "just say no" for 5 hours and throw a ring or a pledge card at the students as they are running as fast as they can from my class? Let me answer my own question. Because you put me, and the entire "abstinence movement" into a tiny little box.

Well, like you are with your responses to the postings and comments on my blog, I'm only going with the information I have. The newspaper articles I referenced didn't give details about the curriculum of your five-hour classes; they focused on encouraging abstinence through dancing and positive messages about self-worth. If I came away with the impression that your abstinence program presented an overly simplified view of human sexuality, it's because that's how it was presented.

You are correct when you say that sex is a powerful, powerful thing. I agree wholeheartedly. That's why I do what I do. Because sex is so powerful it has the potential to be so painful. 2 minutes of sex can destroy a lifetime. Young people usually find this out the hard way. I just want to be the voice of encouragement that inspires some young people to avoid the consequences all together, possibly even save their lives. People can write what they want and criticize, but I for one do not want to be remembered for sitting back and allowing the young people around me to have the accuse that nobody cared enough to tell them the truth and that they are worth more than our society gives them credit for. I want to be one who offers hope of a better way, inspires young people to believe in and value themselves, their bodies and their futures.

I'm all over that. Seriously, I am. Could it be that you've done your own bit of box-building, assuming that people like me, who object to abstinence-only education, are hedonists trying to rid society of the last remaining strictures against personal pleasure at all costs? I think abstinence is absolutely necessary for the vast majority of teenagers. Hell, there are plenty of emotionally immature or unstable adults who would do well to take a vow fo chastity until they get their personal shit together.

My objection has never been to the idea of abstinence for kids, but to the school of thought that demands abstinence education be completely devoid of accurate information about physiology and birth control methods. Let's face it--if you communicate your message of abstinence effectively enough, if it really takes root in a kid's head, the additional knowledge about condoms and less risky sexual behaviors is not going to compel him to run out and have sex despite truly believing he shouldn't. If your message doesn't convince a kid to remain abstinent until marriage, accurate information about safer sex practices will greatly reduce the risk of him impregnating someone or contracting a disease. I mean, it was drilled into me fairly early in life that shooting people is wrong. Subsequently learning to fire a rifle when I was in high school didn't make me more disposed to chuck my moral framework and start plinking folks from a clock tower.

I fail to understand how presenting the full spectrum of information necessary for healthy sexual behavior falls into the category of disrespecting kids, or is somehow designed to convince them their intrinsic worth is less than if we don't bother to teach them about condoms, or mutual masturbation, or piggybacking barrier contraception with the pill.

Yes, I understand that abstinence is the best way to avoid pregnancy and STDs. I truly hope that your curriculum does all you claim, that you present kids with realistic, workable options for making good choices and protecting themselves against coercion. I simply don't believe that withholding information about protection is morally defensible, given human nature and the extent to which teenagers are hard-wired to get it on. Yes, I believe that humans can rise above their instincts, if you want to look at it that way, and that teaching kids accurately about the risks of sexual behavior should and can make them decide to put it off until they're physically and emotionally ready. But knowledge about contraception has to be there as a backup. Withholding that knowledge puts kids at sea without a life raft, and I find that unconscionable.

Good old anecdotal evidence can prove anything you want it to, but I was fully versed in the physiology of reproduction from a young age. The sex ed curriculum in my grammar school covered the range of contraception available at that time, along with the effectiveness rates of each when used correctly. It also talked about the emotional risks of becoming sexually active too early. I decided I wasn't ready to do something that had even the remotest chance of landing me in the spot my parents found themselves in as teenagers (namely, pregnant with me and frog-marched to the altar). I made it through high school with my virginity intact, and when I later became sexually active, it was a carefully considered decision fortified with highly reliable, properly used birth control. My sole pregnancy was carefully planned, the baby wanted. Storybook. And in that storybook, knowledge is power.

So keep fighting your good fight, Aimee. I hope you can understand why those of us on this side of the fence think your curriculum should be augmented with precise instruction on what to do should the individual's informed conscience lead him or her into sexual activity before marriage.

Massive Sunday Morning: A Response to Aimee Short

Last month I wrote a post that mentioned a Christian abstinence-promoting teen dance group that plans to travel to Uganda to help Ugandans find God and swear off sex until marriage (please ignore the maddening formatting-that-didn't-quite-take and just read). I was less than optimistic about their chances of success and more than a little cynical about the entire aggressive abstinence movement as a whole.

The founder of the Tucson chapter of the group, one Aimee Short, took the time to leave a lengthy comment on the entry, so I'll return the favor and respond to the points she raised.

I was a virgin on my wedding night. If you knew what happened with my marriage you would feel like a jerk for even attempting to presume I did anything wrong. And just so everyone knows, I will not have sex again until I am married.

I respect Ms. Short's intention to not have sex until she gets married again, and am genuinely sorry for whatever hurt she experienced that makes this even more imperative for her than just religious conviction. I know too many women who have experienced sexual and emotional abuse to ever belittle someone's personal experience, so I do apologize for seemingly callous remarks.

Nobody is trying to deny any young person of having fun or "getting their freak on" as you put it. We ARE trying to help young people avoid out-of-wedlock pregnancy, STDs, and the emotional heartbreak associated with pre-marital sex.

I am not even going to try and convince the readers of this blog (which I am sure already share your viewpoint, however uneducated it may be) that what we do helps teenagers and that it is effective.

My viewpoint may have come across as a bit snarky, so I'll try to explain it clearly. While I simply do not believe that all people need to abstain from sex until they're married, I do believe that it's a big mistake to be sexually active before you're emotionally mature enough to handle it. Our brains are hard-wired to go, go, go, and what seemed like a great idea at the time can come back to bite you in the ass the next morning, or even five minutes later, if you went into it thinking true love and the other person was just looking to get off.

Sex can be a powerful, powerful thing and has the potential to create emotional trauma. It can be bad enough when you make a mistake that's just centered on you (damn, that was stupid, he/she was just using me; crap, I was drunk, I hope she doesn't call me back). It can be a hundred times worse when your mistake also means you broke a sacred vow you signed your name to, let down your parents who thought you were great because you were a virgin, and pissed off your god.

And it can be a million billion gazillion times worse when all of the above happens and--because your abstinence education didn't provide it and your personal abstinence pledge gave you a compelling reason not to research it--you either didn't use protection or used it incorrectly because you had no idea how it works. And that's where the problem lies. Ms. Short says she's trying to help kids avoid pregnancy and STDs, but offers no solutions beyond "don't have sex."

That advice is golden in a perfect world, but does exactly nothing to protect people who get caught up in the moment, or in situations they have zero preparation for because they were told--and told themselves--that they simply would never do that. The membership of Short's own group belies that assumption; at least one guy, quoted anonymously in the original newspaper article this story came from, admitted to losing his virginity at 14, although he's since re-committed himself to abstinence. Did he use a condom? The paper didn't say. If any of the other BreakDown dancers get carried away at some point and have a sexual encounter, will they know how to protect themselves? Look at the numbers of abstinence-pledge kids who engage in oral or anal sex because they don't think it's the "real sex" that their pledges proscribe. I don't think those activities are inherently immoral, but they are risky from a physical health perspective and carry the same potential for emotional trauma good old penis-vagina sex does.

The other problem I have with the abstinence movement is the need of its proponents to formalize the decision and cover it with so many symbolic and ritualistic trappings that it moves into the realm of the sacramental--which comes with its own attendant problems (my, I'm feeling self-referential today). I'm not entirely comfortable with the idea of kids wearing jewelry serving as a prominent statement about their sexuality. Deciding you're not going to engage in sex for recreation is admirable, but wearing the locket or ring every day seems, in my heathen opinion, to put an inappropriate emphasis on a kid's sexuality, to draw more attention to it--even when it's in the negative sense--than is warranted. But that's just me.

Where this becomes troublesome in my mind is when the kid who has made such a huge deal about being abstinent stumbles and does something. When the girl who's gone to the Purity Ball with her dad, or done the Silver Ring Thing and made her pledge in front of the group and wears the ring ends up having sex anyway. Hard enough to wake up the next morning after doing something you feel violates your own personal principles, your own private promise to yourself. Throw in betraying your community and all hell breaks loose.

I suppose that's the point; fear of tribal approbation keeps most people in line to some extent. And, the Abstainers might argue, if there's no threat of shame or other consequence hanging over your head, what's the point of making a promise in the first place? I simply prefer to see more holistic approaches taken that do not require perfection in order to be effective, and that includes acknowledging, accepting, and being honest about realities that don't conform to your ideal world. Vaginal sex doesn't always result in pregnancy or STD--but it can, so you need to be prepared. Oral and anal sex don't always result in STD--but they can, so you need to be prepared. Pre-marital sex does not always result in heartbreak--but it can be very messy indeed, so yes, you need to be abstinent if you're not emotionally mature enough to handle the potential trainwreck.

The last point the Abstince Movement regularly fails to acknowledge is that a marriage license and minister's blessing don't magically make you immune to either STDs or heartbreak. A woman can be a virgin who's never been with a man unaccompanied and still end up with a nasty virus on her wedding night if her husband was neither "pure" nor careful in his youth. Sexual abuse still happens within marriage, as does sexual incompatibility. In short, human sexuality is maddeningly and wonderfully complicated. Just saying no before marriage will solve some problems, but it ain't a magic fix for everything, and it isn't free of its own unintended side effects.

Endnote: My concern that BreakDown's message is overly simplistic for Uganda stands. Emphasizing self-esteem and self-worth as reasons to decline sex outside of a committed relationship, especially for teenagers, and especially for girls, is a praise-worthy goal. But it's hard enough to make that kind of thinking stick in America. I'm not sure that trying to transplant that model wholesale onto another culture will be hugely successful without simultaneously (or first) addressing the issues of gender inequality, the sexual expression of male power and dominance, and poverty.