Administration Plan A: Blocking American women's access to Plan B
The saga of expanding access to emergency contraception (EC) has persisted throughout the Bush Administration, and has lead to retaliation in the science of women's health overall. After two years of delays, on August 26, 2005, the Food and Drug Administration (FDA) once again refused to accept an application to switch the emergency contraceptive Plan B (also known as the "morning-after pill") to over-the-counter status. EC, which prevents pregnancy by blocking ovulation and fertilization if taken within 72 hours of unprotected sex, is currently available without a prescription in over 25 countries. An application to make EC available over-the-counter in the United States was submitted to the FDA in April 2003, and eight months later, two separate FDA expert advisory committees voted 24-4 to accept the application.

Despite these recommendations, in May 2004, then-acting FDA Commissioner Lester Crawford rejected the application, over the protests of scores of physicians, including the American Academy of Pediatrics. At the FDA's recommendation, a second application was submitted to allow over-the-counter sales of Plan B only to those over the age of 17, and during Crawford's confirmation process as FDA Commissioner, he promised a final decision on the matter by September 1, 2005. But on August 26, 2005, he postponed the decision indefinitely, prompting the resignation of Susan F. Wood, Director of the FDA Office of Women's Health. In a statement released on August 31, 2005, Wood said, "The recent decision announced by the Commissioner about emergency contraception, which continues to limit women's access to a product that would reduce unintended pregnancies and reduce abortions, is contrary to my core commitment to improving and advancing women's health. I have spent the last 15 years working to ensure that science informs good health policy decisions. I can no longer serve as staff when scientific and clinical evidence, fully evaluated and recommended for approval by the professional staff here, has been overruled."

In growing distress over the FDA's continued politicization of this decision, consultant and former member of the panel that first recommended approval of over-the-counter-sales of Plan B Frank Davidoff resigned from the FDA on October 6, 2005. A Government Accountability Office (GAO) report to Congress released on November 14, 2005 confirmed the atmosphere of increasing politicization, describing the FDA's rejection of Plan B as "not typical of the other 67 prescription-to-OTC (over-the-counter) switch decisions made from 1994 through 2004." Amidst growing public distrust of the FDA and consternation about blocking access to contraception, in August 2006, the then- Acting Commissioner Andrew von Eschenbach threaded a political needle by enabling pharmacists to provide Plan B without a prescription to those who can prove they are at least 18 years old. There is no scientific evidence about why or how the FDA determined this age threshold. In a circumstance many call retribution against the Office of Women's Health, in February 2007 word came from the FDA that it intends to withhold funding for the rest of the year from the Office, effectively ending operations through September 2007.

Department of Injustice: Omitting EC from the National Protocol on Sexual Assault
Each year approximately 300,000 women are sexually assaulted in the United States, and about 25,000 of those women become pregnant. Despite this fact, the first-ever National Protocol for the treatment of sexual-assault survivors, released in September 2004 by the U.S. Department of Justice (DOJ), contains no information on emergency contraception (EC, or the "morning-after pill"). EC is a safe and effective method of preventing unwanted pregnancies, and can be taken up to 72 hours after unprotected sex. But in spite of recommendations from the American Medical Association, the American College of Obstetricians and Gynecologists, and the American Public Health Association, studies have shown that EC is rarely available in hospital emergency rooms under any circumstances: one study revealed that only 23 percent of Catholic hospitals and 17 percent of non-Catholic hospitals made it available to patients who had been sexually assaulted, and far fewer were able or willing to provide EC to women who had not been sexually assaulted. In August 2005 the American Civil Liberties Union, joined by a coalition of sexual assault groups, religious leaders, and women's health advocates, sent a Freedom of Information request to the DOJ to obtain any records explaining why EC had been deliberately excluded from the National Protocol, which provides guidance to hospitals and emergency care facilities nationwide.

Medicaid: Limiting poor women's last resort
In 2003, 1 in 5 American women of reproductive age did not have health insurance—10 percent more than in 2001. As a result of President Bush's previous cuts to publicly subsidized family planning programs (see Title X), poor women are increasingly turning to Medicaid to meet their family planning needs-in 2001, the program already accounted for over two-thirds of family planning funding available to women nationwide. Despite this situation, in February 2006 President Bush signed into law a budget reconciliation bill that cuts nearly $5 billion from Medicaid over five years. The bill also includes a new provision that will make contraceptive services more difficult for women to obtain: states can now make Medicaid family planning services elective rather than mandatory, and can require individuals to pay more out-of-pocket expenses for contraception. Another onerous provision requires Medicaid beneficiaries to produce a passport or birth certificate to prove citizenship. This puts low-income Americans seeking heath services at greater risk, since many do not have ready access to such documents. The new cuts and restrictions are not only devastating news for the millions of uninsured women who currently rely on Medicaid to cover the cost of family planning, they're also bad health policy. Research conducted by the Guttmacher Institute has shown that when states expand Medicaid coverage for family planning, they can serve more women for less money, since every $1 spent on contraceptive services saves $3 on pregnancy and newborn-related care. The law also targets student loan and social safety net programs for single-parent families, foster children, low-income elderly people, and the disabled.

Federal Marriage Promotion: Dictating women's relationships, denying women's needs
President Bush's FY 2008 budget request calls for $150 million in taxpayer revenues, together with additional state tax revenue, to pay for marriage promotion-including special marriage classes for single women. Government-mandated marriage promotion intrudes on issues that 79 percent of Americans consider private and not the government's business. In a tight budget climate, it takes funds away from investments in proven services and support that move low-income women off welfare, such as child care, job training, and a college education (only one percent of single mothers with a college degree and full-time employment live in poverty). Experts also warn that marriage promotion for cash can have the dangerous, unintended consequence of encouraging women to stay in abusive relationships for financial reasons, thus endangering women and children.

The So-Called "Partial-Birth" Abortion Ban: Criminalizing abortion
On November 5, 2003, President Bush signed into law sweeping legislation limiting women's access to safe abortion-and enacted criminal penalties against doctors who perform them. "Partial-birth abortion" is a political fabrication that has no medical referent, and is not, as many backers have incorrectly stated, an equivalent term for a rare, late-term abortion procedure known as "intact dilation and extraction." The ban's language is so vague and unscientific that it can be construed to apply to many safe abortion procedures in any stage of pregnancy. Further, in violation of numerous court rulings, it contains no exception to protect the health of a woman. In a further diminution of a woman's legal right to control her body, the bill allows a husband to sue his wife for damages in a civil action if she had the procedure without his permission (if the woman is under 18, her parents can sue her). After Bush signed the law, three suits were immediately filed challenging its constitutionality, and in all three states—New York, California, and Nebraska—Federal District Judges struck the law down as unconstitutional, since it contains no exception to protect the health of the woman. The U.S. Department of Justice appealed the courts' decisions to appellate courts in three separate trials, and all three appellate courts affirmed the lower courts' decisions. Despite this unanimous message from the federal judiciary, on February 21, 2006, after the confirmations of  John G. Roberts and Samuel Alito, the U.S. Supreme Court agreed to review Gonzalez v. Carhart (the case in which the U.S. Court of Appeals for the Eighth Circuit upheld the unconstitutionality of the law). The Court heard arguments in October 2006, and the public is awaiting a decision.

Department of Justice: Adding insult to injury
The Bush administration has aggressively eroded the rights of women under the guise of fetal protections. After the President signed the "partial-birth" abortion ban, the Administration added insult to injury when Attorney General John Ashcroft announced that the Justice Department's Civil Rights Division, rather than its Criminal Division, would be responsible for enforcing the ban. In a letter to Ashcroft protesting this decision, Democrats on the House Judiciary Committee wrote: "[I]t is 'Orwellian' that you would have the Civil Rights Division enforce a law which has been essentially found by the Supreme Court to violate the civil rights of millions of American women." Although three federal judges, in response to suits questioning the law's constitutionality, issued temporary restraining orders blocking enforcement, the Justice Department indicated that it would devote all resources necessary to defend the abortion ban. As a first step, it subpoenaed hundreds of confidential medical records of women who underwent abortions from at least six hospitals and a range of clinics across the country. A federal judge in Chicago, citing privacy laws and other considerations, blocked the effort. Medical professionals refused to surrender the records to protect the medical privacy of their patients, and one hospital was declared in contempt of court for not producing the records. A federal judge in Manhattan ruled that the department could subpoena women's hospital records, but following a public outcry, the Justice Department withdrew its subpoena request, citing its desire to speed up the case.

Fetal Rights: Exploiting tragedy to restrict women's rights
President Bush has signed a law that for the first time bestows legal rights on a fertilized egg, thereby giving an egg, embryo, or fetus legal status equal to that of its mother. The so-called "Unborn Victims of Violence Act" establishes new grounds for undercutting women's legal rights, for overturning Roe v. Wade, and for criminalizing a medical procedure. The President joined with Congress to take advantage of the coverage surrounding the murder of Laci Peterson-a pregnant woman who was found murdered nearly three months after she disappeared on December 24, 2002-to enact the legislation. Yet the law would not impact on the Laci Peterson case because it only applies to federal crimes. President Bush signed the bill into law April 1, 2004.

State Child Health Insurance Plus: Covering embryos, not women
The Administration issued a regulation extending coverage under the State Child Health Insurance Plus (SCHIP) to "unborn children," so coverage extends from "conception up to age 19." For the first time, the United States is recognizing that a zygote, embryo, or fetus is a "person" eligible for government aid. Soon after this regulation was issued on October 2, 2002, the Bush administration withdrew its support for bipartisan legislation that added pregnant women to SCHIP, arguing that it was no longer needed since coverage was being provided directly to the fetus. As a result, pregnant women are not guaranteed the health care they need. Treatment for women who are hemorrhaging during birth, for example, is not covered by the regulation.

"Human Subjects": Separating the rights of mothers and embryos
In another attempt to extend legal "personhood" to fetuses and embryos separate from the pregnant women who carry them, the Bush administration has written a new definition of "human research subjects" in the charter of the Secretary's Advisory Committee on Human Research Protections, which advises the government "on issues and topics pertaining to or associated with the protection of human research subjects." This new definition would extend the same rights to embryos and fetuses as mothers.
 
Title X: Denying funds for women's health
For the sixth year in a row President Bush's FY 2008 budget request does not include any increase for the Federal Family Planning Program (Title X), which provides vital health care to low-income Americans, including contraceptive services; gynecological exams; pregnancy testing; screening for cervical and breast cancer, high blood pressure, anemia, diabetes, and STIs including HIV; basic infertility services; health education; and referrals for other health and social services. The Administration's request of $283 million for Title X is only slightly more than the $204 million that the Administration has requested for scientifically unproven "abstinence-only" programs that provide moral instruction rather than health information and services (see Abstinence-Only Sex Education below). Further, strained Title X funds are currently being used to fund such projects as www.4parents.gov, a Department of Health and Human Services website designed to promote parent-child communication that contains biased information and promotes gender stereotypes. For parents, it advises: "Males sometimes respond well to concrete, direct language, while girls often respond well to feeling, relational language." The overly simple guidance for alternatives to pre-marital sex urges teens to "Join a community- or faith-based organization." It also claims, "You're more likely to have better sex when you are married." If funding for Title X had kept up with inflation since 1980, which doesn't take into account increases in the number of people in need of these services, it would now be at $699 million. The Administration's efforts to reduce funding for family planning (including by using funds for websites rather than services), while simultaneously limiting women's access to safe abortion services, emergency contraception (the "morning-after pill"), and affordable childcare, leave the 17 million uninsured American women of reproductive age in a difficult position. The Prevention First Act, which among other things, would increase funding for Title X was introduced in Congress in January 2007.  Congress rejected the President's budget request in FY2008 and instead increased funding for Title X by $17 million—the first increase in years.   

Abstinence-Only Sex Education: Increasing funds for unproven programs
Strong evidence exists that young people who receive comprehensive sexuality education become sexually active later than other teens, have fewer partners, and are more likely to use contraceptives when they do have sex. That's why 8 out of 10 parents support such quality programs for their children and why at least 14 states  rejected this federal funding. Yet religious fundamentalists have continuously objected to the teaching of sex education, and when they failed to sway the American public, they adopted a new strategy of subverting the curriculum itself. They began pushing so-called "abstinence-only-until-marriage" instruction in place of the previously successful combination strategy of abstinence; relationship negotiating skills; and information on the benefits of contraception, including condoms, in preventing unintended pregnancy and sexually transmitted infections (STIs), including HIV/AIDS. Initially, the federal government gave limited funds to the new and unproven abstinence-only approach which withholds public health information from young people, whether they are sexually active or not, and instituted a set of measures to assess their effectiveness. But the Bush administration, aided by allies in Congress, has dramatically loosened the evaluation requirements, while consistently requesting significant increases in funding. The President's FY 2003 and FY 2004 budget requests both called for a $33-million increase for such programs-and his FY 2008 request is for $204 million. As funding mounts, there remains no reliable evidence that abstinence programs delay the initiation of sex or reduce teen pregnancy.

In December 2004, U.S. Rep. Henry Waxman (D-CA) instigated a special investigation into the content of federally funding abstinence-only education programs. His research revealed that two-thirds of abstinence-only grantees use curricula that contain false, misleading or distorted information on reproductive health, and many of them are promoting stereotypes about boys and girls as scientific facts. One curriculum instructs: "Women gauge their happiness and judge their success by their relationships. Men's happiness and success hinge on their accomplishments." Others misrepresent the effectiveness of condoms, teach that exposure to sweat and tears are risk factors for HIV transmission, caution that 5 to 10 percent of women who have legal abortions will become sterile, and present the view that life begins at conception as scientific fact. Several of these federally funded programs also blur the line between church and state. For example, the Silver Ring Thing, a Pennsylvania-based non-profit with an IRS-registered mission of "evangelistic ministry" has since 2003 received $1 million in federal funding for abstinence-only education. In May 2005 the ACLU brought a lawsuit against the Department of Health and Human Services (HHS), challenging the Silver Ring Thing's suitability for federal funding. The Silver Ring Thing abruptly altered its website, removing a statement about the organization's mission "to saturate the United States with a generation of young people who have taken a vow of sexual abstinence until marriage, [which] can only be achieved by offering a personal relationship with Jesus Christ." The case was settled in February 2006, when HHS agreed it would not fund the Silver Ring Thing as it is currently structured, and that any future funding would be contingent on compliance with federal law prohibiting the use of federal funds to support religious activities. Yet still, a November 2006 report by the independent Government Accountability Office found that the government is not screening grantees to make sure that funded materials were medically accurate.

Evaluations of federal abstinence-only programs programs have shown few results for the despite the more $1 billion investments.  A recent comprehensive study of these programs (Mathematica 2007) found no measurable impact on increasing abstinence or delaying sexual initiation among participating youth or on other behaviors such as condom use. This and other research has so far prompted at least 14 states, including California, Colorado, Maine, Ohio, Pennsylvania, Virginia and Wisconsin to reject federal funding for abstinence-only education.

Prescription Drugs: Denying coverage for contraception
Since 1998, Congress has required health plans participating in the Federal Employees Health Benefits (FEHB) program that cover prescription drugs to include coverage for prescription contraceptives. In President Bush's first budget request he proposed eliminating this coverage, even after the Office of Personnel Management, which administers the FEHB program, reported that this coverage did not add any cost to the FEHB premiums. Congress did not accept the proposal.

Science: Basing policy on political dogma, not research
The scientific community has repeatedly voiced concern that politics are driving the Bush administration's science policy. For example, scientists applying for grants from the National Institutes of Health to study HIV/AIDS and other sexually transmitted infections have reported that their applications are less likely to be accepted if they contain terms that the Department of Health and Human Services (HHS) finds controversial, such as "sex workers" or "men who sleep with men"-even when the proposed research topics are about HIV prevention among prostitutes or HIV testing and gay men. In addition, scientists nominated to serve on federal research advisory committees that help decide science and health policy say they have been screened for their political loyalty rather than their scientific credentials. Often bringing an ideological perspective to scientific issues, the Administration has called into question the theory of evolution, distorted the science on abortion as a risk factor for breast cancer despite scientific consensus that it is not, and taken a strong position against stem-cell research—even going so far as to remove members from the Council on Bioethics because of their views on the issue. The political distortions have grown troubling enough to lead a 2005 Nobel laureate in physics to criticize the Bush administration publicly for evaluating research projects politically rather than scientifically. Click here for a detailed report investigating the Bush administration's promotion of ideology over science. 

Center for Disease Control: Gagging scientists and doctors
The Centers for Disease Control and Prevention (CDC), defined as "the lead federal agency for protecting health and safety of people—at home and abroad," altered information on its web site to promote the Bush administration's preference for abstinence-only sex education. The first item to disappear was "Programs that Work," a resource for educators that described sexuality education curricula that have been effective in reducing risky behavior among adolescents. The second was "Facts about Condoms and their Use in Preventing HIV Infection," removed from the CDC web site for several weeks and then re-posted with substantial changes. The original fact sheet described how to use condoms properly and discussed the efficacy of different kinds of condoms. In the new version, this information has been replaced with several paragraphs that promote abstinence only and simply discuss condoms' failure rates.
 
National Cancer Institute: Censoring information
On November 25, 2002, the National Cancer Institute (NCI) posted "Early Reproductive Events and Breast Cancer," a fact sheet intended to replace "Abortion and Breast Cancer," which had disappeared from the NCI's web site several weeks earlier. The original fact sheet, based on a critical analysis of a number of different studies, debunked the myth that spontaneous or induced abortions increase women's risk of developing breast cancer. By contrast, the new fact sheet states that studies are "inconsistent," failing to mention that early studies suggesting a link between abortion and breast cancer were found to be scientifically unsound, and that larger, better designed studies, including one published in the New England Journal of Medicine, found no link whatsoever between abortion and breast cancer. On December 18, 2002 a bipartisan group of congressional representatives wrote to HHS secretary Tommy Thompson asking for an explanation, calling the switch "nothing more than the political creation of scientific uncertainty." The NCI's Board of Scientific Advisors and Board of Scientific Counselors concluded on March 3, 2003 that there is no evidence that having an abortion increases the risk of breast cancer.

Department of Health and Human Services: Harassing grantees
The Department of Health and Human Services (HHS), including the Centers for Disease Control (CDC), is seeking to gag non-governmental organizations that advocate for a comprehensive approach to HIV/AIDS prevention. In June 2004, the CDC proposed new guidelines requiring non-profit grantees to gain CDC approval of all educational materials before posting them on their own websites, citing the federal government's concerns over "controversial" messages that organizations may provide to individuals who are not in monogamous relationships or practicing abstinence. Beyond limiting First Amendment rights to free speech, these actions could hinder efforts to halt HIV transmission. The CDC's recent moves to limit information on its own website about the efficacy of condoms in preventing HIV (see above) raises significant concerns about the guidelines' impact on other organizations' websites. In addition, HHS is using selective and repeated financial audits to harass non-profit grantees that provide comprehensive education on STIs and pregnancy prevention rather than simply adopting an abstinence-only-until-marriage approach. The HHS inspector general has also investigated at least eight AIDS prevention and awareness programs, including Stop AIDS, to see if their content is "too sexually explicit" or "promotes sexual activity." In one case, CDC Director Dr. Julie Gerberding contradicted the inspector general's report, finding instead that "the design and delivery of Stop AIDS prevention activities was based on current accepted behavioral science theories in the area of health promotion." Beyond indicating the Administration's willingness to promote politics over public health, the harassment causes non-profits to waste valuable resources to counter repeated charges. No violations have been found
 
Mother May I: Restricting American scientists' contact with the WHO
In April 2004 the U.S. Department of Health and Human Services (HHS) announced that U.S. government health experts must now get permission from senior Bush administration officials before they can lend their expertise as consultants to the World Health Organization (WHO), and they must agree to advocate U.S. government policies. For two decades WHO has routinely called on experts at HHS to serve as technical consultants on health and science, but William Steiger, Director of the Office of Global Health at HHS, said that his office will now select "an appropriate expert who can best serve both our organizations." Steiger warns that HHS experts are required "to serve as representatives of the U.S. Government at all times and advocate for U.S. Government policies." Requiring that political loyalty outweigh scientific objectivity undermines free speech, fosters an environment of censorship within the scientific community, and limits global progress on critical health issues by preventing U.S. scientists from sharing their findings with the rest of the world. (Click here for "Politics and Science," a complete catalog of similar Administration actions)

Global Health Meeting: Ending 30 years of support
Bowing to pressure from the offices of right-wing Congressman Chris Smith (R-NJ) and Senator Judd Gregg (R-NH), and conservative groups such as the Traditional Values Coalition and the American Life League, the Bush administration withdrew funding for the Global Health Council's annual conference, which the federal government has supported for 30 years. The Traditional Values Coalition criticized the conference for failing to "reflect administration policies" and for anti-Bush lobbying, despite the diversity of participating organizations, which include the Catholic Medical Mission Board, the Pan-American Health Organization, and Save the Children, and the wide-ranging agenda. At the 2004 conference, "Youth and Health: Generation on the Edge," 2,000 international health practitioners, researchers, and advocates from around the world discussed topics critical to young people's health, including infectious diseases, nutrition, reproductive health, the HIV/AIDS pandemic, disaster assistance, early marriage, and substance use. The United States Agency for International Development (USAID), the Centers for Disease Control (CDC), and the Department of Health and Human Services (HHS) all pulled their funding in April 2004—just two months before the conference date.

Title IX: Trying to weaken equality in school athletics
Title IX, the landmark federal law that prohibits sex discrimination in education, is best known for opening the doors of opportunity in sports participation and scholarships for millions of young women and girls. In response to criticism that men's sports programs were being cut as a consequence, the Bush administration established a Commission on Opportunity in Athletics to review Title IX and propose changes. In February 2003, the Commission submitted a series of recommendations to the Secretary of Education, which would have weakened the law's equality requirements to the point of meaninglessness. Following intense public and bipartisan pressure, on July 11, 2003 the Bush administration backed down, but not for long. Undaunted and determined, on March 18, 2005, the Department of Education issued a new policy that lifts the burden of proving equal athletic opportunity off school administrators and places it squarely on the shoulders of female students. The new policy eliminates the longstanding requirement that schools prove compliance with Title IX based on a combination of indicators, including participation rates in club or intramural sports and interviews with coaches, administrators, and students. Instead, proof of compliance is now based on an optional email survey girls are asked to complete on their athletic abilities and interest. If enough girls fail to complete the survey, schools can claim compliance with Title IX by default.

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