Coercion and Reproductive Justice

An essential piece of the reproductive justice and sexual rights movement is the right of all women to make reproductive choices free from coercion.

According to the Guttmacher Institute, coercion in any form is wrong and compromises choice. Coercion violates women’s right to decide freely if and when to have a child and the right to have the government respect her decision.

The Guttmacher report condemns coercion in the form of U.S. state legislatures passing increasingly restrictive abortion restrictions to keep women from ending an unwanted pregnancy. Parental notification or consent, mandatory waiting periods, and inaccurate and biased counseling exist under the guise of “preventing coerced abortion”. Rather, these TRAP laws aim not so much to inform women about the abortion procedure, as to dissuade them from choosing an abortion in the first place.

Increasingly, these laws prevent women from making decisions about how and when to give birth, posing a risk to all pregnant women, including those who want to stay pregnant.

Roe v. Wade gave women the right to choose abortion. Roe v. Wade also gave women the right not to choose abortion.

In the United States, a dark history of forced sterilization and present day controversies about the rights of the disabled remind us that as much as women have a freedom to abortion, if she chooses to continue a pregnancy, she has the equal right to do so.

Coerced abortion occurs in many forms. In January 2014, a Florida man was sentenced  to nearly 14 years in prison for tricking his pregnant girlfriend into taking Cytotec, a brand-name version of misoprostol, which causes miscarriage. Further complicating the issue, he was initially charged with first-degree murder under the Unborn Victims of Violence Act, punishable by life in prison, but he pleaded guilty to lesser charges of product tampering. The fetus was estimated to be at seven weeks.

In 2013 in Texas, a pregnant 16 year old girl claimed her parents were pressuring her to have an abortion when she wanted to continue the pregnancy and get married. When the pregnancy was confirmed, the teenager’s father allegedly became angry and insisted that she have an abortion and it was his decision.  Texas is one of the states that requires parental or judicial permission for a minor to obtain abortion; in this case, the minor had to obtain judicial permission not to have an abortion.

Coerced abortion compromises reproductive justice and often results from broader issues such as domestic and sexual violence, birth control access and tampering, economic disadvantage, education expectations, and religious convictions. Abortion is not the problem. The prevention of choice is the problem.

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Emergency Contraception Controversy & Gender-Based Violence

Access to emergency contraception (EC) has a storied history in the USA and directly impacts victims of sexual violence. Ci3 and the Section of Family Planning & Contraception Research, along with the Center for the Study of Gender and Sexuality hosted a challenging and informative presentation that explored this intersection. Dr. Susan F. Wood, Associate Professor of Health Policy and Director of the Jacobs Institute of Women’s Health at The George Washington University spoke about her role and observations surrounding over-the-counter EC access.

As Assistant Commissioner for Women’s Health at the FDA, Dr. Wood directed the FDA Office of Women’s Health from 2000 to 2005, at which point she resigned on principle over the continued delay of approval of EC over-the-counter.

Dr. Susan F. Wood

Dr. Susan F. Wood

Dr. Wood’s talk, Controversy over Contraception: From Emergency Contraception to Contraceptive Coverage to the Affordable Care Act, began with the historical context of women’s health and federal funding and ended with the implications of the ACA specifically regarding contraceptive coverage and access.Her talk focused primarily on the ongoing struggle to make EC available to all women over the counter.

In her role at the FDA, Dr. Wood witnessed the agency’s attempts to regulate the practice of medicine and pharmacy when it came to emergency contraception, an unprecedented course of action not only in its role as a government agency but also because of the impact on women’s access to family planning services.

The FDA approved Plan B as EC in 1999 as a prescription product for all women of childbearing potential. The manufacturer sought over-the-counter (OTC) approval in 2003.

At this early stage, it was already known that:

  • EC is safe and suitable for all women.
  • EC does not cause an abortion (“The only relation between EC and abortion is that EC prevents the need for an abortion,” says Dr. Wood.)
  • EC needs to be taken soon after (within hours of) intercourse to be the most effective.
  • EC provides victims of rape the option to prevent an unwanted pregnancy.

Despite these facts and extensive studies on the safety for women of all ages, politics and myths about EC — that it would increase adolescent sexual activity, encourage pedophilia, or cause an abortion — delayed FDA approval.

Not until August 2006 did the FDA approve Plan B over-the-counter (OTC) at pharmacies and health clinics, and this approval was limited to women 18 years and older; younger women would still require a prescription. Between 2003-2006, recommendation for approval had been overruled several times, Dr. Wood resigned, and activists across the country lobbied the FDA to make decisions that reflect good medicine and public interest.

In March 2009, a US district court ruled that the FDA decision to restrict access to women under 18 was “arbitrary and capricious” and ordered the FDA to lift restrictions on 17-year-olds within 30 days. Also in 2009, the FDA approved One Step (a one-dose version of Plan B) and Next Choice (a two-dose generic version), but the age restriction remained at 17. In 2010, with the age restriction still in place, The Center for Reproductive Rights filed for contempt of court citing the delays.

In 2011, Teva (One Step) released new data and filed an application to lift the age restriction. With the age restriction ready to be lifted, the FDA was overruled by Health and Human Services Secretary Kathleen Sebelius, who cited the lack of evidence on 11- to 12-year-olds’ ability to use the product. Although this argument was unprecedented and unfounded, President Obama agreed with Kathleen’s lack of evidence argument and the age restriction remained.

It took until June 2013 for the FDA to approve Plan B One Step OTC for all women without age restriction. That is, it took 10 years for women to have OTC access to a safe medicine approved by the FDA for women of all ages.

Plan B as seen over-the-counter. Image from Dr Wood's presentation 11/19/13.

Plan B as seen over-the-counter. Image from Dr. Wood’s presentation 11/19/13.

How does this history of EC approval, restrictions, stigma, and accessibility relate to gender-based violence and the 16 Days of Activism Against Gender-Based Violence campaign?

  1. EC is an essential contraceptive option for women who experience sexual violence. According to the FDA: “Seven out of every eight women who would have gotten pregnant will not become pregnant after taking Plan B, Plan B One-Step, or Next Choice.” Dr. Wood adds, “There isn’t any difference in efficacy for the use of EC for victims of sexual violence.”
  2. EC potentially prevents the extra burden of an unwanted pregnancy for rape victims.
  3. The cost of EC may be prohibitive; EC costs about $50 OTC in most pharmacies. Under the Affordable Care Act, the cost should still be covered through prescription. According to Dr. Wood, in the cases of rape, specifically for populations who cannot afford the $50, access to EC through family planning clinics may reduce the cost.
  4. If a victim of sexual violence seeks care at an emergency room, EC should be provided as part of her treatment.
  5. Even though EC is available OTC, doctors should continue prescribing and counseling EC, especially for victims of sexual violence. According to Dr. Wood, “Time is of the essence, so provision of information, and advance provision of EC can be helpful for all women. In addition, awareness by providers of other EC methods, such as insertion of copper IUD or use of Ella (a prescription only emergency contraception that is effective for up to 5 days) is important.”

16 Days of Activism Against Gender-Based Violence – Nov. 25-Dec. 10

Today marks the first day of the 16 Days of Activism Against Gender-Based Violence. The campaign will run through December 10.

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From the official website:

The international campaign originated from the first Women’s Global Leadership Institute, coordinated by the Center for Women’s Global Leadership in 1991. Participants chose November 25 (the International Day Against Violence Against Women) and December 10 (International Human Rights Day) in order to symbolically link violence against women and human rights, and to emphasize that such violence is a violation of human rights.

This 16-day period also highlights other significant dates including November 29, International Women Human Rights Defenders Day, December 1, World AIDS Day, and December 6, which marks the Anniversary of the Montreal Massacre.  The 16 Days Campaign has been used as an organizing strategy by individuals and groups around the world to call for the elimination of all forms of violence against women by:

  • raising awareness about gender-based violence as a human rights issue at the local, national, regional and international levels
  • strengthening local work around violence against women
  • establishing a clear link between local and international work to end violence against women
  • providing a forum in which organizers can develop and share new and effective strategies
  • demonstrating the solidarity of women around the world organizing against violence against women
  • creating tools to pressure governments to implement promises made to eliminate violence against women
Since 1991, over 5,167 organizations in approximately 187 countries have participated in the 16 Days Campaign. This year, The University of Chicago Section of Family Planning and Ci3 (the Center for Interdisciplinary Inquiry and Innovation in Sexual and Reproduction Health) will join as participants. We will be posting original content and relevant links for each of the 16 days, ranging from personal experiences to film reviews to research.
To join the conversation:

Thank you for your participation, and for your support.