Sunday, May 26, 2002

The fight over The Pill

N. Ky. health board may reject federal family planning money

By Kristina Goetz,
The Cincinnati Enquirer

        COVINGTON — A campaign to redefine the birth control pill is roiling the abortion debate in these riverside hills and beyond.

        It raises these questions:

        Is the birth control pill an abortion drug in disguise? Are public health agencies obliged to dispense tax-paid contraceptives they deem morally wrong?

[photo] Robert C. Cetrulo is leading a campaign to push the Northern Kentucky Independent District Health Board to refuse Title X family planning dollars,
(Patrick Reddy photo)
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        And what's the role of poor women when politics, religion and public health policy collide?

        Opinions are hardening as a landmark decision looms. On June 19, a vote by the local health board could make it the nation's first to reject family planning dollars on grounds that it is money for contraceptives that abort babies.

        The health care of 4,500 poor women in four counties is at stake. Title X finances not only contraceptives, but pregnancy tests, breast exams, sexually transmitted disease screening and a host of other gynecological care.

        “It's an idea whose time has come,” says Robert C. Cetrulo, president of Northern Kentucky Right to Life, an anti-abortion group with considerable clout here.

        In a full-page ad in Saturday's major Northern Kentucky newspapers, the group stated the idea clearly : “Many things denominated as 'contraceptive' are truly abortifacient — the IUD, Norplant, RU-486, the so-called morning-after pill, and the so-called standard birth control pill.”

        Mr. Cetrulo, a man whose organization does not compromise, who says he represents the majority opinion of those living in this part of Greater Cincinnati, is on one side.

        But debate about whether the birth control pill belongs on that list is so passionate that even staunch anti-abortion activists cannot agree.

Rice Leach, commissioner, Ky. Dept. for Public Health: "This department will find someone else to make that service available to those women."
Barb Black, N.Ky. health board: The stance that the pill causes abortions "is a condemnation of the medical community for prescribing it, of pharmacists for dispensing it and even married couples for using it."
Dr. Richard Gautraud, N.Ky. health board: "Birth control pills are the most difficult because they are so much a part of the culture."
        “This is an extremist view,” says Kenton County Commissioner Barb Black, a registered nurse and an anti-abortion leader and one of 29 members of the Northern Kentucky Independent District Health Board.

        She supports keeping Title X, which brought nearly $170,000 this fiscal year to Boone, Campbell, Kenton and Grant counties. Any attempt to redefine America's popular birth control pill as an abortion drug is scientifically flawed, she says.

        “It's a condemnation of the medical community for prescribing it, of pharmacists for dispensing it and even married couples for using it,” she says.

Close vote?

        At this point, the 29-member health board's vote is too close to call, board chairman Greg Kennedy says. Heated meetings of the board — some quoted in NKY Right to Life's ad — show that the Fiscal Court-appointed members are split about down the middle. Mr. Kennedy will only vote if there is a tie, but he supports keeping Title X coming.

        “It's dangerous when politics starts to drive public health policy,” he says.

        Dr. Richard Gautraud, an emergency room doctor and health board member, wants to turn back the money for several reasons, including that birth control pills can cause abortions, he said.

        “Birth control pills are the most difficult because they are so much a part of the culture,” he said. “But it would be hard for me to turn away and pretend it doesn't exist.

        “It's just consistent with the belief that human life begins at conception.”

        The birth control-or-abortion issue has grown into a topic of widespread, grassroots concern with implications far beyond here.

        Nearly 400 people packed a health board meeting this month to voice their own views and hear experts testify.

        Dr. Robert Hatcher, a professor of gynecology and obstetrics at Emory University in Atlanta, flew in to espouse the pill's contraceptive benefits. Considered one of the nation's leading experts on birth control, he said the pill is an accepted contraceptive under definitions used by major health agencies worldwide.

        The pill works in three ways, Dr. Hatcher says. It stops a woman's ovulation, so no eggs are released. It thickens the cervical mucus so sperm have a tougher time getting to eggs. And it changes the lining of the uterus to inhibit implantation of a fertilized egg.

        Those who believe the pill causes abortions point to the third possible effect to back up their views.

        Since the change to the uterine lining takes place under the influence of a drug — and since they believe that life begins at conception — the destruction of that life constitutes an abortion, these people say.

        “Why should the county be engaged in that?” Mr. Cetrulo says. “How is that health care? Pregnancy is not a disease.”

        Abortion supporters and opponents outside the region are paying close attention to what's happening here.

        The American Civil Liberties Union calls attempts to limit contraceptive use “extreme” and “hostile.”

        “It shows that people who are against abortion are not satisfied with simply not providing abortion services,” says Jennifer Dalven, a lawyer with the ACLU's Reproductive Freedom Project in New York.

        “They are really trying to control women's reproductive lives.”

        Here in Northern Kentucky, Denise Sanders, a 25-year-old college student, is convinced that politics is interfering with her right to the same reproductive health services available to most American women everywhere.

        “If they decide not to give out contraceptives, Paps may go down, and Pap smears are what are saving our lives,” says Ms. Sanders, one of 360 students whose care could be jeopardized at Northern Kentucky University.

        “It's another attempt to take away my right as a woman,” she says. “If they can't get rid of abortion, the law, they're going to do something else.”

        William Lutz, a spokesman for the National Abortion and Reproductive Rights Action League in Washington, D.C., agrees the debate bears watching.

        “It is possible that (this) reflects a new area of involvement for the anti-choice movement,” Mr. Lutz says. “We are always on the watch for strategic change.”

        The National Right to Life Committee would not comment on issues raised in the local debate because Northern Kentucky Right to Life is not affiliated with the state or national organization. Mr. Cetrulo said the local group is affiliated with the American Life League and the Kentucky Coalition for Life.

        “(National Right to Life) has compromised many times on candidates who don't take a fully pro-life position,” he said.

        In a statement, National Right to Life says it takes no position on measures that prevent the uniting of egg and sperm. Once fertilization has occurred, however, “a new life has begun and (the group) is opposed to the destruction of that new human life.”

Passionate issue

        To understand the passion here is to understand an anti-abortion sentiment so steeped in local politics and religion that Planned Parenthood's nearest Kentucky office is 70 miles away.

        Nearly one in three Northern Kentuckians is Roman Catholic; that church teaches that abortion and contraceptive use are mortal sins.

        The Republican Party dominates in most towns, and officeholders are unfailingly anti-abortion. Even Democrats vote a strict anti-abortion line, and not one of Northern Kentucky's 17 state representatives supports pro-abortion rights.

        The Northern Kentucky Right to Life is so convinced of support that its candidate questionnaire this fall asks office seekers not only if they oppose abortion — but if they view the pill as an abortion drug as well.

        Robert Hay, a former Boone County commissioner and pharmacist, felt so strongly that dispensing birth control pills was immoral that he quit his job of 19 years at Walgreens in Florence and moved to Huntington, W.Va., last December.

        Now at St. Mary's Hospital Pharmacy, he doesn't have to dispense any contraceptives because the Catholic institution doesn't carry them.

        “Professionally, I rationalized it, quite frankly, for a number of years,” Mr. Hays says of his time in Kentucky. “The issue is: Are our children truly a blessing or are they a curse to be avoided?”

        Supporters of them are just as adamant that contraceptives should not be withheld.

        George Graham lasted 2 1/2 years as the health board's public health director. He quit in disgust in December 2001 to become deputy commissioner of Medicaid services for the state. He is now deputy commissioner for public health.

        Part of his reason for leaving: the board's opposition to taxpayer funding of contraceptives.

        “The issue, to me, is the majority of women who use Title X funds are also the population that is at the lower end of our socioeconomic scale,” Mr. Graham says.

        “The women who are hurt most are the women who need the service the most, because they do not have the financial ability to get it any place else.”

State action

        If Title X is rejected, the state will have to find another qualified agency to provide the services for women in Northern Kentucky.

        “This department will find someone else to make that service available to those women,” said Rice Leach, commissioner of the Kentucky Department for Public Health.

        Steve Davis, director of adult and child health in Kentucky's state health department, says there could be an interruption in services.

        “I want to say in terms of weeks, as opposed to months, but I just don't know,” Dr. Davis said.

        “How would someone from Dry Ridge, Ky., get to Cincinnati if they didn't have transportation?” Mr. Kennedy says. “The answer is: They wouldn't.”

        Since President Nixon signed Title X into law in 1970, making it the only federal funding program for family planning services, only one known health board in the country has rejected its use, experts say.

        McHenry County, Ill., voted to refuse Title X funds in 1997, but that vote came after a different debate.

        There, the issue was whether parents should be notified if their teenage daughters get contraceptives. That vote was prompted after a 37-year-old grade school teacher brought a 14-year-old student to the health department for birth control injections so he could continue having sex with her.

        Tammy Johnson, a 30-year-old mother of two from Florence, worries she won't be able to get Pap smears and contraceptives from the Boone County clinic she visits.

        “My fear is if they quit with the birth control, what else are they going to do?”

        Ms. Johnson receives Title X-funded Depo-Provera contraceptive injections. She has high blood pressure and cannot take the birth control pill.

        Mr. Cetrulo, president of Northern Kentucky Right to Life, says he will push forward his position.

        His organization's power, he says, is built on three simple ideas: It never compromises. It attempts to educate, and then it prays.

        “If those fail we try to defeat people,” Mr. Cetrulo says. “It's not a secret. They get no free passes from us.”


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