President George W. Bush’s reelection presents pro-choice forces with the challenge of another four years of his administration’s relentless war on women. In its policies and practices at home and abroad, the Bush administration has violated the constitutional and human rights of countless women, and endangered their health and lives. President Bush’s record from the past four years reveals his determination to further restrict women’s ability to obtain abortions and to access a full range of reproductive health services. The following highlights many of the anti-choice measures of the Bush administration.

• Curbing Access to Emergency Contraception
• Pushing an Unconstitutional Federal Abortion Ban
• Launching an Assault on International Reproductive Rights
• Blindly Supporting Abstinence-only Programs
• Upholding Phantom Rights for So-called Unborn Victims
• Underfunding Title X

Curbing Access to Emergency Contraception
On May 6, 2004 after delaying a decision for several years, the Food and Drug Administration (FDA) denied women access to over-the-counter emergency contraception (EC), citing inadequate data on the use of the pills among girls under 16. The FDA took this action against the advice of its own medical experts, as well as the nation's obstetricians and gynecologists.

Emergency contraception pills contain hormones that reduce the risk of pregnancy when taken within 120 hours of unprotected intercourse. The sooner it is taken, the better EC works to prevent pregnancy. Because timely access to EC is so important and because the medical evidence overwhelmingly establishes the safety of EC, over four years ago the Center for Reproductive Rights petitioned the FDA on behalf of 70 medical and public health organizations to make EC available over the counter (OTC). After we filed our petition, Barr Laboratories requested OTC status for their EC product, Plan B. In December 2003, the FDA's own expert panel recommended approval of OTC status for EC by a vote of 23 to 4, and the American College of Obstetricians and Gynecologists reaffirmed its support for approval. Nevertheless, Steven Galson, the acting director of the FDA’s Center for Drug Evaluation and Research, decided on his own to reject the recommendations of his staff and deny OTC status for EC.

It has been reported in the Wall Street Journal and the Washington Post that FDA scientists disagreed with the agency’s finding that there was not enough information on how Plan B would affect the sexual behavior of younger women. In fact, there is plenty of evidence that emergency contraception has high success rates and is safe for use without a prescription by women of all ages, including those under 16. Many have speculated that the decision was politically motivated. As Republican Congressman Jim Greenwood (R-Pa.) stated to the Washington Post (6/18), "[M]aybe some folks thought it would be more comfortable politically to give an approval after the election."

Emergency contraception has the potential to prevent 70,000 unintended pregnancies that end in abortion every year. If the administration is serious about reducing the number of abortions in this country without harming women, it should have supported increased access to emergency contraception. Instead, the FDA's action will needlessly place women at risk of pregnancy when contraception fails.

Pushing an Unconstitutional Federal Abortion Ban
On November 5, 2003, President Bush signed into law the first-ever federal ban on abortion, despite a June 2000 U.S. Supreme Court ruling that found similar bans to be unconstitutional. The Supreme Court case, argued successfully by the Center for Reproductive Rights, struck down a Nebraska law that was nearly identical to the federal ban.

The Center for Reproductive Rights opposes the federal abortion ban because the law makes no exception for the health of the woman. On October 31, 2004, the Center filed a lawsuit in federal court in Nebraska on behalf of Dr. LeRoy Carhart, the lead plaintiff in the Supreme Court case, and other physicians to stop the abortion ban from taking effect. Representing doctors from Nebraska, New York, Virginia, and Iowa, the Center argued in a Nebraska federal court that the ban on safe abortion procedures violates the U.S. Constitution and puts women's health in serious jeopardy. Two other lawsuits challenging the federal ban were filed by the American Civil Liberties Union for the National Abortion Federation, in New York, and by the Planned Parenthood Federation of America, in San Francisco.

On September 8, 2004, the Nebraska judge, United States District Judge Richard Kopf, became the third judge to declare the "Partial Birth Abortion Act of 2003" unconstitutional, recognizing the law as a serious threat to women's health. As the court recognized, the ban was unconstitutional for two reasons. First, the ban prohibited physicians from performing more than just a single procedure; it also prohibited physicians from performing some of the safest procedures available. Second, the ban failed to provide any exception for circumstances when the banned procedures would be the safest for the woman. Judge Kopf described congressional findings to the contrary as unreasonable and unsupported by the evidence before Congress itself as well as by the extensive additional evidence before the court.

Launching an Assault on International Reproductive Rights
The Bush administration has increasingly isolated the U.S. from the international community by threatening women’s fundamental reproductive rights around the world. For example:

• In January 2001, President Bush reinstated the global gag rule, which restricts foreign nongovernmental organizations (NGOs) that accept U.S. Agency for International Development (USAID) family planning funds from using non-U.S. funds to provide legal abortion services, to advocate for abortion law reform in their own countries, or even to provide full and accurate medical information to patients. The global gag rule violates the rights of foreign NGOs to freedom of speech and political participation and prevents many women around the world from accessing comprehensive reproductive health services. Such a restriction would be unconstitutional if it were applied to a U.S.-based NGO.

• The Bush administration has sought to undermine global consensus on reproductive rights at the United Nations. Ten years ago, 179 governments around the world agreed at the International Conference on Population and Development (ICPD) that reproductive rights are basic human rights. In an effort to erode this global commitment, the Bush administration tried—unsuccessfully—to obstruct consensus at a series of regional and global meetings aimed at reaffirming commitment to the ICPD recommendations. Similarly, the Bush administration attempted to obstruct the General Assembly’s action agenda for children’s health at the United Nations General Assembly Special Session on Children in May 2002. During negotiations over the wording of the agenda, the administration advocated for language limiting sexual education and information to the promotion of "abstinence-only-until-marriage." While the administration failed in this effort, it was still able to impede the negotiations, turning a blind eye to the glaring needs of adolescents for potentially life-saving information and services.

• In July 2002, after heavy pressure from anti-choice groups citing claims that the United Nations Population Fund (UNFPA) was involved in promoting coercive abortions and sterilizations in China, the U.S. State Department refused to distribute $34 million appropriated by Congress for UNFPA. The Bush administration has persisted in holding back desperately needed funds each year since then, withholding a total of $93 million. This despite evidence that UNFPA's work in China has always been limited to support for voluntary family planning services. The Bush administration's decision continues to severely harm women in approximately 140 countries.

Blindly Supporting Abstinence-Only Programs
The strategy to deny adolescents their right to reproductive choice is demonstrated by the Bush administration’s continued increases in funding for abstinence-only programs and curricula. These programs prohibit any discussion of contraceptives—apart from statistics on failure rates—in favor of ideological messages claiming that sexual activity outside of marriage will lead to psychological and physical harm. Numerous studies and the preliminary findings of a study funded by the U.S. Department of Health and Human Services have established that not only do abstinence-only education programs fail to decrease sexual activity, unwanted pregnancies or the spread of sexually transmissible infections (STIs) among adolescents, they actually lead to a decline in the use of contraception by sexually active adolescents.

Despite this, the Bush administration has significantly increased funding for abstinence-only programs in recent years. In fiscal year (FY) 2002, more than $100 million was allocated for abstinence-only programs -- twice as much as was allocated in the previous year. In FY 2003, $117 was allocated to these programs, and Bush’s FY 2004 budget request would increase federal funding for abstinence-only education to $135 million, an $18 million increase from FY 2003. And in FY 2005, President Bush requested doubling funding for the programs to $273 million. Meanwhile, there is no federal program dedicated to supporting comprehensive sexuality education that includes information on abstinence as well as contraception and prevention of STIs.

The Bush administration and other anti-choice activists have also extended their attacks on adolescents’ reproductive rights beyond U.S. borders. The new $15 billion HIV/AIDS assistance bill, signed into law by President Bush, requires that at least one-third of the yearly disbursement of the funds for prevention programs—roughly $200 million a year—be set aside for abstinence-only education programs. In countries devastated by HIV/AIDS, abstinence is not possible for many women and girls due to the prevalence of early marriage and sexual violence. As a result, the Bush administration’s funding restrictions will force organizations on the frontlines of HIV/AIDS prevention to either forgo desperately needed funds, or continue with programs that are out of touch with the realities of HIV/AIDS transmission.

Upholding Phantom Rights for So-called Unborn Victims
The Bush administration continues to advance its theory of "fetal personhood" in a campaign to undermine the right to choose abortion.

In its 1973 decision in Roe v. Wade, striking down a Texas law criminalizing abortion, the U. S. Supreme Court ruled that a fetus is not a "person" entitled to protection under the Fourteenth Amendment of the federal Constitution. Despite the Court’s ruling, anti-choice lawmakers have repeatedly attempted to elevate the status of the fetus and undermine Roe.

Recognition of the fetus as a "person" under the law could undermine or create conflicts with the rights of pregnant women. The Bush administration adopted regulations that allow states to classify a fertilized egg as an "unborn child¹ " eligible for coverage under the State Children's Health Insurance Program, rather than provide coverage for pregnant women under the program.

The Bush administration also supported federal legislative efforts to elevate the status of the fetus. After Congress passed the Unborn Victims of Violence Act (UVVA) at the administration’s urging, President Bush signed it into law in April 2004. UVVA, which defines "unborn child" and "child in utero" as "a member of the species homo sapiens, at any stage of development, who is carried in the womb," is the first federal law to recognize a fertilized egg as a crime "victim," independent of the pregnant woman who suffers the physical injury.

Underfunding Title X
Family planning clinics are vital to the provision of reproductive health care and often serve as an entry point into the health-care system for young women and low-income people in this country. They offer contraceptive services and education that prevent unintended pregnancy, testing, and treatment for STIs, and other primary reproductive health care.

The U.S. government’s Title X program funds low-cost, confidential family planning services that would otherwise be out of reach for many women. Title X not only benefits millions of Americans each year, but also serves important public health goals. Unless the program is adequately funded, however, many Americans will be unable to obtain these important services.

Each year approximately 4.5 million people receive health-care services at Title X-funded clinics. The vast majority of those using Title X clinics are women, and 60% are under 25 years of age. Nearly two-thirds of Title X clients come from households with incomes below the poverty level.² Title X family planning clinics have served an important need in communities throughout the United States for more than thirty years. The services provided have reduced the number of unintended pregnancies and improved the health of the population.

Unfortunately, the Title X program does not receive enough funding to meet the goal of "making comprehensive voluntary family planning services readily available."³ Nearly half of the pregnancies occurring each year in the United States are unintended, and approximately half of those pregnancies are terminated by abortion.⁴ If Title X funding had been increased at the rate of inflation from its FY 1980 funding level of $162 million, it would have been funded at over $590 million in FY 2002. Yet the Bush administration proposed level funding for the program at a mere $265 million for the 2003 and 2004 budgets, and Congress appropriated $275 million in 2003.⁵ At the same time, the rising costs of contraceptives and diagnostic tests are straining the limited financial resources of Title X providers.⁶

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The Center for Reproductive Rights uses the law to advance reproductive freedom as a fundamental right that all governments are obligated to protect, respect, and fulfill.

Endnotes
1. This is not the first time this administration has supported efforts to redefine personhood. For example, in regulations effective on November 1, 2002, the Department of Health and Human Services amended regulations governing the State Children's Health Insurance program (SCHIP) to classify the fetus as an "unborn child" and expand coverage to "an individual in the period between conception and birth up to age 19."
2. Department of Health and Human Services, Office of Public Health and Science, Office of Population Affairs, Office of Family Planning, http://opa.osophs.dhhs.gov/titlex/ofp.html.
3. Family Planning Services & Population Research Act of 1970, Pub. L. No. 91-572, 84 Stat. 1504 (1970) (codified as amended at 42 U.S.C. §§ 300 et seq. (1991 & Supp. 2000).
4. The Alan Guttmacher Institute, Facts In Brief, Induced Abortion (2003).
5. National Family Planning and Reproductive Health Association, "Title X--America's Federal Family Planning Program," Aug. 8, 2003. See http://www.nfprha.org/pac/factsheets/titlex.asp.
6. Issues In Brief, Nowhere But Up: Rising Costs for Title X Clinics," The Alan Guttmacher Institute (2003).

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Anti-Choice Legislation in State Legislatures