Although emergency contraceptive pills have been prescribed to US women since the discovery of the birth control pill, this regimen has been termed "America's best-kept secret." For fear of legal liability, many providers have been unwilling to prescribe oral contraceptive pills for a purpose other than that for which they are labeled on the packaging. There are indications, however, that access to emergency contraception in the US is improving. PREVEN, the first product to be approved by the US Food and Drug Administration specifically for emergency contraception, was released in 1998. The kit includes a step-by-step information booklet, a pregnancy test, and four birth control pills. In Washington State, collaborative drug agreements between volunteer pharmacists and licensed prescribers enable pharmacists to prescribe emergency contraception pills directly--a move that is estimated to have prevented 207 unintended pregnancies and 103 abortions in less than one year. Planned Parenthood has developed two programs to increase the use of emergency contraception. The first allows clinicians to discuss emergency contraception over the phone with clients (even new ones) and to call in prescriptions to local pharmacies; the second provides women with emergency contraceptive kits to keep on hand in advance of a need for the regimen.
In the US, the Religious Coalition for Reproductive Choice asserts that socially conservative religious groups have misled the American people into believing that all religious people oppose the right to an abortion, reproductive choice, and sex education when, in fact, mainstream clergy are overwhelmingly pro-choice. A 1998 survey indicated that 92% of 420 Jewish rabbis and Protestant clergy support a woman's right to decide when to have children, sex education in religious schools, and discussing sexuality and reproductive choice from the pulpit. The respondents pointed to religious tradition, personal beliefs, medical considerations, and quality of life as the most important factors in sexuality and abortion decision-making. Islamic teachings also encourage reproductive responsibility and personal choice. Religious leaders note that their pro-choice positions are neither new nor radical but have been obscured by right-wing religious groups. A 1995 Time/CNN national poll revealed that Roman Catholic laity deviate from their church hierarchy by practicing contraception (59%), supporting abortion in certain circumstances (82%), and supporting a woman's right to choose abortion in all circumstances (39%). These statistics reflect the fact that 90-95% of Americans identify themselves as religious and 70% as pro-choice. Much support for legalized abortion comes from older women who remember when abortion was illegal and unsafe. Young women must be taught not to be complacent about their reproductive rights.
During the 1994 International Conference on Population and Development (ICPD) in Cairo, 180 nations agreed for the first time that women's reproductive health and empowerment are crucial to national sustainability and growth. In the US the government has increased funding to family planning (FP) and reproductive care services nationwide, while continuing to ensure that abortion remain safe, legal, and increasingly rare. Commitments to FP must be continued in light of the nearly 600,000 annual deaths worldwide from pregnancy-related causes. Commitments to education must continue because two-thirds of the 960 million illiterate adults are women. The goals to reach by the year 2015 are for pregnancies to be planned, children to be wanted, and women to achieve their rightful place in society. Educating women means educating families, and educating families means educating societies.
In this article, former US Senator Paul Simon notes that, in his lifetime, the population of the world has tripled and is expected to quadruple. Among the effects of this population growth will be a 55% increase in nitrate emissions that will feed algae and compromise fish supplies. The US was extremely short-sighted when it reduced funding for the international family planning (FP) programs that benefit all nations. False accusations that the UN Population Fund (UNFPA) operates with a "bloated bureaucracy" ignore the fact that this agency has only 166 employees. More appropriate criticism would assert that the task the UNFPA is trying to accomplish is too important and too vast for such a small staff. Without FP programs, earth would now have to support an additional 400 million people. While contraceptive use by married women in developing countries has increased from 10% in 1965 to above 50% today and life expectancy is increasing, we must recognize the fact that we are currently unable to provide most of the world's population with safe water and sanitation and that increased population size will only exacerbate this problem. Encouraging voluntary FP is humanitarian and prudent and will help protect the entire population of the world.
In Africa, only 46% of women are literate; 60% in Asian countries and 85% in Latin America. Even though educating girls has been repeatedly shown to increase their self-esteem, to increase their influence over their own lives and family and community decisions, to lower fertility, to improve maternal and child health, and to help in decreasing environmental degradation, considerable resistance still exists in developing countries to educating girls. Believing that boys who attend school will complete their education, secure employment, and earn wages to contribute to the well-being of the family, parents encourage boys to attend school and girls to remain at home to help with housework and raising younger siblings. The author recounts the story of a 10-year-old girl in Namibia forced to remain at home with her mother to help care for her younger siblings. The girl looks forward to having her own, albeit smaller, family.
