Ellen Chesler

Roosevelt Institute Senior Fellow

Recent Posts by Ellen Chesler

  • Breaking the Cycle of Poverty: Expanding Access to Family Planning

    Mar 31, 2014Ellen CheslerAndrea Flynn

    Download the paper by Ellen Chesler and Andrea Flynn.

    Download the paper by Ellen Chesler and Andrea Flynn.

    Poverty shapes the lives of an increasing number of American women and their families and has many consequences, including high rates of unintended pregnancy. Conservatives, eager to further dismantle federal programs and defeat the new Affordable Care Act (ACA), have recently rekindled the idea that marriage promotion will reverse rising rates of poverty, unintended pregnancy, and single parenthood. To the contrary, addressing the root causes of poverty requires multiple interventions and far more generous government programs across a range of issues, particularly the expansion of reproductive health and family planning information, care, and services. This paper reviews the recent literature on women’s poverty and health and argues that accessible and high quality family planning services for poor women remain an essential component of poverty reduction. It also looks back at the history of policy debates over this question in the hope of finding a path toward renewed bi-partisan consensus.
     
    Key Arguments:
    • Family planning is a fundamental right of women and the foundation of human security.
    • Single women in poverty head a growing percentage of U. S.  households. Addressing their needs requires multiple policy interventions, but none can work if women are denied the agency to make – and act on – well-informed reproductive health decisions.
    • U.S. subsidized family planning programs meet only 54 percent of national need. The ACA will help bridge the gap, although its promise is threatened by legal challenges to the contraceptive mandate. Women deserve insurance coverage for the contraceptive method of their choice, without qualification. 
    • Many low-income women will fall through insurance gaps. Every state should expand Medicaid. The federal government should lift Medicaid’s five-year eligibility requirement for documented immigrants and increase Title X funding to address increased demand for services.
    • We can learn from history. Research since the 1970 adoption of Title X illustrates that access to improved family planning methods promotes responsible decision-making and reduces unwanted pregnancy and abortion. By contrast, abstinence-until marriage and marriage promotion programs advanced by conservatives have failed and been discredited. 

    Read "Breaking the Cycle of Poverty: Expanding Access to Family Planning," by Roosevelt Institute Senior Fellow Ellen Chesler and Fellow Andrea Flynn.

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  • The Contraceptive Mandate Finally Leads America Out of the Victorian Era

    Mar 31, 2014Ellen CheslerAndrea Flynn

    The Affordable Care Act demonstrates an affirmative, proactive step from government for women's access to reproductive health care, but conservatives are bent on moving backwards.

    The Affordable Care Act demonstrates an affirmative, proactive step from government for women's access to reproductive health care, but conservatives are bent on moving backwards.

    Contraception should be understood as a fundamental right of American women and a necessary foundation of human security. If that seems controversial, consider this: 99 percent of American women approve of birth control and the vast majority use it over many years of their lives. These women deserve and must continue to demand insurance coverage for the method of their choice, without qualification. That’s why the contraceptive mandate in the Affordable Care Act (ACA) is so important and potentially transformative. For the first time ever, all health insurance plans, whether paid for privately or with public subsidies, are required to cover all FDA approved contraceptives at no additional cost.

    Family planning is essential to securing the health and rights of women, but it is also the foundation of sound economic and social policy. Tragically, however, U.S. subsidized family planning programs currently serve just over half of those in need.

    The stakes are especially high for poor women, who cannot afford the high costs of the most reliable and desirable methods and experience much higher rates of early and unwanted pregnancy as a result. Single women in poverty head a growing percentage of U.S. households. In “Breaking the Cycle of Poverty: Expanding Access to Family Planning,” a new white paper released today by the Roosevelt Institute, we argue that addressing their needs, and opening up opportunities to them and their children, will require multiple policy interventions, but none can work if women are denied the right and the agency to make, and act on, well-informed decisions about their own bodies.

    Decades of social science research demonstrate that access to reliable and affordable family planning methods promotes responsible decision-making and reduces unwanted pregnancy and abortion. It allows women to pursue educational and employment opportunities that strengthen their families and their communities. A majority of women who participated in a recent study by the Guttmacher Institute, for example, report that birth control enables them to support themselves financially, complete their education, and get or keep a job. Other recent studies also show that providing family planning services at no cost results in more effective contraceptive use, decreased rates of unintended pregnancy, and dramatic declines in abortion rates.

    Many American conservatives, however, reject these claims. They blame single mothers for America’s rising tide of poverty and inequality, not the other way around. They insist that access to sexual and reproductive health information and services exacerbates social problems by promoting promiscuity and unintended pregnancy, when in fact, the exact opposite is true. They promote abstinence-education and marriage promotion programs that have been tried before and been discredited, because they simply do not work.

    This conflict was front and center last week as the U.S. Supreme Court heard 90 riveting minutes of argument in Sebelius v Hobby Lobby Stores, Inc. and Conestoga Wood Specialties Corp. v Sebelius, a pair of cases brought by two privately held corporations owned by Christian conservatives. The owners claim that the ACA violates the religious freedom of employers forced to cover the costs of contraception. Much of the testimony turned on technical questions of whether corporations, as opposed to the individuals who own them, legitimately have rights to assert in this instance, and whether they may impose those rights on employees who don’t share their views. There were also important matters of scientific integrity at stake, with the plaintiffs claiming that Intrauterine Devices (IUDs) and morning-after pills constitute methods of abortion, despite overwhelming medical agreement and numerous reputable scientific studies showing that, like everyday birth control pills, they only act to prevent conception.

    All but lost in the court’s conversation were larger concerns about the health and well-being of women and families – and of our society as a whole. The Supreme Court hearing comes in the wake of more than three years of persistent attacks by extreme conservative lawmakers who have already decimated publicly subsidized services in states across the country and left many low-income women without access to basic family planning and to other critical reproductive and maternal health care services.

    As legal scholar and policy analyst Dorothy Roberts observed, “when access to health care is denied, it’s the most marginalized women in this country and around the world who suffer the most—women of color, poor and low-wage workers, lesbian and trans women, women with disabilities... And this case has far-reaching consequences for their equal rights. Birth control is good health care, period.”

    Today, by government estimates, more than 27 million American women already benefit from the ACA’s contraceptive mandate, and 20 million more will enjoy expanded coverage when the law is fully implemented. Yet even by these optimistic assessments, many low-income women will continue to fall through insurance gaps, partly thanks to a 2012 Supreme Court ruling that enables states to opt-out of Medicaid expansion mandated by the ACA. More than 3.5 million – two-thirds of poor black and single mothers, and more than half of low-wage workers – will be left without insurance in those states.

    Conservative opposition to contraception is not new. As we observe in our paper, the U.S. controversy over family planning dates back to Victorian-era laws that first defined contraception as obscene and outlawed its use. Those laws carried the name of Anthony Comstock, an evangelical Christian who led a nearly 50-year crusade to root out sin and rid the country of pornography, contraceptives, and other allegedly “vile” materials that he believed promoted immorality. Sound familiar?

    It took nearly a century for the U.S. Supreme Court to reverse course and guarantee American women the right to use contraception under the constitutional doctrine of privacy first enunciated in 1965. The ACA promises us even more. It places an affirmative, positive obligation on government to provide women the resources to realize our rights. The question before us is simple: Do we turn back the clock and allow a new Comstockery to prevail, or do we move ahead into the 21st century by defending the full promise of the Affordable Care Act’s contraceptive mandate?

    Read Ellen and Andrea's paper, "Breaking the Cycle of Poverty: Expanding Access to Family Planning," here.

    Ellen Chesler is a Senior Fellow at the Roosevelt Institute and author of Woman of Valor: Margaret Sanger and the Birth Control Movement in America.

    Andrea Flynn is a Fellow at the Roosevelt Institute. She researches and writes about access to reproductive health care in the United States. You can follow her on Twitter @dreaflynn.

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  • The WPA Had a Low Price Tag but a Lasting Legacy

    Apr 8, 2013Ellen Chesler

    The WPA looks like a small investment by today's standards, but it remade the country.

    There’s hardly a community in the United States without a park, bridge, school, or library constructed by the WPA. Just think of the built legacy right here in New York: Hunter’s College’s handsome mid-century modern building on Park Avenue; LaGuardia Airport; the bucolic parkways, enduring beachfront facilities and swimming pools of Robert Moses; stunning murals in public spaces throughout the city.

    The WPA looks like a small investment by today's standards, but it remade the country.

    There’s hardly a community in the United States without a park, bridge, school, or library constructed by the WPA. Just think of the built legacy right here in New York: Hunter’s College’s handsome mid-century modern building on Park Avenue; LaGuardia Airport; the bucolic parkways, enduring beachfront facilities and swimming pools of Robert Moses; stunning murals in public spaces throughout the city.

    So it is actually surprising to learn on this anniversary that the entire federal appropriation for the legislation in 1935 was only $4.9 billion. And total spending across the country reached only $13.4 billion before the program expired in 1943, when wartime conscription and the recovery of private industry and manufacturing finally ended the unemployment crisis brought on by the Great Depression.

    Of course, money went a lot further back then. Salaries at 30 hours per week were pegged to prevailing wages and varied considerably by region, ranging from $20 to $100 per month. Federal spending on some WPA projects also leveraged state and local funds, adding by one estimate up to another 10-30 percent in investment. All together the program funded some 8 million jobs and put a meaningful dent in the number of unemployed who were looking for and able to work.

    This was far from a foundation for state socialism or a “seed bed for Communists,” as some of the program’s strongest critics on the right then described it. Spending was also, by and large, not politically motivated or determined by partisanship, as many feared it would be – with jobs distributed across party lines and, just as meaningfully, across ethnic and racial divides, even in the south. To placate unions skeptics on the left, no formal job training was allowed, and yet evaluations of projects demonstrated high levels of efficiency and little corruption or waste.

    Yet the WPA was most definitely a watershed in the history of American state building. The country’s entire GDP was only $860 billion in 1935. Of that, a mere 5 percent or so represented total government spending, and most of that money paid for local school teachers, police, fire, and sanitation.

    Federal Social Security expenditures were just ramping up. Defense spending was still negligible, with U.S. foreign policy focused mainly on being a “good neighbor” as FDR memorably put it. Even as the president promised to invest in public works and social welfare to reboot the economy, he also committed to rebalance the budget, and by attempting to do so in his second term actually prolonged the economic downturn. More public works, not less, would have been a good thing, stimulating and vastly expanding the private economy, as World War II wound up doing only a few years later.

    Today, U.S. government spending, inclusive of local, state, and federal, domestic, foreign, and military expenditures, represents some 40 percent of our giant $13.67 trillion GDP. Years of Republican presidencies notwithstanding, we live in a mixed-economy and a country remade by Franklin Roosevelt.

    This 78th anniversary of the WPA inspires us to find in our history a model for increased investment in public works today, perhaps leveraging the private sector, not just hard-strapped states and municipalities. With the WPA as a model, federal resources can easily capitalize a U.S. infrastructure bank, which could in turn raise capital in markets across the globe. The financial structure is not complicated. All we need is the political will.

    Might it be helpful to remind deficit hawks that Roosevelt was reelected in 1936 with 60 percent of the popular vote and 98 percent of the electoral vote in 1936, with a budget in deficit but the WPA underway?

    Ellen Chesler is a Senior Fellow at the Roosevelt Institute and author of Woman of Valor: Margaret Sanger and the Birth Control Movement in America.

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  • Emergency Contraception Use Spreads, but Many Women Are Still Left Out

    Feb 26, 2013Ellen CheslerAndrea Flynn

    New evidence shows more young women are using emergency contraception but we still have work to do to reduce all barriers.

    New evidence shows more young women are using emergency contraception but we still have work to do to reduce all barriers.

    A federal study released recently shows that use of emergency contraception (EC) in the United States, known colloquially as the “morning after” pill, has more than doubled in the past decade. This is good news. It demonstrates the critical and expanding role the method may now be playing in enabling women, particularly young women, to prevent unplanned pregnancies. But there are still serious hurdles women face in accessing this method of birth control. While access has expanded, there is still work to be done.

    The study, conducted by the Centers for Disease Control and the National Center for Health Statistics, strengthens the case for promoting EC widely and making it more readily available. Based on interviews with more than 12,000 women from 2006-2010, the research finds that EC use among all sexually experienced women between the ages of 15-44 has increased to 11 percent (up from a baseline of 4.2 percent). That number is even higher among women 20-24, one of the highest risk groups for unplanned pregnancy. Nearly a quarter of this cohort now reports having used EC.

    This is no coincidence. In 2006, nearly a decade after EC first entered the market under the trade name Plan B and after years of stalling and political maneuvering by the Food and Drug Administration (FDA), the agency finally ruled that the product can be provided without prescription to women over the age of 18. A year later, a federal judge ordered the FDA to make it available to women over the age of 17. An important provision of the Obama administration’s Affordable Care Act (ACA) also now promises to cover the cost of all methods of contraception, including this one.

    The government study confirms what we already know: accidents happen. Half the participants report having used EC out of fear that their initial birth control method had failed; the other half used it because they had unprotected sex. This reminds us that even women who have a “plan A” need a “Plan B,” or, as the product is now also marketed, a “Next Choice.” Nearly one-third of all U.S. women using contraception rely on the pill, and approximately 16 percent use condoms – both effective methods when employed perfectly, but also ones prone to human error. Condoms break, and sometimes women forget to take a daily low-dose pill. And then there are still the many women who, because of lack of access, cost, forgetfulness, or spontaneity, still don’t consistently use birth control and need protection after the fact.

    One of the most common arguments against EC is that it is really just an early abortion method masked as contraception. This simply has no basis in science, as most recently explained by the International Federation of Gynecology and Obstetrics. Unlike medication abortion, which terminates a pregnancy in its earliest stages, EC actually prevents a pregnancy from occurring.

    The next most popular and equally erroneous claim is that increased access to EC – and, for that matter, any program or product that provides access to abortion, contraception, or sexuality education – will promote risky sexual behavior. Studies from diverse countries over many years tell us this is not the case. But new research coming out of New York City now confirms that access to EC right here at home does not encourage young people to become more sexually active. In fact, it does just the opposite. The NYC Department of Health recently reported a 12-point drop over 10 years, from 51 to 39 percent, in the proportion of public high school students who are sexually active. Over the past few years, the proportion of sexually active students using contraception, including Plan B, increased from 17 to nearly 27 percent. Both trends coincided with an expansion of school-based health centers that provide free contraception (including EC), counseling, and sexuality education.

    So now we have homegrown data to show that when young people have access to sexual health information, no or low-cost products and services, they make better and safer decisions about their reproductive and sexual lives.

    But while the federal data illustrates an overall increase in EC use, it also reveals an educational and economic divide among women who use it, suggesting the need for better information and access for low-income women. The CDC study finds that EC use is highest among college-educated women (12 percent), compared to women who have only completed high school or received a GED (7 percent). A 2011 study conducted by researchers at the Boston University School of Public Health also found that while a majority of pharmacies in low-income neighborhoods do have EC available, they often provide incorrect information about eligibility.

    Add this to a number of other potential barriers, and it is clear why EC use isn’t higher.

    The drug is not actually sold over the counter, where it would be most accessible, but rather behind the counter, where a pharmacist must retrieve it. (Still, this makes it more widely available in the 72-hour window after unprotected intercourse when it works most effectively.) Nine states around the country have a “conscience clause” on the books that permits pharmacists to deny filling a prescription on religious or moral grounds. Only 17 states and the District of Columbia explicitly require hospital emergency rooms to provide EC and related services to sexual assault victims.

    The cost of EC is prohibitive for many potential clients. Plan B and Next Choice, the two most popular products on the market, range in price from $35 to $60 at a pharmacy and from $10 to $70 at Planned Parenthood and other public health clinics, which offer an income-based sliding fee scale and often include counseling and other services.

    Even at these high prices, the limited market for the product may not provide private drug companies any incentive to advertise it beyond women’s magazines or other niche marketing sites. This means that young women just becoming sexually active, and all women who do not regularly visit a clinic or a private physician, may never learn about it. Age restrictions requiring a photo ID and concerns about confidentiality may also be intimidating and restrict use.

    There are also a number of potential hurdles to EC provision under the Affordable Care Act. Will women be able to use their private insurance or Medicaid benefits to purchase it at a drug store? Or will they need to visit a Planned Parenthood or community clinic? What about the many states that are not planning to participate in the Medicaid expansion? How will low-income women in those states receive information about and access to EC and, for that matter, regular methods of contraception?

    In recent years, Planned Parenthood has put forward an effective reproductive health information campaign using online and cell phone platforms. Millions of women, and especially young people, are now texting or visiting its website each month to learn about and gain access to EC, along with other important sexual health information.

    The Obama health care plan needs to imitate and vastly expand this marketing approach if it is to be effective. At long last, the Affordable Care Act promises to provide a national policy that prioritizes women’s health and primary, preventive care. But we must seek greater clarity about its implementation. Our next challenge will be to buttress the ACA with an inventive, far-reaching public information campaign so a broad and diverse population can understand and access its many benefits. How about calling this campaign “Morning After in America"? For those Americans old enough to remember Ronald Reagan, this surely has a familiar ring!

    Ellen Chesler is a Senior Fellow at the Roosevelt Institute and author of Woman of Valor: Margaret Sanger and the Birth Control Movement in America. Andrea Flynn is a Fellow at the Roosevelt Institute. She researches and writes about access to reproductive health care in the United States. 

     

    Contraception image via Shutterstock.com.

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  • What Did the State of the Union Say to Women?

    Feb 14, 2013Ellen CheslerAndrea Flynn

    The president didn't just lay out specific policies that will benefit women. He also shifted the theory of how government can help them.

    The State of the Union address is inherently a political exercise, intended to chart a course for governing but also to let important constituencies know that they are heard and valued. On Tuesday night, President Obama seemed intent on sounding down-to-earth, sensible, unthreatening, and easy to understand. He presented a long list of concrete proposals as if there couldn’t be any disagreement over their merits.

    The president didn't just lay out specific policies that will benefit women. He also shifted the theory of how government can help them.

    The State of the Union address is inherently a political exercise, intended to chart a course for governing but also to let important constituencies know that they are heard and valued. On Tuesday night, President Obama seemed intent on sounding down-to-earth, sensible, unthreatening, and easy to understand. He presented a long list of concrete proposals as if there couldn’t be any disagreement over their merits.

    For women, a critical voting bloc who helped deliver his second term, the president checked off many important boxes. He spoke about ending violence against women, guaranteeing them equal pay, preventing teen pregnancy, providing working families with more daycare and early child education, and promoting military women in combat roles. He also acknowledged that women around the world are drivers of prosperity and must be empowered if we hope to reduce global poverty and secure emerging democracies.

    Hearing this litany of familiar issues was reassuring, but the overall theme of the speech provided an even more important takeaway. Without much fanfare, the president put forward a reshaped agenda for government programs that are, as he put it, not “bigger” but “smarter.” This is vital for women because it would have the government target policies and marshal resources for women and families, which, in turn, prevent larger and costlier social and economic problems. It’s a welcome departure from forgetting about women and children and waiting around to address the unfortunate consequences after the fact.

    No grand principles were enunciated. But the president craftily put forward a theory of change that emphasizes strategic and comprehensive investments and interventions to establish a floor of well being for at-risk women and families.

    • He called on the House of Representatives to follow the Senate’s lead and reauthorize the Violence Against Women Act, not just as a moral imperative but because studies since its passage demonstrate the effectiveness of the social services and criminal justice reforms this pioneering legislation funds. Over two decades, rates of intimate partner violence and homicides have decreased dramatically, as the White House recently reported.
    • He called for expanding mandatory and free early childhood education – currently available to only three in ten American children – not just because it’s the right thing to do for hard-pressed parents, but because the data shows that it also boosts graduation rates, decreases teen pregnancy, and even correlates with palpable reductions in violent crime in communities across the country.
    • He promised to fight to increase the minimum wage and pass the Paycheck Fairness Act. This would close a real gender earnings gap. It would also benefit the nearly two-thirds of all minimum wage workers who are female, many of them single heads of households who can’t possibly lift their families out of poverty without this critical and long overdue intervention. Small businesses have long opposed a raise, despite studies that demonstrate a return to employers through increased productivity.
    • He mentioned the Affordable Care Act only in passing, but it too provides many additional preventive policies, which, as he noted, are already improving services while driving down health care costs overall. For example, the ACA has already brought comprehensive, affordable family planning and reproductive health care to more than 1 million women. By 2016, it could extend those services to as many as 13 million additional uninsured women if the many state challenges to contraceptive coverage and the Medicaid expansion do not undermine its potential reach and impact. And here again, as we have written previously, data demonstrates incontrovertibly that these services will dramatically reduce rates of unintended pregnancy and abortion.
    • While the focus of the president’s speech was primarily domestic, he also mentioned America’s responsibilities in the world and obliquely referenced the signature efforts of his administration to mainstream gender considerations into our diplomatic, defense, and development policies. Under the president and Secretary of State Hillary Clinton, the United States has joined 30 other countries in adopting a National Action Plan on Women, Peace, and Security, facilitated by the United Nations, which applies gender considerations and disaggregates spending across all agencies to require focused investment to improve the status of women. The government recognizes that this is not just the right thing to do, but also the smarter course if our aim is to meet the security and development challenges of our foreign policy. This shift in thinking lies behind the decision to promote military women to combat rank, for example, because in conflicts that involve civilian populations, as in Afghanistan and Iraq, women officers on the frontlines have played critical roles in connecting with local populations. And local women empowered by the U.S. presence have in turn become important agents in post-conflict resolution and peace processes and in relief and reconstruction efforts.

    The president’s State of the Union provided a blueprint for a strong, positive government obligation to secure the wellbeing of women and families at home and abroad. Not a lot of detail was offered, nor was there any fancy philosophical framework for what would represent a palpable shift in U.S. priorities and our traditional ways of governing. He spoke as if this was all pretty much just common sense – the better part of wisdom.

    But certainly if Senator Marco Rubio’s response is any indication, the president’s intentions, however masked in straightforward, anodyne rhetoric, face innumerable obstacles to their realization. That should not, however, stop us from applauding and getting behind the potential for meaningful policy change.

    Ellen Chesler and Andrea Flynn are Fellows at the Roosevelt Institute.

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