Testimony on Pending Legislation: Assembly Bill 343
Before Assembly Committee on Family Law
May 26, 2005
Testimony of Alice Reilly-Myklebust, RN, MSN
Director of Student Health Services
University of Wisconsin-River Falls
Regarding Wisconsin Assembly Bill 343 Prohibiting the University of Wisconsin System from Advertising the Availability of, Prescribing, and Dispensing Certain Hormonal Medication or Combination of Medications, and doing so on University Property
My name is Alice Reilly-Myklebust, and I am a Registered Nurse and Director of Student Health Services at the University of Wisconsin-River Falls, and I have served in this role for nearly 12 years.
I have many concerns about this bill:
First of all, whether the bill was intended to do so or not, this bill would essentially prohibit advertising the availability of, prescribing, and dispensing all forms of oral contraceptives by UW System university health services. According to Attorney General Lautenschlager’s official opinion related to this bill (April 5, 2005), she states that “the language of the proposed legislation is vague enough that it could be interpreted to cover other forms of oral and hormonal contraception,” in addition to emergency contraception. She also states that she believes the proposed legislation would violate several provisions of the United States and Wisconsin Constitutions, namely, “It attempts to regulate in an area that the United States Supreme Court has repeatedly held to be constitutionally protected” [right to privacy in relation to intruding into family matters such as contraception, equal protection in relation to targeting services only needed by women, and right to free speech by prohibiting the advertising of contraception].
Representative LeMahieu’s suggestion that this bill is necessary because access to birth control, such as emergency contraception, encourages a woman to be promiscuous is a mischaracterization of the many wonderful, bright, intelligent female students attending UW System universities. Furthermore, it is unsubstantiated in research. For example, a study published in the January 5, 2005 issue of the Journal of the American Medical Association (Raine, Harper, Rocca, Fischer, Padian, Klausner, & Darney) found that women who have ready and easy access to emergency contraception are no more likely to engage in unprotected sex or abandon use of other contraception than women who do not have easy access to the pills.
At the University of Wisconsin-River Falls, clinical health services provided through Student Health Services, including my salary, are funded solely by segregated and user fees paid directly by students, not by state tax dollars, and therefore students should have the greatest voice in determining the kind of services provided that they are paying for, and this has historically and continuously been the case on our campus. So, this bill limiting services that students want and pay for themselves is not appropriate.
Hopefully it is the intent of all of us to prevent unwanted pregnancies. Making emergency contraception easily available could prevent half of the 3.5 million unintended pregnancies that occur each year in the United States, and as many as 700,000 abortions could be avoided (Trussell, Stewart, & Hatcher, 1992 and Kaiser, 2004). Prohibiting access to emergency contraception and other oral and hormonal forms of birth control will ultimately increase the number of unintended pregnancies and hence abortions for UW System female students, severely limiting their ability to pursue their education and employment opportunities. This will potentially lead to these women and their children seeking state-supported services.
Emergency contraception is a well-accepted and routinely used means of birth control currently prescribed by health care providers. Prohibiting college health professionals from providing education and offering emergency contraception, and other forms of oral and hormonal contraception, would be crippling in our goal to serve the whole student, with a focus on prevention. Additionally, emergency contraception is really no different than any other form of hormonal contraception. The only difference is when you decide to take it, prior to intercourse or after intercourse. Finally, emergency contraception is time sensitive, and the sooner it is taken, the more effective it is in preventing pregnancy (Piaggo, Von Hetzen, Grimes, & Van Look, 1999 and Grimes, 2002). Hence, making it easily and quickly available, or even better making it available before it might be needed, is the most effective use of this form of contraception.
The mode of action of emergency contraception has been under debate, but recent research by members of the Population Council’s International Committee for Contraception Research and other scientists indicates that the most popular form of emergency contraception appears to work by interfering with ovulation, thus preventing fertilization, and so does not disrupt events that occur after fertilization, which has been the most controversial aspect of emergency contraception (Corxatto, Brache, Pavez, Cochon, Forcello, Massai, & Salvatierra, 2004; Ortiz, Ortiz, Fuentes, Parraguez, & Croxatto, 2004; Muller, Llados, & Croxatto, 2003).
Emergency contraception is a safe and effective form of contraception, and this legislation goes against the multitude of efforts to increase the availability and use of EC. For example, the Wisconsin Public Health Association, which is a non-profit organization dedicated to promoting sound public health policy and providing public health education for its members and the people of Wisconsin, at the May 2005 Annual Conference, passed a Resolution entitled, “Public Education and Access to Emergency Contraception,” (Wisconsin Public Health Association, 2005) which states: “Whereas contraception is an integral part of reproductive health care and that barriers to access can lead to unintended pregnancies and preventable abortions,” and “women are more likely to use emergency contraception (EC) if they have it readily available through advance prescription,” and “the Food and Drug Administration states that EC is safe and effective,” and therefore “WPHA supports measures that improve women’s awareness of and access to a full range of contraceptive options, including emergency contraception.”
Finally, in an e-mail exchange between a UW-River Falls student and Representative LeMahieu’s office, it was suggested by Representative LeMahieu’s office that it would be better for women who are sexually assaulted to “get help from medical workers who can help women cope with a sexual assault rather than allowing her to simply go to a UHS, get a prescription for the morning after pill, not tell anyone and then try to live with the hurt and the emotional pain on her own.”
Suggesting that a female student who has been sexually assaulted who presents at a UW System university or college health service would only get some pills and be sent on her way does not reflect the reality of what System university or college health services and the many committed health professionals who work there do. My colleagues and I in the UW System have worked in college health for many years and have spent a good portion of our lives working to provide the best possible care and services, with what is best for students at the heart of this. We simply would not give a student who has been sexually assaulted some pills and send her on her way. That is not how we do business. We offer the full array of services and resources that are available to a student who has been sexually assaulted, and help support and facilitate the student in accessing these. Some examples are campus counseling services, additional appropriate campus health services, advocacy and legal support services, support groups, etc. and the continued follow-up necessary with many of these services. We also help the student address the issue of the impact of the assault on her academics and provide referral for support and services for this.
UW System university health services are the best place for students to receive appropriate, comprehensive, prevention-focused health services by professional, experienced college health professionals, and emergency contraception and birth control are a vital component of this care. I therefore urge you to vote against Assembly Bill 343.
Alice Reilly-Myklebust, RN, MSN
Director of Student Health Services
University of Wisconsin-River Falls
410 South Third Street
River Falls, WI 54022
Corxatto, H.B., Brache, M., Pavez, L., Cochon, M.L., Forcello, F., Massai, A., and Salvatierra, A.M. “Pituitary-ovarian function following the standard levonorgestrel emergency contraceptive dose or a single 0.75-mg dose given on the days preceding ovulation.” Contraception, 2004, 70(6), p. 442-450.
Grimes, D. “Emergency contraception and Fire Extinguishers: A prevention paradox.” American Journal of Obstetrics and Gynecology, 2002, 187, pp. 1536-1538.
Kaiser Family Foundation’s Emergency Contraceptive Pills Fact Sheet, February 2004
Muller, A.L., Llados, C.M., and Croxatto, H.B. “Postcoital treatement with levonorgestrel does not disrupt postfertilization events in the rat.” Contraception, 2003, 67(5), pp. 415-419.
Ortiz, M.E., Ortiz, R.E., Fuentes, M.A., Parraguez, V.H., and Croxatto, H.B. Post-coital administration of levonorgestrel does not interfere with post-fertilization events in the new-world monkey Cebus paella.” Human Reproduction, 2004, 19, pp. 1352-1356.
Piaggo, G, Von Hetzen, H., Grimes, D.A., Van Look, P.F.A. “Timing of emergency contraception with Levonorgestrel or the Yupze Regiman.” Lancet, 1999, 353 (9154), p. 721.
Raine, T.R., Harper, C.C., Rocca, C.H., Fischer, R., Padian, N., Klausner, J.D., & Darney. “Direct access to emergency contraception through pharmacies and effect on unintended pregnancy and STIs: a randomized controlled trial.” Journal of the American Medical Association [JAMA], 2005 Jan 5; 293 (1), pp. 54-62.
State of Wisconsin Department of Justice, Attorney General Peggy A. Lautenschlager Advisory Opinion Regarding Proposed Legislation Banning Emergency Contraception at UW, dated April 5, 2005
Trussell, J., Stewart, F., Guest, F., Hatcher, R.A. “Emergency contraceptive pills: A simple proposal to reduce unintended pregnancies.” Family Planning Perspective, 1992, 24, pp. 269-273.
Wisconsin Public Health Association Resolution – 2005, “Public Education and Access to Emergency Contraception.”