California: A Beacon for the Nation

1. California: A Beacon for the Nation Reproductive Rights, Health and Justice in California

2. Margaret C. Crosby Staff Attorney American Civil Liberties Union Foundation of Northern California, Inc. Phyllida Burlingame Director Reproductive Justice Policy Project American Civil Liberties Union Foundation of Northern California, Inc. Valerie Small Navarro Senior Legislative Advocate ACLU of California

3. California’s leadership in reproductive health policies Sex Education Contraception Prenatal Care Abortion Adolescent Health

4. California’s Pioneering History Before Roe v. Wade: • California Legislature: • Replaces criminal abortion law with American Law Institute model • reform law (Therapeutic Abortion Act) 1967 • California Supreme Court: • Strikes down criminal abortion law (People v. Belous) 1969 • Strikes down Therapeutic Abortion Act (People v. Barksdale ) 1972 • California Voters: • Pass Proposition 11, adding “privacy” to Constitution. 1972

5. Constitutional protection: California’s right to privacy Article I, Section 1: “All people are by nature free and independent and have inalienable rights. Among these are enjoying and defending life and liberty, acquiring, possessing, and protecting property, and pursuing and obtaining safety, happiness, and privacy.”

6. Statutory Protection:Reproductive Privacy Act “The Legislature finds and declares that every individual possesses a fundamental right of privacy with respect to personal reproductive decisions. Accordingly, it is the public policy of the State of California that: (a) Every individual has the fundamental right to choose or refuse birth control. (b) Every woman has the fundamental right to choose to bear a child or to choose and to obtain an abortion, except as specifically limited by this article.” Health & Safety Code Section 123462 (2002)

7. Sex Education California is the only state that has never accepted federal (Title V) funds for abstinence-only sex education. 2003: Legislature passes SB 71, which requires that sex education in California public schools be medically accurate, comprehensive and bias free. Education Code Sections 51930 et seq. 2007: the Legislature passes AB 629, which requires any publicly funded sexual health program from to provide medically accurate information on contraception. Health and Safety Code Sections 151000 et seq. California law (AB 629) bars the state from accepting federal abstinence only funding (expired but reauthorized in ACA). California has requested and received new federal funds for teen pregnancy prevention programs (PREP).

8. Contraception Public programs • Medi-Cal covers contraception for eligible low-income residents. • Legislature establishes Family PACT (Planning, Access, Care and Treatment) program in 1996, expanded in 1999 under federal Medicaid Section 1115 waiver, now covering increased numbers of California women and adolescents in need of contraceptive counseling and care.

9. Contraception Private insurance 1999: California Legislature enacts Women’s Contraceptive Equity Act, requiring employment-based health plans that include prescription drugs to cover prescription birth control drugs and devices. Health and Safety Code Section 1367.25; Insurance Code Section 10123.196. • WCEA includes a narrow exemption for religious employers (entities engaged in worship and teaching faith and employing and serving people of same faith) • California Supreme Court upholds the statute’s application to religiously-affiliated employers with diverse workforces against a constitutional challenge. Catholic Charities v. Superior Court (2004). • Current HHS requirement for contraceptive coverage in new health plans adopts language of narrow religious employer exemption in CA WHEA.

10. Pharmacy access • Legislature passes SB 644 in 2005 • Pharmacist must fill all valid prescriptions • If pharmacist expresses religious or moral objection to filling a prescription, the pharmacy must receive advance written notification and have protocols in place to ensure that patient obtains timely access to drugs. • Business & Professions Code Section 733

11. AbortionConstitutional Protection Low-income women • The California Constitution prohibits the state from eliminating Medi-Cal coverage of abortion as long as it funds prenatal care and childbirth.| • The government must be neutral in its treatment of childbirth and abortion and cannot use its resources to weight the options available to low-income women. • Committee to Defend Reproductive Rights v. Myers (1981) Young women • The California Constitution prohibits the government from requiring parental consent or a court order for minors’ access to abortion. • “All people” are entitled to the fundamental right to privacy, which protects childbearing decisions.Court finds that parental involvement laws endanger teenagers. American Academy of Pediatrics v. Lungren (1997) • Voters reject three initiatives to change California Constitution to require parental notification: Propositions 71 (2005), 85 (2006) and 4 (2008).

12. AbortionStatutory Protection In 2002, the California Legislature passes SB 1301, the Reproductive Privacy Act, which codifies Roe v. Wade. The Reproductive Privacy Act protects access to pre-viability abortion and abortion necessary to protect a women’s life or health. The Reproductive Privacy Act establishes that outside its parameters, the government “shall not deny or interfere with a woman's fundamental right to choose to bear a child or to choose to obtain an abortion.” Health & Safety Code Section 23462 .

13. Adolescent Health • California’s medical emancipation laws allow minors of any age to obtain pregnancy-related care, including contraception (Family Code Section 6925) and HIV testing (Health and Safety Code Section 121020 ). • California’s first medical emancipation laws, protecting access to pregnancy care, date to 1950s. • California law permits minors 12 and older to consent to a range of sensitive health care services, including confidential access to treatment for sexually transmitted infections (Family Code Section 6926 ); treatment for rape (Family Code Section 6927 ) or other sexual assault (Family Code Section 6928 ). • 2011: the Legislature updates law passing AB 499, adding confidential access to preventative STI care.

14. Teen Pregnancy • California’s teen pregnancy rate declined by 52% between 1992 and 2005, the steepest drop registered by any state over that period—and far above the national decline of 37%. • Public health experts credit this record decline to California’s enlightened public health policies and programs, including comprehensive sex education, Family PACT and confidential access to reproductive health care and counseling. Source: Boostra, “Winning Campaign: California’s Concerted Effort To Reduce Its Teen Pregnancy Rate” Guttmacher Policy Review (Spring 2010).

15. Prenatal Care and Childbirth • Public programs Medi-Cal (prenatal, delivery and postpartum care) Access for Infants and Mothers (AIM) (sliding scale comprehensive health insurance) • Private insurance 2011: Legislature expands coverage: • SB 155 requires maternity coverage in individual health insurance plans • SB 299 requires continuation of employer based coverage during pregnancy disability leave

16. A Woman’s Life:Integrated Reproductive Health Care

17. Contacts American Civil Liberties Union ,California Legislative Office 1127 11th Street, Ste. 534 Sacramento, CA 95814 916 442 1036 Valerie Small Navarro Senior Legislative Advocate VSmallNavarro@acluleg-ca.org American Civil Liberties Union of Northern California 39 Drumm Street San Francisco, CA 94111 415 621 2493 Margaret C. Crosby Staff Attorney mcrosby@aclunc.org Phyllida Burlingame Reproductive Justice Policy Director pburlingame@aclunc.org