women's clinics. that was done in the guise of making a statement. and my concern as a pediatric neurologist, we have people like me that to procedures, a gastroenterologist that are much more dangerous than an abortion. so my question to them, and my next? if you are worried about the safety then what will happen? right now we can stop the progress of closing down now women's clinic but that is

done through the governor and the board of health but if we make those changes permanent right now the republicans have the majority in the house and the senate and that makes it difficult to go back to that is down the road to keep virginia moving and i would tell you that a big part of my job as a lieutenant governor is economic development we want to bring businesses in manufacturing jobs that pays for the things we like to talk about if we do that we need to welcome people we don't want to feature women like the

lgbt community that is the direction we need to go into to move virginia for berg. >> i have a suggestion about how to dance the debate we mentioned the colorado situation for extending birth control and despite the fact one of the most conservative members led the fight against his own party. >> that is the great suggestion we will take you up on that. [applause]

we will bring up more opinions. [inaudible conversations]

>> now we have the distinguished panel you have memorized my last slide if you were more successful to reduce the unplanned pregnancies people have thought about it so they will dig into some of these issues. and with the typical response it is amazing how

much she knows to be up on the hill. i call and then she tells me who to call. and with the things that i have heard. initiative very concerned about that the governor brought up and then with racial issues to be sophisticated about it. or we could do things that our wrong.

hit then to move to another city to go upstream and with birth control measures. ratios - - rachel's reaction was so god. [laughter] he teaches states of what it takes to do a good job and then it you get a chance. >>.

>> i want to thank bill and ron that the two of you have inspired me to work on this issue as i read that opportunity society is a powerful book i would met my bias how they achieve uncles is the most powerful things they can do to increase opportunity upstream u.s. say delivers assistance to offer patients of full range of the most effective to be a half a dozen states around the country but all the governing bodies the cdc

talked-about how it is the board to have access and the academy of pediatrics the narrative of tories including all adolescents. is middle of the bird events that are not wacky things that all. there is the big gap for what happens and health centers. the you get the pill today but only with women's health it is a false choice there would be lawsuits so when

faced with this jury's and then to come back. so we have a couple of examples for the very first health center at amarillo texas with premature birth and now that the entire health center is the wind to schedule properly too often they're not counseled did not know the efficacy but since it you tell patients and make them aware of the efficacy rates a i think my

colleague talks about coercion. we should not force them to do anything it should be a true choice and right now it is not a true choice right now doing six times as many iud implants as before the training. the revenue is up 400 percent because of word-of-mouth then they tell their friends and patient volume is way at band satisfaction is much higher. we ask who chose the better it? you? with your provider or did the provider choose it? who want to make sure they're not forced by the boards of 95 percent said they chose if they have liberation they make great choices. another area of real issue

is women are using a contraceptive method. but as amended is not that effective. so for no other health issues so we insure that becomes a standard part of the intake. >> guest: to become pregnant in the next year? that is a standard part and

if it is no then we should have day conversation about contraceptive counseling. but unfortunately that is not a standard part of care. only 80 percent of the women are considered plant yet there's a there for another variety of reasons but nobody is asking as intention as a result the winner coming back a few months later accidentally pregnant with negative outcomes that we were just speaking about because it is not a central piece to women's care as it should be. speaking to the notion of cost we have a statewide project in delaware, we

crossed medicaid data and discover a 74 .6% of the birth were unplanned that is three and for medicaid birth of a plant. it is extraordinarily expensive for the state but it is an unusual opportunity to save money at the same time. it is all about patient choice. so that should be offered on the same day but second there not a panacea but we

know that last year 1. 4 million unplanned berth in the country but we want to increase opportunity to make sure they can achieve their full potential to include this that we cannot simply start the conversation once they're born that they go to parents who want them and planned for them and think it is a good time to have them. the basic idea women should plan their pregnancy to have children when they want them this is what i want for my own children i have three college age girls myself. it has changed the conversation around the dining room table but i want them to become pregnant when they want to not a minute

before. i would want them to have access to the most effective methods if they don't work we can move on to something else but my daughter who's 23 was never offered it doesn't even know about them. so eidenshink it is important to recognize refocused on improvement of low income but it is best class medicine for all. [applause] >> i could not agree with mark more. about their child bearing

and i could not agree more they have amazing potential that means several things that we have an obligation to remove any and all barriers, we have to major women can afford them they were available and accessible and women who have just had a baby and have had delivered have other message that they pay attention to the availability of women's to have just add an abortion because we don't talk about that a whole lot. that is the missing piece.

that is something as we go forward. in that regard to learn the lessons of history once a history major always say history major. having to do with contraception and some of that specifically in this country is not great we have an obligation to learn those lessons one of the initial the bids was approved by the fda and within days there were proposals to offer

financial incentives if they agreed to get the implant in silly it embroiled of that bed in incredible controversy from which i don't think it never recovered and within a couple of years in 13 states legislators have introduced provisions that were not adopted or enacted to offer financial incentives that they agreed to get the implant. in seven states legislators introduced measures mandating use of implants for women on welfare or if they gave birth to a drug expose infant or to women who had a publicly funded abortion. there were not adopted by proposed also in five states judges handing down decisions offering deals to

people who were convicted of child abuse reduced sentences with a contraceptive in plant so it than the fed that had such potential and completely engulfed it with controversy especially in those communities that we were seeking to serve in the into the matter said from potential to controversy. it was incredibly unfortunate and even more unfortunate we're starting to see the ripples of that. it would offer $2,500 with a 25 per dollar payment but

the district the attorney went so far to ban the prosecutors that worked for him to offer reduced sentences that was convicted of child abuse leading to sterilization. apparently they took this action. so it is not widespread that we have to be watching constantly so while these have enormous potential with the obligation to remove any and all boundaries that could stand in the way of women to get access, there are minefields we have to be mindful of and remember the principle to give women the

voluntary and informed choice is that the heart of a family planning programs for decades and we need to remember that principle and that for some women the choice of a method is not about efficacy but the choice this woman wants to make a what is best for her life at the end of the day the method she chooses voluntarily that she thinks will best fit into her life is what she can use most effectively to avoid a pregnancy she does not want to have. [applause] >> i feel when we talk about

this issue it is almost on two levels so much progress and momentum around the country, coming out colorado and iowa and the st. louis is so exciting was so much potential and a lot of land mines and i want to put that into political context based on the experience of a national campaign talking to people from diverse you people dash who points. one of the most encouraging gains is for a broad bipartisan support if you look at the list of arguments of the potential of commons there is something there for everyone and it happens to be true.

reducing unintended pregnancy it does reduce abortion and save money and improve child out, and empowers women to achieve their goals. but what we can learn from is where people have come together to talk about this. colorado is worth spending time on because it is exciting but cautionary the legislator is a very conservative pro-life self-proclaimed redneck republican who saw the value of making iud stand implants available to women in the state they weren't the only that bids available but it reduced the barrier so women

could choose those as well as other things. a lot of young women did choose those methods. that initiative was privately funded and when it came time for this date to step up and continue the initiative of the modest sum of $5 million he was a champion you should allow cannot because his quotations are priceless but i have a couple of them but for virginia it could be very helpful. he said in view are like i am into not support abortion union people to have a better life and save taxpayer dollars why would you not support this legislation? he really thought the cost argument savings to medicated me the way to bring his colleagues along

he could only get three republicans to join the and it is extremely telling and cautionary. it is important he said it was fear behind the scenes than similar to what we hear on the hill they said i get it out above to supported the research and the argument is there as a fantastic policy it is the political liability good politicians don't give up the first time and is the expectation that other people will come back next year and have success i think they learned how to tweak the approach and talk about it the other landmine is the iud and implant and i

find it a little unfortunate that so many headlines coming out of colorado at colorado is giving iud is to teenagers. they were making available to women including teenagers but the headline grabs people's attention and i don't think that has been helpful as it is a cautionary tale how to talk about this in a policy space and we definitely find that when we talk to republicans women talk about women we get a very different response that doesn't mean they have to be excluded but it is important the cost argument is very powerful but there is some land mines

there adding that a legislator was very motivated to save the government money to give this incentive but perhaps that had unintended consequences we have to get the policies aligned with the affordable care act the contraception requirement to make all that it's available with no cost sharing to a private plan is a huge step medicaid is a huge step but there are a number of states where people don't have access to medicaid and expansion including virginia there's a lot of low income women that don't have that choice and that is still a big policy barrier it isn't just the national picture but the specific states to help improve access is

important. even with financing and policies and supply side we have a lot of work to do on the ground with the demand side if we want the voters to help make the decision we have a lot of work to educate those voters and the consumers. the national campaign recently finished research with the target audience who would benefit from the iud and the implant we've learned a lot have to talk about it or not talk about it the first word is to use the word a lark. [laughter] so listen to the patient but also the voters and what

they want. in some research findings knowledge about a the iud is very limited what people do know is inaccurate or confusing we found 77 percent of adults said they know little or nothing 68 percent said little or nothing about iud is so how they communicate their desires if they don't have good knowledge themselves? we often talk about sex at -- sex education for teenagers but we cannot stop. there is the fantastic policy initiative i would encourage you to check out. . .

so i want to again, caution us to think about how we talk about this and who people have in mind when we talk about the policy

ideas. yes. so, okay, we will have more discussions now. >> yes, we will. [inaudible question] >> is financing a big problem? or can they figure it out and mostly get the federal government to pay their share?

>> i think i would toss to andrew for the national sense. many people in a variety of states think they are loosing money but they are making money. this a procedure. cost is actually less of a -- >> we are not talking about benefit cost. you are talking about it brings in more money. >> we have seen the data. so the notion of it is so expensive -- >> can you draw that to the next grid. can you believe it is say all the more reason >> there are places where that is not the case. but in many cases cost is not -- there is a lot of good policy that can be done. there is important areas we need to do work on. for example the post-abortion acts but in the middle of the bell curve in most places we

have worked cost is actually not the barrier here. >> go ahead. jump in any time. >> i want to make two points. i think one thing we hear from family planning centers all of the time is in addition to cost it is being able to have that upfront money so you can have the iud and implant waiting in the closet for the woman who comes in and wants it. so is being able to have the upfront money to make that investment. i think as andrea said we made a lot of progress on insurance side and medicaid and expanding in many states unfortunately not virginia. we made a lot of progress on the affordable care act and making sure women have the choice of contraception methods in their private coverage.

we still have the gap between medicare and private coverage. we have low income women who don't qualify for medicare, recent immigrants who don't qualify, people on and off coverage, we we cannot just look at the insurance side. we have to make sure there is a part of funding available to cover people without or in between insurance programs. and that is where the national family planning program can step in and provide that funding to meet the needs of women who don't have insurance coverage on the day they come in. >> and just to jump in. i think that is where the perfect storm between the politics and policy. the title ten program, which is what provides the flexible funding, and there is good research showing when a clinic gets the title 10 funding it provides better family planning care including access to the

full range of methods, that program has been proposed for elimination by the house appropriation bill and cut by 10% in the senate for political reasons which makes no sense when it is clear it helps reduce abortion and save money. that is the political reality we face. >> and rachel talked about an important issue which is the question of if health centers can't stock the methods many don't realize you can get 90-120 day turns when you get the methods. one of the improvements we do is negotiate contract do is get 120 day term do is have the cash flow to have the methods there. i think there are ways we can we can work in the cost method area. >> bringing up politics, it is

fastinating, brookings and this issue, but they are mysterious. you said republicans said they would orderinarily support this. i think it is a fantastic policy. but they are fearful. what are they fearful of? >> becoming unemployed? >> i think they are fearful of primary challenges from the far right and i think don corn said that in the national journal article. i am not making this up. i heard this from republicans on the hill that i talked to. i wish one of them would stand up and do what they thing is right and test the proposition and we would find out. because they are -- i think those are extreme views that are

not where most voters are. but obviously we have jerry mander districts and it depends on where you are from. we call it had whack a mole program. on different days they are afraid of different things. if you are talking about teams they are afraid of saying we will encourage every 14-year-old to go out and have sex if we make an iud available even though there is no evidence that is true. or we are afraid we are condonni condonni condonning sex outside of marriage or afraid certain methods of contraception may act as abortion methods or the argument obtained on different days is there is a lot of fear. >> i think the fact that mark udall lost the senate in colorado after talking about

reproductive health and bee being attacked by the denver post, which is a liberal newspaper, as being a one-issue candidate is a big element in colorado. don't you think, andrea? >> i do. and i think it is fascinating he was beat by a republican who went out of his way to show he supported contraception and went out of his way to say it was valuable for women. he wanted to propose over-the-counter contraception which doesn't help with iud and implants. but he went out of his way to say i am for contraception, too. i think it was interesting and one that got more republicans to think about things and i don't think we have seen that with iud's and implants at the federal level.

a number of republicans have supported over-the-counter access. >> another issue coming in and it is related to what you said about the number of adults and limited information without other forms of contraception is there has been little use until now. when where started working on my book they were saying 2% of women using contraception were using a long-lasting one. you know better than i do it is up to something like 12% now and higher among u.s. district young women. so the word is spreading very rapidly and i think that will play into the politics because it goes back to your question about young women maybe not voting as much. but as this becomes better known and as more people are using it and it remains supported by the medical community that will make

a difference politically. but we have to be patient about that. >> we have not talked about enough king pin which is a great story. most people traveling all over all saw this decline every year since 1991 except two years, down 60% and we have ten times the rate of japan, twice as great as most european countries. so there is room for a lot of progress here. this administration right at the beginning started a program call teen prevention which is getting the most thorough evalleysation of any program i know of. it is in 102 places around the country. we have already talked about all of the potential damages of more effective forms of birth control especially with young teenager and the house cut it and the senate cut it by 80%. what were they thinking?

i don't understand why this is happening. >> i want to be clear the teen pregnancy prevention program doesn't provide contraception. it is an educational program. i think educating people on how to wait and how to do it on the delivery services is different. that is a gold standard program and it is mind-boggling it would have been proposed for elimination. i think from everything we heard it was gotten caught up in politics -- shocking. i think the larger politics around planned parenthood have shifted into putting that ttp program at risk. we are hopeful it can get restore and science and evidence will prevail. >> science and evidence prevail.

that has a ring to it, right? right. one time that i have been very pleased at the bill that is not going to pass. we are into continuing resolution and maybe we will get it for another year. it is a brilliant program. here is the last question and we will open up the audience. what is the number one we can do to make the long-acting forms more available? what is the single active thing we should do? go ahead, rachel. >> i think it is a lot of training and working at the service delivery. it is a lot of the staff at the site are older and like me are carrying around baggage from 20

years ago or the transition to getting the to place of thinking these methods are appropriate and fine for teens and young adults is a long transition. i think it is the hands-on training of how to do it but i think it is the just, talking to people and helpling people understand that this needs to be part in parcel of the service deliver package at every site. >> rachel said mark you are doing the most important thing. are you done yet? >> thank you. i would also say if we could establish quality family planning guidelines for the kind of work that should be going in health centers and timed payments to meeting the guidelines that would be a gray thing. we don't have the guidelines. >> this is a version of training because you would have good guidelines and then you would target payment?

>> no, not target payment. >> let me ask had question. this is a investigation of training -- first, we would have the guidelines, and then there would be someway to train clinics on how to follow them. okay. what do you think? >> well, i very much agree with this. this is the supply side. since it has been covered i would say we have to work on the demand side, too. i think educating the public more broadly and getting especially young women knowledgeable about the fact that there is a safe and effective and hassle free and so forth is really, really important. >> i get very uncomfortable when we have performance standards where we are grading people.

and that makes me really uncomfortable. i am the performance standard where we look at this and i get nervous when we end up in the world of performance standards which is all of the rage proith fright now. i get nervous for providers have a stake in what you chose. >> mark talked about having a screening question that is on every health care form when you go to your doctor for, you know, just an annual checkup, and you

are a woman of reproductive age, there should be a screening question there on do you intend to get pregnant in the next year or intend to and i think that could be a game-changer. but to get doctors and other providers to do that you might have to regulate or provide a financial incentive. would that be going too far in your view? >> where i get uncomfortable is when it affects the choice of women. >> absolutely foundational to me is that women should have the unchartered ability to chose the method they think is best for them. >> i think we all agree. >> audience, we will start here. nick zil. >> you cannot tep tell us about the adoption study.

>> you had no discussion on the medical complications of the methods and the media coverage of medical complications. the stories i see talk about the risk and don't end at the end of the article saying these are the most effective contraceptions. maybe we need to balance the talk and the benefits >> that is a really good point. there is a lot of attention to sort of the side effects and some of the problems. we have to remember, and i am sure the doctor/lieutenant governor would remind us of this, any medical device or pharmaceutical project has risk but the key point is in counseling with women to talk honestly about the benefit and the downside of the methods so

they can make an informed choice. and to put the risks in context and from the research we did with the young women and national survey work we did, those negative stories, even the fine print you hear in ads on tv about all of the side effects, those loom large in women's mind and that is often all they know about the method. i think that is something we we have a lot of work to do. >> there is a lot of risk associated with unwanted pregnancy. >> right. yes. >> hi, i am lauren hague. talking about the cohertion, what about the bad brands that came out when they first came out? my mom was like why would you

want to do that? it is unsafe basing on the unsafety of the '90s implant she had. what do you think about that? >> i think we should reiterate what mark said and that is if the american college of the obgyn and the american pediatrician academy said this is not only safe but should be the first line of defense for any woman who wants to avoid a pregnancy what more medical endorsement can you get? it is true, and mark i am sure you know more about this than i do, that a lot of providers out there, including existing doctors will tell a woman i don't do that. it is not safe.

i have friends where their doctor after reading my book and asking for an iud were told by their doctor we don't do that and they are not safe. so there is a re-education job to do. >> it is so unfortunate these new ideas are getting this blame. what the research shows coming from st. louis is that when woman those these methods they like them longer than the pill and stay with them longer so that is where the lower pregnancy rate s. and they return to their normal cycle once faster off coming off. so lots of things women like better. >> next question up here in the front. >> hello, i am richard perry.

i am wondering if you thought it to be hesitation about focusing on teens with an educational and this method of lack and i remember one of you said you want to test college women, not teens, and i happen experiencing the minority communities where we talk with the importance of girls more than women. when we talk of women's health issues they don't kr the path belong to them. so what i do to talk about writing in terms of teens and whether we have that now. >> andrea, repeat the question, quickly. >> i think the question was why the hesitation to talk about the teens and if you talk about

women, which includes teens, teens may not hear themselves in that. >> i think that is a good point. i think it is a political hesitation from anything. from a medical point of view the academy of pediatrics said it is fine but it is more of a political issue. we are having this con variation on two levels. and there is how we talk about in a policy and political space and how we talk about it when why try to reach girls and women. it would be nice and convenient and simple if we could use the same terms all of the time but we have to tweak the message viteae we are using this term lark because it is easy to

categorize. the research we did with women has shown that packaging makes no sense to them. they don't understand why you would treat something that goes in your uterus as one thing. iud and im'plants is a few more sill bals but that is not the best way to talk about it. >> i think we know this but the vast majority of unplanned pregnancy happens to people who are not teens. it is generally women in their 20s. >> you had mentioned that you

have done a lot of provider education but what is being done on the primary care level. i know a lot of women don't see a gynocoloo until later in life so what is being done on the provider level? >> not enough. >> we are seeing the patients early there and there is a big gap between what is best and what is actually happening. >> and to add on to that. not to pick on the pediatrician in the audience but it isn't just the primary care level. i think we need to focus more on the pediatrician and the adolescent care doctors and the doctors seeing women in their teens who can set them up for

being able to make responsible decisions going forward. >> okay. so at least i heard that this is an important issue and there is evidence we could do something about it if we get the policy right and we are moving in that direction. this is generally a good story and we need to keep it going. thank you for coming and joining me. thank you, panel. good day. >> this monday on landmark cases. by 1840, the mississippi river near new orleans was a breeding area for diseases. crescent city was the only slaughter house and the other houses took them to court.

follow the slaughter house cases of 1873. we are joined by paul mint, constitutional law attorney and michael ross, author of the book justice of shattered dream. the personal stories of the butchers, the state of new orleans, and the attorneys involve in the decision will be discussed. and we will talk your calls and tweets during the event. get background on each case and order the copy of the landmark cases companion book for $8.95 at cspan.org/landmarkcases. this weekend, your c-span city tour joined by time warner

cable explores the history and littery life of buffalo, new york. we will visit the mark twain room at the buffalo and eerie county library whose center piece is the hand written m manuscript huckleberry fin. >> the irish settled here because they came over after the famine. it would take one relative to find out about the jobs along the waterfront working in the grain elevators or the mill and word went back to ireland you want to come to buffalo. you would not become rich but they found steady employment. it is called the first ward. it has its name because when buffalo was first created it was divided into five political

wards and this area along the water has been the first ward always. >> on september 6, 1901 president william mckinley was assassinated been buffalo and we will tour a museum featuring events around his death and the gun used. and discover the history of the buffalo front and how it evolved. >> we are at silo sit city. this is original built for different companies. this is the owner of rich nigh's metal on ohio street. besides being regenerated for purposes of art, and history tours and we take people around and tell them the mihistory, the is poetry readings and opera and all different reasons for the

silos >> see all of the programs saturday at 6 p.m. and sunday afternoon at 2:00. the c-span city tour. working with cable affiliates and visiting cities from across the country. a signature feature of booktv is festivals and here is the schedule beginning this weekend. live from austin for the texas book festival. and live in the nation's heartland for the wis consin book festival. in the middle of the month is the louisiana music festival. at the end of november we are live from florida for the 18th

year in a row for the miami book festival. just some of the fairs and festivals this fall on c-span2's booktv. >> welcome to booktv in prime time. congress is out this week so we thought we would talk the opportunity to show you some of your book programs during the week as well as on your usual schedule on the weekend. we will focus on our "after words" program tonight. this is our program where we invite a host on inview inter -- interview a bestselling author. this is the producer of "after word words". what do you look for when you put the show together? >> we look for someone who will engage with the guest and