Speaking from my new, almost seven months perch as a federal official, i want to share that as a physician and Public Health practitioner, im speaking to you from both of those heads knowing my words are those of a person will always be herself as a doctor first. People who only know me as someone who works in government asked me, have you ever been a real doctor . I assure you, from the way in which i approach my work, that i still am. So know that i mean it and understand when i say i really appreciate this meeting and your work because what you do is so much closer to the people, the community, and the patients than i am at this point in my career. For the administration, so much of the work and progress of the past several years has been rooted in the belief passed down from generation to generation that we can continue to strive toward equity. And that we can Work Together to level the Playing Field for all americans. That we can give all of our sons and daughters, our families, the opportunity to grow and thrive and succeed. Its at the heart of that. The progress is at the foundation of our countrys values. We know that health is the bedrock that forms the foundation. You dont have to look far to see the results of that incredible work of the past several years, which now includes having more than 20 million more americans who for the first time have access to coverage that they need for themselves and families. Work that has led to a more than 50 decline in the uninsured rate for African Americans and a 27 decline for latinos. Today, women can no longer be denied coverage for a preexisting condition like childbirth. But we also know there is a lot more we have to do. And even more sometimes when we think about africanamerican and latino neighbors who are less likely to have access to Health Coverage and access to care. Zika challenges us to mobilize around that reality. While women do have improved access, we still have work to do for Womens Health knowing that Womens Health is far more than Reproductive Health but that we cant separate the two. Progress on Womens Health is a comprehensive approach focusing on health and wellbeing for all women. Daughters, sisters, mothers and grandmothers. Two months ago at the white house United States of women summit, women from all walks of life came together. They said by working today, we can change tomorrow. I was fortunate to moderate a panel on unplanned pregnancy. In that conversation, there were many reminders that i wanted to share briefly for today. Because in that conversation about unplanned pregnancy, we had to remember that what we convey to women, and sometimes i say women and teens because i dont want us to think about one population we are addressing. We want to convey things in a way that really addresses the needs, desires an understanding of the people that we serve. That conversation we had was informed by panelists from new york city and sierra leone among others. The diversity with which we need to approach that work to achieve equity is key. I have been able to observe in the work we have been doing on zika what that means to address maternal and Reproductive Health with equity in mind and because of the work i have done in puerto rico, to understand that when you are addressing these issues for populations in which the Economic Conditions can far outweigh the concerns about a disease for which four out of five people infected have no symptoms, the conversation that require true information and informed decisionmaking for an individual are needing to be informed by the insights that everyone at the panel here today will share. I want to stress that because one of the things i understand working at the federal level is that with all of our expertise and science and policy guidance, thats what it is. Its work that we do on behalf of populations. What has to happen with that work is it has to be translated to be useful for the individual people who need to be able to make personal decisions for themselves. In this case, around Reproductive Health. And i know as a physician how much that relies on shared Decision Making conversations with clinicians who understand, who have the information required to be able to help women make those decisions. Some of the work we have done at hhs in response to zika have been investing more than 300,000 in emergency funding to our title 10 programs in puerto rico to expand access to contraception. We have been doing training. This is to ensure that our work with partners is culturally and linguistically appropriate. And to ensure that our services really reach those in need them most. At the office of Population Affairs last month released a toolkit for providers for counseling women. We are also working with states, territories, tribes and local governments on steps they can take to prevent and respond to zika. Alongside that health care work, we are sharing advice on the best ways to control mosquitoes, working to improve diagnostic capacity and to keep the blood supply free of zika. We already mentioned Vaccine Development and improving diagnostic testing. And underneath all of that, what might be most important is the hard work that is done every day to improve our communications, an especially important technical and human skill for Everything Else that needs to be done to equitably ensure access and enable women to make the decisions they need for themselves. We are working with a number of partners to improve womens access to effective contraception. As we do all of this, i also understand the limitations of our reach on the federal level which is why its so important , for us to continue to partner with you. And to take your feedback so that we can continue to be better at our efforts. But we do need to work with you to spread the word about zika, how its transmitted, how pregnant women, women of childbearing age and actually everyone can protect themselves. And we need ongoing advocacy for our communities for us to have the resources that we need to implement not just mosquito prevention efforts and contraception efforts, but sustainable improvements in conditions which, in addition to helping us address zika in the long run when we talk about disparities and equity, can make many more kinds of differences in the lives of people along the way. Thank you for your work. Thank you to the panelists for what you do and i look forward to our ongoing partnership. [applause] ms. Taylor thanks to both of you for setting the stage for this important conversation. Im jamila taylor, a senior fellow at the center for american progress. I will be moderating the Panel Discussion portion of todays program. We have an Impressive Group of Womens Health experts here on the panel today. I will introduce them briefly but also encourage you to access their full bios online. First, in the beautiful red dress, we had Annemarie Bonita has the senior director for , Government Relations at the National Latina institute for Reproductive Health. In that role she is responsible for the organizations washington, d. C. Office and oversees all Government Relations and policy advocacy work. Prior to joining the latina institute, she worked as Public Policy director for planned parenthood affiliates in california. Next we have Claire Coleman in her seventh year as president and ceo of the Family Planning and Reproductive Health association. Before joining, she served as president and ceo of planned plan parenthood mid Hudson Valley in new york. She has held a number of positions in the United States house of representatives including chief of staff and , legislative director for Appropriations CommitteeRanking Member nita lowey. At the end we have dr. Christopher zahn. Hn is Vice President of practice activities for acog. A retired air force officer, and member of acogs armed forces district, he received his medical degree from Uniformed Services university and is a specialist in comprehensive obstetrics and gynecology and has been practicing for 29 years. Before joining acag he served as a physician and the department of obstetrics and gynecology and pathology at Walter Reed National military medical center. Last but not least, we have latonya mapp fret. She joins planned Parenthood Federation of america in 2011. She is the executive director of planned parenthood global and Vice President global. In this role, she sets the course for the International Engagement on all International Issues and, prior to joining planned parenthood, she worked for the United Nations childrens fund, as well as the u. S. Agency for international development. Thank you all again for being here. The first question i have this afternoon is directed to all of you. I wanted you all to describe how your organizations are working zika amongst women. Lets start with claire. Thank you. The national Family Planning and Reproductive Health association is a Membership Association in all 50 states and several territories and the district of columbia. We represent nearly 800 institutional providers of Family Planning and Sexual Health care nationwide so that includes 33 state governments, 15 of the nations federally qualified Health Centers and 80 of planned parenthood affiliates as well as many other private , notforprofit providers of Family Planning. We are working on zika response from two approaches. The first is in Service Delivery. The federal advisories around how we should address peoples concerned, women and men in Health Services has led to concern and confusion in the field about how to translate guidance which has moved as new information has come to light to individual patients who come in with concerns. We actually have a team in texas today meeting with title 10 Family Planning grantee and their Service Delivery network to talk about how to translate the guidance of coming from the feds and local Health Department into practice. How do you operationalize preparedness and what do providers in local communities need to know today in order to be appropriately responsive to the field . We also work in advocacy and communications raising the voice and concerns of this network. We have about 4100 Health Center sites around the country in governmental units, private notforprofit units which are working to interpret this guidance, operationalize it for the community, do Community Awareness and make sure they have supplies on hand. Its important for us to participate in the Coalition Efforts to call attention both from the administration and the congress to the pressing need for resources. Jamila anne marie . The National Institute for Reproductive Health and justice, it is the only Latina National organization that represent 28 million latinas and their families. We do it through reproductive justice lens. What we do is twofold. A lot of what we are doing is we have Community Mobilization that works in teams in new york and florida, in texas and virginia which also happens to be the hotspots where zika is taking place. A lot of our work right now is working with the community and trying to answer questions and trying to hear what their concerns are and what their needs are. Then relaying that backup to d. C. , which of the second part of our work which is the advocacy and lifting those concerns and addressing them and putting pressure on congress, for example, to move forward with emergency funds. Jamila thank you. Its a pleasure to be here and thank you for having this conversation right now. Conversation. Its important for us at planned parenthood because we have the privilege of serving one out of five women in this country and over one Million People per year in latin america and africa. For us, its incredibly important to keep women at the center of this debate around zika. On a normal day, women who are marginalized and sit in parts of the country, whether its geographic or parts of the world where they are not receiving services, they have unmet needs for Family Planning we are trying to address. On a normal day, in latin america in particular, the rate of unsafe abortion is startling. We were talking earlier this week with our colleagues in the government about the average 15yearold in latin americas initial sexual entrance was through violence or rape. These are women who when we, when i later start saying why dont we just wait to get pregnant while we figure out how to handle zika. They cant do that. Its very important that women remain at the center and we take the caution from who and cdc that Reproductive Health has to be a huge part of the response. That is where our work centers. Zahn thanks dr. Very much for the opportunity to be here. Acah is slightly over 50,000 members of obstetrics and gynecology and this area is of special interest to us. This is the first time, its a unique time, it is the first time in history when there is a mosquitoborne illness whose primary impact his birth defect. Never before seen. Its an incredible time to be involved in Womens Health care. Our major goal is primarily clinical. Were in daily, both day and night contact with the cdc. , we work very closely with them. And spreadmplement the message and information the cdc develops. Im sure everyone is aware of these guidelines and they can quite frequently. We have updated our guidelines probably six times in the last couple of months. In fact the most recent one came , out last night to advise and also not surprisingly, when there was Little Information known in the beginning, the guidelines were relatively brief. Now there is more known, but clearly we know far less and the guidelines are much more expanded. And therefore challenging to understand and implement. Isng back to the operation the implementation these is translating those guidelines into practice in the trenches. A patient shows up who has been exposed or traveled somewhere in what to do and how to get the testing done and how to interpret the testing and advise what her risks are, what the prognosis is as best we can and how to further manage the pregnancy. We work very closely with the other Womens Health care organizations, nurse practitioners, midwives, Family Practice to anyone involved in Womens Health to try to get this message out as much as possible. And also we are involved in advocacy, not only for the funding issue but also access to health care and reproductive rights, etc. Clearly there are two populations. The women who are pregnant or planning to and their aspects and clearly there is avoiding the pregnancy. And to paraphrase dr. Freeden said we dont know how to prevent zika but we do know how to prevent pregnancy. We need to make an effort to do that. Jamila thank you. Can you walk us through the standards of care in a zika related case for to attritions that obstetricians for pregnant women particularly . Dr. Zahn i should have made more copies but i have our most recent practice advisory. Generally for women, it varies based on whether the person lives in an endemic area versus has traveled or been exposed. Unfortunately, as of the last week to a week and a half, we now have an endemic area on the mainland. But for people with the majority at this point, there will be those people who travel to an infected area. There are guidelines as to who should be tested and what type of testing should be done. It has gotten a little bit easier with the most recent guideline. There is a division between whether they have been exposed within the first two weeks or it has been after two weeks but before 12. Again there are guidelines as , far as what type of testing should be done in the early exposure. Its a combination of molecular tests called pcr done on both the blood and the urine specimen and, depending on the result of that, a follow on test looking for antibodies is done. They sort of flip in people exposed beyond two weeks. He towing between 2 and 12 weeks. If the woman test negative and she is asymptomatic, we would generally recommend an ultrasound to make sure there are no abnormalities. If the ultrasound is normal, they are cleared for the most part. Patients that test positive its a more intensive , surveillance looking for abnormalities. I can keep on going for three hours. [laughter] going back to the issue about far less known than what we know we know that 80 of women who , are exposed will not develop symptoms which makes it incredibly challenging. We also dont know that if a woman gets infected, what her risk of transmission is. We dont know how many actual babies will be infected and the rates that have been reported range from 1 30 which is huge. Secondly, we dont know if there certain women and babies that might be at higher risk of getting infected compared to those who dont. There might be underlying immune profiles or other cofactors that may play a role into how that manifested. For the women who are asymptomatic but exposed, how they develop disease. The other is the time course. For women, we used to think based on some of the initial data that women were at higher risk of having an infected fate as if they were exposed in the first trimester. Early in pregnancy. But there has been subsequent reports that refute that and later andbe exposed the fetus can develop after maladies. Personally, one of the scariest aspects of this, clean note their basic Science Research that has been done that and a lot of infectious diseases, the damage that occurs in whatever organ system it is can be related to the infection and the immune response. We know from some data in zika that that zika can directly attack brain cells, the neurons in the brain. One of the real fears and a clear unknown is that even an infected woman with a normal baby that does not show symptoms of microcephaly we , dont know that that virus is not going to continue to attack the brain cells of the newborn after birth. We have no idea what those developmental abnormalities may or may not be. What the risks are and what the percentage will be. One of the most important aspects of everything we do is the registry the cdc has created to follow these children after birth to see what happens to them down the line. Jamila thank you for that. I want to shift things and talk about the the title x Family Planning program which claire talked about. It is a huge part of four organization and the work you do. As important as the Title X Program is in terms of Family Planning for women, its also been a big topic on the hill. As well as in the media in terms of making sure that women have access to Family Planning through title x clinics. Can you talk more about how important title x is in terms of access for Family Planning for women . At first, i would love it to be more central. Neither the president possibly original quest for emergency spending which came about two months before the cdc confirmed causality and all of the negotiations that have happened throughout the spring added additional sources for the title x Family Planning network. Lets talk about title x briefly. It was enacted in 1970 under Richard Nixon and is intended to provide a network of direct Health Services, as well as support for poor, low income, uninsured or underinsured people across the United States. Today, the network has about 4100 Service Sites in all 50 states and the territories and d. C. We see about 4 Million People. Just to put that into perspective, its estimated 20 million just women of Reproductive Health age need public funding to utilize the resources. We are meeting about a fifth of the need with the resources that congress allocates. See patients must without regard to their ability to pay. That is true of all programs. And whether or not they can prove citizenship, they must be seen in our network. Folks with no insurance walk through our doors every day. Title x subsidizes care of people who have no other source. The hospital and dallas operates outpatient Health Centers. 30 states run title x networks in states like alabama, north and south carolina. As well as idaho, vermonts. These are all states where the title x money goes through the network. And they are being seen regardless of their ability to pay. To afford the staffing to do a wide righty of counseling. E we need funds to actually buy supplies and have it available same day on site same day across the country, but particularly in endemic areas. To, forre being asked wiccae connect with programs. Acause that population is population that we often see in title x. But there are no funds to do any community education, any partnership development, any awareness. And the last thing i would say because you are not stopping me yet its a network that has taken 40 million in cuts since 2010. Its a network that has lost enormous capacity, lost 1. 1 Million People out of the networks and close Health Centers and laid off staff. I came from providing services and i did three rounds of layoffs in three years. You cannot bounce back when the crisis arrives unless you have the money to put the people into place that make these services possible. From what you said so brilliantly, title 10 has an Important Role in communities. Its already underfunded in terms of any. Terms of the need. Also when you think about a Public Health concern like zika, you will have even more people in need of access to services through title 10 clinics so thank you for that. Let me shift things to anne marie. I would love for you to talk about the potential impact that zika could have particularly on the latino community. It was something that dr. Mullen touched on in her remarks, particularly how communities of color could experience a disproportionate impact when it come to zika so please talk about that. Thank you very much. I will echo a lot of what has been said. We rely on title x clinics to access care because we have a diverse community. And we have a lot of roadblock in ability to access care. Certain things that are uniquely impacting the community is just education and competent care. My earlier remarks i was saying that we hear from people on the ground and one thing we hear constantly is that there is very Little Information right now going to the community. It is hot and cold. Seek is really dangerous or will not impact me at all. There is a desire to learn more. There been requests that we know who have the ability but they dont have the access to those training to learn more about zika and what it can do. Right now with the community is the families in Central America and trying to find out what they know so they know what to do here in the United States particularly in the endemic areas. There has been cuts to title x clinics but we have not seen the aca fully realize. Fully realized. In states where we are focused in like florida and texas, Medicaid Expansion has not happen there and its so important so folks can have access to care if the clinic is open. I can keep going on the impact on how there is limited access, limited education, and limited resources and that is impacting our community. We have a lot to do. Thank you for that. You mentioned florida which has been in the media and in the news over the past couple of days particularly for new cases of locally acquired transmission of zika from mosquitoes. One of the things i wanted to mention about florida is the fact that florida has not expanded medicaid leaving lots of people without access to Health Services they need. And also there over 2 million women there who want access to contraception and contraceptive services that dont have it so there are issues outside these new cases around local transmission. Its the fact that access to Family Planning and contraception is limited for some women in florida. I want to shift things a little bit and talk about the International Context a bit. As most of you know, the olympics are set to begin in rio tomorrow. There has been some conversation about whether or not it has been safe to travel to rio particularly with the impact of zika there. I want to talk things over to latonya to talk a little bit about brazil and the context of zika. Particularly women in the country. Thank you. I will pick up where many of our panelists were coming from. Zika will highlight of Public Health gap. We can talk about that in our country and understand where they are and were marginalized women and women who dont have access to Health Facilities will land. But think about that from the aspect of a developing country, even a middle income country like brazil where there is a host of communities, particularly women, even afro caribbean women in brazil and other very special communities in that country and countries around latin america, they dont have access on a normal day to Family Planning, information about zika to doctors even. Where as we know that will be necessary as we seek to address this issue. When we think about what women will need for zika and to deal with this, we know they will need more access to contraception, not less. We look at where the funding is going, where the emphasis and the communication around mosquitoes is going. I am a little worried that women in brazil and other countries in latin america are not going to be as prepared and ready for this. We have seen that i think. I think the trend will follow that if we are not able to operationalize this in those countries. From the perspective of our partners we work with in latin america, it has been very clear that we have to do more of the same kind of work around Family Planning. We have to do a lot more around education to communities. Its not just in the u. S. Think about women who every day have to deal with the complexities of their lives, having to think about this and not sure and not receiving information, no targeted services or advocacy towards them and lots of leaders talking about the issue but not much funding going toward it other than for mosquitoes in research and most of that is coming from outside those countries. I think its crucial for us to think about, again, women being the center of this. When you think about that, how do you get information and services out to these women . How do you increase their access especially with sexual transmission where people hear it in the news but they are not quite sure what it means. Is it the same or not . Giving people the information they need to see for themselves what they need. I think that has to be from trusted providers like planned parenthood in the u. S. But also the hundreds of partners we support in latin america. These are the people that women could do anyway. We have to make sure they are provided with the resources to be able to continue to have that conversation with their clients and get that out into the community to the various communitybased programs we run. Thats an important point. Another thing that sort of comes to mind when we talk about underserved communities is how do we get information to those communities. As amory mentioned, the latino community, there are people that are not even getting information and it is not been translated into spanish. How do we reach the heart of these committees, especially when we are sitting here in rdc bubble talking about sica and what these communities need. A young woman in southeast d. C. , what does she know about zika and how she can get information about transmission . From the international perspective, we have to look to organizations already doing it on other issues. There are other issues. I think about africa and ebola and malaria and the hivaids epidemic. There are many communitybased organizations dealing with similar Public Health crises. We cannot act like they are not there and just say we need to go look at mosquitoes in some sort of vaccine. We have to lift those organizations up. Planned parenthood as many partners around the role that do this work every day in their communities. They are farreaching communities outside the major cities of most of the countries in latin america. We have to support organizations like unfpa who is there every day doing this work and have a particular role but they are getting less funding than ever before. We have to think about international Family Planning that is getting less money than ever before. Its here and we have to address these issues but we are not thinking about how to support and strengthen those structures and partners already in place and we need to do that. That into the communities go to. That is to the trust. You said earlier that zika is an example that highlights where we have gaps in care and caps off of access and gaps of services. We know what to do to prevent an unintended pregnancy. We should dedicate those resources and build upon them instead of cutting them which is what we are seeing happening. Looking at the infrastructure, building on it and going back to what you have said which is there are many communitybased organizations including us who are on the ground and are already trusted for people to turn to. We need the resources to give them the information. I think that is a key element to what we are doing. Right. You mentioned resources. We talked about the lack of moving forward on the terms of its funding from congress. The request was made several months ago by the president , 1. 9 billion, to exist to address sica transmission and the u. S. And abroad. What do we do while we are waiting for congress to appropriate the funding we need . We cant wait. There has been some effort from administrative agencies to move money that was available. Puerto rico got 300,000 in emergency money in april. That money directly went from title x into the grantees in puerto rico. Its important to underwrite their efforts. The rate of unintended pregnancy and puerto rico is criminally high. Women do not have access to methods at a much greater rate than we see in the mainland u. S. So 300,000 was a drop in the bucket. The system they were able to put that money righties. There has been a lot of emphasis on training. Its not unimportant. Thats getting the pipeline together. The notion is that there are many places in the country, especially in Governmental Health systems or the local Health Department is Family Planning on monday, infectiouss disease tuesday, the school nurse on wednesday, back, local health apartment on thursday because the local Health Department is doing everything. These are not Networks Offering five day access to contraception. When you wind up in a crisis in a governmental Family Planning system, sometimes delay is because we dont do Family Planning until next monday. The notion of trying to be ready every day for a patient who may come to the door says they have been traveling and are exposed and are worried. What do i do . So we can meet their needs immediately. Thats what we have been doing without any extra money. I would love congress to stop the shell game over existing resources. There is no way we can fill the gap in Public Health in the u. S. Without coming to a reckoning about how much we have destroyed the Public Health infrastructure in the United States. Its not just Family Planning, its also true for stds. We understand zika is a sexually transmitted infection. We lost 30 of the capacity and a sexually transmitted disease system in this country due to funding cuts over the last six years. This is not a battle ready Public Health infrastructure. Its unfortunate that it takes a crisis to draw attention. In the past, this country has been able to pull it together in crisis. This is a place where we have stopped dead in our not making this is a place where we have stopped dead, we are not making progress in the face of a crisis. The other thing to highlight is it is more than just having providers and supplies to provide contraception. Thats based on the assumption that 100 of the women will want it. We have cultural aspects that we need to consider. To highlight puerto rico, the unplanned pregnancy rate is incredibly high, but some of that is cultural. They just dont believe in contraception and some of it is religious background. We face some of the same issues in the mainland u. S. So it is critical that we get the importance of the education out that this is a Public Health crisis and contraception is not just a pregnancy prevention because of having sex. Its prevention because of this incredible illness that can affect the unborn or affect the fetus. The education piece, certainly looking from our perspective, we have to educate our providers to get the word out and talk to their patients and work on the local communities but weve got to educate the patients best what the risk really is and try to address some of these cultural and various misperceptions about contraception and the dangers. Weve got another battle to fight as well. It also comes home that notion of institutional racism in our society. When we talk about building trust, people who are in the community, whether they are an institution providing health care or are a community resource, this is a place where people go to trust. Its not going to be earned in a crisis. There is concern in puerto rico that they are being experimented on for prevention. If you not honest about that, if you dont go into that conversation saying we recognize there has to be a reckoning then a reckoning, then there is no way we can engage patients appropriately to make the decisions based on the risk that are right for them and sensitive to their needs and respect their autonomy. Think about it also. To your point about education, think about women who think about these things on unwanted pregnancies. Think about the ones that want pregnancies. Its impossible to believe that every woman is going to say, i will take off for a year when it is time for them to get pregnant. We have to get information and have to provide services and medical facilities for women who do want to have babies even in an endemic area with zika. Were just highlighting together that the Public Health infrastructure and the resources that go into this under zika have to be thought about there is no time for politics. Serious. Its something we need to do soon and it should have been done before. To build on the Public Health infrastructure, Sex Education is is a huge component, that also recognizing that not everybody has the ability to access care because there is a policy in place like undocumented individuals cannot purchase into obamacare. They also cannot purchase it along with the help of subsidies they cant have Affordable Health care. We have to look at all the components to make it battle ready. I would be remiss to say in terms of contraception and latinos, a lot of is not being able to get to a clinic. Texas implemented hb2 partially and a lot of those clinics shut down. To drive to a clinic as far away and you have to take time off of work if you have a job to be able to do it. Access to contraception is a huge component of white latinos why latinos dont have the ability to access care. I would argue that what we have known is that 96 of latinos who are catholic say they use contraception. We need to debunk the myth about our community about why or why not were using contraception. That is part of building this Public Health infrastructure so we can respond to emergencies in a timely way like zika. I will add, and we will deftly get to questions from the audience after this last point. The bella bond the point build upon the point of restrictions and policies that keep folks from accessing Health Services, a lot of the states, the cdc has estimated could see an uptick in zikarelated cases. Those are states that have highly restrictive abortion laws. Access to safe abortion should be a part of the full spectrum of Reproductive Health care for women in the situation. With that said, we will pass things over to the audience for questions. The floors open. Go ahead. My question is around the last point. Its about access to safe abortions particularly if zika cannot be diagnosed until the fourth month. In so many states, access is only for the first trimester. Would you comment on that and also the issue globally . I can quickly talk about the fight for safe abortion continues. What happens here is we have been talking about these issues for a long time so whether it is zika or some other kind of issue that a woman has to have when she makes these decisions with her doctor, it is very clear that we have to ensure that there is an availability of safe abortion for every woman and access to it and not her jumping through hurdles. Its especially true now, we could talk about texas which might be a good example. There is no clinics and you have zika and their soon will be a situation where its endemic there as well. What does a woman do . I go back to what planned parenthood has had for a long time we have to be in places where safe abortion is legal and provide access to the most marginalized women who cannot get it and overseas, i think its exactly the same thing. We probably have a bigger conversation because in many of those countries if not most, its illegal to have an abortion period and it has to be something very serious where the country allows it in certain circumstances of health and is zika one of those . Then you get into a policy question, which many our partners are starting to look at now. I would add that all of the state policies focusing and attacking abortion, what is happening is limiting the full spectrum of comprehensive Reproductive Health care would also impacting access to care. Your closing down clinics like texas. Florida has passed a bill which has not been implemented but it would defund planned parenthood. That is a huge concern. You see the trickle impact and how it impacts peoples ability to have full autonomy of their bodies and therefore cannot protect themselves when things like this happen. We see an onslaught of this. Many of us are working on the forefront to fight these statelevel laws that are negatively impacting womens care. Right here. The one in the back. Hello there. I feel very concerned for the young women in texas and their access to abortion. My question is to you, sir. As the position. Abortion is a medical procedure and i would imagine between a psychiatrist and an obstetrician, if a womans fetus is claimed to have, if evidence indicates microcephaly, certainly an abortion would be medically necessary if not for the Emotional Health of the family, etc. , do you follow . Its a difficult question. Is a difficult predicament. Because it is a difficult predicament. Thank you for reading between thank you. I very much understand and has been said, we certainly support as an organization as well as our providers for the full range of reproductive care available which includes abortion. Part of the challenge has also been when a woman manifests these findings by ultrasound, it may be late in their pregnancy and there are clearly state laws that impact the upper limit when they can be done. That is a separate problem. Your point, i dont think i would use the term medically necessary. The determination is it should be an option. There should be an informed and shared decisionmaking process between the patient and their provider. Its the patient that ultimately makes that decision. I dont think there would be any clinician that would say its medically necessary you terminate this pregnancy for whatever reason. It could be a genetic abnormality or chromosomal or a congenital defect or even a and a lethal defect after birth. We dont tell patients that are going to die after they are born. You should abort now. Strictly the patients decision. There are women who want to know so they can prepare to take care of an infected infant. There are women who choose to terminate. It is the patients choice after a fully informed Decision Making process. And time for her to process that and talk with family and her support system to make that decision. We have time for one more question back here. Thank you so much. One of the questions i wanted to ask is about making sure women have the information they need. Obviously im a strong supporter of women having access to contraception. My question is more of a technical one. The cdc has been putting out guidelines for women who are exposed or testing positive for zika. When they might give information about potential problems for the fetus. Initially they had been saying 28 to 30 weeks is when they might be able to detect. Some information that it might be sooner. I was wondering if you could comment on the state of the research, when women are getting information. And if providers, frankly is it a training issue . Or is it really just dependent on the individual pregnancy . The unfortunate thing, this goes back to what i said earlier, there are far more in unknown been known. There is no answer to question. Even in those patients, the little data out there, presumably infected during the first trimester. When it is manifested in the fetus, it is a wide range. There is one case report where, i forget the exact timing, it was roughly around 19 weeks and the ultrasound was normal and three weeks later the fetus was infected. Was severely affected. We dont have the ability to counsel women that even if she tested positive to say, first of all, your likelihood of developing the microcephaly is this, secondly, even if that were to happen, how long it might take to develop. It is unfortunately difficult. And the access to care. The stage of pregnancy for many of us have gone to this where you are not getting regular ultrasounds. They are not indicated that bested the pregnancy. You are talking ahead to access resources much more often. Though the difficult even insurance context because insurance has limits how often and the expectations. In these situations, we are going to be scrambling to figure out how to get access, how does it get paid for etc. Im qualified to speak to that part of this consideration. Regardless of how much money you have, you will be in the situation were known can really tell you how often testing will be required and i think that is also what we have to bear in mind. Internationally, even in the context of florida, there are new guidelines asking women to get tested for sycamore often throughout their pregnant too. Insurance coverage has also been an issue, even in that context. We will continue to talk about this issue and i thank everyone for being here today. This was such a good panel and conversation. I also want to thank dr. Mullen. And dr. Berger gave opening remarks. Cap will continue to work on this issue and think of new analysis, especially around the house how zika will disproportionately impacts low income communities. Thank you all for being here. [applause] [captions Copyright National cable satellite corp. 2016] which is responsible for its caption content and accuracy. Visit ncicap. Org] [captioning performed by the national captioning institute, which is responsible for its caption content and accuracy. Visit ncicap. Org] a jamest on q robertson describes in his book after the civil war. States rights, state relations went back very, very deep, as many generations as settlers in the country. Im not literally im not belittling slavery. You can justify the actions of and men like robert e. Lee Stonewall Jackson they fight because virginia needs them. Because they support the confederate cause. Neither one of them did. Tonight at 8 p. M. Eastern on q a. , live everyournal day. Coming up, why republicans are supporting the libertarian candidate and their effort to get a thirdparty candidate elected in 2016. Jennifer clarke on the efforts of some states to impose tighter voter id requirements, and with announcing the air force announcing that a new fighter jet is ready, Marcus Weiss Gerber talking about production. Be sure to watch washington journal. Join the discussion. At www. Cspan. Org, you can watch our Political Affairs programming any time on your desktop, laptop, or mobile device. Heres how. Go to our home page, cspan. Org, and here you can type in the name of a speaker, and event topic, review the search results, click on the program that you want to watch, or refine your search. If you are looking for the most current programs, our homepage has many current programs available for your immediate viewing, such as cspans washington journal or events would cover that day. If you are a cspan watcher, check it out on cspan. Org. Up next, cspan felt issues spotlight on police and Race Relations. Some headlines from recent we in the New York Times obama faces growing expectations on race and policing. In the hill, obama calls for continued talks on race. The headline of your story reads, reluctantly, obama leads u. S. Into debate on race, policing. Why reluctantly . The president has found himself caught in the middle on this issue struggling to find out the right thing to say to the country. On one hand, you want people to or really supportive of Law Enforcement, who want to see him speaking out against these issues, violence against police, and on the other hand, people what the first black president to be a leading voice in calling out bias in Police Departments. The president has also talked in the past, especially after the verdict that did not convict George Zimmerman after the Trayvon Martin shooting, they doesnt feel like it is necessarily productive for him to be leading a National Conversation on race, that havent worked that well in the past when politicians have tried to do that. Unfortunately, he has found himself in a situation where there is really nothing that he can do. With that in mind, how much time has the president really been spending focused on the police and Race Relations issue . In the past few weeks, it has taken up quite a bit of his time. He cut short a trip that he made to europe. He was in dallas speaking at a memorial alongside president george w. Bush. He has also been meeting with activists. Law enforcement officers, civil rights advocates, and others to try to figure out what the country can do to try to put an end to the kind of violence we have seen recently. President obamas task force on policing came out with recommendations last year. He has met with activists, police, and political leader as as recently as last month. What came out of that meeting . Nothing came out of the meeting that was different from what the president and his administration had advocated before. That is one of the challenges here. The president is basically saying, these are the steps that we need to take, but also ones that a lot of Law Enforcement communities have been taking, and they dont send to be working. Some of the specific ones that he is reiterating now are needing more data to be made public by Police Departments about interactions between officers and communities, particularly controversial interactions. Better training for how Police Officers can deescalate a situation as opposed to allowing it to turn into something more violent. President obama spoke at a memorial 25 Police Officer shot and killed in dallas. This part of the memorial starts at a memorial dedicated to the officers shot and killed in dallas. This begins with a statement by Dallas Police chief david brown and them we will hear from the president. [applause] chief brown thank you. Thank you. Thank you. Thank you. Thank you so much. Thank you so much. When i was a teenager and started liking girls, i could never find the right words to express myself