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Position statement: Political interference in sexual and reproductive health research and health professional education1

      Political interference in sexual and reproductive health (SRH) research and health professional education threatens the health of women and men. The American Academy of Nursing (academy) strongly supports actions to prevent political interference by supporting academic freedom principles and policies in institutions of higher education generally and in those offering instruction in nursing particularly.

      Background

      The academy has raised the voice of nursing in support of policies that ensure people's access to SRH services. Specific policies focus on the expansion of SRH clinical knowledge and evidence-based women's preventive health services related to preventing unintended pregnancies to assure that all women's health care, including abortion care, is grounded in scientific knowledge and evidence-based policies and standards of care.
      Unfortunately, politicians across the country are pushing for laws and regulations that restrict ethical standards of care and impose politics and ideology on evidence-based clinical care as outlined by the recent policy report led by a coalition of 24 nursing, medical, health, and advocacy organizations. The academy has responded to these threats of political interference with the patient–provider relationship, ethical and evidence-based standards of care, and women's access to safe and quality SRH care, by the following:
      • Participating in an amicus brief to the U.S. Supreme Court opposing a deceptive Texas law requiring medically unnecessary restrictions on clinical practice: Read the amicus brief of the American Nurses Association/academy and the academy's press release from June 27, 2016 applauding the Supreme Court of the United States decision to reject Texas HB2.
      • Speaking out about how political interference with SRH care harms women: See article from the academy's President Berkowitz, “Examining What's at Stake: The Supreme Court, Nurses and Abortion Care Provision” published in Huffington Post Health (February 22, 2016 and quotes from health professionals on political interference in clinical practice [politics over quality health care]).
      • Opposing political interference in the title X family planning program and fully supported proposed Department of Health and Human Services rules strengthening title X regulations that align title X requirements with established Medicaid/Medicare criteria for qualified providers based on professional and facility scope of practice and licensing. See President Obama's approved new rules on December 14, 2016.

       Now the Academy Is Focused on Another Threat—Political Interference With Academic Freedom, Particularly SRH Research and Health Professional Education

      A case in Missouri highlights the most egregious political interference in academic freedom that threatens science, clinical training, and research. In September 2015, under pressure from Missouri politicians, the University of Missouri canceled 10 contracts with planned parenthood eliminating clinical training for nursing and medical students in comprehensive SRH services, including long-acting contraception methods and early abortion care. The University of Missouri thereafter ended admitting privileges for an obstetrics–gynecology faculty member and a planned parenthood physician and attempted to stop a University of Missouri graduate student from continuing her dissertation research on the impact of a 72-hour waiting period on women considering abortions. In response to this abuse of power and threat to academic freedom, individuals from the academy's Women's Health Expert Panel published a response in the Huffington Post on November 13, 2015. Since this posting, growing national attention has brought issues regarding political interference in academic freedom to the forefront of the national conversation on SRH health care research, practice, and the education of the next generation of health care providers.
      In response to these threats, the Academy Board of Directors approved the development and affirmation of a position statement on Political Interference in SRH Research and Health Professional Education that follows.

       Position Statement: Political Interference in SRH Research and Health Professional Education

       Prevention of Political Interference Specific to SRH Research and Education

      The academy opposes attempts by politicians and/or academic administrators to regulate instruction and research related to SRH based on ideology rather than principles of academic freedom and practice or education standards related to SRH. Specifically, the academy
      • Opposes political interference in evidence-based SRH care, education, and research;
      • Opposes the harassment and censorship of students and their faculty advisors who seek to understand and study the impact of legislation and policies on individual and community health outcomes related to restriction of reproductive choice or SRH services;
      • Supports university faculty and students' freedom to discuss issues of SRH and abortion in the classroom and provide instruction in clinical sites that provide a full range of SRH services;
      • Supports faculty and students' freedom to engage in scholarship and research activities related to SRH, including abortion; and
      • Supports faculty and students' freedom from restriction in pursuit of education and clinical training related to all evidence-based unintended pregnancy prevention and SRH care.
      The academy supports the principles and practices of academic freedom in general, and specifically, as they apply to SRH research and health professional education including the following:
      • Supporting the definition of academic freedom as a university's fundamental commitment that all members of an academic community have the broadest possible latitude to speak, write, listen, challenge, and learn.
      • Affirming that the intent of academic freedom to afford members of the academic community the broadest possible scope of unencumbered expression, investigation, analysis, and discourse. Most academic institutions and faculty organizations have put into practice the individual and institutional responsibilities and rights to academic freedom to ensure that faculty and students will not experience political interference in research and education.
      • Recognizing that academic freedom applies to the individuals and institutions through professional and legal principles, policies, opinions, and laws developed by the American Association of University Professors (AAUP) and the American Association of Colleges and Universities
        A Committee on Academic Freedom and Academic Tenure of the AAUP formulated a statement of principles on academic freedom and academic tenure known as the 1915 Declaration of Principles, was officially endorsed by the Association at its Second Annual Meeting held in Washington, DC, December 31, 1915, and January 1, 1916. In 1925, the American Council on Education called a conference of representatives of a number of its constituent members, among them the AAUP, for formulating a shorter statement of principles on academic freedom and tenure. The Association of American Colleges (now the Association of American Colleges and Universities) endorsed the statement formulated at this conference, known as the 1925 Conference Statement on Academic Freedom and Tenure, in 1925 and by the AAUP in 1926. Further interpretations, adopted as footnotes to this statement by the Council of the AAUP in April 1970, asserted, “Academic freedom is essential to these purposes and applies to both teaching and research.” Freedom in research is fundamental to the advancement of truth. Academic freedom in its teaching aspect is fundamental for the protection of the rights of the teacher in teaching and of the student to freedom in learning.”
        and endorsed by more than 200 scholarly and professional organizations. In addition to the professional standard of academic freedom, there is a substantial body of law that shapes faculty and institutional claims to academic freedom.
        2A Committee on Academic Freedom and Academic Tenure of the AAUP formulated a statement of principles on academic freedom and academic tenure known as the 1915 Declaration of Principles, was officially endorsed by the Association at its Second Annual Meeting held in Washington, DC, December 31, 1915, and January 1, 1916. In 1925, the American Council on Education called a conference of representatives of a number of its constituent members, among them the AAUP, for formulating a shorter statement of principles on academic freedom and tenure. The Association of American Colleges (now the Association of American Colleges and Universities) endorsed the statement formulated at this conference, known as the 1925 Conference Statement on Academic Freedom and Tenure, in 1925 and by the AAUP in 1926. Further interpretations, adopted as footnotes to this statement by the Council of the AAUP in April 1970, asserted, “Academic freedom is essential to these purposes and applies to both teaching and research.” Freedom in research is fundamental to the advancement of truth. Academic freedom in its teaching aspect is fundamental for the protection of the rights of the teacher in teaching and of the student to freedom in learning.”
      • Supporting principles and policies arising from the 1940 AAUP Statement and case law focused on faculty freedom from external (political) intrusion and institutional intrusion. The following fundamental academic freedom principles and policies are incorporated into hundreds of college and university faculty handbooks (exemplars from public universities—University of Washington (UW),
        UW Faculty Code, Section 24 to 33, “A Statement of Principle: Academic Freedom and Responsibility” approved by Senate Executive Committee, October 7, 2013; Faculty Senate, October 24, 2013; Senate Executive Committee, November 18, 2013; Faculty Senate, December 5, 2013; Certified by Jack Lee, Chair, Faculty Senate, January 9, 2014; and President Michael Young, January 8, 2014. The UW Faculty Code (UW Code) is an exemplar for enacting academic freedom principles. The UW Code emphasizes that the academic community—students, faculty members, administrators, and trustees—is obligated “to respect the dignity of others, to acknowledge their right to express differing opinions, and to foster and defend intellectual honesty, freedom of inquiry and instruction, and free expression on and off the campus.” Expression of dissent and attempts to produce change may not be enacted in ways that “injure individuals and damage institutional facilities or disrupt the classes of one's instructors or colleagues.” Furthermore, campus speakers must be protected from violence and given an opportunity to speak. Those seeking to call attention to grievances may not significantly impede the university's functions. The UW Code stipulates that faculty's exercise of constitutionally protected freedom of association, assembly, and expression, including participation in political activities, does not constitute a violation of duties to the University, to their profession, or to students and may not result in disciplinary action or adverse merit evaluation. In addition to defining the right to academic freedom, the UW stipulates faculty responsibilities, including responsibility to “present the subject matter of their courses as approved by the faculty in their collective responsibility for the curriculum. Within the approved curriculum, faculty members are free to express ideas and teach as they see fit based on their mastery of their subjects and their own scholarship. In addition, the UW Code stipulates institutional responsibilities to academic freedom; that both faculty and students be entitled to “an atmosphere conducive to learning and to evenhanded treatment in all aspects of the instructor–student relationship.” Faculty members have obligations to respect the freedoms of students, meaning that faculty may not refuse to enroll or teach students because of the student's beliefs or the possible applications that students may make of knowledge gained in a course. In addition, the code asserts that students will not be forced by the authority of the faculty to make particular political choices or their roles in society. Furthermore, evaluation of students and the award of credit must be based on their academic performance judged professionally and not on matters such as personality, sexual orientation, or sexual, romantic, familial, or other personal relationships.
        University of California,
        University of California, Academic Personnel Manual 010. General University Policy Regarding Academic Appointees: Academic Freedom. APM – 010. Accessed August 21, 2016.
        University of Michigan,
        University of Michigan Faculty Handbook 1.C. Senate Assembly Statement on Academic Freedom. Retrieved from www.provost.umich.edu/faculty/handbook/1/1.C.html. Accessed August 21, 2016.
        and a private university
        Although most universities today accept the principles of academic freedom, tensions exist between individual and institutional academic freedom under the first amendment that challenge the professions, the AAUP, colleges and universities, and courts. Clearly, the scope of institutional academic freedom between private (especially religiously affiliated) and public sector institutions has tested individual faculty and student freedoms and the four essential freedoms of a university—to determine for itself on academic grounds who may teach, what may be taught, how it shall be taught, and who may be admitted to study. See University of Chicago reference to Freedom of Expression Policy, 2015.
        —University of Chicago
        University of Chicago Freedom of Expression Committee, 2015. Retrieved from http://provost.uchicago.edu/sites/default/files/documents/reports/FOECommitteeReport.pdf. Accessed September 15, 2016.
        ) and form the basis for preventing political interference in SRH research and education.
        • Debate and deliberation may not be suppressed because the ideas put forth are thought by some, or even most, members of the academic community to be offensive, unwise, immoral, or wrong headed.
        • Individual members of the university community, not the university as an institution, will make judgments and act on those judgments not by seeking to suppress speech but by openly and vigorously contesting the ideas that they oppose.
        • Fostering the ability of members of the university community to engage in debate and deliberation in an effective and responsible manner is an essential part of a university's educational mission.
        • Freedom to debate and discuss the merits of competing ideas does not mean that individuals may say whatever they wish, wherever they wish. A university may restrict expression that violates the law, falsely defames a specific individual, constitutes a genuine threat or harassment, unjustifiably invades substantial privacy or confidentiality interests, or is otherwise directly incompatible with the functioning of the university.
        • The university may reasonably regulate the time, place, and manner of expression to ensure that it does not disrupt the ordinary activities of the university. These legitimate, but narrow, exceptions to the well-established general principle of freedom of expression must never be used as a pretense for eroding or obstructing free and open discussion of ideas.
        3UW Faculty Code, Section 24 to 33, “A Statement of Principle: Academic Freedom and Responsibility” approved by Senate Executive Committee, October 7, 2013; Faculty Senate, October 24, 2013; Senate Executive Committee, November 18, 2013; Faculty Senate, December 5, 2013; Certified by Jack Lee, Chair, Faculty Senate, January 9, 2014; and President Michael Young, January 8, 2014. The UW Faculty Code (UW Code) is an exemplar for enacting academic freedom principles. The UW Code emphasizes that the academic community—students, faculty members, administrators, and trustees—is obligated “to respect the dignity of others, to acknowledge their right to express differing opinions, and to foster and defend intellectual honesty, freedom of inquiry and instruction, and free expression on and off the campus.” Expression of dissent and attempts to produce change may not be enacted in ways that “injure individuals and damage institutional facilities or disrupt the classes of one's instructors or colleagues.” Furthermore, campus speakers must be protected from violence and given an opportunity to speak. Those seeking to call attention to grievances may not significantly impede the university's functions. The UW Code stipulates that faculty's exercise of constitutionally protected freedom of association, assembly, and expression, including participation in political activities, does not constitute a violation of duties to the University, to their profession, or to students and may not result in disciplinary action or adverse merit evaluation. In addition to defining the right to academic freedom, the UW stipulates faculty responsibilities, including responsibility to “present the subject matter of their courses as approved by the faculty in their collective responsibility for the curriculum. Within the approved curriculum, faculty members are free to express ideas and teach as they see fit based on their mastery of their subjects and their own scholarship. In addition, the UW Code stipulates institutional responsibilities to academic freedom; that both faculty and students be entitled to “an atmosphere conducive to learning and to evenhanded treatment in all aspects of the instructor–student relationship.” Faculty members have obligations to respect the freedoms of students, meaning that faculty may not refuse to enroll or teach students because of the student's beliefs or the possible applications that students may make of knowledge gained in a course. In addition, the code asserts that students will not be forced by the authority of the faculty to make particular political choices or their roles in society. Furthermore, evaluation of students and the award of credit must be based on their academic performance judged professionally and not on matters such as personality, sexual orientation, or sexual, romantic, familial, or other personal relationships.
        4University of California, Academic Personnel Manual 010. General University Policy Regarding Academic Appointees: Academic Freedom. APM – 010. Accessed August 21, 2016.
        5University of Michigan Faculty Handbook 1.C. Senate Assembly Statement on Academic Freedom. Retrieved from www.provost.umich.edu/faculty/handbook/1/1.C.html. Accessed August 21, 2016.
        6Although most universities today accept the principles of academic freedom, tensions exist between individual and institutional academic freedom under the first amendment that challenge the professions, the AAUP, colleges and universities, and courts. Clearly, the scope of institutional academic freedom between private (especially religiously affiliated) and public sector institutions has tested individual faculty and student freedoms and the four essential freedoms of a university—to determine for itself on academic grounds who may teach, what may be taught, how it shall be taught, and who may be admitted to study. See University of Chicago reference to Freedom of Expression Policy, 2015.
        7University of Chicago Freedom of Expression Committee, 2015. Retrieved from http://provost.uchicago.edu/sites/default/files/documents/reports/FOECommitteeReport.pdf. Accessed September 15, 2016.
      The academy calls for
      • 1.
        Professional organizations in nursing and other health care professions as well as organizations of academic communities
        Partial list of the relevant organizations for the academy to work with on endorsing this statement: National League for Nursing, American Association of Colleges of Nursing, AAUP, American Association of University Women, Association of Reproductive Health Professionals, National Partnership for Women and Families, National Women's Law Center.
        to join in affirming the Statement on Political Interference in SRH Research and Health Professional Education.
        8Partial list of the relevant organizations for the academy to work with on endorsing this statement: National League for Nursing, American Association of Colleges of Nursing, AAUP, American Association of University Women, Association of Reproductive Health Professionals, National Partnership for Women and Families, National Women's Law Center.
      • 2.
        The extension of the academy's position statement to bring attention to political interference in evidence-based SRH research and health professional education.
      • 3.
        The publication of academic freedom principles and practice guidelines specific to SRH research and education using exemplary academic freedom codes from public and private colleges and universities.

      Acknowledgments

      The authors acknowledge the assistance provided by members of the Women's Health Expert Panel (especially Marcia Killien and Judith Berg), Kim Czubaruk, Esq., Policy Manager, and Academy Staff Liaison to the Women's Health Expert Panel and Sarah Lipton-Lubet, JD, of the National Partnership for Women & Families.

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