TAHLEQUAH DAILY PRESS — The decision of when, and how many, children to have is one of the most complex and personal in the life of a woman and her partner.

In the waning days of his administration, President Bush issued a federal rule reinforcing protection for doctors and heath care workers who refuse to perform abortions and other procedures because of their religious or moral objections.

Critics have said the rule is so broad it could limit a patient’s right to care and accurate information. In a story reported by the Associated Press, they said the rule could make it possible for a pharmacy clerk, for example, to refuse to sell birth control pills.

Local agencies do not perform abortions in Tahlequah. The closest abortion providers are in Tulsa and Fayetteville.

However, private physicians and local clinics provide family planning services and will continue to do so, representatives say.

The Cherokee County Health Department’s family planning clinic offers counseling (patients are informed of all options, from abstinence to abortion) and a variety of services, said Sheree Caldwell, advanced registered nurse practitioner in charge of the clinic. The family planning clinic is available by appointment or, in some cases, on a walk-in basis for emergencies.

“According to our guidelines, we have to provide our patients with all the information,” Caldwell said. “We don’t provide all birth control methods, but we do provide them with information about those methods.”

She serves women who already have children, women who are sexually active and want birth control, and women who have not yet become sexually active. The clinic distributes birth control pills, IUDs, patches and condoms.

For those who do not wish to alter their body chemistry through hormones, the clinic also offers cycle beads, which allows women to track their menstrual cycle and avoid sexual relations when they are most likely to ovulate.

“Although we do not provide all the options we love to educate,” Caldwell said.

The clinic has five types of birth control pills available. If the practitioner decides another pill would be better for the patient, or the patient desires another type of pill, Caldwell can write a prescription that the patient can fill at a local pharmacy.

Coming to the family planning clinic has another advantage, Caldwell said. To receive birth control or a prescription, the patient must receive a full exam. This includes pap smear and a breast examination, and a sexually transmitted disease screening.

“It’s a head-to-toe assessment,” Caldwell said.

Caldwell doesn’t foresee any problems with people working in the field not supporting family planning work. If they oppose birth control, there are other medical areas they can work in.

“As a nurse practitioner at the health department, for the Oklahoma State Department of Health, I follow the guidelines set for us by the state, which include the family planning guidelines,” she said. “If I had problems giving birth control pills, I would not be working here.”

The Cherokee Nation this year assumed operation of W.W. Hastings Indian Medical Center, as well as the clinics it operates in its 14-county jurisdiction in northeastern Oklahoma.

Dr. Gloria Graham, Cherokee Nation medical director, said she believes the Cherokee Nation staff is in compliance with the guidelines.

“We are still looking at the final rule and its implications on our health system. We feel that we are already in compliance with the ‘right of conscience’ directive. We will closely follow developments and monitor for any needed updates to our current policies and practices,” she said.

“Any conflict will be resolved in a manner that does not negatively affect the care and treatment of patients,” she said. “Our first priority is to provide the highest possible level of care to our patients.”

The rule requires recipients of federal funding to certify their compliance with laws protecting conscience rights.

Despite multiple laws on the books protecting health providers, the administration argued that the rule was needed “to raise awareness of federal conscience protections and provide for their enforcement,” according to the AP report.

But many groups described the rule as a last-minute push designed to make it harder for women to get services such as contraception or counseling in the event they are pregnant and want to learn all of their options.

Several medical associations, more than 100 members of Congress, governors and 13 attorneys general were among the many thousands who wrote the department to protest the rule after it was proposed. Opponents didn’t like the rule any better after it was finalized.

The rule has raised criticism across the country from advocates of reproductive choice.

For example, Alison Gee, vice president of public policy for Planned Parenthood of Southwest Missouri, denounced it in a letter to the editor published Tuesday in the Springfield, Mo., News-Leader. She called the ruling “a midnight regulation” and “a parting gift to women before he [Bush] leaves office.”

“Because of ambiguous language and leaving terms like ‘abortion’ undefined, health care workers can use the rule to deny access to most forms of birth control based on their own personal beliefs,” Gee said.

She said beginning in January, emergency rooms can refuse to give emergency contraception to rape victims and medical professionals may choose not to discuss all birth control options with patients.

The Planned Parenthood Federation of America said about 200,000 people submitted comments opposing the rule, including about 90,000 comments from its supporters.

Planned Parenthood and others who support wide access to birth control believe such access will prevent abortions by preventing more unwanted pregnancies.

Help-In-Crisis works not only with victims of rape and sexual abuse, but with women who want to regain control of their lives, including their reproductive freedom.

HIC Executive Director Deana Franke said Bush’s ruling reflects “probably being isolated from the realities of rapes and their victims.”

Women in northeastern Oklahoma find it difficult to obtain some services not only because of distance, but because of finances. Many women are uninsured or underinsured and find access to family planning information and services difficult.

“If you have private insurance and a private physician, you can pretty well get what you want and need, especially if you go to someone who shares your views,” Franke said.