Over the past several months Congress has been working at a fast pace to get comprehensive health reform legislation to the President's desk before the end of this year.

Two Senate committees are working on bills which they will ultimately merge into one and send to the full Senate for a vote sometime before Congress adjourns for the August recess.

Meanwhile, there are three committees in the House that are working on health reform. The House committees are collaborating to produce one bill, which is also expected to be voted on by the full House by early August. Broad outlines of a "Tri-Committee" draft bill were circulated last week.

Looking at the various draft proposals that have already been released, it is clear that Congress is making a historic effort to reform health care, as is the Obama administration. Yet with so many "big picture" issues to grapple with, like spiraling health care costs, access and affordability, employer mandates, taxing benefits, and whether to include a public plan option, it's hard to get Congress's attention on some of the "smaller issues," such as pregnancy planning and prevention. However, pregnancy planning and prevention affects the lives of most Americans who would benefit from health reform, and therefore, is very much a part of the "big picture."

Newly sworn in President Obama spoke yesterday of personal responsibility and I hoped he might offer some examples as he had done when campaigning. A few were mentioned, but they tended towards the macro and institutional—understandable given the momentous occasion and the certain knowledge that there were millions of good souls in front of him who were, literally, freezing and had been standing in a huge sardine can for 6 hours or more (not that I am complaining). No time for long lists or numerous examples, eh?

So, to fill the gap: for those of us who worry about family structure and pregnancy planning and best beginnings, what might we say personal responsibility means? Here are four bits and pieces that I have been mulling over:

1. Unless both partners are in a committed relationship, are seeking pregnancy, and are willing to devote two decades and more to child-rearing, having sex without contraception or some attention to family planning is irresponsible.
   


2. It's irresponsible for doctors/nurses/clinics to fail to talk with women about all the effective contraceptive options available to them (and there are lots now).
   


3. When insurance/pharma prescription companies finance Viagra with minimal cost-sharing but get all weird and expensive when it comes to birth control, that's irresponsible.
   


4. Offering a sex education curriculum that does not include generous amounts of attention to respectful relationships and what types of family structures seem to benefit children the most is irresponsible.

I welcome additions....