Daily Women's Health Policy Report

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Daily Women's Health Policy Report by the National Partnership for Women & Families
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Ala. Lawmaker Might Try Again on 'Heartbeat' Abortion Ban Measure

Fri, 01/30/2015 - 19:20

Alabama Rep. Terri Collins (R) is considering introducing legislation similar to a bill (HB 490) she proposed last year that would have banned most abortions once a fetal heartbeat is detectable, the Florence Times Daily reports.

Ala. Lawmaker Might Try Again on 'Heartbeat' Abortion Ban Measure

January 30, 2015 — Alabama Rep. Terri Collins (R) is considering introducing legislation similar to a bill (HB 490) she proposed last year that would have banned most abortions once a fetal heartbeat is detectable, the Florence Times Daily reports.

Previous Legislation

Last year's bill passed the state House but did not advance in the state Senate. Under the bill, physicians would have been required to check for a fetal heartbeat before an abortion. The measure would have made it a felony to perform an abortion if a fetal heartbeat were detectable, which is generally between about six to eight weeks of pregnancy. Current state law prohibits abortion at 20 weeks of pregnancy.

Potential New Legislation

The state's legislative session begins on March 3. Collins indicated that this year's measure, if she decides to introduce it, might have different language.

Collins said, "We're trying to see what the courts have said and maybe work out a better approach." She added, "I've begun discussing it with some people. Sometimes you can change the language ... and go at it another way."

Planned Parenthood Southeast Vice President of Public Policy Nikema Williams noted that some women are not aware they are pregnant after six to eight weeks. She added, "I think what we've seen so far in Alabama when they pass unconstitutional legislation, the courts have sided with the Constitution" (Sell, Florence Times Daily, 1/27).


Va. Senate Committee Rejects Attempt To Repeal Ultrasound Mandate

Fri, 01/30/2015 - 19:20

A Virginia Senate committee on Thursday rejected a bill (SB 733) that would have repealed a 2012 measure (Code of Virginia 18.2-76) mandating that a woman receive an ultrasound before an abortion, the AP/San Francisco Chronicle reports.

Va. Senate Committee Rejects Attempt To Repeal Ultrasound Mandate

January 30, 2015 — A Virginia Senate committee on Thursday rejected a bill (SB 733) that would have repealed a 2012 measure (Code of Virginia 18.2-76) mandating that a woman receive an ultrasound before an abortion, the AP/San Francisco Chronicle reports.

The Republican-led state Senate Education and Health Committee voted 8-7 against the measure. The vote fell along party lines, with Democrats supporting the measure (AP/San Francisco Chronicle, 1/29).

The committee on Thursday also defeated a bill (SB 920) that would have ended the 24-hour mandatory delay between the ultrasound and the abortion procedure.

In addition, the committee rejected a bill (SB 769) that would have overturned a rule that bans health plans sold through Virginia's health insurance marketplace from covering abortion.

Debate

State Sen. Mamie Locke (D) called the ultrasound requirement "personally invasive, emotionally onerous and medically unnecessary" (Nolan, Richmond Times-Dispatch, 1/29). Locke introduced the repeal bill (AP/San Francisco Chronicle, 1/29).

Physician groups also spoke out against the current law, saying it constitutes political interference in the doctor-patient relationship (Richmond Times-Dispatch, 1/29). Gov. Terry McAuliffe (D) also supports repealing the requirement (AP/San Francisco Chronicle, 1/29).

Meanwhile, antiabortion-rights groups, including the Family Foundation of Virginia and the Virginia Catholic Conference, said mandated ultrasounds help women "make a more informed choice," according to the Richmond Times-Dispatch.

However, abortion-rights advocates said the aim of the mandate is to increase barriers to abortion (Richmond Times-Dispatch, 1/29).


Colo. Teen Pregnancy Prevention Bill Advances

Fri, 01/30/2015 - 19:19

The Colorado House Finance Committee on Thursday voted 10-1 to approve a bipartisan measure (HB 1079) that would expand the state's Teen Pregnancy and Dropout Prevention pilot program, the Colorado Independent reports.

Colo. Teen Pregnancy Prevention Bill Advances

January 30, 2015 — The Colorado House Finance Committee on Thursday voted 10-1 to approve a bipartisan measure (HB 1079) that would expand the state's Teen Pregnancy and Dropout Prevention pilot program, the Colorado Independent reports (Cheek, Colorado Independent, 1/29).

Program Details

The pilot program currently operates only in the state's Western Slope (AP/Sacramento Bee, 1/29).

According to bill co-sponsor state Rep. Jessie Danielson (D), "[The] program provides information about abstinence, contraception, family planning and other choices, like avoiding drugs and alcohol, avoiding peer-pressure -- just avoiding unhealthy behavior so they can stay in school, get an education and then have more opportunities down the road." State Rep. Don Coram (R) is the bill's other co-sponsor.

Bill Details

The measure would extend the program statewide for teenagers who qualify for Medicaid.

The bill also calls for the program to be funded through the state's General Fund. Coram and Danielson cited a fiscal note that estimated the program would save $7,559 per Medicaid beneficiary who avoided pregnancy, which would total more than $1 million during the first year of the program's extension (Colorado Independent, 1/29). According to the Denver Post, the bill specifically calls for $5 million in state funding (Draper, Denver Post, 1/30). Currently, the pilot is funded mostly from federal funds, with 10% local matching funds (Colorado Independent, 1/29).

In addition, the bill would extend the program's repeal date by four years, from 2016 to 2020 (AP/Sacramento Bee, 1/29).

Next Steps

The bill now goes to the state House Appropriations Committee (Denver Post, 1/29). If approved, the measure would proceed to the full state House for consideration (AP/Sacramento Bee, 1/29).


Datapoints: A Look at Abortion Coverage in the ACA's Marketplace Plans, Repro Health Report Card, More

Fri, 01/30/2015 - 18:58

This week's charts depict why abortion coverage is unavailable in many states' ACA marketplace plans for 2015. We also feature a national reproductive health report card and an interactive look at abortion restrictions in Missouri.

Datapoints: A Look at Abortion Coverage in the ACA's Marketplace Plans, Repro Health Report Card, More

January 30, 2015 — This week's charts depict why abortion coverage is unavailable in many states' ACA marketplace plans for 2015. We also feature a national reproductive health report card and an interactive look at abortion restrictions in Missouri.

State of Abortion Coverage



Part of an issue brief examining abortion coverage in Affordable Care Act (PL 111-148) marketplace plans for 2015, this Kaiser Family Foundation graph shows that the majority (60%) of previously uninsured women who are eligible for ACA tax credits do not have abortion coverage in the health plans available to them through the marketplace.

As further detailed in this KFF map, women in 24 states do not have access to marketplace plans with abortion coverage because their states have banned such coverage. Seven other states have not imposed such restrictions but have no plans that offer the coverage, while 19 states and the District of Columbia have at least one marketplace plan that offers abortion coverage (KFF issue brief, 1/21).


Repro Report Card



The Population Institute's annual report card on reproductive health and rights in the U.S. shows mixed results for 2014. The institute notes that teen pregnancy rates continued to decline nationally and that more women gained access to reproductive health care as a result of the Affordable Care Act (PL 111-148). However, state-level policies created many setbacks for women's health.

The report card took into account four broad categories -- access, affordability, effectiveness and prevention -- as well as several more-specific criteria. Overall, 15 states received an "F," while just four -- California, New Mexico, Oregon and Washington -- received an "A." The U.S. as a whole received a "C" grade, a slight improvement from the "C-" the institute issued the previous year (Population Institute release, 1/8).


Spotlight on Missouri



Missouri drew national attention last year when the state Legislature overrode Gov. Jay Nixon's (D) veto to enact a 72-hour mandatory delay before abortions (Missouri Revised Statutes 188.039.1). In an interactive graphic, the Columbia Missourian presents a series of charts and illustrations lending context to the abortion debate in Missouri and how the state moved onto "the national radar for abortion restriction[s]" (Keel, Columbia Missourian, Dec. 2014).


Blogs Comment on Anti-Choice 'Playbook,' IUD Facts, More

Fri, 01/30/2015 - 17:39

Read the week's best commentaries from bloggers at ANSIRH, Ms. Magazine and more.

Blogs Comment on Anti-Choice 'Playbook,' IUD Facts, More

January 30, 2015 — Read the week's best commentaries from bloggers at ANSIRH, Ms. Magazine and more.

ABORTION RESTRICTIONS: "Will Abortion Opponents Use a Familiar Playbook To Push for a 20 Week Ban?" Carole Joffe, Advancing New Standards in Reproductive Health's "ANSIRH Blog": Although the House earlier this month canceled a vote on a 20-week abortion ban (HR 36), it "is not the end of the story for the federal 20 week ban" because "a modified version of this bill will be voted on at a later date," Joffe writes. Joffe explains that abortion-rights opponents' justification behind such bans, "that the fetus can feel pain at 20 weeks," has been widely dismissed "by medical experts, and by organizations such as the American College of Obstetricians and Gynecology." She writes that in pushing for the ban, "anti-abortion politicians are following a tried and true playbook: choose an aspect of abortion provision that is unsettling to a public that is not informed about the science, ignore the testimony of leading medical experts on the abortion issue, and instead, rely on arguments made by alternative 'experts,' who may lack the credentials or research background in their purported areas of expertise or draw on so-called junk science" (Joffe, "ANSIRH Blog," ANSIRH, 1/27).

What others are saying about abortion restrictions:

~ "Who Has Late Abortions -- And Why?" David Grimes, Huffington Post blogs.

CONTRACEPTION: "IUD Expulsion: Is it as Scary as it Sounds?" Claire Tighe, Ms. Magazine blog: Tighe comments on the various ways an intrauterine device can become "expelled," which, according to an article by Corinne Rocca, "'is a fancy way of saying that an IUD has been pushed out of its ideal location at the top of the uterus.'" According to Tighe, expulsion is rare, occurring between 0.05% and 8% of the time, but "[t]here are a few different factors that can affect the possibility of expulsion, like your age and pregnancy history, how long it's been since the IUD was inserted, and even how well your health care provider inserted the IUD in the first place." She notes the IUDs are more likely to be expelled during menstruation than other times in a woman's cycle and are "most likely" to become expelled during "the first three months" following insertion. Tighe writes that women concerned about a possible expulsion should check to see if they can feel the IUD's strings and call a provider, among other care suggestions (Tighe, Ms. Magazine blog, 1/27).

What others are saying about contraception:

~ "Salon's Guide to Where Babies (Don't) Come From: Let's Talk About IUDs!" Katie McDonough, Salon.

ABORTION PROVIDERS: "Threats Against Abortion Providers Have Doubled Since 2010, Report Finds," Teddy Wilson, RH Reality Check: "[T]here has been significantly higher levels of threats and targeted intimidation of doctors and staff in recent years" across the U.S., according to the National Clinic Violence Survey, Wilson writes. According to Wilson, the report found the "[i]ncidents of wanted-style posters of abortion providers, pamphlets targeting doctors and clinic staff, and harmful information and pictures of doctors posted on the Internet have all significantly increased over the past four years." Further, the survey found that 8.7% of clinics reported stalking in 2014, an increase from 6.4% in 2010, and 19.7% of clinics reported "severe violence." He adds, "Increases in the incidents of harassment of abortion clinics appear to coincide with the increasing amount of legislation passed to restrict access to reproductive health care" (Wilson, RH Reality Check, 1/28).

What others are saying about abortion providers:

~ "The Disturbing Levels of Stalking and Intimidation Plaguing Abortion Doctors," Tara Culp-Ressler, Center for American Progress' "ThinkProgress."

MEDICATION ABORTION: "Study: Evidence-Based Protocols for Medication Abortion are Safe, Effective," Emily Crockett, RH Reality Check: A new study has found "evidence-based alternatives to the [FDA]-approved regimen for medication abortion are safe and effective," Crockett writes. She notes that the five-year study found that "the protocols were more than 98 percent effective for pregnancies of up to 42 days' gestation, and more than 95 percent effective up to 63 days." By contrast, FDA protocols "only recommend using medication abortion up until 49 days of gestation ... and are less than 85 percent effective after 49 days," in addition to requiring a "higher dose of medication and more doctor's visits," she writes. According to Crockett, the study adds to the "robust body of evidence" that laws restricting medication abortion by requiring physicians adhere to FDA protocol "have no scientific basis" (Crockett, RH Reality Check, 1/28).


Colo. Teen Pregnancy Prevention Bill Advances

Fri, 01/30/2015 - 17:34

The Colorado House Finance Committee on Thursday voted 10-1 to approve a bipartisan measure (HB 1079) that would expand the state's Teen Pregnancy and Dropout Prevention pilot program, the Colorado Independent reports.

Colo. Teen Pregnancy Prevention Bill Advances

January 30, 2015 — The Colorado House Finance Committee on Thursday voted 10-1 to approve a bipartisan measure (HB 1079) that would expand the state's Teen Pregnancy and Dropout Prevention pilot program, the Colorado Independent reports (Cheek, Colorado Independent, 1/29).

Program Details

The pilot program currently operates only in the state's Western Slope (AP/Sacramento Bee, 1/29).

According to bill co-sponsor state Rep. Jessie Danielson (D), "[The] program provides information about abstinence, contraception, family planning and other choices, like avoiding drugs and alcohol, avoiding peer-pressure -- just avoiding unhealthy behavior so they can stay in school, get an education and then have more opportunities down the road." State Rep. Don Coram (R) is the bill's other co-sponsor.

Bill Details

The measure would extend the program statewide for teenagers who qualify for Medicaid.

The bill also calls for the program to be funded through the state's General Fund. Coram and Danielson cited a fiscal note that estimated the program would save $7,559 per Medicaid beneficiary who avoided pregnancy, which would total more than $1 million during the first year of the program's extension (Colorado Independent, 1/29). According to the Denver Post, the bill specifically calls for $5 million in state funding (Draper, Denver Post, 1/30). Currently, the pilot is funded mostly from federal funds, with 10% local matching funds (Colorado Independent, 1/29).

In addition, the bill would extend the program's repeal date by four years, from 2016 to 2020 (AP/Sacramento Bee, 1/29).

Next Steps

The bill now goes to the state House Appropriations Committee (Denver Post, 1/29). If approved, the measure would proceed to the full state House for consideration (AP/Sacramento Bee, 1/29).


Va. Senate Committee Rejects Attempt To Repeal Ultrasound Mandate

Fri, 01/30/2015 - 16:33

A Virginia Senate committee on Thursday rejected a bill (SB 733) that would have repealed a 2012 measure (Code of Virginia 18.2-76) mandating that a woman receive an ultrasound before an abortion, the AP/San Francisco Chronicle reports.

Va. Senate Committee Rejects Attempt To Repeal Ultrasound Mandate

January 30, 2015 — A Virginia Senate committee on Thursday rejected a bill (SB 733) that would have repealed a 2012 measure (Code of Virginia 18.2-76) mandating that a woman receive an ultrasound before an abortion, the AP/San Francisco Chronicle reports.

The Republican-led state Senate Education and Health Committee voted 8-7 against the measure. The vote fell along party lines, with Democrats supporting the measure (AP/San Francisco Chronicle, 1/29).

The committee on Thursday also defeated a bill (SB 920) that would have ended the 24-hour mandatory delay between the ultrasound and the abortion procedure.

In addition, the committee rejected a bill (SB 769) that would have overturned a rule that bans health plans sold through Virginia's health insurance marketplace from covering abortion.

Debate

State Sen. Mamie Locke (D) called the ultrasound requirement "personally invasive, emotionally onerous and medically unnecessary" (Nolan, Richmond Times-Dispatch, 1/29). Locke introduced the repeal bill (AP/San Francisco Chronicle, 1/29).

Physician groups also spoke out against the current law, saying it constitutes political interference in the doctor-patient relationship (Richmond Times-Dispatch, 1/29). Gov. Terry McAuliffe (D) also supports repealing the requirement (AP/San Francisco Chronicle, 1/29).

Meanwhile, antiabortion-rights groups, including the Family Foundation of Virginia and the Virginia Catholic Conference, said mandated ultrasounds help women "make a more informed choice," according to the Richmond Times-Dispatch.

However, abortion-rights advocates said the aim of the mandate is to increase barriers to abortion (Richmond Times-Dispatch, 1/29).


Ala. Lawmaker Might Try Again on 'Heartbeat' Abortion Ban Measure

Fri, 01/30/2015 - 15:53

Alabama Rep. Terri Collins (R) is considering introducing legislation similar to a bill (HB 490) she proposed last year that would have banned most abortions once a fetal heartbeat is detectable, the Florence Times Daily reports.

Ala. Lawmaker Might Try Again on 'Heartbeat' Abortion Ban Measure

January 30, 2015 — Alabama Rep. Terri Collins (R) is considering introducing legislation similar to a bill (HB 490) she proposed last year that would have banned most abortions once a fetal heartbeat is detectable, the Florence Times Daily reports.

Previous Legislation

Last year's bill passed the state House but did not advance in the state Senate. Under the bill, physicians would have been required to check for a fetal heartbeat before an abortion. The measure would have made it a felony to perform an abortion if a fetal heartbeat were detectable, which is generally between about six to eight weeks of pregnancy. Current state law prohibits abortion at 20 weeks of pregnancy.

Potential New Legislation

The state's legislative session begins on March 3. Collins indicated that this year's measure, if she decides to introduce it, might have different language.

Collins said, "We're trying to see what the courts have said and maybe work out a better approach." She added, "I've begun discussing it with some people. Sometimes you can change the language ... and go at it another way."

Planned Parenthood Southeast Vice President of Public Policy Nikema Williams noted that some women are not aware they are pregnant after six to eight weeks. She added, "I think what we've seen so far in Alabama when they pass unconstitutional legislation, the courts have sided with the Constitution" (Sell, Florence Times Daily, 1/27).


Survey Shows Increase in Violence Against Abortion Providers, Clinics

Fri, 01/30/2015 - 15:45

Abortion providers are experiencing an increase in threats and intimidation from abortion-rights opponents, according to a Feminist Majority Foundation survey, Medical Daily reports.

Survey Shows Increase in Violence Against Abortion Providers, Clinics

January 30, 2015 — Abortion providers are experiencing an increase in threats and intimidation from abortion-rights opponents, according to a Feminist Majority Foundation survey, Medical Daily reports.

The survey marks the group's first comprehensive look at the issue nationwide since 2010.

Key Findings

Overall, the survey found that antiabortion-rights-related violence affects 19.7% of abortion clinics in the U.S.

The survey found that abortion providers are facing more targeted harassment, such as "wanted-style" posters and pamphlets that identify clinics' staff members and disclose their personal data and pictures (Castillo, Medical Daily, 1/28). The proportion of clinics that faced these types of threats increased from 26.6% in 2010 to 51.9% in 2014 (FMF survey, January 2015).

The survey also showed increases in other types of extreme antiabortion-rights threats, including break-ins, vandalism and severe violence. According to the report, "[A]nti-abortion extremists strategically target a vulnerable minority of clinics, aiming to force them to close their doors before moving on to the next set of targets."

In addition, the researchers found that women visiting abortion clinics not only face shaming and other harassment, but that restricted access to abortion clinics can be associated with intimate partner violence, maternal death and other negative effects on women's health (Medical Daily, 1/28).


Increased Use of Preterm Birth Prevention Methods Could Decrease U.S. Preterm Birth Rate

Thu, 01/29/2015 - 22:13

In a clinical opinion, researchers assess the U.S. preterm birth rate, which despite falling to 11.4% in 2013, the lowest level since 1997, remains one of the highest PTB rates in the world. The researchers examine factors contributing to this decline, such as changes in medical guidelines on assisted reproductive technology and antismoking policies, to determine how to further improve the U.S. PTB rate.

Increased Use of Preterm Birth Prevention Methods Could Decrease U.S. Preterm Birth Rate

January 29, 2015 — Summary of "Why the United States Preterm Birth Rate is Declining," Schoen et al., American Journal of Obstetrics & Gynecology, January 2015.

Although the U.S. preterm birth (PTB) rate has declined, the nation's "incidence of PTB still remains among the highest in the world, especially compared with other developed countries," according to a clinical opinion by Corina Schoen of the Division of Maternal-Fetal Medicine at Thomas Jefferson University's Sidney Kimmel Medical College and colleagues.

According to the authors, the U.S. PTB rate, which refers to births occurring before 37 weeks of gestation, dropped by 11% from 2006 to 2013, when it reached 11.4%, the lowest rate since 1997. The authors note that the decline followed an increase from 9.4% in 1981 to an all-time high of 12.8% in 2006. The authors explain that it is important to understand the reasons why the U.S. PTB rate has declined in order to bolster PTB prevention in the U.S.

Reasons for PTB Rate Drop

Changes in Obstetric Population Characteristics

The authors write that changes in birth rates among teenagers and women over age 35, who are both at increased risk of PTB, could be one contributing factor to the lowered PTB rates in the U.S.

They explain that the total birth rate among teenagers fell by 6% in 2012, continuing a trend of lower teen birth rates since 1991, while the birth rate among women ages 35 and older increased between 2012 and 2013. According to a 2006 Vital Statistics report that accounts for the absolute number of births among teens and women older than 35, "the magnitude of decline in the teenage birth rate slightly outweighs the increased PTB rate in the advanced maternal age population and may account for a small part of the decline in PTBs," the authors write.

The authors also examine fluctuations in the rate of multiple gestations, which "have long been associated with increased risk for poor obstetric outcomes, including PTB." The authors note that a 76% increase in the live birth rate for twins between 1980 and 2009 is mainly tied "to the increased use of assisted reproductive technology (ART), rather than to the increase in pregnancies in women" ages 35 and older. However, there were fewer total PTBs in 2013 than in 2006, suggesting that other demographic changes likely are at play. Further, the authors note that the number of triplet deliveries decreased for almost all races in 2012, but they noted the decline was likely "negligible ... on the total PTB rate" because such births are comparatively rare.

The authors add that the decline in "higher order multiple births" was likely "influenced by the revised [ART] guidelines released by the American Society for Reproductive Medicine in 2006," which "were further refined to recommend single embryo transfer for women" younger than 35 with favorable prognoses. The authors note that also reducing the number of ART twin pregnancies would "have a much larger effect on the PTB rate."

Implementation of Evidence-Based Guidelines

The opinion also notes that "[a]dherence to guidelines derived from high-quality evidence" might have helped stem the PTB rate in the U.S. For example, the authors write that "[i]t is possible that the effort to prevent nonmedically indicated deliveries" before 39 weeks' gestation by the American College of Obstetricians and Gynecologists and Society for Maternal-Fetal Medicine "reduced the number of women who otherwise would have delivered in the late preterm period." According to the opinion, U.S. "rates of induction of labor declined 3% at 35 weeks' gestation and 7% at 36 weeks' gestation" between 2006 and 2012.

Likewise, the authors write that state policies aimed at preventing PTBs, such as South Carolina's recent "hard-stop policy to nonmedically indicated early term deliveries," have been associated with declining PTB rates.

Interventions in Women With Identifiable Risk Factors

According to the opinion, various interventions for women with identifiable risk factors could also be associated with falling PTB rates, including:

~ The use of 17 a-hydroxyprogesterone caproate for singleton births in women who previously had a spontaneous PTB, which is estimated to result in about 10,000 fewer PTBs annually in the U.S.;

~ The use of cerclage in women who previously had a spontaneous PTB and have a short cervical length, which is estimated to prevent more than 23,000 PTBs annually in the country and could reduce the U.S. PTB rate by 0.22% if fully implemented; and

~ The use of vaginal progesterone treatment in women with short cervical lengths, which could prevent an estimated 9,500 singleton deliveries before 34 weeks' gestation annually in the U.S. and reduce the country's overall PTB rate by 0.02%.

Policies and Regulations

The authors also note that "significant reductions in the rate of PTB have been observed after adoption of smoking bans in public places." According to the authors, 181 smoking laws against smoking in the workplace existed in 2006, when the PTB rate was at its highest, compared with the 628 such laws currently in place. Research has "demonstrated a statistically significant 10.45% reduction in PTB in states where a smoking ban was in place compared with states without a ban." Further, the authors note that it is estimated that the U.S. PTB rate "would decrease by approximately 15% if smoking in pregnancy stopped."

PTB Reporting

The authors write, "The ability to correlate PTB risk factors such as obesity, infections, poor maternal education, or smoking and the birth outcome would be invaluable in determining the attributable risks in this targeted population; however, because of current reporting levels, this is not yet feasible."

The authors write that 39 states, three U.S. territories and Washington, D.C., currently report such data using updated birth certificate reporting methods. However, a "National Vital Statistics Report in 2013 examined the quality of birth certificate data from 2 states" and found that such data had several limitations, including differences between what the states reported and individual patient files.

The authors note that while it is not certain how a change in the way such data are reported would affect PTB rates, future CDC analyses on the issue "are anticipated highly." They explain that much of the data are currently entered manually, although many hospitals "are either using, or moving towards using, electronic medical records as their sole sources of clinical data," which "could revolutionize the pregnancy data that are collected and drastically improve reporting of ... risk factors."

Conclusion

According to the opinion, reducing the amount of "nonmedically indicated deliveries would have the highest effect" on U.S. PTB rates.

In addition, targeted therapies "through programs or toolkits should be devised to bring the PTB rate more in line with the rest of the developed world." The opinion notes that such reductions can be accomplished by using the reviewed strategies on a wider basis. For example, "all states should be encouraged to adopt similar models and to report their outcomes accordingly." Further, birth certificate reporting data should be improved and standardized, while education and community outreach on screenings that could help prevent PTB should be implemented.


'Tremendous' Women's Health Gains 'In Danger' From ACA Opponents, Commentary Says

Thu, 01/29/2015 - 22:13

In a commentary, Guttmacher Institute President and CEO Ann Starrs details several of the improvements in women's health that have resulted because of the Affordable Care Act. She discusses the importance of protecting and strengthening such gains amid court challenges and proposed legislation designed to undermine the law.

'Tremendous' Women's Health Gains 'In Danger' From ACA Opponents, Commentary Says

January 29, 2015 — Summary of "Safeguarding the ACA's Gains for Women," Starrs, The Lancet, Jan. 3, 2015.

The Affordable Care Act (PL 111-148) "has greatly enhanced women's access to the health coverage and care they need to time and space their pregnancies and achieve healthy births," writes Ann Starrs, president and CEO of the Guttmacher Institute. However, she adds that "these tremendous gains are in danger of being rolled back" because of "persistent challenges, chief among them attacks by conservatives who want to repeal the law entirely or undermine its key components."

Benefits of the ACA for Women

Starrs notes that the ACA has provided "a path to health insurance for millions of previously uninsured people by expanding eligibility for public and subsidised private coverage programmes, including for young adult and low-income women who are at high risk of experiencing an unintended pregnancy." She cites estimates from the Urban Institute "that the uninsured rate among non-elderly adults in the USA dropped by 30% between September 2013 (before the coverage expansion began) and September 2014."

Starrs also writes about how "[t]he ACA has also improved the quality of health coverage," including "guarantee[ing] that all private insurance plans cover contraceptive counselling, services and supplies without patient cost-sharing." In particular, access to contraceptives without cost-sharing "helps women select the method that will work best for them in successfully avoiding an unwanted pregnancy," she adds, noting that the percentage "of women obtaining oral contraceptives with no cost-sharing soared from 15% before the law's implementation to 67% in spring 2014."

Starrs also highlights several other benefits of the ACA for women, including that the law "bans health plans from limiting coverage related to pre-existing conditions such as pregnancy," "closed long-standing loopholes that allowed many health plans to exclude coverage entirely for prenatal and delivery care or to provide it only with substantial additional premiums," and "requires plans to cover without cost-sharing a wide range of preventive prenatal and post-partum care."

Relationship Between Family Planning Clinics, ACA

Further, Starrs emphasizes the "critically important role" of "the nationwide network of health clinics that provide subsidised family planning care" in enrolling individuals in health coverage under the ACA.

Importance of Protecting Women's Health Gains

Starrs continues that these examples highlight "the positive impact the ACA and family planning clinics can have on sexual and reproductive health, progress that is likely to lead to substantial improvements in related health indicators, including reduction of high rates of unintended pregnancy and premature births in the USA."

However, she adds, "It is deeply concerning that opponents of the ACA continue to attack these gains legislatively and through the courts." Starrs concludes that instead of "seeking to restrict women's health-care options, we should seek to protect and expand them."


Investigation Explores Role of Patients' Social Influences in Contraceptive Counseling

Thu, 01/29/2015 - 22:12

In an analysis of contraceptive counseling conversations between patients and providers, researchers found that patients were much more likely than providers to initiate discussions on influences from the media, friends or other aspects of their social networks. The study also found that provider engagement during such discussions was generally limited, suggesting that "providers may not recognize the relevance" of social influences for patients and presenting "missed opportunities for patient education."

Investigation Explores Role of Patients' Social Influences in Contraceptive Counseling

January 29, 2015 — Summary of "Bringing Patients' Social Context Into the Examination Room: An Investigation of the Discussion of Social Influence During Contraceptive Counseling," Levy et al., Women's Health Issues, January/February 2015.

Research from recent years shows "growing evidence of the influence of social context on women's contraceptive behavior," but little is known about the frequency and nature of discussions on social influence during contraceptive counseling visits, according to a study led by Kira Levy of the University of California-Berkeley and UC San Francisco Joint Medical Program.

For the study, Levy and colleagues analyzed audio recordings of patient visits "[t]o begin to elucidate the ways in which social influence emerges during family planning counseling and how it is currently being addressed."

Methods

The study involved English-speaking women of reproductive age who self-identified as African-American, Latina or white, and were interested in discussing birth control during visits to six clinics in the San Francisco Bay Area. The patients completed surveys to provide their demographic information and basic reproductive history.

The patients consented to having their visits audio recorded. The recordings were later transcribed and analyzed to determine whether the visit included any comments on social influence, "defined as any mention by the patient or provider of influence from any member of the patient's social network (a friend, family member, coworker, or partner) or the media (online, TV, or radio) with regard to contraception," the researchers wrote. They noted that it was possible for a single visit to include mentions of social influence initiated by both the provider and the patient, if social influences were addressed more than once in the same visit.

The researchers conducted both quantitative and qualitative analyses of the resulting data to determine potential predictors of discussion of social influence, as well as themes that could aid understanding of such discussions and improve contraceptive counseling.

Results

Of the 342 recorded patient visits included in the final analysis, 42% included at least one mention of social influence. In the majority of those visits (75%), the patient initiated mentions of social influence; less commonly, the provider (10%) or both the patient and provider (15%) initiated the discussions.

In bivariate analysis, younger patient age was associated with increased likelihood of mentioning social influence, the study found. The association between age and social influence remained in multivariate and other analyses. Other variables were not consistently associated with social influence across multiple methods of analysis.

The main qualitative themes that emerged included:

~ The context in which the topic of social influence was initiated;

~ "[T]he content of the social influence"; and

~ Engagement by providers once the topic was raised.

Context of Initiation

In patient-initiated discussions of social influence, the majority of participants' comments fell "on the uncertain side of the spectrum" and "express[ed] being either conflicted or undecided about their method choice," the researchers wrote. Such patients often expressed interest in a method but had concerns based on a social influence and wanted to know more from the provider. A smaller proportion of patients fell on the certain side of the spectrum, referencing social influence as a way to affirm their thoughts on a method.

Provider-initiated discussions of social influence mainly included inquiries to the patient "about information or interest [she] might have based on her social network" or "addressing the negative media coverage of a specific pill brand (Yaz)," the researchers wrote.

Content of Comments

In terms of the content of the comments, the intrauterine device -- mentioned at 59 visits with social influence -- was the most frequently discussed method. Social influence attributed to all methods was more commonly negative than positive, except for the levonorgestrel IUD, which had an equal number of visits mentioning negative and positive influence.

Social influence most commonly came from friends, followed by the media, sisters, mothers, other family members and partners. By method, the majority of influence related to the implant, injections, IUDs and the ring came from friends, while the majority of influence related to the pill and patch came from the media.

The "most common subject matter of social influence" included method side effects (58 visits) and adverse events (34 visits), the researchers wrote, noting that the stated issues were not always medically confirmed. The "vast majority" of side effects raised were negative, but some positive side effects, such as controlling acne or lighter periods, were also mentioned, they found. Other subjects mentioned included "general social influence," such as knowing someone who uses a particular method (32 visits); method discovery (23 visits); and "fear of unwanted pregnancy based on" someone else's experience with a certain method (11 visits), according to the study.

Provider Engagement

"Overall, providers were much more likely to engage with the subject matter of the social influence than around the source of the social influence," such as "inquiring more about the patient's sister's experience on a method," the researchers wrote. Although subject matter engagement was more common, it tended to be "limited," such as "the provider acknowledging the content shared by the patient and giving general information in response," they added.

When providers engaged with patients about the source of social influence, such as asking what the patient had heard from a source, providers frequently failed to follow up on their initial question "and thus did not have a substantive conversation with the patient about social influences." Further, the "vast majority of patient-initiated mentions of social influence" received no acknowledgement of the social influence from the provider whatsoever, the study found.

The researchers also specifically looked at providers' responses to mentions of negative influence. Most commonly, providers "sh[ied] away from the particular method in question without challenging the negative influence," they wrote.

Discussion

In summary, the findings "indicate that social influences are a common point of discussion during contraceptive counseling in clinic visits, with these discussions most commonly initiated by patients" and "particularly common among younger patients," the researchers wrote.

The fact that patients initiated most of the discussions "suggests that providers may not recognize the relevance of [social] influences or may not know how to engage with them," which is "particularly important given that" women in the study frequently cited negative information that led them to raise uncertainty about a method or dismiss it entirely, according to the researchers. Low levels of provider engagement present "missed opportunities for patient education," they added.

The researchers noted that "[a]ddressing these influences in an efficient and respectful manner is a challenging task to do well," adding that additional research should explore strategies to do so effectively in order to inform provider training in this area.


Study Examines Trends in Sexual Behavior Among Age Cohorts

Thu, 01/29/2015 - 19:21

For this study, researchers assessed sexual behaviors of multiple age cohorts to inform research and public health policy on sexually transmitted infections. They found that sexual behavior has changed in later generations; for example, age at sexual initiation decreased and the proportion of female respondents reporting ever having a same-sex partner increased. The researchers said their findings can inform public health initiatives and reinforce the need for sex education.

Study Examines Trends in Sexual Behavior Among Age Cohorts

January 29, 2015 — Summary of "Trends and Patterns of Sexual Behaviors Among Adolescents and Adults Aged 14 to 59 Years, United States," Liu et al., Sexually Transmitted Diseases, January 2015.

While research exists pertaining to sexual behaviors throughout individuals' lifespans and by generation, no research examines "sexual behaviors by birth cohort among both females and males in the" U.S, according to Gui Liu of CDC's Division of STD Prevention and colleagues.

The authors wrote that such research "could provide background for evaluating the cumulative risk of lifelong [sexually transmitted infections], such as herpes simplex virus and hepatitis B virus, and sequelae of other STIs, such as cervical cancer and other human papillomavirus (HPV)-associated cancers among adults." In addition, they noted that analyzing patterns in sexual behavior among populations might show "macrolevel changes in sexual norms in the" U.S., particularly for "understanding sexual behaviors among adolescents and young adults."

Methods

The study used CDC's National Center for Health Statistics' National Health and Nutrition Examination Survey to examine demographic and sexual behavior data from 1999 to 2012 for individuals ages 14 to 59. Respondents were considered to have been sexually active "if they reported ever having had vaginal, oral, or anal sex and at least 1 sex partner in their lifetime[s]."

The researchers looked at sexual behavior trends in "10-year birth cohorts among adults aged 25 to 59 years at the time of the survey who were born in 1940 to 1989 and had ever had sex." For respondents ages 14 to 24, the researchers "determined the proportions reporting ever having sex and, among those who had had sex, the proportion having at least 3 lifetime partners, at least 2 partners in the past year, and ever having a same-sex partner."

Results

Trends Among Participants Ages 25 to 59

Overall, the study found that the age at which individuals had their first sexual experience "declined with successive birth cohorts for both males and females." Specifically, median sexual age was:

~ 17.9 years for women born between 1940 and 1949;

~ 16.2 years for women born between 1980 and 1989;

~ 17.1 years for men born between 1940 and 1949; and

~ 16.1 years for men born between 1980 and 1989.

According to the study, age at sexual initiation among women decreased among non-Hispanic whites, non-Hispanic blacks and Mexican Americans, with the greatest decline occurring among non-Hispanic whites. By contrast, the age decline for sexual initiation among men was only evident among non-Hispanic whites.

The study also found that the "median number of lifetime partners among females [increased] from 2.6 ... to 5.3" between the 1940 to 1949 cohort and the 1970 to 1979 cohort, with the increase most prevalent among non-Hispanic whites. Meanwhile, the "[m]edian number of lifetime partners among males increased from 6.7 ... among those born in 1940 to 1949 to 8.8 ... among those born in 1970 to 1979," although the increase was only evident among non-Hispanic whites.

In addition, the study found that the percentage of women ages 31 to 59 who reported having same-sex partners increased "from 5.2% among those born in 1940 to 1949 to 9.3% among those born in 1970 to 1979." According to the study, non-Hispanic black women were most likely to report having same-sex partners. By contrast, the study noted that there was no significant difference in the number of men ages 31 to 59 who reported having ever had same-sex partners either by age group or race/ethnicity.

Trends Among Participants Ages 14 to 24

The study found that the share of teenagers and young adults who reported having "vaginal, oral, or anal sex increased with age."

The study also found that sexually experienced participants ages 20 to 24 were more likely to have had at least three lifetime partners than those ages 14 to 19, but that "a large proportion" of women (45.2%) and men (55%) ages 14 to 19 years also reported having at least three lifetime partners. According to the study, non-Hispanic black women ages 20 to 24 "were more likely to have at least 3 lifetime partners compared with other racial/ethnic groups," as were non-Hispanic black men in both age groups.

Meanwhile, the researchers found that 39.4% of women and 48.6% of men ages 14 to 19 said they had at least two partners in the last year. According to the study, women in that age group were more likely than women ages 20 to 24 years to report having at least two sexual partners within the past year, but there was no such difference among males. Further, the study found that "[n]on-Hispanic white females aged 14 to 19 years and non-Hispanic black females aged 20 to 24 years were most likely to report having at least 2 partners in the past year," while "non-Hispanic black males were more likely to report at least 2 partners in [the] last year" than any other racial/ethnic group in both age groups.

The study also found that women ages 20 to 24 were more likely to report having had a same-sex partner than those ages 14 to 19, while roughly the same percentage of men (3%) in both age groups reported ever having a same-sex partner.

Discussion

Liu and colleagues noted that the findings "may inform interpretation of trends in STIs and health outcomes associated with STIs." For instance, the study's findings on sexual behavior trends "parallel previous findings that risk of HPV infection is greater among those who became sexually active after the sexual revolution and that incidence of HPV-related oropharyngeal cancers increases in successive birth cohorts."

In addition, the findings could help inform "modeling STI incidence over time and its effects on such outcomes as HIV risk and pelvic inflammatory diseases." Further, the findings suggest that models may need "to include recent national-level data when estimating STI incidence and prevalence."

Liu and colleagues wrote, "Historical trends of sexual behaviors provide a context for examining sexual behavior among adolescents and young adults" and "indicate an increasingly accepting attitude toward sexual activity." As a result, they recommend additional research to "examine sexual behaviors and incident STIs among adolescents and young adults with the perspective of macrolevel trends in sexual behaviors among those aged 25 to 59 years." Further, they noted that their findings "highlight the importance of sexual health education, including STI prevention information and HPV vaccine, before sexual initiation" and for young adults.


Vaginal, Sublingual Misoprostol Dosing Faster Than Oral for Second-Trimester Medication Abortion, Trial Suggests

Thu, 01/29/2015 - 19:20

A randomly controlled trial at an Australian hospital found that administering misoprostol vaginally or sublingually generally worked about two hours faster than oral dosing to complete a second-trimester abortion. Women who took the drug orally also required a significantly greater total dosage than women in the other two groups to complete an abortion, although women in all three groups reported similar levels of satisfaction with the procedure.

Vaginal, Sublingual Misoprostol Dosing Faster Than Oral for Second-Trimester Medication Abortion, Trial Suggests

January 29, 2015 — Summary of "For Second-Trimester Abortion with Misoprostol, Oral Dosing May Not Yield the Quickest Result," Perspectives on Sexual and Reproductive Health, Hollander, December 2014.

In a digest, Perspectives on Sexual and Reproductive Health Executive Editor Dore Hollander describes a randomly controlled trial that found vaginal or sublingual administration of misoprostol during second-trimester medication abortions "may work more quickly than those in which the drug is given orally." The results of the trial were originally published in Obstetrics & Gynecology.

Methods

The study involved 302 women with pregnancies involving medical complications or fetal anomalies who were obtaining medication abortions at a Perth, Australia, hospital between 14 weeks and 24 weeks of gestation in 2009 to 2013.

All of the women received an oral dose of 200 milligrams of mifepristone 24 hours to 48 hours before they were admitted to the hospital, as well as 800 micrograms of misoprostol vaginally upon admission.

A total of 200 women were randomly assigned to receive up to five doses of either:

~ 400 mcg of misoprostol orally every three hours; or

~ 400 mcg of misoprostol vaginally every four hours.

Meanwhile, 102 of the women received 400 mcg of misoprostol sublingually every three hours, up to five times.

The women's vital signs, pain levels and nausea levels were checked every three hours until their abortions were complete. Participants also completed a four-item questionnaire to assess their satisfaction.

Results

The study found that "[a]bortion took significantly longer" among women in the oral administration group compared with the other groups, Hollander writes. Specifically, the median time to complete an abortion among the oral group was 9.5 hours, compared with 7.4 hours among the vaginal group and 7.8 hours among the sublingual group.

Abortions were not complete 12 hours after the initial misoprostol dose in 37% of women in the oral group, compared with 21% in each of the other groups. Further, after 24 hours, 11% of women in the oral group did not yet have complete abortions, compared with 4% in each of the other groups. Women in the oral group also received a significantly higher total dosage of misoprostol than those in the other groups.

The satisfaction questionnaires showed comparable reports across all groups on women's opinion of the procedure, whether they would recommend it to others, pain perception and how their pain had been managed.

Discussion

The researchers noted the "practical implications" of their findings regarding variations in the duration of abortion with different regimens, Hollander writes. They suggested that women receive information about these differences prior to the procedure.


Study: Increased LARC Use Linked to Fewer Abortions

Thu, 01/29/2015 - 19:20

Researchers examined associations between increased use of long-acting reversible contraception in Iowa and the state's declining abortion rate between 2005 and 2012. They noted that expanded access to both abortion and contraception in the state at the time created an "ideal" context in which to study the potential link. Their findings suggest that an increase of "1 LARC user per 100 women in a given region was associated with a 4% reduction in the odds of abortion for women living in that region."

Study: Increased LARC Use Linked to Fewer Abortions

January 29, 2015 — Summary of "Did Increasing Use of Highly Effective Contraception Contribute to Declining Abortions in Iowa?" Biggs et al., Contraception, February 2015.

"Emerging evidence suggests that [long-acting reversible contraception] use may be associated with reductions in unintended pregnancies and abortions," according to researchers led by Antonia Biggs of the University of California-San Francisco's Bixby Center for Global Reproductive Health and the Philip R. Lee Institute for Health Policy Studies. However, the authors note that research "isolating the effects of LARC use on abortion is limited."

In the study, the researchers analyzed abortion and LARC data from Iowa to investigate whether "larger regional increases in LARC use would be associated with fewer abortions." The study "offers a new contribution to the literature by considering the temporality of LARC use and abortion, a prerequisite to establishing causation," they noted.

Methods

Iowa from 2005 to 2012 "present[ed] a unique setting and time period to test the association between LARC use and abortion," the researchers wrote. They explained that unlike many other states during that time period, "access to abortion care expanded in Iowa," as the result of a telemedicine program that launched in 2008.

The combination of the telemedicine program, which offered access to medication abortion, and the continued availability of surgical abortion services in the state "resulted in an overall increase in the number of abortion facilities in Iowa, from 9 in 2005 to 18 in 2011," according to the researchers. Thus, the corresponding decline in abortions in Iowa during the study period "cannot be attributed to abortion restrictions or a reduction in abortion facilities," they noted.

Meanwhile, contraception access in the state increased between 2005 and 2012 via two initiatives. First, Iowa in 2006 "expanded its income eligibility requirements so that women at or below 200% of the Federal Poverty Guidelines (FPG) were eligible for Medicaid-funded family planning services." Second, the privately funded Iowa Initiative To Reduce Unintended Pregnancies operated from 2007 to 2013 to help "reduc[e] unintended pregnancies through increased funding for Title X and other family planning agencies serving low-income women in the state" and bolster LARC use and awareness.

For their analysis, the researchers assessed "family planning visit and vital statistics data to examine whether baseline changes in LARC use led to subsequent reductions in the number of abortions within each of Iowa's 26 Induced Termination of Pregnancy (ITOP) regions." The researchers collected abortion data from the Iowa Department of Public Health and data on family planning visits from IDPH, the Family Planning Council of Iowa and Planned Parenthood of the Heartland.

Results

The researchers found that statewide LARC use increased at Iowa family planning centers "from less than 1% of reproductive age family planning clients in 2005 to 15% in 2012," representing an additional 8,064 LARC users.

According to the researchers, there was an increase in "[t]he percentage of LARC users among reproductive age women in the population ... from 0.09% in 2005 to 1.48% in 2012," while the "number of in-state resident abortions per 1000 reproductive age women declined from 8.7 abortions in 2005 to 6.7 in 2012," accounting for a total of 1,311 abortions.

Further, the researchers found that the increase of "1 LARC user per 100 women in a given region was associated with a 4% reduction in the odds of abortion for women living in that region" per year. In addition, "[i]ncreases in the percentage of the population living in poverty were also associated with significantly reduced odds of abortion," they wrote.

Discussion

"This study demonstrates a significant longitudinal association between increases in LARC use and the subsequent declines in abortion across Iowa regions," the researchers wrote, noting that they can "reasonably assume" that the decline is not linked to abortion restrictions "[g]iven the increase in abortion access and lack of [new] legal restrictions" on the procedure during the study period.

Further, the researchers linked the increase in LARC use to several factors, including:

~ The "introduction of the single-rod contraceptive implant to the US market in 2006";

~ Changes in "professional guidelines recommending LARC for a broader spectrum of women";

~ Shifting, "more favorable views about LARC" among providers; and

~ "[I]ncreasing awareness and knowledge about LARC" among women.

The researchers also cited low-income women's access "to low or no-cost contraception through the Medicaid family planning waiver" and additional funding for family planning agencies in Iowa, as well as "two statewide social marketing and media campaigns funded by [IIRUP] aimed at increasing LARC use" in 2009 and 2011.

Biggs and colleagues also highlighted the finding that the "proportion of LARC users in Iowa was equally divided between IUD (7.9%) and implant (7.1%)," whereas most LARC users in the U.S. use IUDs. The researchers explained that "[b]y the end of the study period, nearly all agencies reported that they offered both IUD and implants onsite with no differences in availability," while "[n]ationally and in other states, it is estimated that about two thirds of sites offer IUDs and 40% offer implants onsite."

The researchers examined several possible reasons why "increases in the percentage of the Iowa population living in poverty were associated with reduced odds of abortion," noting that women who lived in Iowa during the study period "unlike women in other states, had greater access to no-cost contraception in a broad range of clinics and locations through the Medicaid Waiver" and IIRUP initiatives.

Further, the researchers noted that the "number of abortion facilities in a given region was associated with reduced odds of abortion," a trend they said could result from "the places where women had access to abortion services in Iowa [being] the same places where women could access LARC methods."

Overall, the "findings support the need to continuously provide women with access to both abortion and contraceptive services which together help to ensure that women can make and carry out their own childbearing decisions," the researchers wrote.


Op-Ed: Lawmakers Should Listen to Women's Health Care Providers, 'Stay Out' of Exam Rooms

Thu, 01/29/2015 - 18:50

"[A]bortion counseling and services" are an "important part" of comprehensive women's health care, but "the struggle to keep abortion safe, legal and accessible to women in need has resurfaced once more," writes ob-gyn Jamila Perritt, medical director Planned Parenthood of Metropolitan Washington, D.C., in a CQ Roll Call opinion piece.

Op-Ed: Lawmakers Should Listen to Women's Health Care Providers, 'Stay Out' of Exam Rooms

January 29, 2015 — "[A]bortion counseling and services" are an "important part" of comprehensive women's health care, but "the struggle to keep abortion safe, legal and accessible to women in need has resurfaced once more," writes ob-gyn Jamila Perritt, medical director Planned Parenthood of Metropolitan Washington, D.C., in a CQ Roll Call opinion piece.

Perritt writes that federal and state lawmakers are proposing antiabortion-rights bills that purport "to protect women," but "effectively t[ie] the hands of doctors and leav[e] our patients out in the cold." She urges lawmakers "to listen to women's health care providers."

For example, Perritt writes that lawmakers must understand that abortions are part of a variety of services that abortion providers offer as part of caring for patients. She notes, "A woman who is thinking about ending her pregnancy, or who is unsure about what to do or where to go, receives accurate and unbiased information about her options -- parenting, adoption and abortion -- and receives support throughout the process."

Further, lawmakers "need to know abortion is safe largely because it is legal," which makes it "subject to rigorous research, constantly evolving best practices and ... part of a regular medical practice for many women's health care providers," she writes. The legality of abortion also ensures that patients have access to trained medical professionals, who provide "[s]upport without fear" or "judgment."

"[M]y professional experience shows me every day pregnancy is deeply personal, and abortion is a private decision a woman must make for herself and her family," Perritt writes, adding, "Those decisions need to be respected" and lawmakers need "to stay out of [the] exam room" (Perritt, CQ Roll Call, 1/28).


Op-Ed: Colo. Education Dept. Needs Support for Comprehensive Sex Ed Programs

Thu, 01/29/2015 - 18:36

Colorado school boards that have moved away from abstinence-only sexual education programs should support the state Department of Education and help "channel political capital through sponsorship of reproductive rights and gender equality campaigns," Alison Kent, a graduate student at the University of Colorado-Denver, writes in a Denver Post opinion piece.

Op-Ed: Colo. Education Dept. Needs Support for Comprehensive Sex Ed Programs

January 29, 2015 — Colorado school boards that have moved away from abstinence-only sexual education programs should support the state Department of Education and help "channel political capital through sponsorship of reproductive rights and gender equality campaigns," Alison Kent, a graduate student at the University of Colorado-Denver, writes in a Denver Post opinion piece.

While a "growing body of research claims comprehensive sex education bolsters reproductive health rights and prevents unwanted pregnancies," such "policies continue to face political barriers across local jurisdictions," according to Kent.

Kent writes that Colorado in 2007 "passed a law supporting comprehensive sex education funding." In 2013, the law was modified to give "schools the right to appeal to the State Board of Education by way of an 'opt-out' clause," which "allows individual school districts to enact their own parental permission policies and, by virtue of its nature, contradicts evidence indicating teen pregnancy rates decline when comprehensive sex education policies are in place," she explains. Kent notes that such "flexibility and variability ... undermines the opportunity for inclusivity, and weakens the current state of comprehensive sex education in Colorado."

Further, Kent notes that recent Republican gains in the state Legislature could make it "particularly difficult to advocate for a budget that increases funding for comprehensive sex education in place of abstinence-only programs."

According to Kent, all of these factors mean that "[a]s the 2016 elections approach, local school districts must support the Colorado Department of Education in sustaining statewide comprehensive sex education" before such courses are "swept under the rug by outdated and conservative curriculum" (Kent, Denver Post, 1/27).


Mo. State House Weighs Three Antiabortion-Rights Bills

Thu, 01/29/2015 - 18:35

Abortion-rights supporters during a Missouri state House committee hearing on Tuesday raised concerns about several antiabortion-rights measures introduced by state lawmakers, the AP/Sacramento Bee reports.

Mo. State House Weighs Three Antiabortion-Rights Bills

January 29, 2015 — Abortion-rights supporters during a Missouri state House committee hearing on Tuesday raised concerns about several antiabortion-rights measures introduced by state lawmakers, the AP/Sacramento Bee reports.

The committee heard testimony on three of the dozens of antiabortion-rights measures proposed by state lawmakers this year. According to the AP/Bee, the hearing was the first in 2015 to consider such legislation. After hearing testimony, the committee did not take any action on the measures.

Bill Details

The committee discussed two bills that would increase parental involvement requirements for a minor seeking an abortion. Under current state law, a minor is required to obtain consent from one parent or a judicial bypass from the requirement.

One of the measures (HB 99), sponsored by state Rep. Rocky Miller (R), would require notice to the second parent or guardian of a minor who intends to have an abortion. The state House passed a similar measure in 2014, but it did not advance in the state Senate. The most recent version of the bill would waive the requirement in cases of medical emergencies, or when a second parent is subject to a protective order or has been found guilty of particular crimes.

The other bill (HB 81), sponsored by state Rep. Sonya Anderson (R), would require a minor seeking a judicial bypass to file her case in the county where she resides. Under the bill, minors who were not seeking a judicial bypass would have to obtain a notarized signature from a parent or guardian as proof of consent for an abortion. A similar measure Anderson filed in 2014 was not debated and did not receive a vote in the state House.

In addition, the committee heard testimony on a measure (HB 124) that would require women seeking abortions to watch a video containing state-mandated information at least 72 hours before the procedure.

Debate Over Parental Consent Measures

Supporters of abortion rights at the hearing expressed concern that HB 99 could endanger minors. State Rep. Stacey Newman (D) said, "I don't think these exceptions cover every family that's not a normal, perfect family. I believe this is designed to actually shame a minor and put them in more jeopardy."

Meanwhile, American Civil Liberties Union of Missouri lobbyist Sarah Rossi cautioned that the judicial bypass measure would make the judicial bypass system "exponentially more difficult." She explained that the majority of attorneys willing to assist with judicial bypass cases are in St. Louis, the location of the only abortion clinic in the state.

However, Anderson said, "Every provision in this bill is designed to better protect the health of the pregnant minor, the [fetus] and parental rights" (French, AP/Sacramento Bee, 1/27).


In Reversal, House Lawmaker Says He Now Supports Abortion Rights

Thu, 01/29/2015 - 18:10

Although he previously opposed abortion rights, Rep. Tim Ryan (D-Ohio) writes in an Akron Beacon Journal opinion piece that he has "come to believe that we must trust women and families -- not politicians -- to make the best decision for their lives" and now supports abortion rights.

In Reversal, House Lawmaker Says He Now Supports Abortion Rights

January 29, 2015 — Although he previously opposed abortion rights, Rep. Tim Ryan (D-Ohio) writes in an Akron Beacon Journal opinion piece that he has "come to believe that we must trust women and families -- not politicians -- to make the best decision for their lives" and now supports abortion rights.

Ryan writes that "being raised in a Catholic household," he "always considered" himself to be an abortion-rights opponent. However, he explains that "over the past 14 years in political office," his "position has evolved as [his] experiences have broadened, deepened and become more personal."

Specifically, Ryan writes that becoming a "father and husband" and talking with "women of all ages, races and socioeconomic backgrounds about the circumstances and hardships that accompany this personal choice" have led him to support abortion rights. He explains, "I have sat with women from Ohio and across the nation and heard them talk about their varying experiences: abusive relationships, financial hardship, health scares, rape and incest."

Ryan adds, "No federal or state law banning abortion can honestly and fairly take into account the various circumstances that make each decision unique."

However, Ryan argues, "[w]here government does have the ability to play a significant role is in giving women and families the tools they need to prevent unintended pregnancies by expanding education and access to contraception." He writes that such policies will help "reduc[e] the number of unintended pregnancies, which make up the vast majority of abortions" (Ryan, Akron Beacon Journal, 1/28).

Comments, Reaction

Ryan said after his op-ed was published that while "[t]here will always be people who are upset, no matter what side you are on," he has gotten "overwhelmingly positive" feedback "from women in the district and around the state" (Eaton, Cleveland Plain Dealer, 1/28).

Planned Parenthood Action Fund President Cecile Richards praised Ryan's op-ed. She said in a statement, "Abortion is a complex and deeply personal issue, and Congressman Ryan's journey is not unusual. [He] joins the overwhelming majority of Americans who want women to have access to abortion and don't want politicians to interfere in women's personal medical decisions" (Carr Smyth, AP/Miami Herald, 1/28).


Op-Ed: Lawmakers Should Listen to Women's Health Care Providers, 'Stay Out' of Exam Rooms

Thu, 01/29/2015 - 18:02

"[A]bortion counseling and services" are an "important part" of comprehensive women's health care, but "the struggle to keep abortion safe, legal and accessible to women in need has resurfaced once more," writes ob-gyn Jamila Perritt, medical director Planned Parenthood of Metropolitan Washington, D.C., in a CQ Roll Call opinion piece.

Op-Ed: Lawmakers Should Listen to Women's Health Care Providers, 'Stay Out' of Exam Rooms

January 29, 2015 — "[A]bortion counseling and services" are an "important part" of comprehensive women's health care, but "the struggle to keep abortion safe, legal and accessible to women in need has resurfaced once more," writes ob-gyn Jamila Perritt, medical director Planned Parenthood of Metropolitan Washington, D.C., in a CQ Roll Call opinion piece.

Perritt writes that federal and state lawmakers are proposing antiabortion-rights bills that purport "to protect women," but "effectively t[ie] the hands of doctors and leav[e] our patients out in the cold." She urges lawmakers "to listen to women's health care providers."

For example, Perritt writes that lawmakers must understand that abortions are part of a variety of services that abortion providers offer as part of caring for patients. She notes, "A woman who is thinking about ending her pregnancy, or who is unsure about what to do or where to go, receives accurate and unbiased information about her options -- parenting, adoption and abortion -- and receives support throughout the process."

Further, lawmakers "need to know abortion is safe largely because it is legal," which makes it "subject to rigorous research, constantly evolving best practices and ... part of a regular medical practice for many women's health care providers," she writes. The legality of abortion also ensures that patients have access to trained medical professionals, who provide "[s]upport without fear" or "judgment."

"[M]y professional experience shows me every day pregnancy is deeply personal, and abortion is a private decision a woman must make for herself and her family," Perritt writes, adding, "Those decisions need to be respected" and lawmakers need "to stay out of [the] exam room" (Perritt, CQ Roll Call, 1/28).