Daily Women's Health Policy Report

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Daily Women's Health Policy Report by the National Partnership for Women & Families
Updated: 1 hour 51 min ago

Featured Blogs

8 hours 39 min ago

"Mississippi Abortion Clinic 'Not Going Anywhere' After Vandalism," (Wilson, RH Reality Check, 3/24); "Arizona May Force Doctors To Tell Women Their Abortion Can Be Reversed," (Culp-Ressler, "ThinkProgress," Center for American Progress, 3/26).

March 27, 2015

FEATURED BLOG

"Mississippi Abortion Clinic 'Not Going Anywhere' After Vandalism," Teddy Wilson, RH Reality Check: "An act of vandalism at Mississippi's last abortion clinic will not intimidate clinic workers from providing reproductive health care to women in need," Wilson writes. According to the facility, Jackson Women's Health Organization, "a 'masked intruder' came onto the ... clinic property and 'proceeded to methodically destroy' the security cameras and attempted to 'destroy the power lines coming into the building,'" he writes. The vandalism follows a report from "earlier this year [that] found that threats of harassment, intimidation, and violence against abortion providers have doubled since 2010," Wilson writes, adding, "Reproductive rights advocates have raised concerns that radical anti-choice activists have been emboldened by a wave of legislative attacks on reproductive rights" (Wilson, RH Reality Check, 3/24).

FEATURED BLOG

"Arizona May Force Doctors To Tell Women Their Abortion Can Be Reversed," Tara Culp-Ressler, Center for American Progress' "ThinkProgress": Arizona lawmakers have advanced a bill (SB 1318) to Gov. Doug Ducey (R) that would "requir[e] doctors to tell patients that 'it may be possible to reverse the effects of a medication abortion if the woman changes her mind,'" making Arizona "the first state to pass this type of requirement," Culp-Ressler writes. She explains that the "[s]o-called 'abortion reversal' involves injecting the hormone progesterone into a patient after she has taken mifepristone, the first [drug] in the two-part process to terminate a first-trimester pregnancy with medication." She notes that "medical professionals say there's no scientific evidence to suggest the hormonal injection is effectively reversing the effects of mifepristone," adding that Daniel Grossman -- a fellow with the American College of Obstetricians and Gynecologists and vice president for research at Ibis Reproductive Health -- "has repeatedly said that there isn't enough proof to justify this particular hormone treatment and ACOG does not feel comfortable recommending it." Further, Culp-Ressler writes that while research has found that "most women are not unsure about their procedures," physicians "would likely refrain from giving [a patient] the first mifepristone pill" if the patient "appears to be unsure about going through with the procedure" (Culp-Ressler, "ThinkProgress," Center for American Progress, 3/26).

What others are saying about abortion restrictions:

~ "The 'Reach' of Anti-Choice Hyde Amendment May Get Wider," Emily Crockett, RH Reality Check.


Women's Health Advocates Call on Ore. Legislature To Pass Comprehensive Women's Health Bill

8 hours 40 min ago

Women's health advocates on Wednesday marched to the Oregon Capitol to show support for a measure (SB 894) aimed at closing gaps in reproductive health coverage for women in the state, the Salem Statesman Journal reports.

Women's Health Advocates Call on Ore. Legislature To Pass Comprehensive Women's Health Bill

March 27, 2015 — Women's health advocates on Wednesday marched to the Oregon Capitol to show support for a measure (SB 894) aimed at closing gaps in reproductive health coverage for women in the state, the Salem Statesman Journal reports (Yoo, Salem Statesman Journal, 3/25).

Bill Details

The measure, called the Comprehensive Women's Health Bill, would require all health plans in the state to cover abortion, contraceptives and maternity care. It would also require health plans to cover a 12-month supply of birth control dispensed at one time. Democratic state Sen. Elizabeth Steiner Hayward, Sen. Sara Gelser, Rep. Alissa Keny-Guyer and Rep. Barbara Smith Warner introduced the bill (Women's Health Policy Report, 3/2). State Reps. Val Hoyle (D) and Jennifer Williamson (D) and others have also co-sponsored the legislation.

According to the Statesman Journal, a hearing on the measure will be scheduled soon (Salem Statesman Journal, 3/25). If the legislation is ultimately approved, Oregon will become the first state to ensure such coverage in all health plans (Sevcenko, GoLocalPDX News, 3/26).

Advocates Call for Passage

Steiner Hayward said in a speech during the demonstration, "Our bodies are our bodies and it's not up to the government to tell us what to do with them." She added that women should be able to decide whether and when they want to become pregnant (Salem Statesman Journal, 3/25).

Further, Steiner Hayward added that the bill is needed because there is "ambiguity" under the Affordable Care Act's (PL 111-148) Medicaid expansion "on whether or not the full range of reproductive health services, including safe and legal abortion, is offered under the Oregon Health Plan" (GoLocalPDX News, 3/26).

Meanwhile, NARAL Pro-Choice Oregon Executive Director Michele Stranger Hunter said that unequal access to reproductive health care disproportionately affects immigrant, low-income and minority women. She said that although the ACA requires many insurers to cover contraceptives without cost-sharing, some transitional health plans do not have to comply with those standards. Further, she noted that the ACA does not require health plans to cover abortion. Stranger Hunter said that during a time when states across the U.S. are passing laws to restrict abortion, Oregon women need to be protected.

Bill's Next Steps

According to the Statesman Journal, the bill must be scheduled for a work session in the state Senate health care committee by April 10 in order to have a shot at moving forward during the current legislative session. However, committee Chair Laurie Monnes Anderson (D) said the bill is not yet ready for a hearing and could not pass the committee "the way it is now."

Monnes Anderson said that NARAL and Planned Parenthood are working with insurers to amend the language. Once changes are made, she plans to talk with members of the state Legislature's Democratic caucus to ensure the bill has the 16 votes it needs to be approved by the full state Senate (Salem Statesman Journal, 3/25).


N.Y. Assembly Passes Bill To Protect Abortion Rights

8 hours 40 min ago

The New York Assembly on Wednesday voted 95-51 to approve legislation (AB 6221) that would codify abortion rights established under Roe v. Wade into state law, the AP/Washington Times reports.

N.Y. Assembly Passes Bill To Protect Abortion Rights

March 27, 2015 — The New York Assembly on Wednesday voted 95-51 to approve legislation (AB 6221) that would codify abortion rights established under Roe v. Wade into state law, the AP/Washington Times reports.

The measure is expected to meet opposition in the state Senate, where it failed to pass in earlier sessions (Virtanen, AP/Washington Times, 3/25).

Background

The measure is part of the Women's Equality Act, which was initially designed as a multipiece legislative package addressing a range of issues, including sex trafficking, pay equity, pregnancy discrimination and abortion rights. The package has been introduced in two previous sessions but failed to pass in the state Senate, where some conservatives opposed the abortion-rights provision.

Although state Assembly leaders and Gov. Andrew Cuomo (D) back the package in its entirety, state Assembly Speaker Carl Heastie (D) said lawmakers have agreed to consider the bills individually to end the impasse that has prevented it from advancing (Women's Health Policy Report, 3/18).

Bill Details

New York legalized abortion in 1970, three years before the Supreme Court ruled in Roe that states cannot ban abortion prior to viability. However, the New York statute only permits abortion after viability to protect a women's life, and not to preserve her health.

NARAL Pro-Choice New York President Andrea Miller explained that the state's abortion statute is written so that abortion procedures needed to protect a woman's health are allowed as exceptions to the state's penal law against them. She said women seeking abortions for medical reasons have been turned away from hospitals and had to seek care elsewhere. Further, she said some women were charged by prosecutors, although the charges were later dropped.

Comments

Heastie said, "The Assembly majority believes that in the fight for true women's equality, the most basic right of all is a woman's right to make reproductive health decisions for her own body."

Separately, state Rep. Jane Corwin (R), who voted against the measure, said it was unnecessary because New York would maintain its abortion-rights protections even if the Supreme Court reverses Roe. In addition, she said the bill could lead to confusion by removing part of the state's penal law and leaving it to the courts to decide whether to expand or limit abortion rights (AP/Washington Times, 3/25).


Ariz. Antiabortion-Rights Bill Heads to Gov.

8 hours 40 min ago

The Arizona Senate on Wednesday voted 18-11 to advance a bill (SB 1318) that would impose several abortion restrictions, the AP/Sacramento Bee reports.

Ariz. Antiabortion-Rights Bill Heads to Gov.

March 27, 2015 — The Arizona Senate on Wednesday voted 18-11 to advance a bill (SB 1318) that would impose several abortion restrictions, the AP/Sacramento Bee reports.

The bill now heads to Gov. Doug Ducey (R), who has antiabortion-rights views but has not announced a position on this particular measure (Van Velzer, AP/Sacramento Bee, 3/26).

Bill Details

One provision in the bill aims to bar women in the state from purchasing health plans that include abortion coverage on the Affordable Care Act's (PL 111-148) insurance marketplace. The restrictions would not apply to pregnancies resulting from rape or incest, or when a pregnancy threatens a woman's life.

In addition, the bill includes a provision that would require physicians to tell women medically unproven statements about being able to reverse a medication abortion. Specifically, providers would be required to state that administering high doses of progesterone could reverse a medication abortion.

The bill also would require that physicians provide documentation to the state Department of Health Services showing that they have hospital admitting privileges (Women's Health Policy Report, 3/25).

Comments

Supporters of the coverage ban have claimed that additional restrictions are needed to prevent taxpayer funding from going toward abortions for individuals who receive tax credits to purchase coverage under the ACA. However, opponents have said that public funding already does not support such procedures (Schwartz, Reuters, 3/26).

Further, several abortion-rights supporters raised concerns about the medication abortion provision. Kathleen Morrell, a physician who performs abortions and works with Physicians for Reproductive Health, said the information a provider would have to share about reversing a medication abortion is "experimental." She added, "It's untested, and if we don't know it works then why are we doing it?"

In addition, state Sen. Katie Hobbs (D), said the provision requires physicians to provide patients with misinformation, adding, "I don't think we should be inserting that into state statute."

Meanwhile, state Sen. Kelli Ward (R), who was in favor of the bill, said the provision allows women to make informed decisions (AP/Sacramento Bee, 3/26).


Blogs Comment on Clinic Vandalism, Barriers to EC Access for Native American Women, More

12 hours 8 min ago

Read some of the week's best commentaries from bloggers at RH Reality Check, ACLU and more.

Blogs Comment on Clinic Vandalism, Barriers to EC Access for Native American Women, More

March 27, 2015 — Read some of the week's best commentaries from bloggers at RH Reality Check, ACLU and more.

ABORTION PROVIDERS: "Mississippi Abortion Clinic 'Not Going Anywhere' After Vandalism," Teddy Wilson, RH Reality Check: "An act of vandalism at Mississippi's last abortion clinic will not intimidate clinic workers from providing reproductive health care to women in need," Wilson writes. According to the facility, Jackson Women's Health Organization, "a 'masked intruder' came onto the ... clinic property and 'proceeded to methodically destroy' the security cameras and attempted to 'destroy the power lines coming into the building,'" he writes. The vandalism follows a report from "earlier this year [that] found that threats of harassment, intimidation, and violence against abortion providers have doubled since 2010," Wilson writes, adding, "Reproductive rights advocates have raised concerns that radical anti-choice activists have been emboldened by a wave of legislative attacks on reproductive rights" (Wilson, RH Reality Check, 3/24).

EMERGENCY CONTRACEPTION: "Native American Women Still Don't Have Access to OTC Emergency Contraception," Martha Kempner, RH Reality Check: "U.S. senators last week sent a letter to the secretary of Health and Human Services, Sylvia Mathews Burwell, urging her to look into" the Indian Health Service's failure to "update its policies to make [emergency contraception] available in the pharmacies it runs," Kempner writes. According to Kempner, IHS has not yet followed through on its pledge to do so, which it made when FDA "in 2013 approved over-the-counter access to certain [EC] pills without any age restrictions." Citing two surveys highlighting the difficulty of accessing EC at IHS facilities, Kempner writes that such issues are "particularly disturbing" because the "Native American women who rely on these health centers often live in rural areas where access to other health care and even pharmacies is limited." She notes that Sen. Barbara Boxer (D-Calif.) and the other senators in their letter asked HHS to "share the steps [HHS] has taken towards updating its policy and provide a clear timeline for when that process will be completed" (Kempner, RH Reality Check, 3/24).

PREGNANCY DISCRIMINATION: "Supreme Court Delivers Fairness to Pregnant Workers in UPS Case," Lenora Lapidus, American Civil Liberties Union's "Blog of Rights": "The Supreme Court on Wednesday issued an important ruling for pregnant workers in the case of Peggy Young," a UPS worker who had to take unpaid leave after being denied a light-duty assignment while pregnant, Lapidus writes. She notes that in Young's case, lower courts had ruled "it was perfectly fine for employers" to "deny [pregnant workers] light-duty accommodations, even when the employer gives light-duty to many other groups of workers." However, she writes the high court on Wednesday ruled "that employers cannot impose a 'significant burden' on pregnant workers and that a pregnant worker can show that her employer's practices are unjustified if the employer makes accommodations for a large percentage of non-pregnant workers, while denying the same kinds of accommodations to pregnant workers." According to Lapidus, the decision "is a gain for women across the country" and "furthers the purpose of the Pregnancy Discrimination Act [PL 95-555]," which aims to set "women on an equal footing and ensur[e] that they can't be fired or forced onto leave when they become pregnant" (Lapidus, "Blog of Rights,"ACLU, 3/25).

ABORTION RESTRICTIONS: "Arizona May Force Doctors To Tell Women Their Abortion Can Be Reversed," Tara Culp-Ressler, Center for American Progress' "ThinkProgress": Arizona lawmakers have advanced a bill (SB 1318) to Gov. Doug Ducey (R) that would "requir[e] doctors to tell patients that 'it may be possible to reverse the effects of a medication abortion if the woman changes her mind,'" making Arizona "the first state to pass this type of requirement," Culp-Ressler writes. She explains that the "[s]o-called 'abortion reversal' involves injecting the hormone progesterone into a patient after she has taken mifepristone, the first [drug] in the two-part process to terminate a first-trimester pregnancy with medication." She notes that "medical professionals say there's no scientific evidence to suggest the hormonal injection is effectively reversing the effects of mifepristone," adding that Daniel Grossman -- a fellow with the American College of Obstetricians and Gynecologists and vice president for research at Ibis Reproductive Health -- "has repeatedly said that there isn't enough proof to justify this particular hormone treatment and ACOG does not feel comfortable recommending it." Further, Culp-Ressler writes that while research has found that "most women are not unsure about their procedures," physicians "would likely refrain from giving [a patient] the first mifepristone pill" if the patient "appears to be unsure about going through with the procedure" (Culp-Ressler, "ThinkProgress," Center for American Progress, 3/26).

What others are saying about abortion restrictions:

~ "The 'Reach' of Anti-Choice Hyde Amendment May Get Wider," Emily Crockett, RH Reality Check.


House Passes Medicare Legislation That Includes Abortion Restrictions

12 hours 34 min ago

The House on Thursday voted 392-37 to approve Medicare legislation (HR 2) that contains antiabortion-rights language in a provision that would fund community health centers, the New York Times reports.

House Passes Medicare Legislation That Includes Abortion Restrictions

March 27, 2015 — The House on Thursday voted 392-37 to approve Medicare legislation (HR 2) that contains antiabortion-rights language in a provision that would fund community health centers, the New York Times reports (Steinhauer/Pear, New York Times, 3/26).

Background

The Medicare legislation aims to put in place a long-term solution to a problematic formula that Medicare uses to determine physician reimbursements. Congress has been addressing the issue with short-term fixes for years.

Abortion-rights advocates have raised concern about the abortion restrictions in the community health centers provision. Specifically, the provision includes Hyde Amendment language that restricts federal funding for abortion (Women's Health Policy Report, 3/23).

Prospects in the Senate

The bill now heads to the Senate, which is unlikely to vote on it before lawmakers adjourn Friday for a two-week recess. Senate Democrats do not favor the abortion restrictions or the House bill's two-year extension of the Children's Health Insurance Program, which they had hoped to extend for four years (New York Times, 3/26).

However, Senate Democrats have become more accepting of the two-year CHIP extension, and some of them became less resistant to the abortion restrictions after House Minority Leader Nancy Pelosi (D-Calif.) adjusted the provision's language (Scott, National Journal, 3/26).

Sen. Debbie Stabenow (D-Mich.), who disliked the abortion and CHIP provisions, said, "That certainly was a big vote in the House. We need to look at the details" (New York Times, 3/26).


Ariz. Antiabortion-Rights Bill Heads to Gov.

12 hours 45 min ago

The Arizona Senate on Wednesday voted 18-11 to advance a bill (SB 1318) that would impose several abortion restrictions, the AP/Sacramento Bee reports.

Ariz. Antiabortion-Rights Bill Heads to Gov.

March 27, 2015 — The Arizona Senate on Wednesday voted 18-11 to advance a bill (SB 1318) that would impose several abortion restrictions, the AP/Sacramento Bee reports.

The bill now heads to Gov. Doug Ducey (R), who has antiabortion-rights views but has not announced a position on this particular measure (Van Velzer, AP/Sacramento Bee, 3/26).

Bill Details

One provision in the bill aims to bar women in the state from purchasing health plans that include abortion coverage on the Affordable Care Act's (PL 111-148) insurance marketplace. The restrictions would not apply to pregnancies resulting from rape or incest, or when a pregnancy threatens a woman's life.

In addition, the bill includes a provision that would require physicians to tell women medically unproven statements about being able to reverse a medication abortion. Specifically, providers would be required to state that administering high doses of progesterone could reverse a medication abortion.

The bill also would require that physicians provide documentation to the state Department of Health Services showing that they have hospital admitting privileges (Women's Health Policy Report, 3/25).

Comments

Supporters of the coverage ban have claimed that additional restrictions are needed to prevent taxpayer funding from going toward abortions for individuals who receive tax credits to purchase coverage under the ACA. However, opponents have said that public funding already does not support such procedures (Schwartz, Reuters, 3/26).

Further, several abortion-rights supporters raised concerns about the medication abortion provision. Kathleen Morrell, a physician who performs abortions and works with Physicians for Reproductive Health, said the information a provider would have to share about reversing a medication abortion is "experimental." She added, "It's untested, and if we don't know it works then why are we doing it?"

In addition, state Sen. Katie Hobbs (D), said the provision requires physicians to provide patients with misinformation, adding, "I don't think we should be inserting that into state statute."

Meanwhile, state Sen. Kelli Ward (R), who was in favor of the bill, said the provision allows women to make informed decisions (AP/Sacramento Bee, 3/26).


N.Y. Assembly Passes Bill To Protect Abortion Rights

12 hours 47 min ago

The New York Assembly on Wednesday voted 95-51 to approve legislation (AB 6221) that would codify abortion rights established under Roe v. Wade into state law, the AP/Washington Times reports.

N.Y. Assembly Passes Bill To Protect Abortion Rights

March 27, 2015 — The New York Assembly on Wednesday voted 95-51 to approve legislation (AB 6221) that would codify abortion rights established under Roe v. Wade into state law, the AP/Washington Times reports.

The measure is expected to meet opposition in the state Senate, where it failed to pass in earlier sessions (Virtanen, AP/Washington Times, 3/25).

Background

The measure is part of the Women's Equality Act, which was initially designed as a multipiece legislative package addressing a range of issues, including sex trafficking, pay equity, pregnancy discrimination and abortion rights. The package has been introduced in two previous sessions but failed to pass in the state Senate, where some conservatives opposed the abortion-rights provision.

Although state Assembly leaders and Gov. Andrew Cuomo (D) back the package in its entirety, state Assembly Speaker Carl Heastie (D) said lawmakers have agreed to consider the bills individually to end the impasse that has prevented it from advancing (Women's Health Policy Report, 3/18).

Bill Details

New York legalized abortion in 1970, three years before the Supreme Court ruled in Roe that states cannot ban abortion prior to viability. However, the New York statute only permits abortion after viability to protect a women's life, and not to preserve her health.

NARAL Pro-Choice New York President Andrea Miller explained that the state's abortion statute is written so that abortion procedures needed to protect a woman's health are allowed as exceptions to the state's penal law against them. She said women seeking abortions for medical reasons have been turned away from hospitals and had to seek care elsewhere. Further, she said some women were charged by prosecutors, although the charges were later dropped.

Comments

Heastie said, "The Assembly majority believes that in the fight for true women's equality, the most basic right of all is a woman's right to make reproductive health decisions for her own body."

Separately, state Rep. Jane Corwin (R), who voted against the measure, said it was unnecessary because New York would maintain its abortion-rights protections even if the Supreme Court reverses Roe. In addition, she said the bill could lead to confusion by removing part of the state's penal law and leaving it to the courts to decide whether to expand or limit abortion rights (AP/Washington Times, 3/25).


Women's Health Advocates Call on Ore. Legislature To Pass Comprehensive Women's Health Bill

12 hours 50 min ago

Women's health advocates on Wednesday marched to the Oregon Capitol to show support for a measure (SB 894) aimed at closing gaps in reproductive health coverage for women in the state, the Salem Statesman Journal reports.

Women's Health Advocates Call on Ore. Legislature To Pass Comprehensive Women's Health Bill

March 27, 2015 — Women's health advocates on Wednesday marched to the Oregon Capitol to show support for a measure (SB 894) aimed at closing gaps in reproductive health coverage for women in the state, the Salem Statesman Journal reports (Yoo, Salem Statesman Journal, 3/25).

Bill Details

The measure, called the Comprehensive Women's Health Bill, would require all health plans in the state to cover abortion, contraceptives and maternity care. It would also require health plans to cover a 12-month supply of birth control dispensed at one time. Democratic state Sen. Elizabeth Steiner Hayward, Sen. Sara Gelser, Rep. Alissa Keny-Guyer and Rep. Barbara Smith Warner introduced the bill (Women's Health Policy Report, 3/2). State Reps. Val Hoyle (D) and Jennifer Williamson (D) and others have also co-sponsored the legislation.

According to the Statesman Journal, a hearing on the measure will be scheduled soon (Salem Statesman Journal, 3/25). If the legislation is ultimately approved, Oregon will become the first state to ensure such coverage in all health plans (Sevcenko, GoLocalPDX News, 3/26).

Advocates Call for Passage

Steiner Hayward said in a speech during the demonstration, "Our bodies are our bodies and it's not up to the government to tell us what to do with them." She added that women should be able to decide whether and when they want to become pregnant (Salem Statesman Journal, 3/25).

Further, Steiner Hayward added that the bill is needed because there is "ambiguity" under the Affordable Care Act's (PL 111-148) Medicaid expansion "on whether or not the full range of reproductive health services, including safe and legal abortion, is offered under the Oregon Health Plan" (GoLocalPDX News, 3/26).

Meanwhile, NARAL Pro-Choice Oregon Executive Director Michele Stranger Hunter said that unequal access to reproductive health care disproportionately affects immigrant, low-income and minority women. She said that although the ACA requires many insurers to cover contraceptives without cost-sharing, some transitional health plans do not have to comply with those standards. Further, she noted that the ACA does not require health plans to cover abortion. Stranger Hunter said that during a time when states across the U.S. are passing laws to restrict abortion, Oregon women need to be protected.

Bill's Next Steps

According to the Statesman Journal, the bill must be scheduled for a work session in the state Senate health care committee by April 10 in order to have a shot at moving forward during the current legislative session. However, committee Chair Laurie Monnes Anderson (D) said the bill is not yet ready for a hearing and could not pass the committee "the way it is now."

Monnes Anderson said that NARAL and Planned Parenthood are working with insurers to amend the language. Once changes are made, she plans to talk with members of the state Legislature's Democratic caucus to ensure the bill has the 16 votes it needs to be approved by the full state Senate (Salem Statesman Journal, 3/25).


Ark. Teen Pregnancy Bill 'Frustratingly Incomplete,' Opinion Piece States

Thu, 03/26/2015 - 20:22

An Arkansas bill (HB 1534) that "would require public colleges and universities in Arkansas to develop an 'action plan' to combat teen pregnancy" is "a fine idea" but "also frustratingly incomplete because of what it doesn't mention: contraception," Benjamin Hardy writes for the Arkansas Times' "Arkansas Blog."

Ark. Teen Pregnancy Bill 'Frustratingly Incomplete,' Opinion Piece States

March 26, 2015 — An Arkansas bill (HB 1534) that "would require public colleges and universities in Arkansas to develop an 'action plan' to combat teen pregnancy" is "a fine idea" but "also frustratingly incomplete because of what it doesn't mention: contraception," Benjamin Hardy writes for the Arkansas Times' "Arkansas Blog."

Hardy writes that under the bill, the college action plan would have to "include information at college orientation dealing with the subject of unplanned pregnancies." Further, it would require the college action plan to "'integrate information that is recognized as medically accurate by the American Congress of Obstetricians and Gynecologists about the prevention of unplanned pregnancy into academic courses if and when appropriate, including without limitation abstinence education,'" he writes.

Hardy praises the bill for not solely focusing on abstinence and for requiring that "the information integrated into academic courses be 'recognized as medically accurate' by ob/gyns." Further, he points out that the Arkansas bill is "written broadly enough [that] the action plan it mandates might well include improving student access to contraceptives."

However, he questions how there can "be an honest discussion of reducing teen pregnancy rates without directly confronting the issue of birth control." He cites the "dramatic" results of a study that offered no-cost contraceptives to teenagers in St. Louis, noting that participants' rates of pregnancy and abortion "were less than a quarter the rates among their sexually active peers nationwide" (Hardy, "Arkansas Blog," Arkansas Times, 3/24).


Kan. House Passes Bill Banning Certain Abortions; Gov. Signature Expected

Thu, 03/26/2015 - 20:22

The Kansas House on Wednesday voted 98-26 to approve a bill (SB 95) that would ban physicians from performing a certain abortion procedure, the AP/Sacramento Bee reports.

Kan. House Passes Bill Banning Certain Abortions; Gov. Signature Expected

March 26, 2015 — The Kansas House on Wednesday voted 98-26 to approve a bill (SB 95) that would ban physicians from performing a certain abortion procedure, the AP/Sacramento Bee reports.

The Kansas Senate last month voted to approve the bill. The measure now heads to Gov. Sam Brownback (R), who has indicated he will sign the measure.

If approved, the state will be the first in the nation to adopt such a ban (Hanna, AP/Sacramento Bee, 3/25).

Bill Details

Abortion-rights opponents say the bill, which was drafted by the National Right to Life Committee, would ban a method of abortion called dilation and extraction. According to the Kansas Department of Health and Environment, the method accounted for 578 of the roughly 7,500 abortions performed in the state in 2013.

The measure would permit exceptions if continuing the pregnancy would result in the death or irreversible physical impairment of a major bodily function (Women's Health Policy Report, 3/11).

Physicians who violate the measure could face misdemeanor charges for a first offense and felony charges thereafter.

In considering the bill, the House rejected a proposed amendment that would have allowed physicians to perform the procedure before 24 weeks' gestation if the woman's membranes ruptured (Carpenter, Topeka Capital-Journal, 3/25).

Abortion-Rights Supporters Voice Concerns, Pledge Legal Action

Trust Women, a Kansas-based abortion-rights group, has said it will challenge the law in court. Trust Women CEO Julie Burkhart said, "Policymakers should be ashamed that they are putting women's lives at risk because they care more about politics than good health care."

Elise Higgins, a spokesperson for Planned Parenthood of Kansas and Mid-Missouri, said her organization is also considering legal action (AP/Sacramento Bee, 3/25). PPKMM CEO Laura McQuade noted, "This bill not only fails to improve women's health and safety but puts them in harm's way by denying doctors the ability to provide the safest care available for their patients."

Separately, state Rep. Steve Brunk (R), who supported the bill, said, "This bill has been written very, very carefully and has been thoroughly vetted by a number of different legal minds in order to make sure that it passed muster through the court" (Topeka Capital-Journal, 3/25). According to the AP/Bee, the state since January 2011 has spent about $1.2 million to defend antiabortion-rights laws (AP/Sacramento Bee, 3/25).


Two Antiabortion-Rights Bills Advance in Tenn. House

Thu, 03/26/2015 - 20:21

A Tennessee House subcommittee on Tuesday voted to advance two bills that would place new restrictions on abortion in the state, the Tennessean reports.

Two Antiabortion-Rights Bills Advance in Tenn. House

March 26, 2015 — A Tennessee House subcommittee on Tuesday voted to advance two bills that would place new restrictions on abortion in the state, the Tennessean reports (Wadhwani, Tennessean, 3/25).

According to the AP/Rock Hill Herald, the bills aim to implement abortion restrictions previously struck down by the state Supreme Court. The Tennessee House Health Subcommittee approved the new measures with voice votes (Johnson, AP/Rock Hill Herald, 3/24).

Bill Details

According to the Tennessean, one of the bills would impose a mandatory delay before a woman can obtain an abortion and require that she be provided with biased counseling prior to the procedure.

The other measure (HB 1368) would require all facilities that perform more than 50 abortions annually to be certified as ambulatory surgical centers. According to the Tennessean, the requirement could force some clinics to close (Tennessean, 3/25).

The AP/Herald reports that companion bills for both measures are before the state Senate Judiciary Committee (AP/Rock Hill Herald, 3/24).

Debate

State Rep. Matthew Hill (R) said the mandatory delay is intended to provide a woman seeking an abortion with a chance "to consider other options for the well-being of herself and her unborn child."

However, state Rep. John Ray Clemmons (D) said, "There seems to be a misunderstanding that a lady who decides to get an abortion ... can simply wake up and have an abortion." He noted that the measure would require women to incur additional expenses by having to make two trips to an abortion clinic, adding, "I do have concerns we are placing substantial obstacles" in the way of women's access to abortion (Tennessean, 3/25).


Ohio House Passes 'Heartbeat' Bill That Could Ban Abortion as Early as Six Weeks

Thu, 03/26/2015 - 20:20

The Ohio House on Wednesday voted 55-40 to approve a bill (HB 69) that would ban abortion if a fetal heartbeat is detectable, which can be as early as six weeks into pregnancy, the Cleveland Plain Dealer reports.

Ohio House Passes 'Heartbeat' Bill That Could Ban Abortion as Early as Six Weeks

March 26, 2015 — The Ohio House on Wednesday voted 55-40 to approve a bill (HB 69) that would ban abortion if a fetal heartbeat is detectable, which can be as early as six weeks into pregnancy, the Cleveland Plain Dealer reports.

The bill now heads to the state Senate for consideration (Higgs, Cleveland Plain Dealer, 3/25). According to the AP/San Francisco Chronicle, the chamber will have the rest of the Ohio Legislature's two-year session to consider the measure (Carr Smyth, AP/San Francisco Chronicle, 3/25).

Similar bills have failed in two previous state legislative sessions.

Bill Details

State Reps. Christina Hagan (R) and Ron Hood (R) proposed this year's bill, which would make it a fifth-degree felony for a provider to perform an abortion if a fetal heartbeat can be detected. It includes exemptions if an abortion is needed to save a woman's life or prevent serious health complications (Women's Health Policy Report, 3/5). It does not include exemptions for cases of rape or incest (Cleveland Plain Dealer, 3/25).

Individuals who violate the ban could face up to a year in prison and fines of up to $2,500.

The measure also would create a legislative committee to encourage adoption (Women's Health Policy Report, 3/5).

Vote Details

The bill was approved mostly along party lines (Cleveland Plain Dealer, 3/25). According to the Columbus Dispatch, most of the chamber's Republicans and one Democrat voted in favor of the bill, while most Democrats and 10 Republican lawmakers voted against it.

Conservatives during debate over the measure rejected several amendments, including one that would have added exemptions for cases of incest and rape (Candisky, Columbus Dispatch, 3/26).

According to the Plain Dealer, abortion-rights supporters in the state House voiced several reasons why the bill should be rejected, including concerns that it would violate both the state and U.S. constitutions and only would make abortion more dangerous for Ohio residents (Cleveland Plain Dealer, 3/25).

State Rep. Michael Curtin (D) said the bill is "a profound abuse of power," noting, "This legislation unequivocally states that government ... knows better" than physicians and those involved with the pregnancy.

State Rep. Teresa Fedor (D), who also opposed the bill, revealed that she had been raped and had an abortion. She called the bill "fundamentally inhuman" and "unconstitutional," adding, "How dare government get in my business" (Columbus Dispatch, 3/26).

Separately, Hagan argued that individuals should not be allowed to stop a fetus' beating heart (Palmer, Reuters, 3/25).

Chances of Becoming Law Dim

According to the Columbus Dispatch, the measure faces potential opposition from some members of the state Senate and Gov. John Kasich (R). The lawmakers have expressed concern that the measure would be found unconstitutional if challenged in court.

Ohio Senate President Keith Faber (R) said the state Senate would hold hearings on the measure "at some point" (Columbus Dispatch, 3/26). However, he added, "I'm still waiting for that legal scholar to come forward and say that the heartbeat bill is constitutional."

Meanwhile, antiabortion-rights groups said they plan to increase lobbying efforts on the state Senate to pass the bill (Cleveland Plain Dealer, 3/25).


Datapoints: Supreme Court Case Puts Women's Coverage at Risk, State Abortion Bans Restrict Care

Thu, 03/26/2015 - 19:52

In today's graphics, we look at the nationwide reach of a Supreme Court case that could threaten women's access to affordable health insurance under the Affordable Care Act. We also spotlight the spread of 20-week and telemedicine abortion bans in the states.

Datapoints: Supreme Court Case Puts Women's Coverage at Risk, State Abortion Bans Restrict Care

March 26, 2015 — In today's graphics, we look at the nationwide reach of a Supreme Court case that could threaten women's access to affordable health insurance under the Affordable Care Act. We also spotlight the spread of 20-week and telemedicine abortion bans in the states.

Women's Coverage at Risk



An interactive map from the National Women's Law Center highlights how King v. Burwell -- a challenge to the Affordable Care Act (PL 111-148) recently heard by the Supreme Court -- would impact the millions of women enrolled in health coverage through the federal insurance marketplace. The case tests whether individuals and families in states that use the federal marketplace can continue to receive tax credits for the purchase of health coverage.

NWLC's analysis details how many women are eligible for tax credits in each state that uses the federal marketplace, as well as the number of women of color affected in each state (NWLC, 2/18).


States Target Telemedicine Abortion



Conservative state lawmakers are increasingly moving to ban telemedicine in abortion care, including in states where such services are not even offered. A USA Today map shows where states have imposed such bans by requiring doctors to be present in the room when administering medication abortion drugs to a patient. Iowa's telemedicine ban is being challenged in court and is the only state that has passed a ban but continues to have such a program in place, through Planned Parenthood of the Heartland (USA Today, 3/17).


GIF Shows Spread of 20-Week Bans



Anti-choice state politicians have increasingly prioritized unconstitutional bans on abortion at 20 weeks of pregnancy. Planned Parenthood's GIF, updated as of March 4, shows the status of such efforts, including ongoing court challenges (Planned Parenthood Action Fund, 3/4).


Datapoints: Supreme Court Case Puts Women's Coverage at Risk, State Abortion Bans Restrict Care

Thu, 03/26/2015 - 19:51

In today's graphics, we look at the nationwide reach of a Supreme Court case that could threaten women's access to affordable health insurance under the Affordable Care Act. We also spotlight the spread of 20-week and telemedicine abortion bans in the states.

Datapoints: Supreme Court Case Puts Women's Coverage at Risk, State Abortion Bans Restrict Care

March 27, 2015 — In today's graphics, we look at the nationwide reach of a Supreme Court case that could threaten women's access to affordable health insurance under the Affordable Care Act. We also spotlight the spread of 20-week and telemedicine abortion bans in the states.

Women's Coverage at Risk



An interactive map from the National Women's Law Center highlights how King v. Burwell -- a challenge to the Affordable Care Act (PL 111-148) recently heard by the Supreme Court -- would impact the millions of women enrolled in health coverage through the federal insurance marketplace. The case tests whether individuals and families in states that use the federal marketplace can continue to receive tax credits for the purchase of health coverage.

NWLC's analysis details how many women are eligible for tax credits in each state that uses the federal marketplace, as well as the number of women of color affected in each state (NWLC, 2/18).


States Target Telemedicine Abortion



Conservative state lawmakers are increasingly moving to ban telemedicine in abortion care, including in states where such services are not even offered. A USA Today map shows where states have imposed such bans by requiring doctors to be present in the room when administering medication abortion drugs to a patient. Iowa's telemedicine ban is being challenged in court and is the only state that has passed a ban but continues to have such a program in place, through Planned Parenthood of the Heartland (USA Today, 3/17).


GIF Shows Spread of 20-Week Bans



Anti-choice state politicians have increasingly prioritized unconstitutional bans on abortion at 20 weeks of pregnancy. Planned Parenthood's GIF, updated as of March 4, shows the status of such efforts, including ongoing court challenges (Planned Parenthood Action Fund, 3/4).


OTC Oral Contraception Access With Little or No Copay Could Increase Use, Curb Unintended Pregnancy

Thu, 03/26/2015 - 19:22

In this study, researchers examined how over-the-counter access to oral contraceptive pills could affect health care costs, unintended pregnancy rates, contraceptive use and other factors. They concluded that "it is in the financial interest of public healthcare programs to cover a large portion of the cost of [OTC] contraceptive pills," after finding that OTC access to the pills "could increase the use of effective methods of contraception and reduce unintended pregnancy and healthcare costs."

OTC Oral Contraception Access With Little or No Copay Could Increase Use, Curb Unintended Pregnancy

March 26, 2015 — Summary of "Potential Public Sector Cost-Savings From Over-the-Counter Access to Oral Contraceptives," Foster et al., Contraception, Feb. 27, 2015.

"[T]he need for a prescription to obtain a reliable contraceptive method is a barrier to use" for many women, according to researchers led by Diana Foster of the University of California-San Francisco's Bixby Center for Global Reproductive Health and Department of Obstetrics, Gynecology and Reproductive Science.

They noted that "inconsistent or lack of contraceptive use, rather than contraceptive method failure" is the leading cause of unintended pregnancy in the U.S. About half of U.S. pregnancies are unintended, a rate that "has remained steady ... for the past 2 decades," Foster and colleagues wrote.

According to the researchers, making oral contraceptive pills (OCPs) available over the counter (OTC) potentially could "increase contraceptive use and continuation rates by facilitating continuity of use and encouraging OCP use among women who currently do not use any method or use less effective methods."

In their study, Foster and colleagues examined the effects OTC OCPs would have on "use, unintended pregnancies and associated pregnancy and contraceptive costs."

Methods

Researchers used state and national data to predict how OTC OCPs could affect contraceptive use among low-income women who are at risk of unintended pregnancy.

Specifically, the researchers considered two possible scenarios -- high OCP adoption and low OCP adoption -- and predicted OCP adoption based on the out-of-pocket costs of each pill pack. They also predicted the number of unintended pregnancies in each scenario and "estimate[d] the public sector cost of providing OCPs and medical care for pregnancy under each scenario (no OTC access, low OTC use, high OTC use), effect on contraceptive failure rates (none, 50% reduction, 50% increase) and out-of-pocket costs for a pack of pills (from $0 to $50)."

Results

The researchers found that among low-income women at risk of unintended pregnancy:

~ 21% reported being very likely to use OCPs if they were available OTC at drug or grocery stores;

~ 15% reported being somewhat likely to use OCPs in those circumstances;

~ 26% reported being unsure or not likely to use OCPs if they were available OTC; and

~ 39% reported having no interest in OCPs.

Further, the researchers found that "[t]he likelihood of using OCPs among low-income women who are somewhat or very interested in OTC OCPs varie[d] by price," ranging from 100% of women saying they would use the pills if a pack were available at no cost, to just 4% if a pack cost $50. As a result, Foster and colleagues concluded that making OCPs available OTC "would have almost no effect on the contraceptive method distribution if the out-of-pocket cost for an OTC pill pack is $50 and the most widespread adoption of OCPs if the OTC pack is entirely covered by insurance."

In addition, the researchers found that making OCPs available OTC without copayments would:

~ Decrease the share of low-income women using less-effective contraceptive methods from 31% to 18% under the high OCP adoption model and from 31% to 24% under the low-OCP adoption model;

~ Decrease the share of low-income women using no contraceptive methods from 18% to a range of 14% to 15%; and

~ Decrease the share of women using contraceptive methods more effective than OCPs from 17% to a range of 14% to 15%.

Low OCP Adoption Model

Under the low OCP adoption model with no copays, the number of OCP users would increase from 31% to 42%, with 63% of the new adopters switching from using a less effective method, 25% switching from using no contraception and 13% switching from a more effective method.

Further, the number of unintended pregnancies among low-income women would decrease by 11% (from 251 per 1,000 women annually to 223 per 1,000 women annually) if there are no changes to the OCP failure rate; by 15% (213 per 1,000 women) if OTC access reduced the failure rate; and by 7% (233 per 1,000 women) if OTC access increased the failure rate.

In addition, under the low OCP adoption model, contraception- and pregnancy-related medical costs covered by insurance would decrease by 1% without any change to the OCP failure rate and by 4% if the OCP failure rates decreased by 50%, while the amount would increase by 3% if the OTC access increased the OCP failure rate.

High OCP Adoption Model

Meanwhile, the researchers found that under the high OCP adoption model with no copays the number of OCP users would increase from 31% to 52%, with 62% switching from a less effective contraceptive method, 22% switching from using no contraception and 16% switching from a more effective method.

Further, the number of unintended pregnancies among low-income women "would decrease by 18% (204 per 1,000 women) with no changes to the pill failure rate, 25% (187 per 1,000 women) if the failure rate reduces by half and 12% (221 per 1,000 women) if the failure rate increases by half," they wrote.

Contraception- and pregnancy-related costs to insurers would decrease by 6% if there were no improvement in OCP failure rates, by 12% if OTC access decreased OCP failure rates by 50% and by less than 1% if such access increased OCP failure rates by 50%.

Overall, the researchers found, "Savings are maximized at an out-of-pocket cost per pack of $10-20 -- the price point where pill costs are offset by the copay but the copay is not so high as to discourage use." Specifically, the researchers wrote that a $10 copay would incur savings for insurers of "3-10% (low to high use models) on pregnancy and pill costs if there is no change in OCP failure rate, 6-15% if the OCP failure rate decreases and 0-5% if the OCP failure rate increases."

Discussion

According to Foster and colleagues, the study shows "that OTC access to oral contraceptives is likely to increase low-income women's use of more effective contraceptive methods." In addition, if OCPs were available OTC without out-of-pocket costs, "there would be a significant drop in the number of low-income women at risk of unintended pregnancy using no method or a less effective method" of contraception. Accordingly, the rate of unintended pregnancy among low-income women would decline by 11% to 18% if OTC access did not affect OCP failure rates, by 15% to 25% if it decreased failure rates and by 7% to 12% if it increased failure rates.

Foster and colleagues suggested that "it is in the financial interest of public healthcare programs to cover a large portion of the cost of contraceptive pills." However, they noted that while "projected savings are maximized at $10-20 copay, the number of pregnancies averted is maximized at no out-of-pocket costs." Specifically, they wrote that "the proportion of women using OTC OCPs is directly correlated with out-of-pocket cost of the product," with "little advantage" conferred from OTC access among low-income women if the copays are more than $10.

Foster and colleagues concluded, "Removing the prescription barrier, particularly if pill packs are available at small or zero out-of-pocket cost, could increase the use of effective methods of contraception and reduce unintended pregnancy and healthcare costs."


Commentary Stresses Importance of Setting Appropriate Family Planning Quality Measures

Thu, 03/26/2015 - 19:22

Researchers note that while it is important to develop standard quality measures related to family planning, metrics based solely on increasing the uptake of long-acting reversible contraceptive methods "may not be appropriate in the setting of a decision as complex and contextualized as the choice of a contraceptive method." They offer several recommendations for "measures that better capture the quality of contraceptive care in the context of women's needs and preferences."

Commentary Stresses Importance of Setting Appropriate Family Planning Quality Measures

March 26, 2015 —Summary of "Performance Measures for Contraceptive Care: What are We Actually Trying To Measure?" Dehlendorf et al., Contraception, Feb. 9, 2015.

While there has been an increasing push to measure "quality in specific areas of health care," which "can drive quality improvement and influence the degree to which these areas are prioritized" by stakeholders, no such performance measures have been developed for family planning, write Christine Dehlendorf of the University of California-San Francisco and colleagues.

Meanwhile, "the reproductive health community is increasingly directing research and interventions towards the perceived underuse of highly effective" contraceptive methods, particularly long-acting reversible contraception (LARC), such as intrauterine devices and implants, they write.

As a result, some stakeholders have urged using measures to help encourage LARC use. The authors write that one option would be "to simply measure the percentage of women receiving family planning care who decide to use a highly effective method, with higher uptake being equated with higher quality of care," or to use an approach weighting methods by their effectiveness and taking into account their level of use in the population.

'Cause for Concern'

At first glance, using measures that prioritize "the uptake of higher efficacy methods" appears logical when considering the desire to reduce unintended pregnancies and combat provider misconceptions about LARCs, the researchers write.

However, Dehlendorf and colleagues add that "there is cause for concern that this focused, outcome-based measure may not be appropriate in the setting of a decision as complex and contextualized as the choice of a contraceptive method."

They explain that the selection of a birth control method "is highly preference-sensitive due to the large number of available options and women's varied preferences for method characteristics," such as efficacy, bleeding patterns and whether methods contain hormones.

In addition, they note that method selection is connected "to intimate issues related to fertility, relationships and sexuality," including whether women want to get pregnant and their comfort level with a device inside their body, among other considerations. They add, "Protecting women's reproductive autonomy therefore requires the recognition that women's preferences need to be paramount in the choice of a contraceptive method even if they are not consistent with the public health goal of decreasing unintended pregnancies."

Further, the researchers argue that "quality measures that focus only on the short-term outcome of choice of a [LARC] method are problematic" because they encourage providers to promote or emphasize certain "methods at the expense of attention to patient preferences." There are also potentially negative effects on "long-term outcomes, such as patient satisfaction and method continuation," which have been shown to be linked to each other.

Consideration of Vulnerable Populations

Dehlendorf and colleagues add that "[i]ncentivizing counseling ... focused on LARC methods could be particularly problematic among" groups of women who have historically experienced "reproductive coercion," such as low-income women, "women of color, women with disabilities, young women and those in the correctional system."

Thus, "counseling that is biased towards [LARCs], rather than focused on women's needs and preferences, has the potential to amplify existing biases and disparities within the US health care system and worsen preexisting distrust among communities of color and other vulnerable populations," the authors explain.

They add that such a quality measure "may be problematic even if it did not influence counseling, as its mere existence could be perceived negatively by communities sensitized to these issues as evidence of a focus on controlling women's reproduction, rather than on empowering women."

Potential Solutions

Dehlendorf and colleagues suggest that a "combination of measures" likely will be needed to capture "the multidimensional nature of quality, including interpersonal quality, availability of information and access to services," as well as "the importance of both the patient experience of counseling and whether each woman is able to choose the appropriate contraceptive method for her."

Specifically, patient experience measures are "of particular value in the assessment of contraceptive care" because of "the personal nature and complex context of contraceptive decision making," they argue.

Meanwhile, the authors state that process metrics based on the availability of contraceptive choice could help combat "provider resistance to provision of [LARC] methods and the resulting limitation on women's ability to choose these methods -- while avoiding [the] pitfalls" of uptake-based measures. They write that such measures could include "a measure that incentivizes the provision of information about LARC methods," as implemented by the United Kingdom's National Health Services. Another option, they write, could be "a performance measure based on whether ... women are offered LARC methods," as recommended by the American College of Obstetricians and Gynecologists.

In addition, another approach could be to use claims data on LARC uptake to "identify practices that are well below the mean" of LARC use "in order to provide the opportunity to address" related barriers, without setting an explicit benchmark for providers to reach. A similar option could be to establish "a minimum 'floor' standard ... in order to differentiate providers who offer these methods at all from those who do not." The researchers caution that "care would need to be taken" with such an approach "to ensure that [the] intent [of the measure] was clear in order to avoid the interpretation that promotion of LARC methods was being incentivized."

Further, the researchers also raise the possibility of having "an intermediate-outcome measure" that "focuses on use of any" contraceptive method "considered to be either moderately or highly effective." They add that while such an approach "allows for greater consideration of patient preferences," it could also "incentivize providers to deemphasize counseling about condoms," resulting in negative effects for patient preferences and sexually transmitted infection risk.

Conclusion

Dehlendorf and colleagues continue, "Measurement of quality in contraceptive care may ensure that family planning services are prioritized in our evolving health care system and that attention is paid to continuous quality improvement in order to ensure that women receive the best possible care."

They add that "[m]easures that, either individually or in combination, reward the quality of contraceptive care from both a patient and systems perspective, while protecting women's autonomy, should be prioritized by those developing performance measures."

The researchers also stress that organizations that formally endorse quality measures, including the National Quality Forum, "can help to ensure that the preference-sensitive nature of contraceptive decision making is reflected in measures designed to incentivize quality family planning care."


Resources Aim To Address Implementation Gaps in ACA's Well-Woman Visit Benefit

Thu, 03/26/2015 - 19:22

Access to well-woman visits without cost-sharing is one of the preventive care services available to women under the Affordable Care Act (PL 111-148), but a lack of information and outreach about the benefit has left many women unaware that it is available to them. To address the issue, a group of women's health experts has created a consumer guide, a toolkit for providers and consumer advocates, and an issue brief describing the benefit itself, key components of well-woman visits, and how such visits can improve women's health.

Resources Aim To Address Implementation Gaps in ACA's Well-Woman Visit Benefit

March 26, 2015 — Summary of "Well-Woman Visits: Guidance and Monitoring Are Key in This Turning Point for Women's Health," Fitzgerald et al., Women's Health Issues, March 2015.

Although the Affordable Care Act's (PL 111-148) preventive services provision requires insurers to cover at least one annual well-woman visit (WWV) without cost-sharing, there is a dearth of "guidance, education, and outreach associated with implementation of WWVs," leaving "many women ... unaware of the benefit," according to Therese Fitzgerald of the Mary Horrigan Connors Center for Women's Health and Gender Biology and colleagues from the Connors Center, National Women's Law Center and Brigham & Women's Hospital's Division of Women's Health. They note that the issues have "jeopardize[d] women's access to key preventive care services."

For example, research has shown that 40% of women do not know about the ACA's WWV benefit and that 20% of women delayed preventive care because of cost. Such findings "are not surprising given the lack of education and outreach on WWVs," according to the authors. For instance, some HHS fact sheets about women's health services do not mention WWVs, an omission the authors call "as objectionable as [the sheets'] failure to include contraceptive services and supplies."

To address implementation issues related to the WWV benefit, Fitzgerald and colleagues' associated groups, along with Pfizer, have created "resources for consumers, providers and policymakers on WWVs to ensure that women are able to understand and access" the preventive care services offered under the ACA.

Consumer Guide to WWVs

The groups consulted with an advisory panel comprised of health and policy experts to draft a "consumer-friendly resource that can be used to educate women about this new benefit." The guide is offered in two languages and is "health literacy-appropriate."

Fitzgerald and colleagues explain that the guide includes information on "what to expect at a WWV," as well as answers to frequent questions about the visits, such as:

~ What is a WWV?;

~ How much do WWVs cost?; and

~ What happens during WWVs?

The guide also includes information on how women should prepare for a WWV, as well as links to other resources.

In addition, the groups created a toolkit for consumer advocates and providers on WWVs to help them educate women about the visits and "what they mean for women's health." The toolkit has:

~ Factsheets and other resources about WWV best practices; and

~ Information about how WWVs can help to improve women's health throughout their lives.

Policy Issue Brief

The groups also created "an issue brief for primary care providers and policymakers" about ways that "changes in health care delivery can improve the availability and use of education and counseling" through routine visits. The brief also describes ways to "improve the successful integration of education and counseling services into women's primary care," the authors wrote.

Conclusion

Fitzgerald and colleagues note that "WWVs are a key component and gateway to the constellation of preventive care now consistently available to women under the ACA." They write that additional resources for "consumers, providers and policymakers on WWVs will empower more women to access comprehensive, personalized, preventive care."

Further, they call for HHS to "monitor the utilization of preventive" services "by collecting, analyzing and reporting data" on how women are using WWVs and the effects of such visits on the "receipt of recommended preventive care." Such data are important to gauge whether the ACA preventive care provisions have "been fully implemented and to determine if there are barriers for women, particularly marginalized subgroups of women, in gaining access to this valuable preventive resource," Fitzgerald and colleagues conclude.


Study Links Abortion Legalization, Decreases in Infant Mortality in the U.S.

Thu, 03/26/2015 - 19:22

In this study, researchers examined changes in infant mortality in relation to the legal status of abortion and found that the fastest declines in infant mortality from 1970 to 1973 occurred in states where abortion was legalized in 1970. According to the researchers, the findings suggest more research is warranted about current abortion restrictions and their effect on infant mortality, as well as racial and economic inequities in infant mortality rates.

Study Links Abortion Legalization, Decreases in Infant Mortality in the U.S.

March 26, 2015 — Summary of "Reproductive Justice and the Pace of Change: Socioeconomic Trends in US Infant Death Rates by Legal Status of Abortion, 1960-1980," Krieger et al., American Journal of Public Health, April 2015.

"As restrictions increase on access to abortion in the United States, it is timely to revisit and build on previous research that examined whether US infant mortality rates were affected by 1960s and 1970s policies that expanded access to abortion," according to a study by Nancy Krieger of the Harvard T.H. Chan School of Public Health and colleagues.

The researchers "hypothesized that between 1960 and 1980, the steepest annual percentage declines in the infant death rate would occur" in "states that legalized abortion in 1970, relative to states that decreased restrictions or kept abortion strictly illegal prior to national legalization of abortion in 1973." As a corollary, they hypothesized that "state abortion law status would be less associated with mid- to late-1960s declines in infant mortality" that previous research connected to "beneficial economic and social changes" related to the Civil Rights Act and the "War on Poverty."

Methods

The researchers used national mortality data from 1960 to 1967 and from 1968 to 1980 to calculate the infant death rate.

Specifically, the researchers "stratified the individual-level mortality records and census denominator data by age, gender and race/ethnicity and aggregated them to the county level." The findings were broken down by "state legal status and income quintile, for the total US, Black, and White population."

States were classified into three groups for the analysis:

~ States where abortion was legalized in 1970 (four states);

~ States where "a model penal code enacted between 1967 and 1972" made abortion laws "less stringent" (14 states); and

~ States where abortion remained illegal until Roe v. Wade in 1973 (32 states and Washington, D.C.).

Results

The researchers found that all three sets of states saw "the fastest decline in rates" from 1970 to 1973 and that "these declines were evident in the bottom 3 and top 2 income quintiles." However, the researchers noted that the "largest decline" was seen among "the lowest 3 income quintiles in the states that legalized abortion."

According to the researchers, "[t]he only other period" when the annual percentage change in infant mortality rates declined in both the bottom three and top two income quintiles was during the mid-1960s. During that time period, the "declines were smaller and did not vary by state abortion law status," but they "were especially evident for Black and White infants in the lowest 3 income quintiles," the researchers wrote.

Discussion

The researchers wrote that their "descriptive analysis newly extends and integrates previous strands of research that separately examined US trends in infant mortality rates in the 1960s and 1970s in relation to legalization of abortion, abolition of Jim Crow laws, and the War on Poverty."

They added that their findings offer a "reverse mirror to" current abortion restrictions, "conjoined with rising economic inequality and voter intimidation," and concluded that the findings "imply that research is warranted on how currently rising restrictions on abortions may be affecting US infant mortality rates and racial/ethnic and economic inequities in these rates."


Study Outlines Strategies To Recruit, Retain Nurses for Abortion Care

Thu, 03/26/2015 - 19:21

A study based on interviews with registered nurses found that exposure to abortion care was integral to recruiting them into the field, while providing flexibility was integral for their retention. The researchers concluded that the study demonstrates "that a clear trajectory exists for development of expert nurses in abortion care provision," and they offered several recommendations on how to further promote such a trajectory.

Study Outlines Strategies To Recruit, Retain Nurses for Abortion Care

March 26, 2015 — Summary of "Recruitment and Retention Strategies for Expert Nurses in Abortion Care Provision," McLemore et al., Contraception, Feb. 20, 2015.

While registered nurses (RNs) "have a strong tradition of participating in sexual and reproductive health care ... the participation of nurses is considered to be one of many current barriers to abortion care provision," according to a study by Monica McLemore of the University of California-San Francisco School of Nursing and colleagues.

According to the researchers, "expert RNs" are "'those who do not exclusively rely on analytical principles (rules, guidelines or maxims) to connect their understanding of a situation to an appropriate action'" and "'who can zero in on the accurate region of a problem without wasteful consideration of a large range of unfruitful possible problem situations.'"

In their study, McLemore and colleagues aimed "to explore perspectives and experiences of recruitment, retention and career development of expert RNs in abortion care provision."

Methods

The researchers analyzed a subset of data from a larger study of RNs from 14 sites in the San Francisco Bay Area. The subset included 16 RNs, all of whom "had to have exposure to women needing or seeking abortions in the last [five] years" to be included in the study.

For the study, researchers conducted 25- to 90-minute interviews between November 2012 and August 2013. The interviewers asked the RNs "to discuss their careers in nursing, summarizing their work experiences"; "think of a time when a woman needing an abortion presented to their unit and to recount that day"; and answer various follow-up questions.

Results

The study participants were about evenly divided between RNs with fewer than five years of experience and RNs with more than 10 years of experience.

Recruitment

The researchers wrote that exposure to abortion care "quickly emerged as a dominant theme relevant to recruitment," with sub-themes of "exposure through education" and "through previous employment."

In terms of education, the researchers said many of the study participants volunteered or did non-nursing jobs "in abortion care to meet the volunteer requirements/pre-requisites for their RN school applications." However, they wrote that many study participants attested as to how "educational exposure to providing abortion care is optional in most schools of nursing."

Regarding exposure through employment, the researchers found that going from being a student to an employee provides RNs with the chance to choose an employer based on their interests. Further, they noted that employees who had "had a personal history of abortion or sought out professional opportunities to participate in abortion care during their training ... were more likely to seek work in abortion care."

Retention

The researchers found that "[o]nce RNs have been successfully recruited, on the job orientation and training must occur given the disparities in basic knowledge regarding abortion care provision."

Respondents said a key aspect of retention was "the need for personal flexibility," in the context of their attitude toward their work and other personnel, as well as in "their reactions to the unpredictable nature of abortion care," according to the researchers. In particular, researchers found that designated staff RNs emphasized the importance of flexibility in patient advocacy "in the context of needing to provide space for the agency of women, especially when negotiating with others for care provision."

The researchers also found that respondents identified "'growing our own'" as another key aspect of retention. According to the study, the concept refers to "an employer-based commitment to providing RNs with on the job knowledge and skill acquisition that allows them to develop into expert RNs."

Career Development

The researchers also found that there is little "infrastructural support for career development in nursing outside of acute care settings," noting that many of the study participants indicated a "need for employers to assist in the development of these opportunities."

Specifically, the RNs cited the need for "[e]ngaging in activities of legitimacy," such as "participation in professional meetings, membership in societies, developing quality and process improvement projects, acknowledgement as full members of a team, engagement with clinic leadership and policy and procedure development."

Further, some respondents said employers should provide RNs with more skill-advancement opportunities, such as through advanced education.

Discussion

McLemore and colleagues write the data "show that a clear trajectory exists for development of expert nurses in abortion care provision." However, the researchers also wrote that "[t]here are several infrastructural barriers to RN participation in abortion care," including;

~ A "lack of visibility of the RN workforce in abortion care";

~ A "lack of professional certification" and "access to competency development"; and

~ "[O]utdated assumptions that the peri-operative or labor and delivery ... skill set is adequate for gaining expertise in abortion care."

The researchers offered several recommendations, including that "future workforce development efforts ... include and engage nursing education institutions and employers to design structured support for [the expert nurse] trajectory" and "integrate values clarification exercises and observational rotations for RN students in abortion care provision."

In addition, they wrote that "[i]n the abortion care provision context, the infrastructure within nursing" to retain staff via the concept of growing our own "needs to be built and does not currently exist." Further, they noted that efforts to assist RNs' career development should include integrating them "in more traditional nursing professional organizations to increase the visibility of RNs doing abortion care, and to expand the pool of future providers."

In summary, McLemore and colleagues wrote that their findings "should encourage employers to provide opportunities for exposure to abortion care, develop activities to recruit and retain nurses, and to support career development." The findings also "highlight approaches to support trajectories to develop expert nurses in abortion care provision," they concluded.