Daily Women's Health Policy Report

Syndicate content
Daily Women's Health Policy Report by the National Partnership for Women & Families
Updated: 1 hour 57 min ago

Improvements Needed in Care for Women With Late Diagnosis of Lethal Fetal Anomalies, Survey Suggests

Wed, 11/26/2014 - 19:01

Researchers surveyed maternal-fetal medicine specialists about their attitudes and practices regarding cases that involve the diagnosis of lethal fetal anomalies after 24 weeks of gestation, including the availability of abortion services in such circumstances. While most respondents felt that abortion should be allowed in such cases, they varied in their knowledge about the availability of such services and how they advised women facing diagnoses of lethal fetal anomalies late in their pregnancies.

Improvements Needed in Care for Women With Late Diagnosis of Lethal Fetal Anomalies, Survey Suggests

November 26, 2014 —Summary of "Late Termination of Pregnancy for Lethal Fetal Anomalies: A National Survey of Maternal-Fetal Medicine Specialists," Jacobs et al., Contraception, Oct. 7, 2014.

Although maternal-fetal medicine (MFM) specialists care for women with complicated pregnancies, "little is known about their attitudes and practices regarding TOP [termination of pregnancy] as a management option following late diagnosis of lethal fetal anomalies," according to Adam Jacobs of Mt. Sinai Medical Center and colleagues from Planned Parenthood of New York City and the Obstetrix Medical Group of Washington.

The researchers surveyed U.S. members of the Society of Maternal Fetal Medicine (SMFM) to determine MFM specialists' "current practices and to identify barriers that they may face in providing late TOP services or referrals for patients."

Methods

The researchers conducted an anonymous survey by mail in 2011. The survey asked SMFM members about:

~ Which medical options physicians or their staff members discuss with women who present after 24 weeks of gestation with lethal fetal anomalies;

~ Whether abortion services after 24 weeks of gestation are available at the physicians' affiliated medical center and, if not, why;

~ The availability of referrals for abortion services after 24 weeks; and

~ Other barriers to accessing abortion services after 24 weeks.

They survey also asked physicians whether they consider anencephaly, polycystic kidneys, renal agenesis, severe hydrocephalus, trisomy 13 and trisomy 18 to be lethal fetal anomalies, on a five-point scale ranging from strongly agree to strongly disagree. According to the researchers, while there is "no universally accepted definition or 'set' of lethal anomalies" in the medical community, these conditions have been cited in the literature as lethal.

Results

Of the 2,119 U.S. members of SMFM, 817 practicing physicians responded. Their median age was 51, median MFM practice experience was 18 years and their practice locations were about equally distributed across the U.S.

Discussion of Management Options

Out of 810 respondents who answered the question about management options they or their staff members discuss with women who present after 24 weeks with lethal fetal anomalies, 93% said they "discuss delivery near term or when spontaneous labor ensues or maternal compromise arises."

Meanwhile, 75% of the respondents said they "discuss the option of TOP soon after the diagnosis," the researchers found. In multivariate analyses, the strongest predictor of this response "was agreeing with the opinion statement, 'Termination of a pregnancy affected by a lethal anomaly should be allowed under all circumstances.'" Respondents also were more likely to discuss TOP as an option if they practiced in the Western region of the U.S.

Availability of Abortion Services

Of the 817 total respondents, 40% "indicated that their medical centers offered TOP to patients" who were seeking to terminate pregnancies after 24 weeks because of lethal anomalies, while an additional 12% "cited available services within 50 miles." Meanwhile, among all respondents:

~ 49% offered referrals to abortion services that were located more than 50 miles away;

~ 36% "provid[ed] information about resources without direct referral"; and

~ 17% "indicated that they offered information without direct referral as the only option."

Physicians in the Western U.S. were "significantly more likely" to be affiliated with a medical center that offered abortion services after 24 weeks for lethal fetal anomalies and "significantly less likely only to provide information without referral."

Of the 485 respondents who said their affiliated medical center did not provide abortions after 24 weeks for lethal fetal anomalies, 477 provided reasons. Specifically, physicians cited "state legal prohibitions" (67%), "restrictive hospital policies" (49%), hospital staff's reluctance to participate in such services (34%), "lack of physicians skilled in later TOP" (14%), antiabortion-rights activism or community resistance (15%) and "economic considerations" (3%).

However, 121 of the 320 respondents who cited state laws as the reason were incorrect and in fact "practiced in states that did not ban post-24-week TOP for lethal fetal anomalies at the time of the survey," according to the researchers. Further, 8% of respondents who answered this question incorrectly said that federal law was the reason their affiliated medical centers did not provide such services.

Barriers to Abortion Services

When asked about the barriers their patients face in attempting to access TOP after 24 weeks for lethal anomalies:

~ 69% cited insufficient funds to cover costs or a lack of health insurance;

~ 64% cited challenges finding a provider;

~ 48% cited problems arranging transportation;

~ 38% cited "time away from home, work or school responsibilities"; and

~ 34% cited resistance from their family members or partners.

Defining 'Lethal Anomaly'

A majority of respondents said that anencephaly (99%), renal agenesis (96%), trisomy 13 (82%) and trisomy 18 (78%) constituted a lethal fetal anomaly. Meanwhile, fewer than one-third of respondents said that polycystic kidneys (31%) and severe hydrocephalus (13%) were lethal fetal anomalies, which Jacobs and colleagues suggested was "perhaps because [these] two conditions were less clearly defined."

Almost 50% of respondents said "that, in actual practice, the determination of lethality is made by a hospital committee or multidisciplinary group rather than by the provider alone."

In addition, 61% of physicians said that U.S. MFM specialists "shared consensus about what constitutes a lethal fetal anomaly."

Physicians' Personal Views

Ninety-three percent of respondents "agreed or strongly agreed" that the abortion decisions in cases of "a pregnancy with a late-diagnosed lethal fetal anomaly should be left to the pregnant woman in consultation with her doctor." Further, 77% said they felt "strongly or very strongly" that TOP should be permitted for lethal anomalies, while 58% felt this way for "anomalies likely to result in significant long-term impairment in surviving infants," the researchers found.

Respondents who agreed that abortion should be allowed in such circumstances "were significantly more likely to be female, less than 50 years old and from the Western region of the United States."

Discussion

"Our research suggests that clinical practices regarding TOP for lethal anomalies may differ by location of practice, perceptions (often mistaken) about legal tenets governing TOP or the personal opinions of physicians, rather than being guided by consistent standards of care," according to Jacobs and colleagues.

The researchers concluded that their "survey supports the need for improvement in services to pregnant women who desire later TOP following diagnosis of serious fetal anomalies." They recommended interventions such as "educating physicians about what is legally permissible, forging policies that provide more consistent standards of care, addressing barriers to access, and improving collaboration between MFM specialists and family planning providers to establish seamless networks of care."

Study: Most Women Can Self-Assess Pregnancy Test Results After Early Medication Abortions

Wed, 11/26/2014 - 19:01

Researchers at the Royal Infirmary of Edinburgh examined whether women could reliably self-assess the results of pregnancy tests after undergoing early medication abortions. They found that that "most women ... neither want nor need scheduled telephone contact from a provider" after an early medication abortion and "feel comfortable with taking the responsibility for interpreting the result of [a pregnancy] test" after their abortions.

Study: Most Women Can Self-Assess Pregnancy Test Results After Early Medication Abortions

November 26, 2014 —Summary of "Can Women Determine the Success of Early Medical Termination of Pregnancy Themselves?" Cameron et al., Contraception, Sept. 18, 2014.

Follow-up appointments to determine the success of early medical termination of pregnancies (TOPs) "traditionally [have] involved a routine clinic visit for ultrasound," which "can lead to unnecessary medical or surgical intervention" and "may limit the number of new referrals that can be seen," according to S.T. Cameron of the Royal Infirmary of Edinburgh, United Kingdom, and colleagues. Further, the researchers noted that patients in an alternative telephone follow-up program instituted by Edinburgh's TOP service in 2011 increasingly requested "not to receive a routine call."

In April 2012, Edinburgh's TOP service began allowing women who had early medication abortions to not receive the telephone call if they chose a self-assessment option, "provided that they understood how to conduct and interpret [a] urinary pregnancy test and signs and symptoms that indicated the need to contact the TOP service," the researchers explained.

Cameron and colleagues conducted a study to determine how many women selected the self-assessment option, how many of them later contacted the abortion provider and the time frame until any women presented with an ongoing pregnancy (failed TOP).

Methods

The researchers conducted a "retrospective review of the TOP service databases ... for all women choosing self-assessment" within the study period at a hospital outpatient clinic and a community sexual and reproductive health (SRH) clinic in Edinburgh.

According to the study, the medication abortion regimen used by Edinburgh's TOP service was a 200 milligram dose of mifepristone, with women taking an 800 microgram dose of misoprostol 24 to 48 hours later.

All women who underwent early medication abortions were provided with a low sensitivity pregnancy (LSUP) test during their clinic visit and instructed on when and how to self-administer the test. Clinic staff members also informed the women of signs or symptoms "that might indicate an ongoing pregnancy and for which they should contact the [TOP] service," the researchers wrote. The women were also offered no-cost contraceptives to start on the same day they received the misoprostol.

Women selecting the self-assessment option signed a form indicating that they wished to do so and understood that they were responsible for contacting Edinburgh's TOP service if:

~ The pregnancy test was positive, invalid or they were not certain of the result; or

~ The pregnancy test was negative and they had bleeding for fewer than four days, persisting pregnancy symptoms or their next period did not arrive within one month post-treatment.

Results

The researchers analyzed data on 1,791 women between April 2012 and October 2013 who had an early medication abortion and selected to expel the pregnancy at home, including 1,726 (96%) who chose the self-assessment option. While all women from the SRH clinic selected the self-assessment option, 42 of the women from the hospital opted to receive a follow-up by telephone and 23 opted to schedule a clinic visit to administer an ultrasound as a follow-up.

Cameron and colleagues found that 220 (13%) of the women who opted for self-assessment contacted the TOP service after their abortion. Of those, 188 (11%) made primary contact by telephone and 32 (2%) made an unscheduled or emergency visit to a hospital outpatient clinic or SRH.

Of the 188 women who called the TOP service, 120 scheduled clinic visits and 100 cited reasons flagged by the self-assessment instructions. Specifically:

~ 43 were because of less bleeding than expected;

~ 28 were for an invalid LSUP test result;

~ 17 were for a positive LSUP test result;

~ Seven were because of concerns about persisting pregnancy symptoms; and

~ Five were because they had not had a period post-treatment.

Overall, the researchers found that eight of the women who opted for self-assessment had an ongoing pregnancy, or failed TOP. All of those patients underwent subsequent, successful TOPs.

Discussion

"This study showed that when given the option, most women who are planning to go home to expel a pregnancy following an early medical TOP choose not to receive a phone call from the TOP service," Cameron and colleagues wrote, noting that the findings suggest "most women feel comfortable with taking the responsibility for interpreting the result of LSUP test."

Further, the researchers noted that the study found "relatively few women (approximately 1 in 10) actually do make contact with the TOP service with a concern related to the procedure" and also "confirmed the low rate of ongoing pregnancy with early medical TOP."

The researchers acknowledged that some providers might be concerned about the added patient responsibility to assess the LSUP test and follow-up, as needed, with the TOP service, especially if late detection of an ongoing pregnancy occurs in an area where "midtrimester abortion is not legal or not available." However, the researchers noted that their "study provides some reassurance in this respect, since the delay between medical TOP and presentation at clinic with diagnosis of ongoing pregnancy did not appear to differ" from research reviews of other follow-up methods.

"The evidence now clearly shows that the pathway for women requesting an early medical TOP who are certain of their decision could consist of a single clinic visit," the researchers concluded.

Abortion Providers Must Delve Into Context of Stigma Surrounding Their Profession

Wed, 11/26/2014 - 19:00

In a commentary, University of California-San Francisco's Carole Joffe writes about the stigma surrounding abortion providers and their marginalization in relation to other physicians. She discusses such issues in the context of both historical developments and recent increases in abortion restrictions throughout the U.S., concluding that one way to address abortion stigma is to explore the difference between stigma, marginality and controversy.

Abortion Providers Must Delve Into Context of Stigma Surrounding Their Profession

November 26, 2014 —Summary of "Commentary: Abortion Provider Stigma and Mainstream Medicine," Joffe, Women & Health, September 2014.

"[A]bortion provision has been highly regulated in the United States, and abortion providers have been subjected to unacceptable levels of violence and harassment -- with some researchers referring to this violence as an 'epidemic,'" writes Carole Joffe, a professor at the Bixby Center for Global Reproductive Health at the University of California-San Francisco. She cites several examples of this harassment and regulatory restriction, including the deaths of several members of the "abortion-providing community," congressional interference in the practice of abortion medicine and the "[h]undreds of 'TRAP laws'" adopted by states that are "widely acknowledged to have little to do with safety and everything to do with forcing clinics to close," among other antiabortion-rights legislation.

Roots of Abortion Stigma

According to Joffe, the stigma that comes with being an abortion provider likely originates from the era before Roe v. Wade, "when illegal abortions were plentiful and supplied by a wide range of providers." She writes that although some of the physicians who provided abortions during this time "were trained and competent" doctors "who risked imprisonment and loss of license" for performing the procedures, others "were far less competent, and often unethical -- the infamous 'back alley abortionists' or 'butchers' as they have been named."

These incompetent providers "became the face of abortion providers" because their patients were "disproportionately seen in hospital emergency rooms," Joffe argues, adding that as a result, obstetrics and gynecology departments were very hesitant to "normaliz[e] abortion care within their hospitals."

According to Joffe, this hesitation was "one of several factors that led to freestanding clinics becoming the major site for abortion services in the U.S." However, in turn, this development led to some positive results, such as lowering abortion care costs compared with hospital-provided care and allowing clinics "to hire nursing and counseling staff who -- unlike many hospital nurses -- support women's abortion decisions," Joffe writes, adding that clinics have also "amassed an impressive safety record -- according to researchers, ... about 14 times safer than childbirth."

However, Joffe writes that this development also made abortion more detached from mainstream medicine and more susceptible to restrictive legislation and harassment from abortion opponents. In response to these restrictions, providers "have expended huge amounts of resources on legal fees to try to challenge various restrictions, or failing that, to figure out how to best comply with them without compromising patient care," she writes. Meanwhile, providers concerned about ongoing harassment have installed security features such as "bullet-proof glass, video cameras, and so on" both at their homes and their offices, Joffe adds.

Role of Medical Community

Joffe asks, "But what about the response from elsewhere in medicine?" She notes that others in the medical community during the years since Roe have offered "little overt defense" of abortion providers, likely because of "a combination of still-lingering memories of the pre-Roe era, wariness about the potential of retribution from the anti-abortion movements, and perhaps most significantly, the medical profession's longstanding aversion to controversy of any kind."

However, Joffe acknowledges that "[i]n recent times ... as the number of restrictions on abortion has multiplied, and grown ever more extreme, more individual physicians and medical organizations have protested this treatment." For example, "Marcia Angell, the former editor of the New England Journal of Medicine and currently a professor at Harvard Medical School, and Michael Greene, a professor of obstetrics and gynecology, also at Harvard," recently penned a "blistering essay in USA Today" protesting physicians' comparatively silent reaction to this "'legal assault.'" Further, she notes that "other physician groups, such as medical societies in Pennsylvania, Wisconsin, Texas, and Arizona, have begun to speak out against abortion restrictions," as has the American College of Obstetricians and Gynecologists, which, historically, maintained "relative silence about abortion."

Overcoming Stigma

"The path to overcoming the stigma facing abortion providers is not clear-cut," Joffe writes. According to Joffe, the establishment of the "privately-funded Fellowship in Family Planning and Abortion for post-residency ob-gyns interested in specialized training" has helped to normalize the procedure within mainstream medicine. Still, abortions will likely "continue to take place in freestanding clinics, and the problems discussed here will remain" for the foreseeable future.

Although there are no "easy answers -- either practical or theoretical to the dilemmas facing abortion providers," Joffe argues that "[s]tudents of stigma need to push further to distinguish analytically between 'stigma' and two related concepts that are often applied to abortion providers: 'marginality' and 'controversy.'" She writes, "Pushing further on these distinctions is a fruitful way for our work to proceed."

Conceptual Model Explains Best Practices for Abortion Referral-Making

Wed, 11/26/2014 - 19:00

As access to abortion services continues to decrease in much of the U.S., it is increasingly critical that health and social services providers can provide women with "assistance [in] locating and accessing abortion care," Provide's Melanie Zurek and colleagues write. They describe a conceptual model developed by Provide to assist providers in improving their referral-making practices and effectively fulfilling "their role in ensuring access to care."

Conceptual Model Explains Best Practices for Abortion Referral-Making

November 26, 2014 — Summary of "Referral-Making in the Current Landscape of Abortion Access," Zurek et al., Contraception, Oct. 20, 2014.

As closures of abortion facilities across the U.S. continue to "decrease the availability of already limited services, women will require greater assistance locating and accessing abortion care," according to Melanie Zurek -- executive director of Provide, an organization that works to ensure access to safe abortion in the U.S. -- and colleagues.

In this paper, the authors describe Provide's development of best practices for abortion referral-making, as well as a conceptual model and set of core competencies for such referrals.

Need for Competent Referrals

Zurek and colleagues define abortion referral-making "as a process of connecting a woman in need of abortion care with a facility that provides services," which they note "may be a critical, yet for many years overlooked, component of access."

They explain that nationwide in 2011, there were 839 specialized abortion facilities and reproductive health clinics that performed 94% of abortions in the U.S. However, 89% of U.S. counties have no abortion provider. Proximity to abortion providers varies regionally, with 93% of counties in the Southeast and 94% of counties in the Midwest having no abortion providers, compared with 65% of counties in the Northwest, the authors add.

While a small proportion of women seeking abortion services will be able to obtain them through the same physician office that diagnosed the pregnancy or are already aware of abortion providers in their area, most women "will need to investigate and locate one," Zurek and colleagues wrote.

For these women, the authors write, "success in locating [abortion] care and the time and effort this will take will depend on several factors," such as:

~ "The number, public visibility and proximity of abortion providers";

~ "[Th]e number and visibility of Crisis Pregnancy Centers," which sometimes "falsely present as abortion providers in order to deliberately delay or deter women from accessing abortion care"; and

~ Personal resources, such as Internet access and the ability to effectively search for and identify actual providers online.

For women "who must identify a previously unknown provider, ... the availability of someone who can assist may be the critical link to care," according to Zurek and colleagues. However, "[u]ntil recently, little attention has been paid to the role of referrals in ensuring abortion access," and, "[a]s a result, abortion referral behavior is often inadequate," they explain.

Improving Referrals

In 2013, Provide launched an abortion-referral training program for health and social services providers that is being implemented in Kentucky, North Carolina, Oklahoma, South Carolina and West Virginia.

Early results show that such providers "want evidence-based information about abortion and skills in referral-making, and that providing this reduces misconceptions about abortion and improves confidence in referral-making behavior, among other shifts in knowledge, attitudes, and behaviors," Zurek and colleagues write.

Conceptual Model and Core Competencies

The authors describe Provide's conceptual model and the "competencies [Provide] identified as the foundation of [its] program" so they can be "use[d] by clinicians and others wishing to reflect upon and/or build their own referral-making practices, as well as for educators and researchers who may wish to address abortion referral-making in their work."

To develop these best practices, Provide "sought guidance from sources that included field experience, peer-reviewed research, and professional norm-settings entities in abortion and other areas of health care" and "conducted two internal, unpublished reviews of these sources." The reviews showed "a gap around abortion referrals in published research and resources," that, "coupled with some evidence that abortion referral behavior among health care professionals is often inadequate ... , suggests a conceptual model for abortion referral-making that can be implemented and evaluated can help."

Provide's model "proposes that referral behavior functions on a spectrum" that ranges from "passive" -- such as offering a list of area abortion providers -- "to an active, caring role," which "may include assistance scheduling an appointment, assistance in accessing supportive services such as transportation, childcare, and abortion funding or insurance, follow-up on service utilization and outcomes, and assessment of patient satisfaction with the referral and with the care received."

Meanwhile, the core competencies "are organized around the factors that influence referral-making identified in the conceptual model, and are located in the cognitive, affective, and skill-based domains," according to the paper. For example, cognitive competency means possession of "accurate up-to-date knowledge of abortion," such as "how poverty and marginalization affect access" and which local agencies provide financial or other assistance.

Conclusions

"Competent referral providers play a critical role in directing women to safe, appropriate care responding to a range of health needs," Zurek and colleagues write, adding that early results from their training program show "that competent referral providers can also help clear up common misperceptions and/or deliberate misinformation about the legality and safety of abortion, and can assist women with multiple or complex social and/or medical circumstances they face when accessing abortion care."

They call on health care professionals "to assess their current referral-making practices and be able to competently refer their patients and clients for abortion," including by "seek[ing] the knowledge and skills to do so, and mak[ing] a commitment to play their role in ensuring access to care."

Common Methods for Estimating Chlamydia Screening Rates Inaccurate, Study Finds

Wed, 11/26/2014 - 18:49

Inconsistent methods for calculating chlamydia screening rates have made it difficult to accurately assess how many women undergo annual testing, which is recommended for all sexually active women under age 26. In this study, University of Washington-Seattle researchers compared methods that rely on self-reports and insurance data, finding that neither method alone is sufficient to accurately estimate screening rates.

Common Methods for Estimating Chlamydia Screening Rates Inaccurate, Study Finds

November 26, 2014 —Summary of: "Estimating Chlamydia Screening Coverage: A Comparison of Self-Report and Health Care Effectiveness Data and Information Set Measures," Khosropour et al., Sexually Transmitted Diseases, November 2014.

Professional medical associations and U.S. government health organizations recommend that all sexually active women younger than age 26 undergo annual chlamydia screening, but "efforts to monitor the uptake of the testing recommendations have been problematic," according to a study by Christine Khosropour of the University of Washington-Seattle's Department of Epidemiology and colleagues.

The problems stem from "inconsistencies" in the definitions of and methods for calculating the sexually active population and the number of women who have had annual testing, the researchers explained. These inconsistencies have resulted in estimates of screening rates that "vary widely," they wrote.

Existing Estimation Methods

"[O]ne of the most widely used and cited methods" to estimate chlamydia testing rates is the Healthcare Effectiveness Data and Information Set (HEDIS) measure, which uses administrative and claims data from private and Medicaid health plans to estimate how many sexually active women undergo annual testing.

However, the HEDIS measure does not incorporate women who were tested out of plan and also "may misestimate the number of women who are truly sexually active and require screening," the researchers explained. To address this, CDC researchers use self-reported data from the National Survey of Family Growth when calculating their screening estimates, although the "validity of self-reported chlamydia testing has not been well studied," they noted.

Khosropour and colleagues developed a study that aimed to gauge the validity of both the HEDIS measure and self-reports for estimating chlamydia screening rates among sexually active women.

Study Methods

Beginning in July 2010, Khosropour and colleagues surveyed a random sample of women ages 18 to 25 who were enrolled in Group Health Cooperative, a managed care system in Washington state, in 2009. The survey consisted of a two-page, self-administered questionnaire that asked women about their demographics, sexual activity and use of health care services in 2009. The researchers also requested the women's permission to link their survey responses to their electronic medical records from Group Health Cooperative.

The researchers used the survey responses to gauge self-reported sexual activity and chlamydia testing, while the EMR databases were used to calculate the HEDIS measures of those factors.

Women with self-reported sexual activity included those who answered affirmatively to a survey question asking whether they had had vaginal intercourse with a man in 2009, while women were classified as meeting the HEDIS definition of sexual active "if they had diagnosis, prescription, or laboratory codes" from 2009 for services related to Pap testing, pelvic exams, contraception, pregnancy, or screening or treatment for a sexually transmitted infection.

Among women with self-reported sexual activity, the researchers compared rates of self-reported chlamydia testing and HEDIS-determined chlamydia testing, which was defined as women with at least one chlamydia test in their health record in 2009. They also compared rates of women who self-reported that they were sexually active and not tested with the HEDIS measure of untested women in this population.

Results

Out of an initial sample of 1,000 women, the analysis included 377 women who returned the questionnaire and agreed to grant access to their EMR data.

Of those, 269 (71%) self-reported being sexually active in 2009, including 142 (52.8%) who self-reported being tested for chlamydia, although only 108 had a chlamydia test in their record. In addition, 51 of the 269 women indicated that they were tested out of plan, but only 14 of them had a test noted in their record.

Meanwhile, based on the HEDIS definitions of sexual activity and testing, 239 of the 322 women were considered sexually active, 113 (47.3%) of whom were tested for chlamydia.

Discussion

The findings demonstrate "that, for different reasons, neither the HEDIS measure nor self-report is likely to be an accurate measure of chlamydial screening and suggest the need for new approaches to estimate population-level chlamydia screening coverage," according to the researchers.

When directly comparing respondents who both self-reported and were represented by HEDIS data, "HEDIS somewhat overestimated" the sexually active population, compared with the self-report figure, the researchers wrote. This "could lead to an underestimation of the proportion of women screened," they added, noting that the HEDIS measure classified nearly 40% of women who said they had not had sex as sexually active.

Another limitation of the HEDIS measure is that about one-fifth of sexually active respondents said they underwent chlamydia testing out of plan. Many of these women had no record of the test in their EMR, and about one-fourth "were excluded from the HEDIS estimate completely," the researchers wrote.

Meanwhile, nearly 30% of women whose medical records showed that they had been tested said that they had not been screened, "indicating that self-report is not a highly accurate approach for estimating population-level screening coverage," while 26% of those who said they had been tested in plan had no record of such tests in their record, according to the study. "This finding is particularly important for health care providers who rely on patient self-report to assess chlamydia testing history," the researchers wrote.

The researchers predicted that "estimates of chlamydia testing will likely become more accurate" as more people gain health insurance and data sharing across EMR systems improves.

"However, given the additional complexity of defining the sexually active population, the most appropriate method to estimate screening coverage almost certainly involves combining data sources to separately estimate the components of the screening coverage estimate," they wrote, concluding that doing so would enable implementation of "a standardized, population-based testing coverage estimate" that could "provide the best possible estimates of chlamydia screening coverage in the United States."

Parent-Daughter Communication Affects Teens' Likelihood of Discussing Abortion Decisions

Wed, 11/26/2014 - 18:49

Researchers at the University of Chicago examined the effect of parent-daughter communication about sexual health, pregnancy and abortion on teens' abortion decisions and whether they would tell their parents about those decisions. The researchers recommended efforts that focus on providing parents with the necessary tools to discuss sexual health with their daughters, rather than on parental involvement laws mandating such communication during pregnancy.

Parent-Daughter Communication Affects Teens' Likelihood of Discussing Abortion Decisions

November 26, 2014 —Summary of "Parent-Daughter Communication About Abortion Among Nonpregnant African-American Adolescent Females," Sisco et al., Journal of Adolescent Health, December 2014.

"[T]here is strong evidence associating parent-daughter communication [about sexual health] with improved sexual health outcomes such as less favorable attitudes toward risky sexual behaviors, higher rates of contraceptive use, avoidance of sexually transmitted infections (STIs), and effective communication with sexual partners" among nonpregnant teenagers, according to Katherine Sisco and colleagues at the University of Chicago's Department of Obstetrics and Gynecology. Further, they noted that evidence shows that parental communication and the perception of parental support affects whether adolescents will disclose suspected pregnancies to their parents.

By contrast, "there are no such data supporting the value of parent-daughter communication" for pregnant adolescents, the researchers wrote, adding that despite this lack of research, "most states legislate communication between abortion-seeking minors and their parent(s) via [parental involvement (PI)] laws." In fact, the researchers noted that "[s]tudies dating back to the 1980s and 1990s demonstrate that parents are often involved in a minor's decision to have an abortion independent of the legal requirement," but that when teenagers opt not to involve a parent, they often "cite fear of negative parental reactions, lack of or fragile relationships with parents, and desire to avoid parental pressure in the decision-making process."

The researchers conducted a study from May 2010 to March 2011 of "nonpregnant African-American adolescents to better understand parent-daughter communication about abortion."

Methods

For the study, the researchers reviewed "the extant literature ... to identify knowledge and knowledge gaps regarding African-American parent-daughter abortion communication." The researchers then identified and surveyed focus groups of 23 African-American girls ages 14 to 17. According to the study, the focus groups "primarily focused on [four] topics: language adolescents use to discuss abortion, parent-daughter communication, parental attitudes toward abortion, and cultural perspectives on abortion and abortion stigma."

The researchers used information gathered from the focus groups to create a survey that focused on four areas: sociodemographic characteristics; parental relationship variables; parental communication about abortion and sexual health; and parents' perceived attitudes of and reactions to adolescent sex, pregnancy and abortion. According to the study, survey participants were African American, nonpregnant, female adolescents, ages 14 to 17, recruited from three charter high schools in Chicago.

Results

The researchers assessed responses from 265 survey respondents. They found that while 75% of respondents reported having generally discussed sex with their main parent, just 43% said they talked specifically about abortion.

The study also found that:

~ 19.2% of respondents said they thought their parent "would hurt, punish, or kick them out of the house" if they became pregnant and decided to have an abortion, including 21.6% of those who had talked to their parent about abortion and 17.3% who had not;

~ 79.1% said they thought their parent would be supportive, provide monetary support or go along with them to an abortion clinic, including 75% of those who had spoken to their parent about abortion and 82.1% who had not; and

~ 24.7% of respondents said they would not voluntarily tell their parent if they decided to have an abortion, including 23.9% who had talked to their parent about abortion and 25.2% of those who had not.

Further, the researchers found that whether respondents had communicated with their parent about abortion "was significantly associated" with:

~ Having a mother who had experienced a teen pregnancy;

~ Being a supporter of abortion-rights;

~ Having talked about STIs or contraceptives with their parent; and

~ Whether they thought their parent would approve of adolescent sexual activity.

By contrast, the researchers found that discussing abortion with a parent was inversely associated with being experienced sexually or thinking a parent would be supportive of abortion decisions. The researchers wrote that communicating with a parent about abortion "was not significantly associated with parental monitoring or relationship satisfaction."

Discussion

The researchers wrote that the study "has important implications for PI laws," including that the"finding that the vast majority of youth would tell a parent appears to obviate the need for these laws" and how "almost a quarter of those who would not tell often had communicated about abortion and knew the risk that telling a parent would entail."

In addition, the study demonstrates the complexity of parent-daughter communication about sexual health, the researchers argued. Specifically, they wrote that such communication is "not associated with sexual experience" and that abortion communication in particular "is associated with a host of attitudes that the daughter herself holds or perceives to be held by her parent and parent-daughter relationship factors."

In summary, the findings "suggest that it would be prudent to focus efforts on giving parents and families the tools and resources to hold conversations about sexual and reproductive health with their nonpregnant daughters," while "[p]olicies that force communication at the time of abortion seem misplaced," the researchers concluded.

Attempt at County-Level Admitting Privileges Law Rejected in Ind.

Wed, 11/26/2014 - 18:34

An Indiana county council committee on Tuesday abandoned a proposed ordinance that would have required the county's only abortion provider to obtain admitting privileges at a nearby hospital, WNDU News reports.

Attempt at County-Level Admitting Privileges Law Rejected in Ind.

November 26, 2014 — An Indiana county council committee on Tuesday abandoned a proposed ordinance that would have required the county's only abortion provider to obtain admitting privileges at a nearby hospital, WNDU News reports.

The committee's decision means the bill will not be sent to the full St. Joseph's County Council for consideration.

A state law (SB 292) requires abortion providers to have either admitting privileges at a hospital or an agreement with a local medical provider who does (Gonzalez, WNDU News, 11/25). Providers who have agreements with another medical provider must report the provider's name to the state health department, which keeps the information confidential.

The proposed county ordinance would have required abortion providers to also report that information to the patient. Abortion providers also would have had to keep information on file with the county showing that they have admitting privileges. The county's sole abortion provider does not have such privileges, according to WSBT News (Stopczynski/Fillmore, WSBT News, 11/25).

Debate

At Tuesday's meeting, the committee did not hear public comments but listened to testimony from two medical professionals and a University of Notre Dame law professor.

American Association of Pro-Life Obstetricians and Gynecologists Executive Director Donna Harrison said the proposal was reasonable. Admitting privileges requirements are "one way to ensure patient safety," she said, adding that "[w]hoever is caring for the patient needs to have medical records available."

However, Ellyn Stecker, a family practice doctor who opposed the proposal, said that if women in the county had to travel elsewhere to obtain abortions because there were no nearby providers, it would "increase their cost" and "delay the obtaining of the abortion" (WNDU News, 11/25). She noted that first trimester abortions are "extremely safe" when performed "in certified facilities which is what we have here," adding that "every week that's added in the pregnancy will increase [a woman's] risk" (WSBT News, 11/25).


Wis. Family Planning Providers Say State Audits Appear Politically Motivated, Place Clinics at Risk

Wed, 11/26/2014 - 18:33

Safety-net family planning providers in Wisconsin and some state lawmakers say state audits alleging that two clinic operators overbilled Medicaid are politically motivated, the Wisconsin Center for Investigative Journalism/Green Bay Press Gazette reports.

Wis. Family Planning Providers Say State Audits Appear Politically Motivated, Place Clinics at Risk

November 26, 2014 — Safety-net family planning providers in Wisconsin and some state lawmakers say state audits alleging that two clinic operators overbilled Medicaid are politically motivated, the Wisconsin Center for Investigative Journalism/Green Bay Press Gazette reports.

Audit Details, Clinics' Response

In preliminary audit findings provided to the clinics in August, the state Department of Health Services' Office of Inspector General said the clinics overbilled the Medicaid 340B drug pricing program by $3.5 million, largely in claims for various contraceptives. Under the 340B program, pharmaceutical companies provide medications to safety-net providers at discounted prices. The federal government then reimburses the providers for 90% of the drug costs, while the state pays 10%.

Specifically, the audits said that Wausau-based Family Planning Health Services overbilled Medicaid by $2.3 million from 2010 to 2011, while Oconto-based NEWCAP overbilled the program by $1.2 million during the same time period. FPHS serves about 6,000 people annually in nine counties, while NEWCAP's Community Health Services division served about 3,500 people in six counties last year.

According to the WCIJ/Press Gazette, the audits challenged the reimbursement price for oral contraceptives. The clinics have noted that the price was set by the state itself and is used by other providers.

In addition, the state alleged that the providers entered some claims incorrectly and did not list proper medication invoice prices. However, the providers said they used the state's computerized claim entry system, which does not allow them to enter the prices.

Audits Put Clinics at Financial Risk

The clinics have said that if the state attempts to recoup the allegedly overbilled funds, they would be at serious financial risk and could have to close. The clinics have responded to the claims and are waiting for responses from the OIG. According to the WCIJ/Press Gazette, the clinics can appeal if they are sent notices of intent to recover the funds.

Because the family planning clinics are not fully reimbursed by Medicaid, the 340B program prevents them from losing money on services, explained Jennifer Waloway, NEWCAP's director of community health services. If the clinics were required to bill the way the audits suggest, their businesses would become unsustainable, she said, adding, "I don't understand how they can expect anybody to be sustainable in a business when all you can charge is [the] acquisition price [of the drug]. Nobody can run a business like that."

Beth Hartung, president of the Wisconsin Family Planning and Reproductive Health Association, said that if the state forces other family planning clinics that use the same Medicaid program to take the significantly lower reimbursements for contraceptives, "[i]t would mean, quite frankly, that we would all close."

Planned Parenthood of Wisconsin Public Policy Director Nicole Safar also called the audits potentially "clinic-closing," adding that she feels the providers were being targeted for political reasons. She said, "This is a very under-the-radar way to block access to birth control."

State Rep. Chris Taylor (D) and Sen. Dave Hansen (D) in a letter to the OIG last month wrote that "there appears to be no legal basis" for the audits' claims and asked the office to provide a list of all its open audits to demonstrate that it is not targeting women's health providers.

Taylor noted that Gov. Scott Walker's (R) administration and the Republican-controlled state Legislature have been "hostile to birth control," which makes her suspicious of the motives behind the audits. Walker effectively dissolved the state Family Planning Council, and five Planned Parenthood clinics in Wisconsin closed after lawmakers blocked funding to the organization.

OIG Responds

State DHS Inspector General Alan White said his office "has put a great deal of effort into improving program integrity, and (auditors) take it very seriously," adding that "protecting the taxpayers of Wisconsin is their predominant responsibility."

White would not say why the two clinics were chosen for the audits. However, DHS provided data showing that of the 3,950 open audits, 30 family planning audits are underway and only the audits for FPHS and NEWCAP involve the 340B program. White said, "Under no circumstances would this office be auditing a disproportionate share of providers targeting women" (Golden, Wisconsin Center for Investigative Journalism/Green Bay Press Gazette, 11/25).


FDA Calls for 'Black Box' Warning on Hysterectomy Device Over Cancer Concerns

Wed, 11/26/2014 - 18:08

FDA on Monday recommended an immediate "black box" warning for laparoscopic power morcellators, a surgical tool used to conduct hysterectomies that has been known to spread hidden cancers, the Wall Street Journal reports.

FDA Calls for 'Black Box' Warning on Hysterectomy Device Over Cancer Concerns

November 26, 2014 — FDA on Monday recommended an immediate "black box" warning for laparoscopic power morcellators, a surgical tool used to conduct hysterectomies that has been known to spread hidden cancers, the Wall Street Journal reports.

The black box warning is the strongest warning that the agency issues (Kamp/Levitz, Wall Street Journal, 11/24). However, FDA stopped short of issuing a marketwide recall of the devices, which some opponents of the tool had urged (McCullough, Philadelphia Inquirer, 11/25).

Background on Morcellation Debate

FDA's decision comes after months of debate on the use of laparoscopic power morcellation. The technique was developed as an alternative to invasive surgery for women with symptomatic uterine fibroids, which are responsible for about 40% of the 500,000 hysterectomies performed each year in the U.S.

The technique uses a power device to grind uterine tissue so it can be removed through a tiny incision. Until recently, the device was used in about 50,000 procedures annually in the U.S.

However, laparoscopic power morcellation came under fire for its potential to spread a type of cancer --known as a uterine sarcoma -- within the body. A study published earlier this year in JAMA estimated that one in 368 women undergoing morcellation had uterine cancer that was undetected until after the procedure.

In April, FDA issued a safety communication notice discouraging the use of the procedure (Women's Health Policy Report, 7/24).

FDA Warning

The latest decision from FDA is an upgrade of the April safety notice. Specifically, the agency now says that "doctors should not use the devices... for performing a hysterectomy or removing uterine fibroids 'in the vast majority of women'" (Johnson, AP/U-T San Diego, 11/24).

FDA said the boxed warnings on the devices should inform health care providers that "uterine tissue may contain unsuspected cancer." The warning also says, "The use of laparoscopic power morcellators during fibroid surgery may spread cancer and decrease the long-term survival of patients. This information should be shared with patients when considering surgery with the use of these devices" (FDA release, 11/24).

In addition, the recommended label includes two "contraindications" outlining two specific cases in which morcellators should not be used. Namely, the label recommends against morcellation for women who are in menopause or close to menopause and whose fibroid tissue could be removed through the vagina or through a mini-laparotomy incision, as well as when the tissue that would be morcellated is suspected to be cancerous (Grady, New York Times, 11/24).

Comments and Impact

Commenting on the upgraded warning, William Maisel, chief scientist at the FDA's Center for Devices and Radiological Health, said, "The recommendations we're making today, we believe, are in the best interest of patients," adding that the recommendations "put appropriate restrictions on the use of laparoscopic power morcellation" (Dennis, "To Your Health," Washington Post, 11/24).

The recommendation does not discuss the use of a bag to catch stray cancer cells during morcellation, a method that some doctors say makes the procedure safer. However, Maisel warns that the bags limit what surgeons are able to see during the procedure, presenting problems of their own.

Moreover, FDA's action does not remove morcellators from the market or prohibit their use. Johnson & Johnson has already recalled its morcellation devices voluntarily, but some small manufacturers continue to sell it (New York Times, 11/24).

The American College of Obstetricians and Gynecologists commended the FDA's decision not to ban the device, saying in a statement, "We continue to believe that power morcellation has a role in gynecologic surgery."

Meanwhile, Hooman Noorchashm, a surgeon who has led the opposition to the device, has called for an outright ban on morcellation and a recall of all devices. He argued that the latest warning does not do enough to protect women like his wife, who was diagnosed with stage 4 cancer after morcellation was used during her hysterectomy (Weintraub, USA Today, 11/24).


Wis. Family Planning Providers Say State Audits Appear Politically Motivated, Place Clinics at Risk

Wed, 11/26/2014 - 18:08

Safety-net family planning providers in Wisconsin and some state lawmakers say state audits alleging that two clinic operators overbilled Medicaid are politically motivated, the Wisconsin Center for Investigative Journalism/Green Bay Press Gazette reports.

Wis. Family Planning Providers Say State Audits Appear Politically Motivated, Place Clinics at Risk

November 26, 2014 — Safety-net family planning providers in Wisconsin and some state lawmakers say state audits alleging that two clinic operators overbilled Medicaid are politically motivated, the Wisconsin Center for Investigative Journalism/Green Bay Press Gazette reports.

Audit Details, Clinics' Response

In preliminary audit findings provided to the clinics in August, the state Department of Health Services' Office of Inspector General said the clinics overbilled the Medicaid 340B drug pricing program by $3.5 million, largely in claims for various contraceptives. Under the 340B program, pharmaceutical companies provide medications to safety-net providers at discounted prices. The federal government then reimburses the providers for 90% of the drug costs, while the state pays 10%.

Specifically, the audits said that Wausau-based Family Planning Health Services overbilled Medicaid by $2.3 million from 2010 to 2011, while Oconto-based NEWCAP overbilled the program by $1.2 million during the same time period. FPHS serves about 6,000 people annually in nine counties, while NEWCAP's Community Health Services division served about 3,500 people in six counties last year.

According to the WCIJ/Press Gazette, the audits challenged the reimbursement price for oral contraceptives. The clinics have noted that the price was set by the state itself and is used by other providers.

In addition, the state alleged that the providers entered some claims incorrectly and did not list proper medication invoice prices. However, the providers said they used the state's computerized claim entry system, which does not allow them to enter the prices.

Audits Put Clinics at Financial Risk

The clinics have said that if the state attempts to recoup the allegedly overbilled funds, they would be at serious financial risk and could have to close. The clinics have responded to the claims and are waiting for responses from the OIG. According to the WCIJ/Press Gazette, the clinics can appeal if they are sent notices of intent to recover the funds.

Because the family planning clinics are not fully reimbursed by Medicaid, the 340B program prevents them from losing money on services, explained Jennifer Waloway, NEWCAP's director of community health services. If the clinics were required to bill the way the audits suggest, their businesses would become unsustainable, she said, adding, "I don't understand how they can expect anybody to be sustainable in a business when all you can charge is [the] acquisition price [of the drug]. Nobody can run a business like that."

Beth Hartung, president of the Wisconsin Family Planning and Reproductive Health Association, said that if the state forces other family planning clinics that use the same Medicaid program to take the significantly lower reimbursements for contraceptives, "[i]t would mean, quite frankly, that we would all close."

Planned Parenthood of Wisconsin Public Policy Director Nicole Safar also called the audits potentially "clinic-closing," adding that she feels the providers were being targeted for political reasons. She said, "This is a very under-the-radar way to block access to birth control."

State Rep. Chris Taylor (D) and Sen. Dave Hansen (D) in a letter to the OIG last month wrote that "there appears to be no legal basis" for the audits' claims and asked the office to provide a list of all its open audits to demonstrate that it is not targeting women's health providers.

Taylor noted that Gov. Scott Walker's (R) administration and the Republican-controlled state Legislature have been "hostile to birth control," which makes her suspicious of the motives behind the audits. Walker effectively dissolved the state Family Planning Council, and five Planned Parenthood clinics in Wisconsin closed after lawmakers blocked funding to the organization.

OIG Responds

State DHS Inspector General Alan White said his office "has put a great deal of effort into improving program integrity, and (auditors) take it very seriously," adding that "protecting the taxpayers of Wisconsin is their predominant responsibility."

White would not say why the two clinics were chosen for the audits. However, DHS provided data showing that of the 3,950 open audits, 30 family planning audits are underway and only the audits for FPHS and NEWCAP involve the 340B program. White said, "Under no circumstances would this office be auditing a disproportionate share of providers targeting women" (Golden, Wisconsin Center for Investigative Journalism/Green Bay Press Gazette, 11/25).


Comprehensive Middle School Sex Education Can Help Delay Sexual Debut, Researchers Find

Wed, 11/26/2014 - 17:22

In this study, researchers assessed how a comprehensive middle school sex education program that incorporates family activities would affect students' sexual debut and whether the family component would improve the program's effectiveness. The researchers examined Planned Parenthood League of Massachusetts' Get Real: Comprehensive Sex Education That Works program and found that it can delay vaginal sex among boys and girls and that the family component was particularly significant for boys.

Comprehensive Middle School Sex Education Can Help Delay Sexual Debut, Researchers Find

November 26, 2014 —Summary of "Protective Effects of Middle School Comprehensive Sex Education With Family Involvement," Grossman et al., Journal of School Health, November 2014.

Sex education in middle school "can play an important protective role, as beginning sex education before teens have sex is critical in effectively reducing risky sexual behavior," according to Jennifer Grossman, a research scientist at Wellesley College, and colleagues.

However, Grossman and her co-authors noted that research on middle school sex education programs has shown "mixed findings for their effectiveness in delaying sex for early adolescents," as well as different effects for boys and girls. Further, research into middle school sex education "seldom assess[es] the unique contribution of family activities to the overall effectiveness of school-based sex education interventions."

For their study, Grossman and colleagues examined "whether a 3-year comprehensive sex education program for middle school students that includes family activities is associated with delaying vaginal sex, and whether the family component contributes to its effectiveness."

The researchers evaluated the Get Real: Comprehensive Sex Education That Works program, which is a comprehensive middle school sex education curriculum designed to delay sexual intercourse and provide students with "medically accurate information about protection." According to the study, the program was developed by the Planned Parenthood League of Massachusetts and "designates parents as the primary sexuality educators of their children."

Methods

The researchers surveyed a total of 2,453 students at three "time points: beginning of Grade 6 (baseline, starting in 2009), beginning of Grade 7, and end of Grade 8 (completed by 2012)." Overall, 56% of the students completed surveys in all three years, while 44% either left the area before completing all three surveys or joined after the baseline survey had been administered.

The students lived in the Boston area and attended 13 public schools, nine charter schools and two private schools that were randomly divided into treatment and comparison groups. Educators who received training from the Get Real curriculum developer taught that program in treatment schools, while comparison schools continued to teach the sex education programs they currently had in place.

The researchers assessed students' reported sexual activity, individual and family demographics, income levels, academic performance, strength of parent or guardian relationships, social desirability, Get Real attendance ("dosage") and family participation in Get Real activities.

The researchers used multiple-group logistic regression to evaluate differences in sexual debut between the treatment and comparison groups. They noted that they analyzed data on boys and girls separately for several reasons, including that boys' and girls' experiences might differ because of physiological changes during adolescence and because significantly more boys than girls reported having had sex by the beginning of sixth grade.

Results

There were no significant differences between the groups in reported levels of sexual activity at baseline.

The researchers found that the "adjusted rate of sexual debut (or the implied likelihood of sexual debut) for girls in the treatment group, 22.4%, [was] 15% lower than the adjusted rate for girls in the comparison group, 26.3%." Similarly, they found that the adjusted rate of sexual debut for boys in the treatment group (33.2%) was 16% lower than the adjusted rate for boys in the comparison group (39.6%).

According to the study, neither attendance nor family activity had a statistically significant effect among girls either within the treatment group or when comparing the treatment and comparison groups. However, the study found that completing family activities during sixth grade was statistically significant for boys and that "the overall effect of participating in Get Real remain[ed] statistically significant for both girls and boys" in both models.

Discussion

The demonstrated benefits for both boys and girls "sugges[t] that a theory-based program that provides developmentally appropriate information and builds skills to negotiate healthy relationships can delay sexual debut for middle school students," the researchers wrote. They noted that "early support for family communication was particularly critical for boys' sexual health." According to the researchers, "Get Real may promote change in both the starting point and frequency of conversations about sex between boys and their families."

The researchers continued that while dosage did not have a significant effect on either boys or girls, "the lack of statistical significance may reflect how dosage was modeled, namely estimating the effect of each lesson attended," rather than the "protective cumulative influence over the 3 years."

Conclusion

In summary, the researchers wrote that their "results support other findings that early sex education interventions are important for protecting youth from the negative health and academic consequences of early sexual debut."

The researchers also noted that "state policies vary in their requirements for sex education," despite "research documenting the effectiveness of comprehensive sex education programs" and "high levels of parent support for comprehensive sex education." They wrote, "Greater connection between research, policy, and practice can help to support programs with actual potential to reduce adolescents' risky sexual behavior."

Women's Health Policy Report Will Not Publish on Nov. 27, 28

Wed, 11/26/2014 - 16:59

The Women's Health Policy Report will not publish on Thursday, Nov. 27, and Friday, Nov. 28, in observance of Thanksgiving. The report resumes publication on Monday, Dec. 1.

Women's Health Policy Report Will Not Publish on Nov. 27, 28

November 26, 2014 — The Women's Health Policy Report will not publish on Thursday, Nov. 27, and Friday, Nov. 28, in observance of Thanksgiving. The report resumes publication on Monday, Dec. 1.

Lame Duck is 'Perfect Opportunity' for 'Commonsense Progress for Women,' Op-Ed States

Wed, 11/26/2014 - 15:37

The midterm election results showed that "one thing is abundantly clear -- despite the losses Democrats faced, women's healthcare received sweeping, bipartisan support," writes Dana Singiser, vice president of public policy and government affairs for the Planned Parenthood Federation of America, in The Hill's "Congress Blog."

Lame Duck is 'Perfect Opportunity' for 'Commonsense Progress for Women,' Op-Ed States

November 26, 2014 — The midterm election results showed that "one thing is abundantly clear -- despite the losses Democrats faced, women's healthcare received sweeping, bipartisan support," writes Dana Singiser, vice president of public policy and government affairs for the Planned Parenthood Federation of America, in The Hill's "Congress Blog."

Singiser notes that because of conservative candidates' moderate platforms on women's health, "1/3 of voters who support access to abortion voted for Republicans this year, and voters rejected so-called 'personhood' measures in North Dakota and Colorado." Singiser adds, "Now these voters expect their elected officials to govern as moderates, and keep the government out of women's personal health care decisions."

Four 'Key Opportunities'

In light of that expectation, Singiser outlines four "key opportunities" that Congress can take during the lame-duck session "to make commonsense progress for women in a bipartisan manner consistent with the message of voters in this election."

Specifically, Singiser calls on Congress to "fund family planning and cancer screenings for low-income women" by "includ[ing] a minimum of $300 million in funding for [the Title X Family Planning Program] in any omnibus appropriations legislation"; address "America's teen pregnancy epidemic" by designating "a minimum of $101 million to the Teen Pregnancy Prevention Program"; "stand behind ... service members by including language in the defense authorization bill to provide contraception coverage for all military personnel and their dependents"; and "provide equitable abortion coverage to Peace Corps volunteers ... in a final FY15 omnibus bill."

"Moderates were elected, and the public expects moderates to govern on these issues and others in 2015," Singiser writes, adding, "The lame duck session is the perfect opportunity to show Americans that it's possible" (Singiser, "Congress Blog," The Hill, 11/21).


Attempt at County-Level Admitting Privileges Law Rejected in Ind.

Wed, 11/26/2014 - 15:32

An Indiana county council committee on Tuesday abandoned a proposed ordinance that would have required the county's only abortion provider to obtain admitting privileges at a nearby hospital, WNDU News reports.

Attempt at County-Level Admitting Privileges Law Rejected in Ind.

November 26, 2014 — An Indiana county council committee on Tuesday abandoned a proposed ordinance that would have required the county's only abortion provider to obtain admitting privileges at a nearby hospital, WNDU News reports.

The committee's decision means the bill will not be sent to the full St. Joseph's County Council for consideration.

A state law (SB 292) requires abortion providers to have either admitting privileges at a hospital or an agreement with a local medical provider who does (Gonzalez, WNDU News, 11/25). Providers who have agreements with another medical provider must report the provider's name to the state health department, which keeps the information confidential.

The proposed county ordinance would have required abortion providers to also report that information to the patient. Abortion providers also would have had to keep information on file with the county showing that they have admitting privileges. The county's sole abortion provider does not have such privileges, according to WSBT News (Stopczynski/Fillmore, WSBT News, 11/25).

Debate

At Tuesday's meeting, the committee did not hear public comments but listened to testimony from two medical professionals and a University of Notre Dame law professor.

American Association of Pro-Life Obstetricians and Gynecologists Executive Director Donna Harrison said the proposal was reasonable. Admitting privileges requirements are "one way to ensure patient safety," she said, adding that "[w]hoever is caring for the patient needs to have medical records available."

However, Ellyn Stecker, a family practice doctor who opposed the proposal, said that if women in the county had to travel elsewhere to obtain abortions because there were no nearby providers, it would "increase their cost" and "delay the obtaining of the abortion" (WNDU News, 11/25). She noted that first trimester abortions are "extremely safe" when performed "in certified facilities which is what we have here," adding that "every week that's added in the pregnancy will increase [a woman's] risk" (WSBT News, 11/25).


Featured Blogs

Tue, 11/25/2014 - 17:52

"Ohio Republicans Use Extreme Measures To Advance Radical Six Week Abortion Ban" (Culp-Ressler, "ThinkProgress," Center for American Progress, 11/21); "Nevada Teen Rallies Students To Fight for Comprehensive Sex Ed" (Ramirez, Care2, 11/22).

November 25, 2014

FEATURED BLOG

"Ohio Republicans Use Extreme Measures To Advance Radical Six Week Abortion Ban," Tara Culp-Ressler, Center for American Progress' "ThinkProgress": Culp-Ressler discusses how "Republican lawmakers in Ohio pulled out all the stops to advance an extreme anti-abortion bill [HB 248] in the state's lame duck session" that would ban abortion once a fetal heartbeat is detectable, which can be as early as six weeks of pregnancy. She points out that the lawmakers "added the legislation to the schedule at the last minute ... and even restructured a House committee -- replacing the legislators who oppose the measure with different legislators who support it -- to ensure the bill's passage." Culp-Ressler notes that, as has been the case in several other states, Ohio abortion-rights opponents are split over the measure, with some "argu[ing] it's better to advance an incremental strategy to limit access to abortion that won't trigger immediate court challenges." Meanwhile, "[r]eproductive rights groups are frustrated that abortion opponents would waste taxpayer dollars on risking a lawsuit," Culp-Ressler writes (Culp-Ressler, "ThinkProgress," Center for American Progress, 11/21).

What others are saying about abortion restrictions:

~ "Anti-Choice Activists in Alabama Equate Abortion Clinics With Sex Offenders," Culp-Ressler, Center for American Progress' "ThinkProgress."

~ "What It's Like To Run the Only Abortion Clinic in Your State," Robin Marty, Cosmopolitan.

FEATURED BLOG

"Nevada Teen Rallies Students To Fight for Comprehensive Sex Ed," Ximena Ramirez, Care2: Ramirez writes about Caitlyn Caruso, a high school student who "rallied her classmates to demand a comprehensive and medically accurate [sex education] curriculum" in a Nevada school where students "overwhelmingly reported" that their current sex education course was "'extremely vague and too conservative.'" Caruso, a sexual assault survivor, "believes that sex ed programs need to address identity formation, healthy relationships, and ways to prevent rape and sexual assault in addition to contraception," Ramirez writes. Ramirez adds that Caruso has also formed the Nevada Teen Health & Safety Coalition, which shares "compelling videos," that support "comprehensive, medically accurate, and age appropriate" sex education (Ramirez, Care2, 11/22).


Abortion-Rights Opponents Push Bill To Close Sole North Ala. Clinic

Tue, 11/25/2014 - 17:46

A group of abortion-rights opponents in Huntsville, Ala., aims to close North Alabama's only abortion clinic through legislative efforts after a judge dismissed the group's lawsuit against the clinic, the Huntsville Times reports.

Abortion-Rights Opponents Push Bill To Close Sole North Ala. Clinic

November 25, 2014 — A group of abortion-rights opponents in Huntsville, Ala., aims to close North Alabama's only abortion clinic through legislative efforts after a judge dismissed the group's lawsuit against the clinic, the Huntsville Times reports (Lawson, Huntsville Times, 11/23).

Background

The Huntsville Women's Clinic in October reopened in a new location after closing in June because its old location did not comply with a state law (HB 57) that requires abortion clinics to meet the same building standards as ambulatory surgical centers (Women's Health Policy Report, 10/24).

The Christian Coalition of Alabama filed suit against the clinic, arguing that it should not be allowed to open unless it applies to be zoned as a surgical center. According to the Times, the clinic was granted a zoning variance previously given to other medical clinics in that space.

Madison County Circuit Judge Alan Mann last week denied CCA's request for a temporary injunction and dismissed the case. He said the plaintiffs did not have standing to bring the lawsuit because none of them were affected by the clinic's location. Mann also found that the zoning board acted in its normal capacity when it zoned the clinic.

CCA Pushes School Zoning Bill

James Henderson, executive director of CCA, said it was unlikely that his organization would appeal the ruling. Instead, Henderson, who is also a member of the Alabama Republican Party's executive committee, said the group will ask local lawmakers to support a measure that would require a 2,000-foot minimum barrier between a school and an abortion clinic.

According to the Times, the clinic is located "almost directly across" from a school.

Henderson said David Byrne, chief legal adviser for Gov. Robert Bentley (R), has encouraged the school-barrier effort. In a letter provided to the Times, Byrne wrote that he told Henderson in June he would be "happy to assist" lawmakers "closely associated with" CCA to pre-file any legislation for 2015. However, Byrne in the letter also noted the Governor's Legal Office is prohibited from doing legal work for a private group, according to the Times (Huntsville Times, 11/23).


Studies: Violence Against Women, Girls a Worldwide 'Problem of Epidemic Proportions'

Tue, 11/25/2014 - 17:22

Violence against women and girls is a "global public health and clinical problem of epidemic proportions," and countries need to enact significant policy and financial changes to help curb such violence, according to a five-part series of studies published in The Lancet, Time reports.

Studies: Violence Against Women, Girls a Worldwide 'Problem of Epidemic Proportions'

November 25, 2014 — Violence against women and girls is a "global public health and clinical problem of epidemic proportions," and countries need to enact significant policy and financial changes to help curb such violence, according to a five-part series of studies published in The Lancet, Time reports (Alter, Time, 11/21).

Key Findings

According to the series, one in three women worldwide have experienced physical or sexual violence by a partner, and 7% of women are assaulted during their lifetimes by a non-partner.

In addition, between 100 million and 140 million women and girls have been subjected to female genital mutilation, and more than three million African girls are at risk of FGM annually. Further, about 70 million girls have been married before age 18, according to the series.

WHO's Claudia Garcia-Moreno and colleagues wrote, "The full extent of abuse is even greater, with multiple different forms of violence around the world often remaining uncounted and under-researched" (Boseley, The Guardian, 11/20).

Causes, Impact of VAW

The series noted that a large portion of existing research on violence against women has focused on response, rather than prevention, and on high-income countries. The researchers found that a lack of gender equality is a key contributor to violence against women in low- and middle-income countries.

They added that the root causes of such inequality, including the economic, educational and political marginalization of women, must be addressed to decrease violence against women (Time, 11/21). They also said more needs to be done to address other root causes of violence, including wars and humanitarian crises (Bushak, "The Grapevine," Medical Daily, 11/22).

Meanwhile, Garcia-Moreno said in a statement that the findings demonstrate that health care providers are "missing important opportunities to integrate violence programming meaningfully into public health initiatives on HIV/AIDS, adolescent health, maternal health, and mental health" (Time, 11/21). WHO added the series shows that "[d]espite increased global attention to violence perpetrated against women and girls, and recent advances in knowledge about how to tackle these abuses, levels of violence against women ... remain unacceptably high, with serious consequences for victims' physical and mental health."

Recommendations

The series' authors provided five key recommendations to reduce violence against women.

The authors said that governments worldwide should allocate additional funding to protect survivors and prioritize raising awareness about violence against women; change laws and policies that contribute to gender inequality, such as virginity tests; put more effort toward combatting negative cultural mindsets about women; do more to promote education, health, security and justice; and fund further research on effective ways to prevent and respond to violence against women ("The Grapevine," Medical Daily, 11/22).

Series co-leader Charlotte Watts said, "No magic wand will eliminate violence against women and girls. But evidence tells us that changes in attitudes and behavior are possible, and can be achieved within less than a generation" (Time, 11/21).


Blogs Comment on 'Radical Six Week Abortion Ban,' Localization of 'Personhood' Movement, More

Tue, 11/25/2014 - 17:22

Read the week's best commentaries from bloggers at the Center for American Progress, RH Reality Check and more.

Blogs Comment on 'Radical Six Week Abortion Ban,' Localization of 'Personhood' Movement, More

November 25, 2014 — Read the week's best commentaries from bloggers at the Center for American Progress, RH Reality Check and more.

ABORTION RESTRICTIONS: "Ohio Republicans Use Extreme Measures To Advance Radical Six Week Abortion Ban," Tara Culp-Ressler, Center for American Progress' "ThinkProgress": Culp-Ressler discusses how "Republican lawmakers in Ohio pulled out all the stops to advance an extreme anti-abortion bill [HB 248] in the state's lame duck session" that would ban abortion once a fetal heartbeat is detectable, which can be as early as six weeks of pregnancy. She points out that the lawmakers "added the legislation to the schedule at the last minute ... and even restructured a House committee -- replacing the legislators who oppose the measure with different legislators who support it -- to ensure the bill's passage." Culp-Ressler notes that, as has been the case in several other states, Ohio abortion-rights opponents are split over the measure, with some "argu[ing] it's better to advance an incremental strategy to limit access to abortion that won't trigger immediate court challenges." Meanwhile, "[r]eproductive rights groups are frustrated that abortion opponents would waste taxpayer dollars on risking a lawsuit," Culp-Ressler writes (Culp-Ressler, "ThinkProgress," Center for American Progress, 11/21).

What others are saying about abortion restrictions:

~ "Anti-Choice Activists in Alabama Equate Abortion Clinics With Sex Offenders," Culp-Ressler, Center for American Progress' "ThinkProgress."

~ "What It's Like To Run the Only Abortion Clinic in Your State," Robin Marty, Cosmopolitan.

ANTIABORTION-RIGHTS MOVEMENT: "'Personhood' Leader: Localize the Fight Against Abortion Rights," Jason Salzman, RH Reality Check: After voters recently rejected "personhood" measures in Colorado and North Dakota, Personhood Alliance Policy Director Gualberto Garcia Jones is urging other abortion-rights opponents to "forgo statewide votes and place personhood proposals on municipal ballots," Salzman writes. According to Salzman, "ardent anti-abortion activists from around the country" launched the Personhood Alliance "to insert anti-choice language in local 'ordinances and codes'" and cite "local efforts in Alabama, New Hampshire, and Mississippi as examples of what its future activism might look like." However, Salzman notes that "[p]ro-choice activists" -- such as Cathy Alderman, vice president of public affairs for Planned Parenthood of the Rocky Mountains, and Cristina Aguilar, executive director of the Colorado Organization for Latina Opportunity and Reproductive Rights -- "said they are preparing for the ultra-local fight about to be waged by personhood extremists, and they're confident that voters will strike down ballot initiatives in municipalities as readily as they did on the state level" (Salzman, RH Reality Check, 11/24).

SEX EDUCATION: "Nevada Teen Rallies Students To Fight for Comprehensive Sex Ed," Ximena Ramirez, Care2: Ramirez writes about Caitlyn Caruso, a high school student who "rallied her classmates to demand a comprehensive and medically accurate [sex education] curriculum" in a Nevada school where students "overwhelmingly reported" that their current sex education course was "'extremely vague and too conservative.'" Caruso, a sexual assault survivor, "believes that sex ed programs need to address identity formation, healthy relationships, and ways to prevent rape and sexual assault in addition to contraception," Ramirez writes. Ramirez adds that Caruso has also formed the Nevada Teen Health & Safety Coalition, which shares "compelling videos," that support "comprehensive, medically accurate, and age appropriate" sex education (Ramirez, Care2, 11/22).

SUPPORTING PREGNANCY DECISIONS: "U.S. Law and Policy Should Uphold and Support a Woman's Personal Decisions About Her Pregnancy," Ann Starrs, Huffington Post blogs: An upcoming Supreme Court case examining whether UPS "violated the 1978 Pregnancy Discrimination Act [PL 95-555]" by "fail[ing] to make reasonable accommodation for a pregnant employee" highlights "the often hostile legal and policy environment U.S. women confront on issues surrounding pregnancy," writes Starrs, president and CEO of the Guttmacher Institute. Starrs writes, "Rather than making it more difficult for women to achieve their pregnancy goals, U.S. law and regulations should" implement "policies that allow women and their partners to decide whether and when to become pregnant, to have healthy pregnancies, to raise their families with dignity, and to obtain abortion care to end an unwanted pregnancy." Specifically, Starrs calls on courts and federal and state lawmakers to ensure women are provided "with the contraceptive services, counseling and supplies they need," have "access to affordable, timely and safe abortion care" and -- if they chose to become pregnant -- "are reasonably accommodated by their employers without sacrificing their economic security" (Starrs, Huffington Post blogs, 11/24).

SEXUAL AND GENDER-BASED VIOLENCE: "Why I Never Reported My Sexual Assault," Talia Lavin, Huffington Post blogs: "In recent days, media outlets of every description have been engaged in a long-overdue conversation about rape and sexual assault" because of an "explosion of [sexual assault] allegations against Bill Cosby," but the coverage has also included "backlash ... against Cosby's alleged victims," Lavin writes. She notes, "This all-too-familiar combination -- recrimination for delays in coming forward, coupled with doubt and vitriol -- comes along with the same tired scrutiny of their every action (why did she go to his hotel room? Why did she take a drink, and pills, that he offered her?)" that results in "only 26% of sexual assaults" being "reported to authorities" and just "3 out of every 100 rapes" resulting in conviction. Noting that concerns about such backlash kept her from sharing her own sexual assault story, Lavin notes that sexual assault survivors can "regain some of that sovereignty over [their] own voice[s]" by sharing their stories and by being believed (Lavin, Huffington Post blogs, 11/24).

What others are saying about sexual and gender-based violence:

~ "Map: How Long Does Your State Give Rape Survivors To Pursue Justice?" Jordan Smith/AJ Vicens, Mother Jones.

~ "What Bill Cosby and the University of Virginia Can Teach Us," Jennifer Williams, Ms. Magazine blog.


Abortion-Rights Opponents Push Bill To Close Sole North Ala. Clinic

Tue, 11/25/2014 - 17:21

A group of abortion-rights opponents in Huntsville, Ala., aims to close North Alabama's only abortion clinic through legislative efforts after a judge dismissed the group's lawsuit against the clinic, the Huntsville Times reports.

Abortion-Rights Opponents Push Bill To Close Sole North Ala. Clinic

November 25, 2014 — A group of abortion-rights opponents in Huntsville, Ala., aims to close North Alabama's only abortion clinic through legislative efforts after a judge dismissed the group's lawsuit against the clinic, the Huntsville Times reports (Lawson, Huntsville Times, 11/23).

Background

The Huntsville Women's Clinic in October reopened in a new location after closing in June because its old location did not comply with a state law (HB 57) that requires abortion clinics to meet the same building standards as ambulatory surgical centers (Women's Health Policy Report, 10/24).

The Christian Coalition of Alabama filed suit against the clinic, arguing that it should not be allowed to open unless it applies to be zoned as a surgical center. According to the Times, the clinic was granted a zoning variance previously given to other medical clinics in that space.

Madison County Circuit Judge Alan Mann last week denied CCA's request for a temporary injunction and dismissed the case. He said the plaintiffs did not have standing to bring the lawsuit because none of them were affected by the clinic's location. Mann also found that the zoning board acted in its normal capacity when it zoned the clinic.

CCA Pushes School Zoning Bill

James Henderson, executive director of CCA, said it was unlikely that his organization would appeal the ruling. Instead, Henderson, who is also a member of the Alabama Republican Party's executive committee, said the group will ask local lawmakers to support a measure that would require a 2,000-foot minimum barrier between a school and an abortion clinic.

According to the Times, the clinic is located "almost directly across" from a school.

Henderson said David Byrne, chief legal adviser for Gov. Robert Bentley (R), has encouraged the school-barrier effort. In a letter provided to the Times, Byrne wrote that he told Henderson in June he would be "happy to assist" lawmakers "closely associated with" CCA to pre-file any legislation for 2015. However, Byrne in the letter also noted the Governor's Legal Office is prohibited from doing legal work for a private group, according to the Times (Huntsville Times, 11/23).


Bill Overhauling Campus Sexual Assault Rules Unlikely To See Action in Lame Duck Session

Tue, 11/25/2014 - 15:22

Although legislation changing how college campuses handle sexual assault investigations is unlikely to see congressional action by the end of the year, supporters are optimistic about its chances in 2015, CQ Roll Call reports.

Bill Overhauling Campus Sexual Assault Rules Unlikely To See Action in Lame Duck Session

November 25, 2014 — Although legislation changing how college campuses handle sexual assault investigations is unlikely to see congressional action by the end of the year, supporters are optimistic about its chances in 2015, CQ Roll Call reports.

Sen. Claire McCaskill (D-Mo.) has authored legislation (S 2692) that would require all colleges to use the same disciplinary procedures when handling sexual assault cases. The legislation also would allow the Department of Education to fine schools that do not comply with federal regulations regarding such incidents.

McCaskill said the bill has "such a good group of bipartisan co-sponsors" that she is not concerned about a lack of further action on it this year. She added, "I believe we've done the really hard work of getting the agreement of a number of Republicans before we filed the bill. So I feel pretty good about it moving forward in the new Congress." McCaskill noted that she is also working to make a few "improvements" to the bill, but that the "basics will be the same."

American Association of University Women Vice President of Government Relations Lisa Maatz added that advocates are involving the bill's Republican co-sponsors in the modifications to ensure they still support it. For example, Sen. Lamar Alexander (R-Tenn.), who before criticized the measure, said this week that he has been working with McCaskill "for several months" to ensure the new rules would be effective and not duplicative. Maatz noted, "There are some powerful people on both sides who want it to get done."

Further, some advocates have said they would like to postpone action on the bill until they can assess how colleges and universities are responding to updated rules on campus sexual assault included in the Violence Against Women Act (PL 113-4). Maatz said lawmakers should assess the impact of those changes before updating the bill (Phenicie, CQ Roll Call, 11/24).