In an editorial in the Journal of Adolescent Health, Tessa Madden of Washington University in St. Louis' School of Medicine outlines recent research demonstrating how increased uptake of long-acting reversible contraceptives (LARC) -- including intrauterine devices (IUDs) and implants -- could help reduce pregnancies among adolescents. She urges providers to follow the American College of Obstetricians and Gynecologists' recommendation that LARC be offered to all adolescents "as first-line contraceptives." To address rapid repeat pregnancy in particular, she calls for the creation of guidelines on prenatal and postpartum contraceptive counseling for teens, as well as immediate postpartum placement of IUDs and implants.

Editorial Stresses Potential of Long-Acting Removable Contraceptives To Prevent Teen Pregnancy

March 28, 2013 — "Long-Acting Removable Contraceptives Prevent Teen Pregnancy," Madden, Journal of Adolescent Health, March 2013.

In an editorial, Tessa Madden of the Washington University in St. Louis School of Medicine's Department of Obstetrics and Gynecology summarizes recent research demonstrating the potential of long-acting reversible contraceptives (LARC) to reduce teen pregnancy in the U.S. LARC methods available in the U.S. include two intrauterine devices (IUDs) and the etonogestrel implant, she notes, adding that IUDs and implants "are the most effective methods to prevent pregnancy, with typical failure rates of [less than] 1%."

Madden notes that despite declines in the U.S. teen birth rate in the past two decades, 329,979 live births occurred to teens in 2011. Further, 12% to 49% of teens who give birth become pregnant again in one year, she writes, adding that "rapid repeat pregnancy is associated with adverse socioeconomic outcomes."

The American College of Obstetricians and Gynecologists recommends that providers offer LARC as a first-line contraceptive option for all adolescents. However, "adolescents more commonly use shorter-acting contraceptive methods with higher typical-use failure rates, such as oral contraceptive pills and condoms," Madden writes.

Recent Studies on Adolescent LARC Use

Madden cites a study in the March issue of the Journal of Adolescent Health by Wilson et al., that found "adolescents who attended their postpartum checkup were more likely to report using injectable contraception, the ring and the patch, and were less likely to report relying on condoms for pregnancy prevention."

Madden continues that "evidence demonstrates that implants prevent repeat pregnancies among postpartum adolescents; therefore, we should focus our attention on increasing the use of LARC in this population."

Additionally, results from the Contraceptive CHOICE Project -- an ongoing cohort study that provided participants with the contraceptive method of their choice at no cost -- found that "removing barriers to LARC increases use among women, including adolescents," and that LARC are both "highly effective" and "highly acceptable" among adolescents. "Results from CHOICE and other studies demonstrate that increasing LARC use among adolescents decreases teen pregnancy," she writes, noting that the methods are "forgettable, which means they do not require any effort from the user to maintain the high level of effectiveness."

Barriers to LARC Use

"Healthcare provider misconceptions about the appropriateness of LARC and lack of training in LARC provision are barriers to LARC use among adolescents," Madden continues.

She references an additional study in the March issue of the Journal of Adolescent Health, authored by Kavanaugh et al., which found that fewer than half of publicly funded family planning clinics that responded to a survey "reported regularly discussing LARC with adolescent patients." In another study in the same issue, "Greenberg et al. surveyed 430 adolescent healthcare providers to describe characteristics associated with LARC provision" and found "providers who had completed residencies in Obstetrics and Gynecology or Family Medicine were more likely to provide LARC (88%) compared with providers who had completed residencies in Pediatrics and/or Internal Medicine (26%)."

Madden argues, "To successfully increase LARC use in the United States, it is necessary to address these barriers and facilitate the provision of contraceptive services, including LARC, to teens."

To reduce the risk of rapid repeat pregnancy among adolescents, Madden calls for the creation of guidelines outlining best practices for prenatal and postpartum contraceptive counseling for this population. Additionally, Madden suggests offering immediate postpartum placement of IUDs and implants and offering LARC methods "as first-line contraceptives to all adolescents."

CAMPAIGN FOR BETTER CARE: Choosing Wisely

CAMPAIGN FOR BETTER CARE

Choosing Wisely

The National Partnership is proud to be a consumer partner of the Choosing Wisely campaign. The goals of the campaign are to help patients and doctors choose care that is supported by evidence, not duplicative, free from harm and truly necessary. That’s music to our ears — and hopefully yours.

Learn more »

FAIR PAY: "A Badly Needed Step Forward"

FAIR PAY

"A Badly Needed Step Forward"

Last month, the U.S. Department of Labor rolled back a set of policies that constrained its ability to investigate and root out pay discrimination among employers paid with taxpayer dollars. We pushed hard for this action by the administration, and National Partnership President Debra Ness called it "a badly needed step forward for America’s women and families."

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HEALTH: Reinventing Our Health Care System

HEALTH

Reinventing Our Health Care System

In this month’s edition of ACP Internist, a publication of the American College of Physicians, National Partnership President Debra Ness kicks off a series of columns on the importance of patient engagement. She writes: "True engagement requires listening and learning, making patients and families partners not just in decisions about their individual care but in designing practices and systems that will work for them."

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REPRO RIGHTS: Missouri Women's Health Care Under Attack

REPRO RIGHTS

Missouri Women's Health Care Under Attack

Dr. Colleen McNicholas provides comprehensive reproductive care, including abortion, to patients in Missouri. In this month’s Repro Health Watch, she writes: "In addition to creating significant barriers for women, SB 175 [which would require extra trips to a health provider to obtain a medication abortion] — and bills just like it appearing in legislatures across the country — are medically unjustified and unnecessary. They are an inappropriate intrusion into the doctor-patient relationship and completely disregard patient autonomy, a cornerstone of medical ethics."

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HEALTH CARE: Meaningful Use March Madness

HEALTH CARE

Meaningful Use March Madness

National Partnership Vice President Christine Bechtel recently appeared before a House Energy and Commerce subcommittee to discuss the Electronic Health Record (EHR) incentive program. She testified: "Advancing and using health IT is essential to making health care more accessible, affordable and effective for consumers because health IT is a tool that can empower consumers to work in partnership with professional care team members and make informed choices about treatment options."

More »


Related: Read the new Meaningful Use March Madness blog series that debunks myths about health IT.

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FAIRNESS: Back to the Office at Yahoo

FAIRNESS

Back to the Office at Yahoo

National Partnership President Debra Ness talked to the New York Times about Yahoo CEO Marissa Mayer’s decision to end the company’s work-from-home policy.



Watch the video interview »

WORK/FAMILY: On a Roll with Paid Sick Days

WORK/FAMILY

On a Roll with Paid Sick Days

Momentum for paid sick days is building across the country! This month, the Portland City Council passed — and Mayor Hales signed — a new citywide paid sick days law, making Portland the fourth city in the nation to guarantee workers the right to earn paid sick days!

As it did in 2011, the Philadelphia City Council also passed paid sick days legislation, but it is unclear whether Mayor Nutter will veto the bill (again). The National Partnership and state and national advocates are urging the mayor to approve the bill — while working to build enough support in the City Council to override a potential veto.

There are also dozens of efforts to advance paid sick days proposals across the country this year, including in New York City and Vermont. And the federal Healthy Families Act, which would guarantee workers the right to earn up to seven paid sick days per year, was introduced in Congress last week.

Take action: Urge Congress to support a national paid sick days standard.

Our monthly Datapoint provides a visual snapshot of key research and trends in women's health policy. This month, we spotlight a Japanese study examining how removal of out-of-pocket costs for mammograms and Pap tests affected the proportion of women who obtained the screenings.

Datapoint: Removing Women's Out-of-Pocket Costs May Boost Screening Rates for Breast, Cervical Cancer

March 28, 2013 — Eliminating women's out-of-pocket costs for mammograms and Pap tests appears to increase the likelihood that they will obtain the screenings, according to a new Japanese study in the International Journal of Cancer.

The findings could foretell similar improvements in screening rates in the U.S., now that the Affordable Care Act (PL 111-148) requires most health plans to cover many women's preventive services without additional costs to beneficiaries, according to Amal Trivedi, a Brown University researcher who has studied cancer screenings but was not involved in the new research.

 

Trivedi noted that it is difficult to directly compare the Japanese results to the changes in the U.S. because of differences in the nations' health systems. However, the findings are consistent with prior research showing that out-of-pocket costs deter screenings, he said.

For the study, researchers compared breast and cervical cancer screening rates among more than 34,000 women before and after the Japanese government began providing vouchers allowing some women to receive a no-cost mammogram and Pap test every five years.

Screening rates increased sharply among women who received the vouchers but rose only slightly among women who were ineligible for the program, the researchers found (Seaman, Reuters, 3/27).

Virginia Gov. Bob McDonnell (R) has introduced an amendment that would prohibit abortion coverage in health plans sold through the state's federally run health insurance exchange, the AP/Washington Times reports.

Va. Gov. Proposes Ban on Abortion Coverage in Health Insurance Exchange

March 28, 2013 — Virginia Gov. Bob McDonnell (R) has introduced an amendment that would prohibit abortion coverage in health plans sold through the state's federally run health insurance exchange, the AP/Washington Times reports (Lewis, AP/Washington Times, 3/26).

McDonnell proposed attaching the amendment to two identical bills that will establish a framework for how an exchange will operate in the state. The state Legislature will consider the amendment when it reconvenes on April 3 (Vozzella, Washington Post, 3/26).

The amendment also would bar insurers from offering the coverage as separate, optional riders to health plans. Insurers would be permitted to cover abortions in cases of rape and incest or when the procedure is needed to save a woman's life (AP/Washington Times, 3/26).

Jeff Caldwell, a spokesperson for McDonnell, said the amendment "continue[s] a policy established by the General Assembly in 2011 when it passed initial legislation to govern the possibility of a state-run health exchange."

Caroline O'Shea, deputy director of NARAL Pro-Choice Virginia, said, "By banning women from using their own funds to purchase plans that include this common benefit, Governor McDonnell is restricting Virginians' personal economic decisions as well as their access to comprehensive care" (Washington Post, 3/26).

The Kentucky General Assembly on Tuesday overturned Gov. Steve Beshear's (D) veto of a measure (HB 279) that purports to protect "sincerely held religious beliefs" from infringement unless there is a "compelling governmental interest," the Lexington Herald-Leader reports.

Ky. Legislature Overrides Veto of 'Religious Freedom' Bill

March 28, 2013 — The Kentucky General Assembly on Tuesday overturned Gov. Steve Beshear's (D) veto of a measure (HB 279) that purports to protect "sincerely held religious beliefs" from infringement unless there is a "compelling governmental interest," the Lexington Herald-Leader reports.

In vetoing the legislation on Friday, Beshear argued that it is too vaguely worded and could potentially result in costly lawsuits for the county, city and state governments.

According to the Herald-Leader, more than 50 entities, including government groups, contacted Beshear to express their opposition to the measure, known as the "religious freedom" bill. Meanwhile, supporters argued that 16 other states have passed similar legislation without significant legal disputes.

Reaction to Override

In a statement issued after the veto override, Beshear reiterated his "significant concerns that this bill will cause serious unintentional consequences that could threaten public safety, health care and individuals' civil rights."

Chris Hartman, director of the Kentucky Fairness Campaign, said in a statement, "The General Assembly's override of Governor Beshear's veto is a virtually incomprehensible endorsement of discrimination, and legislators should be held accountable by those who support the rights of women, children, people of color, and all Kentuckians made potentially vulnerable by this law."

State Rep. Darryl Owens (D) said there is "no reason for [the bill]" because no one's religious liberty is in jeopardy (Musgrave/Brammer, Lexington Herald-Leader, 3/26).

Following North Dakota's enactment of legislation (HB 1456) to ban abortions as early as six weeks of pregnancy, the Washington Post's "Wonkblog" interviewed Planned Parenthood Federation of America and Planned Parenthood Action Fund President Cecile Richards about the law's repercussions for women, abortion bans in other states and the legal landscape in the abortion-rights debate.

N.D. Abortion Restrictions Draw Swift Rebukes

March 28, 2013 — Following North Dakota's enactment of legislation (HB 1456) to ban abortions as early as six weeks of pregnancy, the Washington Post's "Wonkblog" interviewed Planned Parenthood Federation of America and Planned Parenthood Action Fund President Cecile Richards about the law's repercussions for women, abortion bans in other states and the legal landscape in the abortion-rights debate.

North Dakota has "effectively banned access to safe and legal abortion," which is "not only outrageous but unconstitutional," Richards said. "Lives are being put in jeopardy" when women cannot access legal abortion, she added.

She noted that North Dakota is among multiple states -- including Arkansas, which recently outlawed abortion after 12 weeks -- where lawmakers have "chosen to side with the extreme right wing over [the state's] women." She added, "[I]t is chilling to think that for women in America, your rights now depend on your Zip code."

Richards predicted that some state abortion restrictions will ultimately reach the Supreme Court, which she hopes "will honor judicial precedent, that this is a right women and men have had for 40 years and won't let it [be taken] away" (Kliff, "Wonkblog," Washington Post, 3/27).

N.D. Gov. Dalrymple 'Sincere' But 'Wrong,' Editorial States

North Dakota Gov. Jack Dalrymple (R) was undoubtedly "sincere when he signed three bills that will make North Dakota's anti-abortion laws the most restrictive in the nation," but "being sincere does not ameliorate being wrong," a Forum of Fargo-Moorhead editorial states, adding that the "fallout will be consequential."

The editorial continues, "The notion that North Dakota can lead a challenge to the U.S. Supreme Court's 1973 Roe v. Wade decision ... [is] not realistic." The state's passage of "anti-woman, anti-medical science legislation that ham-handedly interferes in the doctor-patient relationship" and "criminaliz[es] doctors who serve their patients" will drive physicians, women and families out of the state, the editorial predicts.

Further, the measure "will not prevent a single abortion." Ironically, the "same lawmakers who railroaded the anti-abortion bills through the Legislature oppose a university research project designed in part to prevent unwanted pregnancies. The hypocrisy is mindboggling," the editorial notes (Forum of Fargo-Moorhead, 3/27).

Virginia Gov. Bob McDonnell (R) has introduced an amendment that would prohibit abortion coverage in health plans sold through the state's federally run health insurance exchange, the AP/Washington Times reports.

Va. Gov. Proposes Ban on Abortion Coverage in Health Insurance Exchange

March 28, 2013 — Virginia Gov. Bob McDonnell (R) has introduced an amendment that would prohibit abortion coverage in health plans sold through the state's federally run health insurance exchange, the AP/Washington Times reports (Lewis, AP/Washington Times, 3/26).

McDonnell proposed attaching the amendment to two identical bills that will establish a framework for how an exchange will operate in the state. The state Legislature will consider the amendment when it reconvenes on April 3 (Vozzella, Washington Post, 3/26).

The amendment also would bar insurers from offering the coverage as separate, optional riders to health plans. Insurers would be permitted to cover abortions in cases of rape and incest or when the procedure is needed to save a woman's life (AP/Washington Times, 3/26).

Jeff Caldwell, a spokesperson for McDonnell, said the amendment "continue[s] a policy established by the General Assembly in 2011 when it passed initial legislation to govern the possibility of a state-run health exchange."

Caroline O'Shea, deputy director of NARAL Pro-Choice Virginia, said, "By banning women from using their own funds to purchase plans that include this common benefit, Governor McDonnell is restricting Virginians' personal economic decisions as well as their access to comprehensive care" (Washington Post, 3/26).

The Kentucky General Assembly on Tuesday overturned Gov. Steve Beshear's (D) veto of a measure (HB 279) that purports to protect "sincerely held religious beliefs" from infringement unless there is a "compelling governmental interest," the Lexington Herald-Leader reports.

Ky. Legislature Overrides Veto of 'Religious Freedom' Bill

March 28, 2013 — The Kentucky General Assembly on Tuesday overturned Gov. Steve Beshear's (D) veto of a measure (HB 279) that purports to protect "sincerely held religious beliefs" from infringement unless there is a "compelling governmental interest," the Lexington Herald-Leader reports.

In vetoing the legislation on Friday, Beshear argued that it is too vaguely worded and could potentially result in costly lawsuits for the county, city and state governments.

According to the Herald-Leader, more than 50 entities, including government groups, contacted Beshear to express their opposition to the measure, known as the "religious freedom" bill. Meanwhile, supporters argued that 16 other states have passed similar legislation without significant legal disputes.

Reaction to Override

In a statement issued after the veto override, Beshear reiterated his "significant concerns that this bill will cause serious unintentional consequences that could threaten public safety, health care and individuals' civil rights."

Chris Hartman, director of the Kentucky Fairness Campaign, said in a statement, "The General Assembly's override of Governor Beshear's veto is a virtually incomprehensible endorsement of discrimination, and legislators should be held accountable by those who support the rights of women, children, people of color, and all Kentuckians made potentially vulnerable by this law."

State Rep. Darryl Owens (D) said there is "no reason for [the bill]" because no one's religious liberty is in jeopardy (Musgrave/Brammer, Lexington Herald-Leader, 3/26).

Female veterans who experienced a sexual assault while serving in the military are nine times more likely to develop post-traumatic stress disorder than those who have not been sexually assaulted, according to a report released on Tuesday by the Institute of Medicine, The Nation reports.

Institute of Medicine Study Links PTSD, Sexual Assault in Military

March 28, 2013 — Female veterans who experienced a sexual assault while serving in the military are nine times more likely to develop post-traumatic stress disorder than those who have not been sexually assaulted, according to a report released on Tuesday by the Institute of Medicine, The Nation reports.

For the report, which was mandated under the 2008 National Defense Authorization Act, an IOM panel spent four years conducting research into the various health needs of troops and veterans returning from the wars in Iraq and Afghanistan. As many as 45% of servicewomen experience sexual assault, according to the report. The Department of Defense has estimated that 86.5% of violent sexual assaults are not reported.

The report found that military sexual assault is a singular factor in increasing the prevalence of PTSD among women and that combat-related stress affected women and men equally. Veterans with PTSD are four times more likely to have suicidal thoughts, it noted. The report added that such veterans also experience disproportionate amounts of anxiety, depression and family-related problems.

Compared with men with PTSD, women with the disorder are more likely to report health problems, including depression, according to the report. Men with PTSD are more likely to report increased feelings of anger.

Recommendations

The report recommended that DOD take additional measures to institute a zero-tolerance attitude toward sexual assault, including developing new policies, increasing enforcement of current policies and assessing how commanding officers handle sexual assault complaints and tying those actions to performance reviews and promotion systems.

Reactions

Rep. Chellie Pingree (D-Maine), who last month introduced a bill with Sen. Jon Tester (D-Mont.) that would increase veterans' access to sexual assault treatment, said, "I'm glad we are getting some hard data from this report, but honestly the evidence that sexual assault in the military has been a huge and pervasive problem has been ignored for a long time." She added that sexual assault "is completely avoidable and has nothing to do with fighting a war" (Zornick, The Nation, 3/26).

Pentagon spokesperson Cynthia Smith said DOD would consider the report's findings and recommendations. She added, "We are committed to taking care of our people, and that includes doing everything possible to develop the best programs for our service members and their families."

DOD and the Department of Veteran Affairs are required to issue a joint response to Congress by June (Freking, AP/Huffington Post, 3/26).

Following North Dakota's enactment of legislation (HB 1456) to ban abortions as early as six weeks of pregnancy, the Washington Post's "Wonkblog" interviewed Planned Parenthood Federation of America and Planned Parenthood Action Fund President Cecile Richards about the law's repercussions for women, abortion bans in other states and the legal landscape in the abortion-rights debate.

N.D. Abortion Restrictions Draw Swift Rebukes

March 28, 2013 — Following North Dakota's enactment of legislation (HB 1456) to ban abortions as early as six weeks of pregnancy, the Washington Post's "Wonkblog" interviewed Planned Parenthood Federation of America and Planned Parenthood Action Fund President Cecile Richards about the law's repercussions for women, abortion bans in other states and the legal landscape in the abortion-rights debate.

North Dakota has "effectively banned access to safe and legal abortion," which is "not only outrageous but unconstitutional," Richards said. "Lives are being put in jeopardy" when women cannot access legal abortion, she added.

She noted that North Dakota is among multiple states -- including Arkansas, which recently outlawed abortion after 12 weeks -- where lawmakers have "chosen to side with the extreme right wing over [the state's] women." She added, "[I]t is chilling to think that for women in America, your rights now depend on your Zip code."

Richards predicted that some state abortion restrictions will ultimately reach the Supreme Court, which she hopes "will honor judicial precedent, that this is a right women and men have had for 40 years and won't let it [be taken] away" (Kliff, "Wonkblog," Washington Post, 3/27).

N.D. Gov. Dalrymple 'Sincere' But 'Wrong,' Editorial States

North Dakota Gov. Jack Dalrymple (R) was undoubtedly "sincere when he signed three bills that will make North Dakota's anti-abortion laws the most restrictive in the nation," but "being sincere does not ameliorate being wrong," a Forum of Fargo-Moorhead editorial states, adding that the "fallout will be consequential."

The editorial continues, "The notion that North Dakota can lead a challenge to the U.S. Supreme Court's 1973 Roe v. Wade decision ... [is] not realistic." The state's passage of "anti-woman, anti-medical science legislation that ham-handedly interferes in the doctor-patient relationship" and "criminaliz[es] doctors who serve their patients" will drive physicians, women and families out of the state, the editorial predicts.

Further, the measure "will not prevent a single abortion." Ironically, the "same lawmakers who railroaded the anti-abortion bills through the Legislature oppose a university research project designed in part to prevent unwanted pregnancies. The hypocrisy is mindboggling," the editorial notes (Forum of Fargo-Moorhead, 3/27).

The second edition of the World Health Organization's Safe Abortion: Technical and Policy Guidance for Health Systems -- released in 2012 -- emphasizes the responsibility of the world's health systems to provide safe and legal abortions, write Nathalie Kapp of WHO and Anna Glasier, an honorary professor at the University of Edinburgh. "What sets this guidance apart from other technical and clinical guidelines ... is the emphasis on both the global public health impact of abortion and the human rights imperative for safe abortion care," they add. The "WHO guidance provides a framework for policy-makers and service providers to improve dramatically the health and well-being of the world's women," they write.

WHO Guidance Calls on World's Health Systems To Ensure Safe, Legal Abortions

March 28, 2013 — "WHO Technical and Policy Guidance Emphasizes the Health Systems' Responsibility To Provide Safe Abortion Services," Kapp/Glasier, Contraception, February 2013.

While the rate of safe induced abortions worldwide has declined in recent years, the "rate of unsafe abortion has remained relatively constant since 2000 at around 14 per 1000 women," according to Nathalie Kapp of the World Health Organization's Department of Reproductive Health and Research, and Anna Glasier, an honorary professor at the University of Edinburgh's School of Clinical Sciences. Unsafe abortions result in the deaths of about 47,000 women annually and cause disabilities in an additional five million women, they note, emphasizing that "almost every one of these deaths and disabilities could have been prevented with the provision of safe abortion services."

WHO's Call for Safe Abortion Care

The second edition of WHO's Safe Abortion: Technical and Policy Guidance for Health Systems -- published in 2012 -- "reflects the evidence from clinical studies on methods and technologies, as well as the human rights rationale, for providing safe abortion care services," Kapp and Glasier write. The "recommendations focus primarily on ensuring good quality through use of appropriate technologies in abortion-related care," "ensuring good access by eliminating barriers and provision of affordable services," offering "pain medication to every woman" who has an abortion, and promptly providing information about and access to contraception after an abortion.

Kapp and Glasier continue that "what sets this guidance apart from other technical and clinical guidelines ... is the emphasis on both the global public health impact of abortion and the human rights imperative for safe abortion care." This framework is rooted in a concept of reproductive rights that has developed since the 1994 International Conference on Population and Development in Cairo. The concept "demands an approach to healthcare which is grounded in international human rights treaties and global consensus declarations," Kapp and Glasier write, adding that it calls on nations to protect and ensure women's ability to "decide freely and responsibly the number, spacing and timing of one's children and to have the information and means to do so; and the right to a sexual life free from coercion or violence." To that end, states should "ensure that health systems are equipped to provide safe abortion services within the extent of the law," "[v]igorously pursu[e] decriminalization of abortion-related laws" and ensure equitable access to abortion services, Kapp and Glasier write.

"[H]uman rights have been increasingly applied by international and regional human rights bodies and regional and national courts in the context of abortion," Kapp and Glasier continue, noting that United Nations treaty monitoring bodies have called for member states to reform laws that criminalize medical care that is only needed by women and "make all efforts to ensure" a minimum level of safe, legal abortion services are available.

"Unsafe abortion and its associated mortality and disability are avoidable," the authors conclude, writing, "The WHO guidance provides a framework for policy-makers and service providers to improve dramatically the health and well-being of the world's women."

After comparing national data on women who first gave birth in their teens and those who first gave birth in their 20s or early 30s, researchers found that those who gave birth at younger ages were no more likely than their older counterparts to have low-birthweight infants or deliver preterm. The study noted that some demographic, social and health-related characteristics were associated with these outcomes. The researchers recommended that future efforts focus on "the social and environmental context of [adolescent] pregnancies and their relations with birth outcomes."

Teenagers Not at Higher Risk of Poorer Birth Outcomes, Study Suggests

March 28, 2013 — Summary of "Teenagers are Apparently Not at Increased Risk of Poor Birth Outcomes," Hollander, Perspectives on Sexual and Reproductive Health, Feb. 14, 2013.

This digest in Perspectives on Sexual and Reproductive Health reviewed findings of a study examining predictors of low birthweight and preterm deliveries in adolescents, compared with women who first gave birth in their 20s.

Methods

The researchers assessed data from the National Longitudinal Study of Adolescent Health (Add Health). Their analysis included Add Health participants who were first interviewed in 1994-1995 and had a singleton live birth by the time they were interviewed again in 2007-2008, when they were between ages 24 and 32.

The researchers compared various characteristics -- such as demographics, socioeconomic factors and levels of prenatal care -- and birth outcomes for 1,101 women who first gave birth at ages 13 to 19 with 2,846 women who first gave birth between ages 20 and 33.

Results

Women who gave birth before age 20 were "more likely to fit a high-risk profile," but they were no more likely than older women to give birth to low-birthweight infants or deliver preterm (before 37 weeks of gestation), according to the study. In both age groups, these birth outcomes occurred in about 8% to 9% of women. Overall, women in the younger age group had a slightly later gestation than the older women.

The chance that a woman younger than age 20 would have a preterm birth varied little in relation to most characteristics, with the exception of having been married or cohabitating at the time of pregnancy, which was linked to a higher risk. Among the older age group, preterm birth was associated with baseline body mass index, being Hispanic, and not receiving prenatal care or initiating it late.

For both age groups, the likelihood of having a low-birthweight infant was positively associated with being black, never having been pregnant before and not receiving prenatal care. Mean birthweights also were significantly lower for black women of both age groups.

Discussion

The findings suggest that adolescents in general are not at higher risk than adults for experiencing adverse birth outcomes, the researchers concluded.

Because "conventional risk factors, such as smoking and marital status," appeared to play a relatively small role in teens' birth outcomes, the researchers recommended that future work focus on the context and effects of social and environmental factors related to teen pregnancies.

The federal contraceptive coverage rules have elicited more public comments than any other regulatory proposal from the federal government, according to an analysis by the Sunlight Foundation, The Hill's "Healthwatch" reports.

Contraceptive Coverage Rules Draw Record Number of Comments; Mich. Business Files Latest Lawsuit

March 26, 2013 — The federal contraceptive coverage rules have elicited more public comments than any other regulatory proposal from the federal government, according to an analysis by the Sunlight Foundation, The Hill's "Healthwatch" reports.

More than 147,000 people and organizations have commented on the rules, which require that most health plans provide contraceptive coverage at no additional cost to women. By comparison, about 4,600 people and groups have weighed in on a proposal that drew the second-most comments -- regulations governing the federal pre-existing condition insurance plan under the Affordable Care Act (PL 111-148).

The disparity underscores "just how motivated foes and champions of the contraceptive provision are," the analysis said.

The analysis noted that many of the comments on the contraceptive coverage rules are from members of the Catholic Church, which has urged parishioners to express their disproval of the proposal. Women's groups also have mobilized around the issue, calling on advocates to support the policy as it progresses through the regulatory process (Viebeck, "Healthwatch," The Hill, 3/22).

Mich. Food Company Files for Emergency Relief from Contraceptive Coverage Rules

In related news, a Michigan-based organic foods company on Friday filed an emergency motion for a temporary restraining order preventing the federal government from enforcing the contraceptive coverage rules, CQ HealthBeat reports. The rules took effect on Jan. 1 for private companies with non-grandfathered insurance plans.

Michael Potter -- a Catholic and the sole shareholder of Eden Foods -- filed the lawsuit in U.S. District Court for the Eastern District of Michigan after a dispute with the company's insurance plan, Blue Cross Blue Shield of Michigan. Potter has religious objections to providing contraceptive coverage and has excluded it from his workers' health plan in the past.

The lawsuit states that last fall, Potter renewed his health insurance policy without contraceptive coverage. This February, BCBS officials informed Potter that his plan could no longer exclude the coverage because it would violate the federal rules. Potter refused to sign a contract on a policy that included the coverage but later received a notice that it had been added, according to the suit (Norman, CQ HealthBeat, 3/22).

A coalition of Brazilian doctors on Thursday urged the nation's lawmakers to legalize abortion in the first 12 weeks of pregnancy, the AP/Miami Herald reports.

Brazilian Physicians Urge Lawmakers To Decriminalize First Trimester Abortions

March 25, 2013 — A coalition of Brazilian doctors on Thursday urged the nation's lawmakers to legalize abortion in the first 12 weeks of pregnancy, the AP/Miami Herald reports. Abortion is illegal in the Roman Catholic country except for cases of rape, when a pregnancy threatens a woman's life or the fetus has severe brain abnormalities.

At a news conference, the Federal Council of Medicine -- which represents about 400,000 Brazilian physicians -- said its policy recommendation was driven by the country's high rate of illegal abortions. Government statistics suggest that one million abortions are performed in Brazil annually, often under unsafe conditions. Complications from abortions are the fifth-leading cause of death for Brazilian women, resulting in nearly 200,000 deaths annually.

"Rich women are getting them in safe conditions and the poor, completely unsafe ... with complications, losing their uteruses, losing parts of their intestines, dying," said Roberto Luis d'Avila, president of the physician group. He added, "This inequality is unacceptable from the medical point of view."

D'Avila noted that 80% of the group's 27 regional branches voted in support of legalizing abortion during the first trimester. The group plans to send its recommendations to a Senate committee that is examining potential changes to Brazil's penal law (AP/Miami Herald, 3/21).