Daily Women's Health Policy Report

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Daily Women's Health Policy Report by the National Partnership for Women & Families
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Court Permits Food Company To Deny Contraceptive Coverage in Light of Hobby Lobby Ruling

Tue, 08/12/2014 - 14:44

A federal appeals court on Friday ordered a lower court to grant Freshway Foods an exemption from the federal contraceptive coverage rules in light of the Supreme Court's ruling in the Hobby Lobby case, Bloomberg reports.

Court Permits Food Company To Deny Contraceptive Coverage in Light of Hobby Lobby Ruling

August 12, 2014 — A federal appeals court on Friday ordered a lower court to grant Freshway Foods an exemption from the federal contraceptive coverage rules in light of the Supreme Court's ruling in the Hobby Lobby case, Bloomberg reports.

According to Bloomberg, the ruling appears to be the first exemption granted since the Supreme Court issued the Hobby Lobby decision in June.

Case Details

Francis and Philip Gilardi, the owners of Freshway Foods, filed suit against the rules because they said that offering contraceptive coverage in the company's employer-sponsored health plans would violate their Roman Catholic beliefs.

In March 2013, U.S. District Judge Emmet Sullivan ruled against the Gilardis, saying that he could not permit corporations to assert individuals' religious rights (Zajac, Bloomberg, 8/8). That November, the U.S. Court of Appeals for the District of Columbia Circuit ruled in favor of the Gilardis, sending the case back to a lower court to reconsider the company's request for an injunction (Women's Health Policy Report, 11/4/13).

The government appealed the ruling. Last month, the Supreme Court rejected the government's request to hear the case, remanded the lawsuit back to the appeals court and ordered it to rule in accordance with the high court's Hobby Lobby ruling (Women's Health Policy Report, 7/2).

On Friday, the D.C. Circuit sent the case back to Sullivan. The appeals court ordered the judge to issue a preliminary injunction for Freshway and instructed him to consider extending the injunction to the Gilardis (Bloomberg, 8/8).


Editorial Urges Parents To Vaccinate Their Children Against HPV

Tue, 08/12/2014 - 13:33

Parents can give their children the "gift" of protection from certain cancers by vaccinating them against the human papillomavirus, but experts "agree that [HPV] vaccination rates ... are unacceptably low," according to a Sacramento Bee editorial.

Editorial Urges Parents To Vaccinate Their Children Against HPV

August 12, 2014 — Parents can give their children the "gift" of protection from certain cancers by vaccinating them against the human papillomavirus, but experts "agree that [HPV] vaccination rates ... are unacceptably low," according to a Sacramento Bee editorial.

The editorial explains that the HPV vaccine is "ideally" administered to both girls and boys "between 11 and 13 years old." HPV is the most common sexually transmitted infection and can lead to "some particularly nasty cancers later in life," but "vaccination provides girls more than 90 percent protection from those cancers," the editorial states.

However, according to a recent CDC survey, only 57% of girls and 34% of boys in the U.S. have received the vaccine.

Although public education and providers' suggestions can help to increase vaccination rates, "parents and family members must take responsibility as well," the editorial states (Sacramento Bee, 8/10).


Number of FMLA Lawsuits Spiked From 2012 to 2013

Mon, 08/11/2014 - 15:20

Employees in 2013 filed 877 lawsuits against their employers for allegedly violating the Family and Medical Leave Act, up from 291 in 2012, according to data from the Administrative Office of the U.S. Courts, the Wall Street Journal reports.

Number of FMLA Lawsuits Spiked From 2012 to 2013

August 11, 2014 — Employees in 2013 filed 877 lawsuits against their employers for allegedly violating the Family and Medical Leave Act, up from 291 in 2012, according to data from the Administrative Office of the U.S. Courts, the Wall Street Journal reports (Palazzolo, Wall Street Journal, 8/8).

Under the Family and Medical Leave Act (PL 103-3), eligible employees are allowed to take up to 12 weeks of unpaid leave annually to care for themselves during an illness, a sick family member or a new child (Women's Health Policy Report, 7/31). The law also prohibits employers from retaliating against employees who take such leave.

In FMLA challenges, employees can recover up to double the amount of any lost wages or the cost of caring for family members if leave was denied. However, plaintiffs cannot be awarded punitive damages.

According to the Journal, FMLA cases require a lower threshold of proof than cases challenging most other employment laws. Labor attorney Jeff Nowak of Franczek Radelet PC explained that, unlike discrimination suits that require proof of an employers' intent to discriminate, plaintiffs in FMLA cases must show that their employers deterred them from taking authorized leave under FMLA or interrupted such leave. He added that many employees are more familiar with FMLA laws today than had been in the past.

Meanwhile, Lisa Horn, director of congressional affairs at the Society for Human Resource Management, said that some employers face significant challenges in accommodating leave under FMLA. She noted that the law does not specify what qualifies as a serious health condition warranting leave under the law, adding, "There are opportunities for misuse, and that has been a real challenge for employers and employees who are left picking up the additional work" (Wall Street Journal, 8/8).

NYT Column: Many Factors Affect Impact of Paid Leave

In related news, the New York Times' Claire Cain Miller writes in "The Upshot" that a "paradox" involving U.S. women's participation in the workforce offers insight "about how to shape maternity leave." She explains that "[w]hen measured by who holds a job, American women are falling behind women in other developed countries," but "the American women who are working tend to have more high-achieving careers."

She notes that the U.S. "is the only country besides Papua New Guinea that mandates maternity leave but does not require that it be paid," while "[o]ther developed countries ... offer paid leave" and "other family-friendly benefits like publicly funded child care and the right to demand part-time work."

While "[e]conomists say paid leave is essential to making it possible for women to work," research has shown "that long paid leaves can also hold back women" by having "negative effects on their job opportunities" if, for example, they voluntarily "scale back" or face discrimination from employers who assume women will take leave, according to Cain Miller. Long leaves also can be "expensive for companies, particularly for jobs that build on training and promotions, and employers" may be hesitant to hire people who might leave for a year at a time, she writes.

Cain Miller suggests that one way to "minimize the career penalty women pay for having children is to stop making parental leave all about mothers" and encourage more fathers to take leave. She also calls for policymakers to take steps to "minimize the penalty women pay ... by pulling levers in both policy and culture around the length of leaves and who takes them" (Cain Miller, "The Upshot," New York Times, 8/9).


Admitting Privileges Mandates Create Hurdles for Abortion Providers

Mon, 08/11/2014 - 15:06

Admitting privileges requirements, enacted in several states, have proven to be "a potent tool" for abortion-rights opponents in their goal of limiting abortion access, the Washington Post reports.

Admitting Privileges Mandates Create Hurdles for Abortion Providers

August 11, 2014 — Admitting privileges requirements, enacted in several states, have proven to be "a potent tool" for abortion-rights opponents in their goal of limiting abortion access, the Washington Post reports (Somashekhar, Washington Post, 8/10).

The laws require physicians who perform abortions to have admitting privileges at a nearby hospital. Clinics that cannot meet the requirement are forced to close.

About Admitting Privileges

According to NPR's "Shots," admitting privileges give a physician the right to admit patients to a particular hospital and provide certain services on hospital grounds.

Hospitals typically consider a physician's medical credentials, license and history of malpractice when weighing his or her admitting privileges request. Many hospitals also require that physicians admit a minimum number of patients each year or live within a certain distance of the hospital.

Fifteen states require that abortion providers "have some affiliation with a local hospital," while 11 states have laws that specifically require providers to have admitting privileges, according to the Guttmacher Institute. However, many of the laws are not in effect because courts have temporality blocked them or they have not been implemented yet (Rovner, "Shots," NPR, 8/8).

Compliance Difficulties

Admitting privileges requirements pose a particularly difficult hurdle for abortion providers because often they live too far away from the hospitals or do not typically admit the minimum number of patients. In addition, many religiously affiliated hospitals object to abortion, while other hospitals do not want to be involved with a politically controversial issue.

Physician Willie Parker, who provides abortions at Mississippi's only abortion clinic, said he was not surprised that so many hospitals rejected his application for admitting privileges or did not respond. "For a hospital to [extend admitting privileges], it would be making a conscious decision to take on the state legislature," he said.

More than a dozen abortion clinics have closed under Texas' requirements, at least one closed in Tennessee, and several could close in Oklahoma, Louisiana and Wisconsin if courts allow admitting privileges laws to take effect in those states, according to the Post (Washington Post, 8/10).

Abortion-Rights Supporters, Opponents Debate Motivation

According to "Shots," abortion-rights opponents contend that the laws are medically necessary and that clinics would only close if they are unable to meet basic safety standards ("Shots," NPR, 8/8). Abortion-rights supporters argue that the laws are medically unnecessary because anyone can be admitted through an emergency room (Washington Post, 8/10).

Jeanne Conry, former president of the American Congress of Obstetricians and Gynecologists, said, "Admitting-privileges legislation would impose stricter requirements on facilities where abortions are performed than on facilities that perform much riskier procedures." For example, colonoscopies have a mortality rate 40 times higher than abortion.

Abortion-rights supporters also point out that the reason abortion providers are often unable to meet the minimum requirements for admissions is because so few of their patients require hospitalization.

Meanwhile, Ovide Lamontagne, general counsel for Americans United for Life, said, "Once a physician assumes the responsibility for overseeing the provision of a medical procedure, there's an obligation on the physician to follow the care through to its ultimate conclusion," including any potential emergencies ("Shots," NPR, 8/8).

Legal Landscape

A divide among federal appeals courts over the constitutionality of admitting privileges requirements could persuade the Supreme Court to review the issue, according to the Texas Tribune/New York Times (Edelman, Texas Tribune/New York Times, 8/9).

Elizabeth Nash, states-issues manager for the Guttmacher Institute, said that the laws, if upheld, could have a "huge" effect on clinics compared with other abortion restrictions. "It has just really taken over, in a sense, because it has such the potential for shutting down clinics," she said (Washington Post, 8/10).


CDC Breast, Cervical Cancer Screening Program Has Served Over 4M Low-Income Women

Mon, 08/11/2014 - 15:02

A federally supported breast and cervical cancer screening program has helped millions of low-income women access the screenings since 1991, according to new CDC studies published online in the journal Cancer, HealthDay/U.S. News & World Report reports.

CDC Breast, Cervical Cancer Screening Program Has Served Over 4M Low-Income Women

August 11, 2014 — A federally supported breast and cervical cancer screening program has helped millions of low-income women access the screenings since 1991, according to new CDC studies published online in the journal Cancer, HealthDay/U.S. News & World Report reports (Preidt, HealthDay/U.S. News & World Report, 8/7).

Program Details

According to Medscape, the National Breast and Cervical Cancer Early Detection Program focuses on decreasing breast and cervical cancer disparities among low-income, minority and uninsured women. To be eligible for the program, women must have incomes at or below 250% of the federal poverty level and be uninsured or underinsured.

Congress approved $30 million for the program's first year. Since then, the program has helped a total of more than 10.7 million women access breast and cervical cancer screenings, Medscape reports. In 2010, CDC awarded grants worth more than $161 million through the program (Chustecka, Medscape, 8/7).

Report Findings

More than four million women obtained cancer screenings as a result of the program during its first 20 years of operation, according to the report.

In those two decades, the screenings identified more than 56,000 instances of breast cancer, about 3,200 instances of cervical cancer and more than 152,000 precancerous cervical lesions. The report added that women received appropriate and timely follow-up care in 90% of such cases.

According to the report, the screening program has cost about $145 per woman (HealthDay/U.S. News & World Report, 8/7).


Pa. Christian College Files Lawsuit Challenging Contraceptive Coverage Rules

Mon, 08/11/2014 - 14:59

Valley Forge Christian College last week filed a lawsuit arguing that the Affordable Care Act's (PL 111-148) contraceptive coverage rules violate the institution's religious freedom, the Philadelphia Inquirer reports.

Pa. Christian College Files Lawsuit Challenging Contraceptive Coverage Rules

August 11, 2014 — Valley Forge Christian College last week filed a lawsuit arguing that the Affordable Care Act's (PL 111-148) contraceptive coverage rules violate the institution's religious freedom, the Philadelphia Inquirer reports (Nadolny, Philadelphia Inquirer, 8/8).

Under the federal contraceptive coverage rules, religiously affiliated not-for-profits can fill out a form that enables a third party to arrange and pay for contraceptive coverage. However, many such organizations argued that filling out the form would itself violate their religious beliefs, and the Obama administration is in the process of revising the accommodation process (Women's Health Policy Report, 7/23).

Lawsuit Details

The Pennsylvania college argued in its lawsuit that it is unwilling to "transfer its legal and moral authority to a third party that would provide the same potentially life-threatening drugs and devices."

Specifically, the college is opposed to including coverage of emergency contraception in its health plans. It said in court filings that it would face fines of $100 per beneficiary per day, resulting in "severe economic consequences" if a judge does not temporarily block the requirements (Philadelphia Inquirer, 8/8).


Abortion Access Depends on Judges' 'Willingness' To Oppose Unnecessary Restrictions, NYT Editorial States

Mon, 08/11/2014 - 13:54

In much of the U.S., "women's access to safe and legal abortion care is increasingly coming to depend on the willingness of judges to rigorously examine and reject new (and medically unnecessary) restrictions imposed by Republican legislatures," a New York Times editorial states.

Abortion Access Depends on Judges' 'Willingness' To Oppose Unnecessary Restrictions, NYT Editorial States

August 11, 2014 — In much of the U.S., "women's access to safe and legal abortion care is increasingly coming to depend on the willingness of judges to rigorously examine and reject new (and medically unnecessary) restrictions imposed by Republican legislatures," a New York Times editorial states.

The editorial praises a federal judge who recently "struck down as unconstitutional an Alabama law requiring doctors at abortion clinics to have admitting privileges at a local hospital." The ruling should be "an instructive model for other courts," it argues.

Admitting privileges laws -- "advertised, falsely, as necessary to protect women's health -- [are] one of the main strategies being deployed nationally by opponents of abortion rights to shrink the already inadequate number of abortion providers," the editorial continues.

In the Alabama ruling, Judge Myron Thompson wrote that the law "would actually harm women, especially poor women, by forcing them to wait longer and travel longer distances for the procedure," the editorial notes. In addition, he rejected the state's claims that the requirement protects women's safety, given that "[a]bortion complications are exceedingly rare" and there are "reasonable procedures in place to handle them," the editorial explains.

Thompson's ruling "should command attention as the issue continues to play out before different judges on the way toward likely resolution by the Supreme Court," the editorial concludes (New York Times, 8/10).


Many State Abortion Restrictions Now Before Federal Courts

Fri, 08/08/2014 - 16:58

Federal courts are weighing a number of state laws, crafted by Republican-led legislatures, that create new requirements for abortion clinics or restrict when and how abortions are provided, the AP/Huffington Post reports.

Many State Abortion Restrictions Now Before Federal Courts

August 8, 2014 — Federal courts are weighing a number of state laws, crafted by Republican-led legislatures, that create new requirements for abortion clinics or restrict when and how abortions are provided, the AP/Huffington Post reports.

According to AP/Huffington Post, many of the laws reflect strategies outlined by Americans United for Life, which positions the measures as ways to protect women's health. However, abortion-rights supporters say that the procedure is safe and that the laws are really meant to erode access to abortion.

While states have restricted abortion rights in various ways for decades, the number and variety of measures has expanded in recent years, according to Jennifer Dalven, director of the American Civil Liberties Union's Reproductive Freedom Project. "It used to be a brick-by-brick approach, and now [abortion-rights opponents are] throwing up the wall all at once, so you can't get over it no matter how high you jump," she said.

Laws Targeting Clinics

The AP/Huffington Post reviews the status of the laws in several states.

For example, a number of states have passed measures that require abortion providers to have admitting privileges at nearby hospitals. The laws threaten to force abortion clinics to close if their doctors cannot obtain admitting privileges.

Missouri, Tennessee, Texas and Utah are among the states with such requirements in place, and Louisiana and Oklahoma are scheduled to start enforcing similar requirements on Sept. 1 and Nov. 1, respectively. However, courts have blocked admitting privileges requirements in Alabama, Mississippi and Wisconsin.

With courts divided over the admitting privileges laws, the final decision on their constitutionality might be left to the Supreme Court, according to the AP/Huffington Post.

Meanwhile, Texas and Virginia have both enacted regulations that require abortion facilities to meet the same building standards as ambulatory surgical centers, a requirement that could close facilities unable to make the costly changes.

Other Abortion Restrictions

Courts also are weighing states' bans on abortion after a certain point in pregnancy. For example, Arkansas and North Dakota are both appealing federal court decisions that struck down laws banning abortion at 12 weeks and as early as a fetal heartbeat can be detected, respectively, while about a dozen other states have tried to implement abortion bans at 20 weeks of pregnancy.

Federal courts also recently blocked measures in Arizona and Indiana that aimed to restrict access to medication abortion (Crary, AP/Huffington Post, 8/7).


State Lawmakers Mobilize To Protect Contraceptive Access After Hobby Lobby

Fri, 08/08/2014 - 16:55

State lawmakers are working to protect women's access to contraception in response to the Supreme Court's Hobby Lobby ruling, which allows some for-profit companies to exclude contraceptive coverage from their employer-sponsored health plans based on their owners' religious objections, Politico Pro reports.

State Lawmakers Mobilize To Protect Contraceptive Access After Hobby Lobby

August 8, 2014 — State lawmakers are working to protect women's access to contraception in response to the Supreme Court's Hobby Lobby ruling, which allows some for-profit companies to exclude contraceptive coverage from their employer-sponsored health plans based on their owners' religious objections, Politico Pro reports.

Gretchen Borchelt, director of state reproductive health policy at the National Women's Law Center, said, "There's been a lot of buzz in the states since the [Hobby Lobby] decision because people are so outraged by it, and they want to make sure that women in their state aren't left unprotected."

According to Politico Pro, 28 states already require employer-sponsored health plans that include prescription drug coverage to cover all FDA-approved contraceptives, although not all of those states address self-insured employers.

While several state lawmakers have proposed bills or taken other steps to protect contraceptive access, supporters of the Hobby Lobby decision also could mobilize to try to broaden its effects and undermine state laws, according to Politico Pro. Although the high court's decision was based on a federal law and does not affect state laws on contraceptive coverage, the Wisconsin Office of the Commissioner of Insurance recently announced that it would no longer enforce the state's contraceptive coverage law for employers with religious objections as a result of the Hobby Lobby ruling.

State Initiatives

Lawmakers in Minnesota last week said they will push legislation that would require employers whose plans offer prescription drug coverage to cover contraceptives without cost sharing. According to Politico Pro, the Minnesota bill and a similar measure in Ohio also would bar self-insured employers from discriminating in employment terms, conditions and benefits -- including health coverage -- based on workers' reproductive health decisions.

In New York, the state attorney general and a leading Democrat in the state Senate have proposed a bill that would require employers to tell prospective workers about their contraception coverage policies and notify current employees at least 90 days before making any changes to those policies.

Meanwhile, Massachusetts Attorney General Martha Coakley (D), who is running for governor, said she would establish a fund to help women afford contraception, while Charlie Baker -- the leading Republican candidate in the gubernatorial race -- has promised to set aside $300,000 in state funds for the same purpose if elected.

In Michigan, state lawmakers have taken a different approach and introduced a resolution that asks Congress to bar for-profit employers from using religious objections to deny employees coverage of other health care services, such as blood transfusions or vaccinations (Villacorta, Politico Pro, 8/7).


Blogs Comment on Childbirth Expenses, 'Bad Business' of Deny Contraceptive Cover, More

Fri, 08/08/2014 - 15:21

We've compiled some of the most thought-provoking commentaries from around the Web. Catch up on the conversation with bloggers from Health Affairs, the Huffington Post and more.

Blogs Comment on Childbirth Expenses, 'Bad Business' of Deny Contraceptive Cover, More

August 8, 2014 — We've compiled some of the most thought-provoking commentaries from around the Web. Catch up on the conversation with bloggers from Health Affairs, the Huffington Post and more.

PREGNANCY AND MATERNITY CARE: "Having a Baby: Media Confusion Over Charges, Costs, and the Benefits of Insurance," Marc Berk/Claudia Schur, Health Affairs blog: A recent NBC piece on the expenses related to giving birth "confused the very different concepts of what health care providers charge, what they are actually paid, and what consumers owe, and in so doing obscured one of the key benefits for consumers of being insured," Berk and Schur, both health policy experts, write, noting that the NBC piece gave much higher estimates of delivery costs than other sources have estimated. They explain that NBC's estimates failed to take into account how "the provider's charge does not include the discount negotiated by both public and private payers, and [how], for those with coverage, the 'charge' is usually not relevant," adding that the media in general tends not to discuss how being insured brings value "not just in having coverage but in facing initially lower prices." They urge members of the media to distinguish between "cost and charge," writing that while "an informed decision will require a considerable time investment on the part of consumers," it is not acceptable for the media "to imply that 'what you pay' is several times greater than it really is" (Berk/Schur, Health Affairs blog, 8/6).

What others are saying about pregnancy and maternity care:

~ "Surrogacy is a Mess," Jessica Grose, Slate's "XX Factor."

~ "Why We Need More Research on Antidepressants During Pregnancy and Beyond," Catherine Pearson, Huffington Post blogs.

CONTRACEPTION: "Depriving Women of Contraceptive Care Is Bad Business," Jeffrey Hollender, Huffington Post blogs: Opponents of the federal contraceptive coverage rules claim that the requirement "imposes a financial burden on employers and insurers," writes Hollender, CEO and co-founder of Sustain, a group that manufactures "Fair Trade, sustainable condoms." In fact, "available evidence suggests strongly that coverage of contraception without patient out-of-pocket costs should not raise insurance costs and is likely a cost-savings," Hollender writes, citing several studies and reports that back that conclusion (Hollender, Huffington Post blogs, 8/5).

SUPPORTING WORKING FAMILIES: "Expand FMLA -- Good for Women, Good for Families, Good for All," Linda Meric, Huffington Post blogs: Meric, national executive director of 9to5, writes that August 5 was the "21st anniversary of the implementation of the Family and Medical Leave Act," which "provides an important moment to examine how far our nation has come since President Clinton signed FMLA into law in 1993 and how far we still need to go." She continues, "Since its inception, FMLA has been used more than 100 million times, helping 35 million people keep their jobs and health insurance while they cared for a family health crisis or a new baby." However, leave taken under the law "is generally unpaid" and subject to "eligibility and use restrictions," meaning that "many who qualify for it can't afford to take it, others suffer financially when they do, and millions more who'd like to benefit from it are excluded." She concludes, "It's time to celebrate the FMLA by expanding it to benefit women, to benefit families, to benefit all of us" (Meric, Huffington Post blogs, 8/5).

What others are saying about supporting working families:

~ "New Statistics: Pregnancy Discrimination Claims Hit Low-Wage Workers Hardest," Brigid Schulte, Washington Post's "She The People."

GLOBAL: "France Just Passed a Sweeping Gender Equality Law To Make it Easier To Get an Abortion," Tara Culp-Ressler, Center for American Progress' "Think Progress": As part of "the most comprehensive women's rights legislation in the history of France," the women in the nation "can now end a first-trimester pregnancy for any reason -- and the full cost of the abortion will be financed by the government," Culp-Ressler writes. She notes that the new law, which "also includes provisions to provide support for domestic abuse victims" and "encourage[s] paternal leave and a more equal division of childcare," shows that France's "proactive approach to women's equality sharply diverges from the policies in much of the rest of the world, including the" U.S., where there is no guaranteed paid family leave and a wide pay gap between men and women (Culp-Ressler, "Think Progress," Center for American Progress, 8/6).

What others are saying about global issues:

~ "Menstrual Hygiene Must Become a Matter of Public Concern in Zimbabwe," Miriam Mufaro, Huffington Post blogs.

ADOLESCENT HEALTH: "Sex Ed Classes Should Start as Early as Age 10, Researchers Recommend," Culp-Ressler, Center for American Progress' "ThinkProgress": According to new research, "children should start receiving formal instruction about sexual health as early as age 10" to "significantly decrease the rates of unintended pregnancies, unsafe abortions, maternal deaths, and sexually transmitted infections," Culp-Ressler writes. While "kids' sexuality and gender identity typically begin emerging during 'very young adolescence' ... most sexual health programs aren't tailored toward" kids those ages, she explains. In addition, "[i]nstead of providing teens with medically accurate information about their bodies, many public school districts still rely on 'abstinence-only' courses," she notes (Culp-Ressler, "ThinkProgress," Center for American Progress, 8/5).


Many State Abortion Restrictions Now Before Federal Courts

Fri, 08/08/2014 - 14:41

Federal courts are weighing a number of state laws, crafted by Republican-led legislatures, that create new requirements for abortion clinics or restrict when and how abortions are provided, the AP/Huffington Post reports.

Many State Abortion Restrictions Now Before Federal Courts

August 8, 2014 — Federal courts are weighing a number of state laws, crafted by Republican-led legislatures, that create new requirements for abortion clinics or restrict when and how abortions are provided, the AP/Huffington Post reports.

According to AP/Huffington Post, many of the laws reflect strategies outlined by Americans United for Life, which positions the measures as ways to protect women's health. However, abortion-rights supporters say that the procedure is safe and that the laws are really meant to erode access to abortion.

While states have restricted abortion rights in various ways for decades, the number and variety of measures has expanded in recent years, according to Jennifer Dalven, director of the American Civil Liberties Union's Reproductive Freedom Project. "It used to be a brick-by-brick approach, and now [abortion-rights opponents are] throwing up the wall all at once, so you can't get over it no matter how high you jump," she said.

Laws Targeting Clinics

The AP/Huffington Post reviews the status of the laws in several states.

For example, a number of states have passed measures that require abortion providers to have admitting privileges at nearby hospitals. The laws threaten to force abortion clinics to close if their doctors cannot obtain admitting privileges.

Missouri, Tennessee, Texas and Utah are among the states with such requirements in place, and Louisiana and Oklahoma are scheduled to start enforcing similar requirements on Sept. 1 and Nov. 1, respectively. However, courts have blocked admitting privileges requirements in Alabama, Mississippi and Wisconsin.

With courts divided over the admitting privileges laws, the final decision on their constitutionality might be left to the Supreme Court, according to the AP/Huffington Post.

Meanwhile, Texas and Virginia have both enacted regulations that require abortion facilities to meet the same building standards as ambulatory surgical centers, a requirement that could close facilities unable to make the costly changes.

Other Abortion Restrictions

Courts also are weighing states' bans on abortion after a certain point in pregnancy. For example, Arkansas and North Dakota are both appealing federal court decisions that struck down laws banning abortion at 12 weeks and as early as a fetal heartbeat can be detected, respectively, while about a dozen other states have tried to implement abortion bans at 20 weeks of pregnancy.

Federal courts also recently blocked measures in Arizona and Indiana that aimed to restrict access to medication abortion (Crary, AP/Huffington Post, 8/7).


Studies Identify Link Between Genetic Mutations, Breast Cancer Risk

Fri, 08/08/2014 - 14:24

Women with mutations in a gene called PALB2 have a 14% chance of developing breast cancer by age 50 and a 35% chance of developing the disease by age 70, according to a new study in the New England Journal of Medicine, MedPage Today reports.

Studies Identify Link Between Genetic Mutations, Breast Cancer Risk

August 8, 2014 — Women with mutations in a gene called PALB2 have a 14% chance of developing breast cancer by age 50 and a 35% chance of developing the disease by age 70, according to a new study in the New England Journal of Medicine, MedPage Today reports (Bankhead, MedPage Today, 8/6).

PALB2 is the third gene found to potentially increase the risk of breast cancer. In the mid-1990s, researchers discovered that mutations in the BRCA1 and BRCA2 genes were tied to a heightened risk of the disease (Kelland, Reuters, 8/6). Women with BRCA1 gene mutations have been found to have a 50% to 70% chance of developing the cancer by age 70, while those with the BRCA2 have a risk of 40% to 60%, according to the New York Times. By comparison, the lifetime risk of developing breast cancer in the general population is about 12%.

Previous studies found that PALB2 mutations were linked to breast cancer, but they had not demonstrated the extent that mutations in the gene heightened carriers' cancer risk, the Times reports (Bakalar, New York Times, 8/6).

According to study co-author William Foulkes, about one in 1,000 women have the PALB2 mutation (Thompson, HealthDay/CBS News, 8/7).

Study Methods

For the study, researchers analyzed data from 362 family members with PALB2 mutations, representing 154 families (Reuters, 8/6). The data came from 14 different sites in eight countries.

None of the families carried BRCA1 or BRCA2 mutations, but at least one person in each family had breast cancer and a PALB2 mutation.

Study Findings

The study found that breast cancer risk for women under age 40 with PALB2 mutations was eight to nine times higher than among the general population. Meanwhile, the risk for women ages 40 to 60 with the mutation was six to eight times higher than the general population, while the risk for women over age 60 was five times higher.

The researchers are unsure why younger women with PALB2 mutations appear to have a higher risk of developing breast cancer.

The study also found that women with PALB2 gene mutations had a slightly higher likelihood of developing "triple negative" breast cancer, a form that is more aggressive, more resistant to hormone treatment and more likely to recur (New York Times, 8/6).

The researchers also found that individuals with PALB2 mutations had more than twice the risk of ovarian cancer, compared with the general population (MedPage Today, 8/6).

Certain diagnostic laboratories offer tests to detect the PALB2 mutation. Researchers recommended that women who are found to carry the mutation undergo additional surveillance, such as receiving an MRI breast scan (Reuters, 8/6).

Additional Gene Associated With Breast Cancer Risk

In related news, mutations of the multiple endocrine neoplasia type 1 gene -- or MEN1, which normally acts as a tumor-suppressor -- also increase women's risk of breast cancer, according to a study described in a NEJM letter to the editor, MedPage Today reports (MedPage Today, 8/6).

Although MEN1 mutations were known to lead to a rare form of cancer called multiple endocrine neoplasia, the study is the first to show that those women with the disease also have a more than doubled risk of breast cancer. Researchers noted that because multiple endocrine neoplasia is so rare, the findings are mainly important to women in that population (HealthDay/CBS News, 8/7).


State Lawmakers Mobilize To Protect Contraceptive Access After Hobby Lobby

Fri, 08/08/2014 - 14:20

State lawmakers are working to protect women's access to contraception in response to the Supreme Court's Hobby Lobby ruling, which allows some for-profit companies to exclude contraceptive coverage from their employer-sponsored health plans based on their owners' religious objections, Politico Pro reports.

State Lawmakers Mobilize To Protect Contraceptive Access After Hobby Lobby

August 8, 2014 — State lawmakers are working to protect women's access to contraception in response to the Supreme Court's Hobby Lobby ruling, which allows some for-profit companies to exclude contraceptive coverage from their employer-sponsored health plans based on their owners' religious objections, Politico Pro reports.

Gretchen Borchelt, director of state reproductive health policy at the National Women's Law Center, said, "There's been a lot of buzz in the states since the [Hobby Lobby] decision because people are so outraged by it, and they want to make sure that women in their state aren't left unprotected."

According to Politico Pro, 28 states already require employer-sponsored health plans that include prescription drug coverage to cover all FDA-approved contraceptives, although not all of those states address self-insured employers.

While several state lawmakers have proposed bills or taken other steps to protect contraceptive access, supporters of the Hobby Lobby decision also could mobilize to try to broaden its effects and undermine state laws, according to Politico Pro. Although the high court's decision was based on a federal law and does not affect state laws on contraceptive coverage, the Wisconsin Office of the Commissioner of Insurance recently announced that it would no longer enforce the state's contraceptive coverage law for employers with religious objections as a result of the Hobby Lobby ruling.

State Initiatives

Lawmakers in Minnesota last week said they will push legislation that would require employers whose plans offer prescription drug coverage to cover contraceptives without cost sharing. According to Politico Pro, the Minnesota bill and a similar measure in Ohio also would bar self-insured employers from discriminating in employment terms, conditions and benefits -- including health coverage -- based on workers' reproductive health decisions.

In New York, the state attorney general and a leading Democrat in the state Senate have proposed a bill that would require employers to tell prospective workers about their contraception coverage policies and notify current employees at least 90 days before making any changes to those policies.

Meanwhile, Massachusetts Attorney General Martha Coakley (D), who is running for governor, said she would establish a fund to help women afford contraception, while Charlie Baker -- the leading Republican candidate in the gubernatorial race -- has promised to set aside $300,000 in state funds for the same purpose if elected.

In Michigan, state lawmakers have taken a different approach and introduced a resolution that asks Congress to bar for-profit employers from using religious objections to deny employees coverage of other health care services, such as blood transfusions or vaccinations (Villacorta, Politico Pro, 8/7).


Video Round Up: 'Huge Win' Against Ala. TRAP Law, the Importance of Abortion-Rights Rhetoric, More

Fri, 08/08/2014 - 13:20

This week's videos highlight a federal court ruling that forcefully struck down an Alabama law that threatened to close clinics, the importance of language in the abortion-rights debate and the continued threat of provider harassment.

Video Round Up: 'Huge Win' Against Ala. TRAP Law, the Importance of Abortion-Rights Rhetoric, More

August 8, 2014 — This week's videos highlight a federal court ruling that forcefully struck down an Alabama law that threatened to close clinics, the importance of language in the abortion-rights debate and the continued threat of provider harassment.



On "The Rachel Maddow Show," Center for Reproductive Rights President Nancy Northup applauds a "huge win" for abortion rights this week, when a federal judge struck down an Alabama law that required abortion providers to have hospital admitting privileges. Northup explains why groups like the American Medical Association oppose the medically unnecessary admitting privileges requirements. The judge rightly "called out the politicians" who passed the admitting privileges law for their "underhanded tactics ... and said this is not a law about advancing women's safety" but one that will instead "hurt women's health because it's going to close clinics," Northup says (Kornacki, "The Rachel Maddow Show," MSNBC, 8/4).




MSNBC's Ari Melber and Irin Carmon analyze the language used in the abortion-rights debate. Carmon discusses how the antiabortion-rights movement has fueled the segregation of abortion from other types of medical care, resulting in some clinics that primarily provide abortion care and others that offer a variety of women's health services. She argues that "a balance ... needs to be struck here between saying that abortion is part of a range of reproductive health services that women [might] have throughout their lives ... and on the other hand not apologizing for the fact that these clinics provide abortion" (Harris-Perry, "Melissa Harris-Perry," MSNBC, 8/3).




MSNBC's Rachel Maddow reports on abortion-rights supporters' efforts to protect clinics from antiabortion-rights extremists, noting that "the radical edge of the antiabortion movement does have a real and long history of crossing over into violence." Most recently, antiabortion-rights activists laid "siege" on New Orleans, even harassing an abortion doctor at her home. The doctor -- whose name and face are not shown because of safety concerns -- says it was difficult to be personally targeted but that the protesters also "motivate" her to continue providing abortion care, despite the danger (Maddow, "The Rachel Maddow Show," MSNBC, 7/30).

Video Round Up: 'Huge Win' Against Ala. TRAP Law, the Importance of Abortion-Rights Rhetoric, More

Thu, 08/07/2014 - 18:38

This week's videos highlight a federal court ruling that forcefully struck down an Alabama law that threatened to close clinics, the importance of language in the abortion-rights debate and the continued threat of provider harassment.

Video Round Up: 'Huge Win' Against Ala. TRAP Law, the Importance of Abortion-Rights Rhetoric, More

August 7, 2014 — This week's videos highlight a federal court ruling that forcefully struck down an Alabama law that threatened to close clinics, the importance of language in the abortion-rights debate and the continued threat of provider harassment.



On "The Rachel Maddow Show," Center for Reproductive Rights President Nancy Northup applauds a "huge win" for abortion rights this week, when a federal judge struck down an Alabama law that required abortion providers to have hospital admitting privileges. Northup explains why groups like the American Medical Association oppose the medically unnecessary admitting privileges requirements. The judge rightly "called out the politicians" who passed the admitting privileges law for their "underhanded tactics ... and said this is not a law about advancing women's safety" but one that will instead "hurt women's health because it's going to close clinics," Northup says (Kornacki, "The Rachel Maddow Show," MSNBC, 8/4).




MSNBC's Ari Melber and Irin Carmon analyze the language used in the abortion-rights debate. Carmon discusses how the antiabortion-rights movement has fueled the segregation of abortion from other types of medical care, resulting in some clinics that primarily provide abortion care and others that offer a variety of women's health services. She argues that "a balance ... needs to be struck here between saying that abortion is part of a range of reproductive health services that women [might] have throughout their lives ... and on the other hand not apologizing for the fact that these clinics provide abortion" (Harris-Perry, "Melissa Harris-Perry," MSNBC, 8/3).




MSNBC's Rachel Maddow reports on abortion-rights supporters' efforts to protect clinics from antiabortion-rights extremists, noting that "the radical edge of the antiabortion movement does have a real and long history of crossing over into violence." Most recently, antiabortion-rights activists laid "siege" on New Orleans, even harassing an abortion doctor at her home. The doctor -- whose name and face are not shown because of safety concerns -- says it was difficult to be personally targeted but that the protesters also "motivate" her to continue providing abortion care, despite the danger (Maddow, "The Rachel Maddow Show," MSNBC, 7/30).

Calif. Bill Aims To Protect Contraceptive Coverage

Thu, 08/07/2014 - 17:53

A California Assembly committee is considering a bill (SB 1053) that would require health plans to cover all FDA-approved contraceptive methods, Capital Public Radio reports.

Calif. Bill Aims To Protect Contraceptive Coverage

August 7, 2014 — A California Assembly committee is considering a bill (SB 1053) that would require health plans to cover all FDA-approved contraceptive methods, Capital Public Radio reports.

The state Senate has approved the bill, which is awaiting review by the Assembly Appropriations Committee (Pringle, Capital Public Radio, 8/5).

Bill Details

The bill, authored by state Sen. Holly Mitchell (D), would bolster existing contraceptive coverage requirements under state law and the Affordable Care Act (PL 111-148). Under the measure, health plans would have to cover vasectomies and other male contraceptive methods without copayments or deductibles. The ACA's contraceptive coverage rules include a similar requirement for female contraceptives. It aims to ensure coverage without out-of-pocket costs for a full range of methods (Women's Health Policy Report, 5/8).

Debate

Beth Parker of Planned Parenthood Affiliates of California said the bill would prevent the Supreme Court's Hobby Lobby ruling, which allowed some employers to deny birth control coverage on the basis of their owners' religious beliefs, from negatively affecting contraceptive coverage in California.

Meanwhile, Nicole Evans of the California Association of Health Plans said the bill could limit employers' ability to keep health insurance premiums from rising (Capital Public Radio, 8/5).


States' Abortion Restrictions Used as Wedge in Senate Races

Thu, 08/07/2014 - 17:52

While this year's Senate races lack abortion-related disputes on the scale of former Rep. Todd Akin's (R-Mo.) "legitimate rape" comments, candidates from both parties are using state abortion measures to attack their opponents, Politico reports.

States' Abortion Restrictions Used as Wedge in Senate Races

August 7, 2014 — While this year's Senate races lack abortion-related disputes on the scale of former Rep. Todd Akin's (R-Mo.) "legitimate rape" comments, candidates from both parties are using state abortion measures to attack their opponents, Politico reports.

According to Politico, even for candidates who might otherwise want to avoid abortion-related topics, the "high-profile" nature of the debate -- including ongoing court battles over state laws -- is forcing them to take a stance. In particular, Senate candidates are focusing on state laws that ban abortion after 20 weeks of pregnancy and "personhood" proposals that would define life as beginning at fertilization.

Key Races

For example, in Colorado, Sen. Mark Udall (D) has criticized his challenger, Rep. Cory Gardner (R), for his previous support of unsuccessful personhood proposals in 2008 and 2010, which the Udall campaign says shows that Gardner opposes contraception. A Udall ad also says that "Gardner sponsored a bill to make abortion a felony, including [in] cases of rape and incest."

Meanwhile, Gardner has backed off his previous support for the personhood measure and has said FDA should allow nonprescription access to birth control pills. However, he is still a sponsor of a federal personhood bill, according to Politico.

The Democratic Senatorial Campaign Committee also has used several Republican Senate candidates' past or current support of personhood measures to target them for potentially limiting access to contraceptives.

In North Carolina, outside groups are attacking Sen. Kay Hagan (D) for opposing efforts to ban abortion after 20 weeks of pregnancy. Hagan is responding by criticizing her opponent in the Senate race, Republican Thom Tillis, for abortion restrictions that were passed when Tillis was speaker of the state General Assembly (Winfield Cunningham, Politico, 8/6).


'Gutsy' Judicial Opinions Affirm Abortion 'As a Right Among Others,' NYT Op-Ed States

Thu, 08/07/2014 - 17:52

In recent rulings blocking antiabortion-rights laws in Alabama and Mississippi, "federal judges have demonstrated a new willingness to treat the abortion right as a right among others," New York Times op-ed contributor columnist Linda Greenhouse writes.

'Gutsy' Judicial Opinions Affirm Abortion 'As a Right Among Others,' NYT Op-Ed States

August 7, 2014 — In recent rulings blocking antiabortion-rights laws in Alabama and Mississippi, "federal judges have demonstrated a new willingness to treat the abortion right as a right among others," New York Times op-ed contributor columnist Linda Greenhouse writes.

For example, U.S. District Judge Myron Thompson in his opinion striking down Alabama's admitting privileges law compared gun rights and abortion rights to make a "profound point: that a right -- any right -- without the infrastructure and the social conditions that enable its exercise is no right at all," Greenhouse, a former Supreme Court reporter for the Times, writes. Thompson noted that both rights cannot "'be fully exercised without the assistance of someone else.'"

Similarly, a panel on the 5th U.S. Circuit Court of Appeals looked "beyond abortion jurisprudence" when it "voted 2-to-1 to invalidate Mississippi's admitting-privilege requirement, which would have shut down the state's sole abortion clinic," Greenhouse continues. The judges said that under the 14th Amendment, states cannot shift their constitutional obligations to another state or "'be excused from performance by what another state may do or fail to do.'"

"[J]udges' willingness to step outside the abortion frame and to weigh, from that broad perspective, whether the abortion right has become unduly burdened is something new and potentially of great value in the struggle to preserve women's reproductive freedom," Greenhouse writes, noting that "the right to abortion can become stronger the more tightly it is stitched into the constitutional fabric, the more that smart and gutsy judges are willing to treat it as what it is, a right like any other" (Greenhouse, New York Times, 8/6).


Poll: Many U.S. Teens Think They Are Not at Risk for HIV

Thu, 08/07/2014 - 17:27

Nearly 90% of teenagers believe they are not at risk for contracting HIV, according to a recent survey by the MAC AIDS Fund, Vox reports.

Poll: Many U.S. Teens Think They Are Not at Risk for HIV

August 7, 2014 — Nearly 90% of teenagers believe they are not at risk for contracting HIV, according to a recent survey by the MAC AIDS Fund, Vox reports.

For the survey, the group polled more than 1,000 U.S. residents ages 12 to 17.

Key Findings

About one in three respondents did not realize HIV is a type of sexually transmitted infection, the survey found. In addition, 71% of the teens said they knew using a condom helps to prevent the spread of HIV, while less than 50% said that having only one sexual partner can help to prevent HIV.

According to Vox, health experts caution that lack of awareness about HIV could be one factor contributing to a rise in diagnoses among youth. CDC reports that people ages 13 to 24 account for about one in four new HIV infections in the U.S. and that about 60% of infected individuals are unaware they have HIV.

The findings also highlight stigma and misinformation about HIV among youth, according to Vox. For example, less than 40% of respondents said they would spend time with or talk to a friend or classmate who is HIV-positive to help make that person feel better (Lopez, Vox, 8/4).

Daily Beast: U.S. Teens 'Relatively Clear' on Unhealthy Behaviors With Greatest Risks

Meanwhile, Daily Beast columnist Russell Saunders writes that while the survey "does reveal some worrisome data about [teens'] attitudes and level of information about HIV and AIDS," the results as a whole "indicate that adolescents have a pretty good understanding of what choices are most likely to worsen their health over time."

For example, the survey "at face value" notes "that 88 percent [of] American teenagers don't perceive themselves to be at risk for lifetime HIV infection," but, "[i]n contrast, they are concerned about the risks of developing cancer (38 percent), diabetes (33 percent), heart disease (28 percent) and obesity (22 percent)." Saunders writes, "Comparing the prevalence of HIV infection to mortality and obesity rates in the United States, those attitudes are actually pretty sensible."

Saunders continues, "For an organization like the MAC AIDS Fund, it makes sense to look at the survey results and respond with alarm," but when it is "viewed as part of a bigger picture, it shows that teenagers have a good idea of what their long-term health risks truly are" (Saunders, Daily Beast, 8/6).


Study Finds Wide Variance in Quality of Hospitals' Maternity Care

Thu, 08/07/2014 - 17:26

A new Health Affairs study highlights how quality of maternity care varies at U.S. hospitals, and patients often are unaware of the variances, the AP/Sacramento Bee reports.

Study Finds Wide Variance in Quality of Hospitals' Maternity Care

August 6, 2014 — A new Health Affairs study highlights how quality of maternity care varies at U.S. hospitals, and patients often are unaware of the variances, the AP/Sacramento Bee reports.

For the study, researchers assessed billing data for a national sample of more than 750,000 births in 2010. The researchers grouped hospitals into three categories -- high performing, low performing and average performing -- based on complication rates related to the woman giving birth, not based on the health of the infant.

Researchers adjusted for health disparities among patients, and they did not identify hospitals in their final report.

Findings

The researchers found that about 23% of women who deliver vaginally at low-performing hospitals experienced a major complication, compared with a rate of about 15% at average-performing hospitals and just 10% at high-performing hospitals. According to the study, the most common complications were unusual bleeding and tearing.

Similarly, the researchers found that about 21% of women who delivered via cesarean section at low-performing hospitals experienced a major complication, compared with a rate of 9% at average-performing hospitals and a rate of less than 5% at high-performing hospitals. They determined that the most-common complications associated with C-sections were unusual bleeding and infection.

Efforts To Develop Hospital Comparison Database

According to the AP/Bee, several medical groups are developing databases that will allow women and families to easily compare hospital quality. However, there is no such database currently.

For example, the American Congress of Obstetricians and Gynecologists is developing a hospital comparison database would use clinical data compiled from electronic health records, although it likely will not be ready for consumer use for another three to five years.

Barbara Levy, vice president for health policy at ACOG, said she did not "discount the findings" from the Health Affairs study but noted that researchers relied on billing data rather than clinical data. Levy said that billing data is several steps removed from how a patient actually was treated and that clinical data would present more accurate findings.

Levy said, "I think there is a convincing conclusion that there are differences" among hospitals, but she added that "this kind of a study" cannot accurately show "how substantial the differences are" and "how dramatic the complications are" (Alonso-Zaldivar, AP/Sacramento Bee, 8/5).