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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Austin City Council Approves Resolution Supporting Repeal of Texas' HB 2

Mon, 09/29/2014 - 14:58

The Austin, Texas, City Council on Thursday unanimously passed a resolution supporting a full repeal of a state antiabortion-rights law (HB2), the Austin Chronicle reports.

Austin City Council Approves Resolution Supporting Repeal of Texas' HB 2

September 29, 2014 — The Austin, Texas, City Council on Thursday unanimously passed a resolution supporting a full repeal of a state antiabortion-rights law (HB2), the Austin Chronicle reports. City Council members Mike Martinez, Laura Morrison and Bill Spelman sponsored the resolution.

According to the Chronicle, the measure cites the medical consensus among the American Congress of Obstetricians and Gynecologists, the Texas Medical Association and the Texas Hospital Associations that HB2 is a danger to women's health. It also references the increased cost and travel time associated with abortion clinic closures under HB2, decreased access to abortion and preventive care services, and the state's cuts to family planning services.

In addition to supporting the law's repeal, the measure directs the city manager to study HB2's impact on Austin's residents and present the results to the city's Public Health and Human Services Committee by Nov. 18.

Martinez said in a statement, "Access to full-spectrum reproductive health care in Texas is diminishing as a result of decisions made by our state leadership." He noted that the city's "facilities have been especially strained for resources as people travel from all over Texas to obtain care," demonstrating that HB2 "has nothing to do with women's health or safety" (Tuma, Austin Chronicle, 9/25).


Featured Blog

Fri, 09/26/2014 - 17:29

"Buffalo Clinic First in the Nation To Offer Both Abortion and Birthing Services" (Bader, RH Reality Check, 9/25).

September 26, 2014

FEATURED BLOG

"Buffalo Clinic First in the Nation To Offer Both Abortion and Birthing Services," Eleanor Bader, RH Reality Check: This spring, "Buffalo Womenservices, a 31-year-old reproductive health facility in" Buffalo, N.Y., "opened the nation's first birth center to be located inside an abortion clinic," Bader writes. She notes that although the center has "rais[ed] eyebrows among some members of the Buffalo community who have bristled at putting birth and abortion care in one facility, the model has provoked interest elsewhere." According to Bader, "clinics in Kansas, Ohio, and Tennessee are exploring the feasibility of adding a birth center to their repertoire of services" (Bader, RH Reality Check, 9/25).

Calif. Gov. Signs Bills To Address Contraceptive Coverage Gaps, End Inmate Sterilizations

Fri, 09/26/2014 - 17:20

California Gov. Jerry Brown (D) on Thursday signed a bill (SB 1053) into law that requires health plans in the state to cover contraceptive methods and services without out-of-pocket costs, delays or other restrictions, the Los Angeles Times reports.

Calif. Gov. Signs Bills To Address Contraceptive Coverage Gaps, End Inmate Sterilizations

September 26, 2014 — California Gov. Jerry Brown (D) on Thursday signed a bill (SB 1053) into law that requires health plans in the state to cover contraceptive methods and services without out-of-pocket costs, delays or other restrictions, the Los Angeles Times reports (McGreevy/Mason, Los Angeles Times, 9/25).

The legislation, authored by state Sen. Holly Mitchell (D), applies to all FDA-approved contraceptives and aims to bolster existing contraceptive coverage requirements under state law and the Affordable Care Act (PL 111-148). Under the new measure, health plans will 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 (Women's Health Policy Report, 8/7). The legislation also requires health plans to cover counseling and follow-up services related to contraception and sterilization procedures.

Mitchell said the legislation addresses coverage gaps under federal rules that allow insurers to limit coverage to "reasonable medical management techniques."

She added, "When a healthcare professional advises a woman of the optimal treatment for her medical or family planning needs, no health plan should stand between her and that treatment, nor make it harder for her to get" (Los Angeles Times, 9/25).

Gov. Brown Signs Bill To Bar Forced Inmate Sterilizations

Meanwhile, Brown on Thursday also signed a bill (SB 1135) into law that prohibits sterilization surgeries among the state's inmates without their consent, Reuters reports.

The legislation -- which unanimously passed both chambers of the state Legislature last month -- was proposed after an audit of the state's prisons released in June found that prison officials did not properly obtain informed consent to perform sterilization procedures on 39 female inmates (Skinner, Reuters, 9/25). Previous investigations had uncovered similar issues (Women's Health Policy Report, 7/9/13).

The new law makes sterilization in prisons illegal as a means of birth control, with exceptions for when a patient's life is endangered or if the procedure is required to treat medical conditions for which there are no available alternatives. In addition, it requires a second independent doctor to discuss the procedure's effects with a patient prior to the surgery (Los Angeles Times, 9/25).

The measure will take effect Jan. 1 (AP/San Francisco Chronicle, 9/25).

Bill author state Sen. Hannah-Beth Jackson (D) said in a statement, "Pressuring a vulnerable population into making permanent reproductive choices without informed consent is unacceptable, and violates our most basic human rights" (Los Angeles Times, 9/25).


Blogs Comment on First Birth Center 'Inside an Abortion Clinic,' EC Access, Sharing 'Nuanced' Abortion Stories, More

Fri, 09/26/2014 - 16:56

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

Blogs Comment on First Birth Center 'Inside an Abortion Clinic,' EC Access, Sharing 'Nuanced' Abortion Stories, More

September 26, 2014 — Read the week's best commentaries from bloggers at RH Reality Check, Salon and more.

ABORTION PROVIDERS: "Buffalo Clinic First in the Nation To Offer Both Abortion and Birthing Services," Eleanor Bader, RH Reality Check: This spring, "Buffalo Womenservices, a 31-year-old reproductive health facility in" Buffalo, N.Y., "opened the nation's first birth center to be located inside an abortion clinic," Bader writes. She notes that although the center has "rais[ed] eyebrows among some members of the Buffalo community who have bristled at putting birth and abortion care in one facility, the model has provoked interest elsewhere." According to Bader, "clinics in Kansas, Ohio, and Tennessee are exploring the feasibility of adding a birth center to their repertoire of services" (Bader, RH Reality Check, 9/25).

CONTRACEPTION: "Sen. Murray Introduces Legislation To Improve Emergency Contraception Education, Access," Emily Crockett, RH Reality Check: Crockett comments on Sen. Patty Murray's (D-Wash.) introduction of a bill (S 2876) that "would require any hospital that receives federal funding under Medicare or Medicaid ... to both inform sexual assault survivors who come to the emergency room about emergency contraception and to offer it to them regardless of their ability to pay." The bill would also "launch an education campaign on the drug and its uses" to be carried out through HHS, she adds. Crockett writes that Murray has introduced the same bill each year "for over a decade," adding that the senator would have to reintroduce the bill during the next legislative session if Congress does not consider it before the end of this year (Crockett, RH Reality Check, 9/24).

What others are saying about contraception:

~ "CVS Illegally Charged 11,000 Women Contraceptive Co-Pay," Crockett, RH Reality Check.

ABORTION-RIGHTS MOVEMENT: "Abortion Beyond 'Good' and 'Bad': Why It's So Important To Share Nuanced Stories," Katie McDonough, Salon: Sharing abortion stories "is an important and necessary thing," but because "[w]omen who speak out are still targeted for harassment and other threats," it can be difficult "to talk about the full range of experiences that people seeking abortion go through," McDonough writes. The Center for Reproductive Rights has launched a campaign "featuring women and men telling stories related to their own reproductive healthcare choices," she adds, noting that they "are important stories because they're real stories." McDonough also recounts a time she interviewed a woman who recorded her abortion to illustrate how such stories can "challenge stigma around the procedure and demystify the process for people who only think about abortion as an abstract political concept" (McDonough, Salon, 9/25).

What others are saying about the abortion-rights movement:

~ "Rush Limbaugh Inadvertently Donated To an Abortion Fund," Jenny Kutner, Salon.

SUPREME COURT: "Ruth Bader Ginsburg: '50 Years From Now, People Will Not Be Able To Understand Hobby Lobby,'" Kutner, Salon: Supreme Court Justice Ruth Bader Ginsburg, who "has already (artfully) made clear that she disagrees with the Hobby Lobby decision," is "convinced future generations will not only feel the same way, but that they won't even understand the Supreme Court's ruling in the first place," Kutner writes. In an interview with Elle, Ginsburg also stated that "'one of the reasons ... that there's not so much pro-choice activity'" today is because "'young women ... have grown up in a world where they know if they need an abortion, they can get it,'" Kutner notes. Kutner adds that "[w]hen asked if she believes that the court will swing further to the right over abortion rights, Ginsburg answered optimistically, adding that she thinks the court has 'gotten about as conservative as it will get'" (Kutner, Salon, 9/23).

FEMINISM: "We Need #YesAllWomen Now More Than Ever Before," Madeline Wahl, Huffington Post blogs: In the face of continued violence and harassment against women and "the inadequate way people are coping with the spreading popularity of feminism and idea of equality ... we need #YesAllWomen now more than ever before," Wahl writes, reflecting, in part, on reaction to a speech about feminism by actress Emma Watson before the United Nations. She urges women to use the Twitter hashtag "to continue raising awareness on what women have faced and continue to face ... to share our voices and stop the violence." Wahl continues, "We need to tell each other our experiences of sexual assault, of being catcalled, of body shaming and victim shaming and all other kinds of shaming that should not be tolerated. We have to tell each other that 'no means no' and any unwanted contact, even under the guise of a prank, is not appropriate and not allowed." She adds, "We have to tell the men and women in our lives that equality can be achieved, that peace is within our grasp, that we should actually be proud to be feminists" (Wahl, Huffington Post blogs, 9/24).

What others are saying about feminism:

~ "This Is Why I'm Not a Reluctant Feminist," Jean-Paul Bedard, Huffington Post blogs.


Datapoints: ACA Ends Birth Control Copays for Many, States Delay Abortion Access & More

Fri, 09/26/2014 - 16:12

This week, we feature an infographic highlighting the impact of the Affordable Care Act's birth control benefit, as well as maps depicting state-mandated delays in abortion care and progress in reducing teen birth rates.

Datapoints: ACA Ends Birth Control Copays for Many, States Delay Abortion Access & More

September 26, 2014 — This week, we feature an infographic highlighting the impact of the Affordable Care Act's birth control benefit, as well as maps depicting state-mandated delays in abortion care and progress in reducing teen birth rates.

ACA Ends Birth Control Copays for Increasing Number of Women



Women with private health insurance are increasingly paying nothing out of pocket for their contraceptive method of choice, according to a Guttmacher Institute infographic and accompanying study.

Guttmacher researchers found that the impact of the Affordable Care Act's (PL 111-148) contraceptive coverage benefit has been "substantial and rapid," but they noted that gaps in coverage remain, in part because of the grandfathered status of some health plans, insurers improperly charging copayments or deductibles in some cases, and exemptions for certain employer-sponsored plans on religious grounds (Guttmacher release, 9/18).


States Mandate Delays in Abortion Care



Missouri this month joined North Dakota and Utah in mandating that a woman wait at least 72 hours between when she first seeks an abortion and when she may obtain the procedure, although the specific requirements of the laws vary in each state.

Nationwide, 26 states have laws mandating delays of various lengths before a woman can obtain abortion care, according to this map from the Washington Post's "Gov Beat," based on Guttmacher Institute data as of Sept. 1. Some states also mandate that women receive in-person counseling, which can require an additional trip to the clinic and further complicate access. Mandatory delay laws on the books in Massachusetts and Montana are not enforced due to court orders, "Gov Beat" notes (Chokshi, "Gov Beat," Washington Post, 9/11).


Animation Shows Declining Teen Birth Rates by State



Nationwide, the teen birth rate has been on the decline for years, reaching record lows in 2012. However, as shown in this animation from @MetricMaps -- a Twitter and Reddit account specializing in "visualizing behavioral health data" -- the decrease in birth rates progressed more rapidly in some states and regions than others. Specifically, progress in southern states lagged behind other regions.

According to Mic, states that teach abstinence-only sex education also tend to have higher teen pregnancy rates (Essert, Mic, 9/15).


Calif. Gov. Signs Bills To Address Contraceptive Coverage Gaps, End Inmate Sterilizations

Fri, 09/26/2014 - 14:29

California Gov. Jerry Brown (D) on Thursday signed a bill (SB 1053) into law that requires health plans in the state to cover contraceptive methods and services without out-of-pocket costs, delays or other restrictions, the Los Angeles Times reports.

Calif. Gov. Signs Bills To Address Contraceptive Coverage Gaps, End Inmate Sterilizations

September 26, 2014 — California Gov. Jerry Brown (D) on Thursday signed a bill (SB 1053) into law that requires health plans in the state to cover contraceptive methods and services without out-of-pocket costs, delays or other restrictions, the Los Angeles Times reports (McGreevy/Mason, Los Angeles Times, 9/25).

The legislation, authored by state Sen. Holly Mitchell (D), applies to all FDA-approved contraceptives and aims to bolster existing contraceptive coverage requirements under state law and the Affordable Care Act (PL 111-148). Under the new measure, health plans will 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 (Women's Health Policy Report, 8/7). The legislation also requires health plans to cover counseling and follow-up services related to contraception and sterilization procedures.

Mitchell said the legislation addresses coverage gaps under federal rules that allow insurers to limit coverage to "reasonable medical management techniques."

She added, "When a healthcare professional advises a woman of the optimal treatment for her medical or family planning needs, no health plan should stand between her and that treatment, nor make it harder for her to get" (Los Angeles Times, 9/25).

Gov. Brown Signs Bill To Bar Forced Inmate Sterilizations

Meanwhile, Brown on Thursday also signed a bill (SB 1135) into law that prohibits sterilization surgeries among the state's inmates without their consent, Reuters reports.

The legislation -- which unanimously passed both chambers of the state Legislature last month -- was proposed after an audit of the state's prisons released in June found that prison officials did not properly obtain informed consent to perform sterilization procedures on 39 female inmates (Skinner, Reuters, 9/25). Previous investigations had uncovered similar issues (Women's Health Policy Report, 7/9/13).

The new law makes sterilization in prisons illegal as a means of birth control, with exceptions for when a patient's life is endangered or if the procedure is required to treat medical conditions for which there are no available alternatives. In addition, it requires a second independent doctor to discuss the procedure's effects with a patient prior to the surgery (Los Angeles Times, 9/25).

The measure will take effect Jan. 1 (AP/San Francisco Chronicle, 9/25).

Bill author state Sen. Hannah-Beth Jackson (D) said in a statement, "Pressuring a vulnerable population into making permanent reproductive choices without informed consent is unacceptable, and violates our most basic human rights" (Los Angeles Times, 9/25).


Reported Complaints Do Not Reflect Full Scope of Pregnancy Discrimination Incidents

Fri, 09/26/2014 - 14:25

Although more women are filing pregnancy discrimination claims with the Equal Employment Opportunity Commission, some remain hesitant to report pregnancy discrimination and face challenges when trying to prove the claims in court, according to The Atlantic.

Reported Complaints Do Not Reflect Full Scope of Pregnancy Discrimination Incidents

September 26, 2014 — Although more women are filing pregnancy discrimination claims with the Equal Employment Opportunity Commission, some remain hesitant to report pregnancy discrimination and face challenges when trying to prove the claims in court, according to The Atlantic (Cunha, The Atlantic, 9/24).

Overall, pregnancy-related complaints to EEOC increased by 46% from 1997 through 2011, according to the agency's most recent data. In response, EEOC in July released new enforcement guidelines reminding employers that they are prohibited from discriminating against workers based on past, future or current pregnancies (Women's Health Policy Report, 7/16).

According to The Atlantic, some pregnant workers who experience discrimination fear retribution from current or former employers if they report the incidents.

Colorado-based attorney Brian Stutheit said, "The law clearly states the employer can't retaliate against a woman speaking up for her rights, but many employers do it anyway. They just find another reason down the road." Often employees will be treated well for a period of time after the complaint was filed and then fired months later for an unrelated reason, he said.

Similarly, employment attorney Diane King said, "There are many more women discriminated against in the workplace due to pregnancy, family, and gender than will ever come forward to file a claim." She noted that some women might avoid filing claims for fear of receiving a bad reference, adding, "In some businesses, a simple wink and nod can ruin your chances of getting the next job."

Stutheit said women who do sue their employers can face challenges proving the discrimination in court. According to The Atlantic, filming inappropriate behavior in the workplace often violates privacy laws, so most evidence in the cases is considered circumstantial unless there is a documented paper trail. Stutheit added that it can be difficult to convince eyewitnesses to testify because they fear that they will jeopardize their own job (The Atlantic, 9/24).


Domestic Violence at Least as Common Among Same-Sex Partners as Other Couples, Study Finds

Fri, 09/26/2014 - 14:22

Domestic violence is as at least as prevalent among same-sex couples as it is among heterosexual couples, if not more so, according to study in the Journal of Sex and Marital Therapy, Reuters reports.

Domestic Violence at Least as Common Among Same-Sex Partners as Other Couples, Study Finds

September 26, 2014 — Domestic violence is as at least as prevalent among same-sex couples as it is among heterosexual couples, if not more so, according to study in the Journal of Sex and Marital Therapy, Reuters reports.

For the study, researchers reviewed four separate medical studies consisting of almost 30,000 participants.

Key Findings

The new study found that between 25% and 75% of lesbian, gay and bisexual individuals experience domestic violence. By comparison, at least 25% of heterosexual women experience domestic violence at some point during their lives, according to Reuters.

The researchers said it is unclear why domestic violence might be more common among people in same-sex relationships. However, they suggested it might be because of the stress of being in a sexual minority, among other reasons.

Study lead author Richard Carroll of Northwestern University's Feinberg School of Medicine noted that there "are vulnerabilities that come with being in a homosexual relationship." He added that similar interventions and screenings can be useful for both same-sex and heterosexual couples but that there should be extra elements in screening same-sex couples.

He said, "Healthcare and mental healthcare providers need to be sensitized to dealing with issues of the homosexual population and the willingness and ability to ask about domestic violence and knowing where to refer them if that comes up" (Seaman, Reuters, 9/24).


U.S. Infant Mortality Rate Improves, Still Lags Behind Many Developed Countries, CDC Finds

Fri, 09/26/2014 - 14:22

The U.S. infant mortality rate has improved but was still the fourth highest among 29 developed nations included in a CDC report released on Wednesday, the Los Angeles Times' "Science Now" reports.

U.S. Infant Mortality Rate Improves, Still Lags Behind Many Developed Countries, CDC Finds

September 26, 2014 — The U.S. infant mortality rate has improved but was still the fourth highest among 29 developed nations included in a CDC report released on Wednesday, the Los Angeles Times' "Science Now" reports (Kaplan, "Science Now," Los Angeles Times, 9/24).

For the report, the infant mortality rate was defined as the percentage of infants who were born alive but died prior to their first birthdays. The researchers compared 2010 U.S. infant mortality rates with European countries, as well Australia, Korea, Israel, Japan and New Zealand.

Key Findings

CDC found that the U.S. infant mortality rate had declined from 6.87 infant deaths per 1,000 live births in 2005 to a rate of 6.1 in 2010 (Haelle, HealthDay/U.S. News & World Report, 9/24). By comparison, the lowest 2010 rates identified in the study were 2.3 in Finland and Japan and 2.5 in Portugal and Sweden.

However, some countries did not report infant mortality rates for premature infants born at 22 or 23 weeks of gestation ("Science Now," Los Angeles Times, 9/24). When excluding such infant deaths from the data, researchers found that the U.S. infant mortality rank was 4.2 deaths per 1,000 live births, the ninth highest rate among countries that supplied infant mortality data for infants born at 22 or 23 weeks and about double the rates for Denmark, Finland and Sweden (Adams, CQ HealthBeat, 9/23).

Overall, the U.S. had the fifth-lowest rate for infants born after 24 to 27 weeks, the second-highest rate for infants born after 32 to 36 weeks, and the highest rate for infants born after at least 37 weeks, with 2.2 deaths per 1,000 live births.

Rates in Perspective

The researchers said that if the U.S. could reduce its mortality rate for infants born after at least 37 weeks to Sweden's rate of 1.1, the country's overall infant mortality rate could decline to 3.2, which would be equivalent to 4,100 fewer infant deaths annually.

In addition, CDC said that if the percentage of all births in the U.S. involving infants born preterm -- before 37 weeks -- declined from 9.8% to Sweden's rate of 5.8%, the U.S. infant mortality rate would decline to 3.4, which would be equivalent to 3,200 fewer infant deaths annually ("Science Now," Los Angeles Times, 9/24).

Contributors to U.S. Rates

Lead author Marian MacDorman said that while the researchers expected the U.S. to have a high preterm birth rate, the "higher infant mortality rate for full-term, big babies who should have really good survival prospects is not what we expected."

While noting that the report did not provide a reason for the findings, MacDorman suggested that they were the result of "social factors, such as [sudden infant death syndrome] and injuries," adding, "I don't think it's so much about health care but about the environment and raising a child."

Deborah Campbell -- a professor of clinical pediatrics at Albert Einstein College of Medicine who was not involved in the study -- said the relatively high infant mortality rate in the U.S. is the result of "significant gaps in access to and utilization of prenatal and preconception care." She added that black women and their infants, in particular, have had a higher risk of mortality as the result of issues such as discrimination, malnutrition and a lack of access to quality care (HealthDay/U.S. News & World Report, 9/24).


Survey: Many N.Y. Hospitals, Community Health Centers Lack Structured STI Management Plans

Thu, 09/25/2014 - 21:04

New York health department researchers surveyed hospitals and community health centers in the state to determine where care for sexually transmitted infections most commonly occurred in the facilities and whether they had a dedicated staff member or unit to coordinate STI clinical services and management. They found that "STI care is often scattered across facilities" -- most commonly occurring in the emergency department or ob-gyn clinic -- and that only 30% of facilities "had an organization-wide process for monitoring the quality of STI care."

Survey: Many N.Y. Hospitals, Community Health Centers Lack Structured STI Management Plans

September 25, 2014 —Summary of "Management of Sexually Transmitted Infections in New York State Health Care Organizations: Who is Thinking About the Quality of STI Care?" Janowski et al., Sexually Transmitted Diseases, September 2014.

CDC estimates show that 20 million new cases of sexually transmitted infections (STIs) are diagnosed in the U.S. each year, with the "latest national reports suggest[ing] that bacterial STI rates are rising," according to a study by John Janowski of the New York State Department of Health (NYSDOH) AIDS Institute and colleagues at the NYSDOH Office of Health Emergency Preparedness and Bureau of Healthcom Network Systems Management.

Increasing STI rates "warrant a renewed focus on the management of STIs in health care organizations," but little is known about the "processes and allocated staff for the management of STIs" at hospitals and community health centers (CHCs), the researchers wrote.

After an informal pilot study of 38 New York hospitals in 2010 found that such organizations "had no manner to easily or uniformly collect STI data," the researchers recognized a "need to better understand how facilities are organized to obtain and use STI data."

Methods

In March 2011, the researchers posted a survey through NYSDOH's Health Emergency Response Data System to poll the 291 New York hospitals and CHCs that are regulated by the department and certified to receive funding through Medicaid and Medicare. They followed up with phone calls and emails to facilities that did not immediately respond. The survey closed on July 29, 2011.

The survey asked five questions to gauge information about measuring STI rates, monitoring the quality of care, coordinating STI management, which departments most often treat STIs and "primary staff points of contact."

Because specialty hospitals and same-campus facilities were excluded, 256 of the 291 hospitals were eligible for inclusion in the analysis. Organizations were categorized as either hospitals or CHCs. Organizational characteristics included in the analysis were county-level STI rates, facility type, number of departments frequently treating STIs, caseload and facility size, HIV and family programs, and region.

Findings

The survey yielded responses from 95% of the facilities, including 183 hospitals and 60 CHCs. The researchers found that the departments that most commonly treated STIs were EDs (70%), ob-gyn clinics (51%), general medicine clinics (39%) and HIV clinics (26%). Thirty-six percent of respondents reported that other departments commonly treated STIs. The survey also found that:

~ Fifty-one percent of hospitals and 47% of CHCs said they had a "designated staff person or unit to track and report STIs";

~ Only 30% of all respondents said "that they had an agency-wide process for monitoring the quality of STI care," although CHCs (50%) were more likely than hospitals (23%) to have such a process in place; and

~ Only about one-fourth of respondents from both types of facilities said they had at least one staff member or centralized unit responsible for coordinating STI management. The researchers noted that variables such as facility size, county-level STI rates and the number of departments treating STIs were not "significant predictors of whether a facility has a person/unit that reports STI rates."

Discussion

Overall, the data "show that few hospitals and CHCs have established organizational processes to monitor agency-wide STI rates or the quality of STI" care, the researchers wrote.

Further, no organizational characteristics significantly predicted whether a facility had centralized processes or people for tracking and reporting STI rates or coordinating STI management, which "reflect[s] the reality that STI care is often scattered across facilities," according to Janowski and colleagues.

The researchers noted that while EDs were the "main sites for STI diagnosis and treatment, ... they face barriers to providing STI services, report poorer performance" on quality metrics and "are not designed to provide follow-up or partner services." Likewise, care at ob-gyn clinics can be "episodic or time-limited without integrated plans for ongoing follow-up with patients," they wrote.

Conclusion

The "lack of organizational focus on STIs might preclude the delivery of comprehensive STI management in health care organizations," the researchers wrote, adding, "Serious and costly STI complications could be avoided" with an improved management structure.

The researchers concluded that a "clear need exists for both the health care system and health care organizations to address this gap to ensure that the resurgence in STI rates is curbed."

Many CPC Websites in State Directories Include Inaccurate Information About Abortion

Thu, 09/25/2014 - 21:04

Although abortion "is a safe medical procedure and is less risky than carrying a pregnancy to term," many crisis pregnancy center websites overstate its risks or include other misleading claims, according to researchers from the University of North Carolina-Chapel Hill. The researchers examined the websites of CPCs listed in state-mandated directories that are given to women seeking abortions, finding that 87% of the sites did not disclose that the centers are not medical facilities and that 80% contained false or misleading medical information.

Many CPC Websites in State Directories Include Inaccurate Information About Abortion

September 25, 2014 —Summary of "Crisis Pregnancy Center Websites: Information, Misinformation and Disinformation," Bryant et al., Contraception, July 12, 2014.

Many states that mandate a delay period and counseling before an abortion also require that women seeking the procedure be told about agencies that "offer 'alternatives to abortion,'" according to Amy Bryant of the Department of Obstetrics and Gynecology at the University of North Carolina-Chapel Hill and colleagues at UNC.

Some states with such laws also require that women seeking abortion services are offered written materials with information about abortion, as well as a directory of services and agencies that could offer them assistance.

In each of these cases, the specified agencies include crisis pregnancy centers (CPCs), which are privately owned, not-for-profit "organizations that offer free services to women facing unintended pregnancies," Bryant and colleagues wrote.

CPCs sometimes "promote themselves as women's health clinics" or " imply that they offer abortion services," even though they try "to dissuade women from having abortions" and often "provid[e] misleading or false information about abortion," they added. Further, CPCs "are not governed by the same rules and regulations that govern health clinics," the researchers noted.

Information on CPCs' websites can be particularly problematic, they added. The sites' inclusion in state directories might imply to patients that they are health centers and "sources of accurate information," although most states include "a disclaimer that they do not specifically endorse the views of any particular agency," according to the researchers.

To evaluate these issues, Bryant and colleagues examined the medical information provided on the websites of CPCs listed in state resource directories for pregnant women.

Methods

The researchers used data from the Guttmacher Institute to identify states with so-called "'Woman's Right to Know' laws" that require women to be offered certain information before abortions. They then performed Internet searches to locate states' directories of resources for women seeking abortion services and called state agencies for printed copies when the directories were not available online. They identified all agencies in the directories that were listed as or appeared to be CPCs.

Bryant and colleagues evaluated the CPCs' websites for information about abortion, including whether the site claimed there is a relationship "between abortion and specific outcomes, particularly mental health disorders, breast cancer and poor pregnancy outcomes such as infertility and preterm birth."

Results

The researchers obtained resource directories for 12 states: Alaska, Alabama, Georgia, Idaho, Louisiana, Minnesota, North Carolina, South Carolina, Oklahoma, Texas, West Virginia and Kansas.

Scope of Directories

The majority of the directories did not list any organizations that perform abortions, but those for three states -- North Carolina, South Carolina and Kansas -- listed some comprehensive women's health centers.

Meanwhile, the directories listed 601 agencies that seemed to be CPCs, of which the researchers identified 456 corresponding websites. After excluding nonfunctional sites and those that referred to agencies that were not actually CPCs, such as maternity homes, Bryant and colleagues were left with 348 websites that referred to CPCs. They reviewed the 94 sites that referred to more than one CPC only once, leaving a final sample of 254 websites.

Information on CPC Websites

The review of the websites found that 97% stated that the centers provided free pregnancy testing, while 54% said free ultrasounds were available and 58% mentioned religious references, such as directly stating a Christian affiliation or mentioning a Bible study.

With regard to information about abortion and medical services, the review found:

~ Eighty-seven percent of the sites failed to provide a disclaimer noting that the facility was not a medical center;

~ Eighty percent included "at least one false or misleading statement"; and

~ Information about abortion appeared on 57% percent of sites, of which 92% had inaccurate or misleading statements about it.

The researchers found that the most common inaccuracies listed "were a declared link between abortion and mental health risks, preterm birth, breast cancer, future infertility, miscarriage and ectopic pregnancy." Many sites also "linked abortion and suicidal thoughts and/or suicide," while nearly three-fourths said that abortion can lead to a condition called "postabortion stress," the researchers wrote.

Discussion

The finding that 80% of identified CPC websites "contain misleading or inaccurate information regarding the risks associated with abortion" is "alarming because many states currently list these organizations as places to seek information on alternatives to abortion." Some states use sales of special license plates and other programs to fund CPCs.

Bryant and colleagues argued that it is "unethical" to attempt to deter women from seeking abortion -- "a safe medical procedure [that] is less risky than carrying a pregnancy to term" -- by offering them "inaccurate information about risks."

They also noted that there is a lack of evidence to support the "poor [abortion] outcomes often asserted on these websites." For example, so-called postabortion stress is not a medically recognized disorder, and "[e]xtensive research" has found no link "between a single, legal, first-trimester abortion and an increased risk of mental health problems," the researchers wrote, adding that other studies claiming a causal relationship between abortion and suicide or suicidal thoughts are methodologically flawed.

Women "should be allowed to make a truly informed decision" about abortion "based on medically accurate, evidence-based information," the researchers wrote, concluding that states' resource directories should not include agencies that provide false information.

Analysis Tracks Declines in Abortion Availability, Rates After Implementation of Texas' HB 2

Thu, 09/25/2014 - 19:31

The Texas Policy Evaluation Project's Daniel Grossman and colleagues set out to examine how an omnibus antiabortion-rights law in Texas (HB 2) has affected abortion services in the state. They found that the number of facilities providing abortions in Texas decreased from 41 in May 2013 to 22 in November 2013, after most of the law's provisions took effect. Further, the number of medical abortions decreased by 70%, while the total statewide abortion rate decreased by 13%.

Analysis Tracks Declines in Abortion Availability, Rates After Implementation of Texas' HB 2

September 25, 2014 —Summary of "Change in Abortion Services After Implementation of a Restrictive Law in Texas," Grossman et al., Contraception, July 22, 2014.

State restrictions on abortion have surged over the past few years. Increasingly, these laws focus "on the 'supply' side of abortion" by "mak[ing] it more difficult for facilities to provide services," according to researchers led by Daniel Grossman of the Texas Policy Evaluation Project, Ibis Reproductive Health and the Bixby Center for Global Reproductive Health at the University of California-San Francisco.

One such law (HB 2), enacted in Texas in July 2013, "put into place four supply-side abortion restrictions: abortions are banned after 20 weeks 'post-fertilization' excluding certain exceptions; physicians performing abortion must have admitting privileges at a hospital within 30 miles of the facility; the provision of medical abortion must follow the labeling approved by [FDA] (with some allowances for drug dosages); and all abortion facilities must meet the standards of an [ambulatory surgical center (ASC)]." The first three provisions of HB 2 took effect on Nov. 1, 2013, while the ASC provision was scheduled to take effect on Sept. 1, 2014.

For the study, Grossman and colleagues set out "to rapidly assess the effect of these provisions on abortion services in the first 6 months after HB2 was implemented." The researchers hypothesized that HB2 would result in "a significant decrease in the abortion rate in Texas, as well as in the proportion of medical abortions performed."

Methods

Tracking Clinic Closures

In order to track the law's effect on the number of open facilities in the state, the researchers used data from the Texas Policy Evaluation Project, which "has tracked the number of open facilities providing abortion care in the state through interviews with clinic staff, reports in the press and by intermittent requests to the Texas Department of State Health Services (DSHS) concerning licensed abortion providers" since 2012.

The researchers "focus[ed] on the number of facilities open in three 6-month periods relating to the passage and implementation of" the law: the six months leading up to debate on the measure, the six months during which the law had been passed but was not yet enforced, and the six months after all provisions of the law except the ASC requirements were enforced.

Using data from the U.S. Census Bureau's American FactFinder tool, the researchers "also estimated the number of reproductive-aged Texas women living in a county more than 50, 100 or 200 miles from a licensed Texas abortion provider in each of these periods" by "calculate[ing] the distance that women would need to travel to get to an open facility" during each of the six-month periods, as well as the distances as of Sept. 1, when the ASC requirements were scheduled to take effect.

Data Collection

The researchers noted that vital statistics on abortion typically become publicly available after about two years. In order to perform a faster evaluation, they "collected data directly from abortion providers" between February and May of this year by emailing or telephoning "every licensed abortion facility that provided abortions in November 2012."

Specifically, the researchers requested data for every month from November 2012 through April 2014 on the number of:

~ Induced abortions overall;

~ Medical abortions up to 63 days of gestation;

~ Surgical abortions at less than 12 weeks of gestation; and

~ Surgical abortions at 12 weeks or later.

In addition, the researchers "requested the monthly number of patients who reported residing in the Lower Rio Grande Valley," as "both abortion facilities there had closed by the start of" the third six-month period, Grossman and colleagues noted. They added that the population in this region is "particularly vulnerable" because of "higher levels of poverty than the rest of the state" and the facts that "women would have to travel at least 150 miles to the nearest clinic" and that undocumented immigrants "would need to pass border patrol stations."

Nearly all of the surveyed abortion clinics provided complete data for all three study periods.

The researchers used the acquired data to estimate "the annualized abortion rate per 1,000 women aged 15-44 for each period based on the 2012 population" and determine "the distribution of abortions by procedure type and time period." They also estimated the number of abortions among Lower Rio Grande Valley residents and changes in the number of abortions performed in the state's four largest metropolitan areas: Austin, Dallas/Fort Worth, Houston and San Antonio.

Findings

Number of Facilities

During the first six-month period, which covered Nov. 1, 2012, through April 30, 2013, there were 41 licensed abortion clinics providing care, and none of the facilities closed during that period. Over the duration of the study:

~ Eight clinics stopped providing abortions or closed altogether during the second time period (through Oct. 31, 2013), resulting in 33 remaining facilities;

~ Eleven more clinics closed or stopped providing abortions after most provisions of the law were enforced on Nov. 1, 2013, leaving 22 open facilities;

~ Later, "five facilities reopened when physicians obtained admitting privileges, and five facilities closed because physicians lost temporary privileges or for other reasons," resulting in a total of 22 open facilities at the end of the third period (April 30, 2014).

The researchers noted that clinics outside of the state's four largest cities "were particularly affected, with 11 of 13 clinics closing between" the first and third periods.

Travel to Clinics

Grossman and colleagues found an increase in the "number of reproductive aged women living more than 50, 100 or 200 miles from" an abortion clinic as more facilities closed, with 290,000 women living more than 200 miles away from an abortion clinic by the end of the third six-month period, compared with 10,000 women in the first period. The researchers added that if the ASC requirements take effect -- which would result in a lack of clinics outside of the four largest metropolitan areas -- the 290,000 figure likely would more than double.

The analysis also found:

~ The statewide abortion rate was 13% lower in the third period than the first period, "corresponding to about 9200 fewer abortions annually";

~ Medical abortions decreased by 70% from the first period to the third period, in which seven facilities stopped offering the service; and

~ "There was a small but significant increase in the proportion of abortions performed in the second trimester" during the third period, compared with the first two.

Among Lower Rio Grande Valley residents, the number of abortions declined more rapidly than the state average, decreasing from 1,349 in the first period to about 1,065 in the third period. During the third period, about half of Lower Rio Grande Valley women who obtained abortions "went to the clinic in Corpus Christi, which has since closed," while 15% went to a San Antonio facility and 25% went to Houston.

Discussion and Conclusion

According to Grossman and colleagues, HB 2's "admitting privileges requirement was almost certainly the main driver of the large number of clinic closures observed in the months preceding and following its implementation."

They noted, "In just 1 year, the number of facilities providing abortion in Texas declined by 46%, vast swaths of the state were left without a provider and the number of women required to travel great distances to reach a provider increased dramatically." In addition, the provision "disproportionately affected clinics in smaller cities, where there may be fewer hospitals and where stigma may discourage hospital-based physicians from publicly endorsing the privileging of abortion providers."

Meanwhile, although the 13% decline in the state's abortion rate was "steeper than that reported for both Texas and the nation in recent years," it "may have been muted by a potential increased demand for abortion following the severe reduction in public funding for family planning in Texas in 2011," according to the researchers, who noted that it was "surprising" to them that the decline was not greater, given how many clinics closed.

Further, the researchers commented that the 70% decline in medical abortion runs "[i]n contrast to the national trend toward an increase in the proportion of abortions that are medical." The finding is "dramatic evidence of the law's effect," they wrote.

Grossman and colleagues said they plan to continue their research on the impact of HB 2, including whether it results in women obtaining abortion later in pregnancy. "As more restrictions on abortion care are imposed by state legislatures, it is critical to assess the effect of these laws on women," they wrote.

Ob-Gyns Need Formal Training on Environmental Health, Experts Argue

Thu, 09/25/2014 - 19:25

Writing in the American Journal of Obstetrics and Gynecology, experts in maternal, children's and environmental health argue that while ob-gyns "are well-positioned to provide guidance" to patients on environmental health issues and help reduce maternal and fetal exposure to environmental hazards, they receive "limited" medical education on the topic. The authors report on several initial recommendations from a workgroup of ob-gyn medical program faculty and residents on how to establish formal training for ob-gyns on environmental health.

Ob-Gyns Need Formal Training on Environmental Health, Experts Argue

September 25, 2014 — Summary of "Medical Education for Obstetricians and Gynecologists Should Incorporate Environmental Health," Tinney at al., American Journal of Obstetrics and Gynecology, July 25, 2014.

Ob-gyns "are well-positioned to provide guidance on environmental health issues to patients" and help prevent hazardous exposures, but "medical education on environmental health is limited," according to Veronica Tinney and Jerome Paulson -- both of the Mid-Atlantic Center for Children's Health and the Environment at Children's National Health System -- and John Larsen and Susanne Bathgate of the George Washington University School of Medicine and Health Sciences' Department of Obstetrics and Gynecology.

They discuss the importance of environmental health education for ob-gyns and report on several initial recommendations from a workgroup that examined how to establish formal training for ob-gyns on environmental health.

Dangers of Environmental Hazards, Missed Opportunities To Intervene

According to the authors, data from the National Health and Nutrition Examination Survey indicate "widespread exposure to environmental chemicals among pregnant women and women of child-bearing age including: heavy metals, volatile organic compounds and endocrine disrupting chemicals."

Limiting exposure to such chemicals during pregnancy is critical because "[m]any health outcomes have developmental origins and exposures in utero can have permanent and irreversible impacts on health," they note. For example, if a pregnant woman is exposed to mercury -- such as by consuming fish high in methylmercury -- the heavy metal crosses the placenta and causes a higher dose in the fetus than the woman, meaning that "a mother may be asymptomatic while the fetus sustains neurological damage," the authors explain.

Ob-Gyn's Role in Reducing Exposure

The authors argue that ob-gyns "have a critical and unique role to play" in guiding patients to make informed decisions and reduce exposures that can affect their reproductive health. Ob-gyns can fulfill this role both through clinical care and advocacy to change federal policies, they write.

Clinical Care

The authors write that ob-gyns "are increasingly confronted with clinical situations and questions from patients about the impact of environmental chemicals on their general health, fertility, and pregnancy outcome."

However, most of them "do not ask patients about environmental exposures aside from smoking, alcohol consumption and nutrition," the authors write, citing a recent survey of 2,514 American Congress of Obstetricians and Gynecologists fellows that found about 50% of ob-gyn respondents "rarely conduct an environmental health history," even though 86% of respondents "agree[d] that an environmental health history would identify patient exposures" and 80% of respondents thought such a history would "help prevent harmful exposures."

Advocacy for Policy Reforms

Tinney and colleagues also posit that ob-gyns "can be influential advocates of environmentally safe policies." For example, ob-gyns "can advocate ... for the strengthening of current regulatory oversight of industrial chemicals" and "the development of robust screening regulations," as well as "make precautionary recommendations in the absence of complete data."

Need for Formal Ob-Gyn Education on Environmental Hazards

Despite these opportunities, the authors note that ob-gyns receive little training about environmental issues. For example, they cite a study that found that during four years of medical education, "the average number of hours required for environmental health was only seven hours total." Another study found that just one in 15 ob-gyns reported receiving "training specific to taking an environmental history," they write.

They also note that ob-gyns' "[r]ecognition of environmental hazards ... has gained momentum" since the release of a joint committee opinion by the ACOG Committee on Health Care for Underserved Women and the American Society for Reproductive Medicine Practice Committee on the issue. The opinion "urge[d] clinicians to become knowledgeable on potential environmental exposures and to conduct environmental histories of patients during preconception and prenatal visits," Tinney and colleagues explain.

Formation of Academic Ob-Gyn Program Workgroup

The authors argue that "a formal mechanism to educate [ob-gyns] on environmental health hazards is needed to ensure all trainees are prepared to address patients' concerns."

In response to that need, Mid-Atlantic Center for Children's Health and the Environment and the George Washington University Department of Obstetrics and Gynecology convened a meeting comprising faculty and residents from 16 academic ob-gyn programs, out of which a workgroup was formed to "identify mechanisms to incorporate environmental health topics" into ob-gyn medical education, as well as "barriers that may exist and the resources needed to successfully" do so.

Workgroup's Recommendations

The authors describe several "[i]nitial avenues" that the workgroup identified for establishing formal ob-gyn training on environmental health issues, including:

~ "Integration of environmental health topics for medical education ... at all levels" within medical school curricula;

~ Further development of "[c]linical trainee programs" to promote environmental health awareness among reproductive health professionals;

~ "Inclusion of environmental health questions on resident training exams and board certifying exams";

~ Training of faculty members and other leaders in medical education through the Association of Professors of Gynecology and Obstetrics or by creating "environmental health faculty champions programs" for ob-gyns; and

~ "Requiring continuing education credits in environmental health."

In conclusion, Tinney and colleagues express hope that the ob-gyn education community will respond to "the strengthening scientific evidence" and the ACOG and ASRM joint committee opinion by "expand[ing] environmental health education."

Individual Needs, Not Peer Opinions, Motivate Contraceptive Choices for Adolescents, Young Adults

Thu, 09/25/2014 - 19:23

Abstract: Through qualitative interviews with adolescent and young adult women visiting a Title X family planning clinic, researchers from the University of Colorado Denver School of Medicine identified and evaluated influences on interviewees' decision-making processes for choosing a new contraceptive method. They found that "participants felt that while they valued input from peers and providers, their decision-making was autonomous and derived from their own reasons for choosing a method that best fits their needs."

Individual Needs, Not Peer Opinions, Motivate Contraceptive Choices for Adolescents, Young Adults

September 25, 2014 —Summary of "Adolescent and Young Women's Contraceptive Decision-Making Processes: Choosing 'The Best Method for Her,'" Melo et al., Journal of Pediatric and Adolescent Gynecology, Aug. 12, 2014.

Women ages 14 to 24 have the highest unintended pregnancy rates in the U.S., but there is a "lack of understanding of how adolescents and young women choose contraception," according to Juliana Melo, and colleagues from the University of Colorado Denver School of Medicine's Department of Obstetrics and Gynecology.

Prior research suggests that increased use of long-acting reversible contraceptives (LARC) could lower unintended pregnancy rates in this population. Awareness, cost and provider barriers appear to be "[m]ajor obstacles to LARC uptake" for this group, but "[f]actors that lead to [LARC] initiation in this population remain obscure," Melo and colleagues wrote. However, some research suggests that friends and social networks might influence contraceptive decision-making for adolescents and young women.

The researchers devised a study that used qualitative interviews to analyze adolescent and young adult women's "decision-making processes" in choosing contraceptives, as well as "the role played by peer influence."

Methods

The researchers conducted the interviews at the Children's Hospital Colorado Adolescent Family Planning Clinic, an "adolescent-focused Title X Family Planning Clinic" offering no-cost, confidential services for individuals ages 12 to 24. The clinic "is primarily staffed by nurse practitioners and physicians," they noted.

The interview participants included young women ages 14 to 24 "who were initiating or switching contraception," the researchers wrote. They "used purposive sampling to ensure interviews with users of both long- and short- acting methods," interviewing a total of 21 women between November 2012 and December 2012. The interviews were recorded, transcribed and de-identified.

The researchers followed "a semi-structured interview guide," which included "[q]uestions about past contraception use, reasons why [participants] chose a new form of contraception and outside sources that helped them make their decisions." The researchers also "asked how they discuss contraception with their friends and what they deemed important contraception information to pass onto their friends."

Results

Participants were "racially and ethnically diverse," including Caucasians (41%), Hispanics (36%), African-Americans (14%) and Asians (9%). Half of participants were ages 17 to 19, while 36% were ages 20 to 23, and 14% were ages 15 to 16. In addition, "14% had a prior pregnancy and were mothers" and "91% reported sexual debut had occurred."

The researchers analyzed the findings within a conceptual framework of "four stages of behavior change": contemplation, preparation, action and maintenance.

Contemplation

In this stage, participants "cited the desire to avoid pregnancy as the main motivator for considering contraception," although many "also expressed a strong desire for menstrual cycle control as a major motivator," the researchers found.

They identified three underlying themes related to the desire to avoid pregnancy: "awareness of parental responsibilities," "desire to obtain future goals" and "fear of the pregnancy process." In addition, many participants said that "peer pressure to avoid pregnancy" also played a role.

Preparation

Participants in the preparation stage "focused on gathering and integrating information with their personal reproductive health concerns," which included "effectiveness, duration, convenience, pain at time of insertion, reversibility, cost and side effects." They also desired "cycle control," "'forgetability,'" and "avoid[ing] follow-up," Melo and colleagues found.

Both peer and provider influences were noted in this stage, with the provider "often valued as the more knowledgeable source" and "uniformly identified ... as a source of expert knowledge," while the peer was considered "more relatable," the researchers found.

Action

The researchers found that when it came time to choose a contraceptive method, "[m]ost respondents did not value peer contraceptive imitation; they felt that choosing a contraceptive method was a complex personal decision." When discussing how women should choose a method, "they overwhelmingly explained the user should 'choose the best method for her,'" the researchers wrote.

Maintenance

At the maintenance stage, "participants commonly cited why they were satisfied with the choice they had just made ... and reasons for dissatisfaction with other methods." However, even though new users reported "high anticipation of satisfaction," they "avoided advocating their methods as the 'best' methods for their peers" and "again cited the need [for a peer] to select the 'best method for her.'"

Participants also noted the importance of new users "receiv[ing] comprehensive information about all available methods, particularly as it relates to possible side effects and risks," the researchers found.

Discussion and Conclusions

Although the researchers initially "wondered if many participants would imitate their friends' contraceptive choices," they found that contraceptive uptake was also based "on shared contraceptive concerns such as effectiveness and convenience."

"Ultimately, participants felt that while they valued input from peers and providers, their decision-making was autonomous and derived from their own reasons for choosing a method that best fits their needs," the researchers wrote.

The "adolescent-specific motivators and considerations for contraceptive uptake" identified in the study suggest that "it may be advantageous when counseling adolescents and young women regarding different contraceptive methods to discuss effectiveness, convenience and anticipated bleeding patterns," according to Melo and colleagues.

Providers also should "elicit individual concerns," they wrote, adding that advising a patient to "choose 'the best method for her'" may especially resonate.

Overall, the findings show that adolescent and young women make "autonomous" decisions about contraception, while "balance[ing] the benefits and risks of available methods portrayed by their informants in the context of their personal concerns," according to Melo and colleagues. "Peer influence is primarily based on shared contraceptive goals, while providers are important for myth clarification and education," they found.

'Scholarly Concentrations' at Med Schools Nurture Development of 'Future Leaders' in Reproductive Health

Thu, 09/25/2014 - 18:55

Researchers from Brown University examined how completion of a "scholarly concentration" (SC) in reproductive health care during medical school affects students' career decisions and interests in the field. Overall, students reported that the program reinforced their interest in reproductive health and provided them with a nurturing support system of peers and faculty mentors, while also strengthening their knowledge and research skills. The SC "model holds promise for producing future leaders in the field," the researchers concluded.

'Scholarly Concentrations' at Med Schools Nurture Development of 'Future Leaders' in Reproductive Health

September 25, 2014 —Summary of "Developing Future Leaders in Reproductive Health Through a Scholarly Concentration for Medical Students," Nothnagle et al., Contraception, July 18, 2014.

There is a "pressing need to train future physician leaders to address disparities in reproductive health" in the U.S., evidenced by abortion, adolescent pregnancy and unintended pregnancy rates that "are consistently poor compared to other Western nations," according to Melissa Nothnagle of the Department of Family Medicine at the Alpert Medical School of Brown University and colleagues at Brown.

However, there is a "lack of comprehensive reproductive health curricula in many US medical schools," they noted.

As a potential solution, medical schools increasingly "offer scholarly concentrations (SCs)," through which medical students can "engage in longitudinal, in-depth study outside the traditional medical curriculum," Nothnagle and colleagues explained. For the study, the researchers sought to determine the impact of the Scholarly Concentration in Women's Reproductive Health at Alpert Medical School on students' perspectives, future career choices and interest in reproductive health.

Methods

Program Structure

Students participating in the reproductive health SC at Alpert complete "a scholarly project in women's reproductive health" within the context of a three-year mentorship by a faculty member. First-year students work with their mentors to create a project proposal that is approved by a family physician and an ob-gyn who serve as the program's directors.

SC participants in their first through fourth years attend faculty-led seminars that focus on topics such as low-income women, adolescents, women in developing countries, women with substance misuse disorders or mental health issues, and women in prison.

Further, second-year students must write a 3,000-word essay that reflects on an issue of "controversy in reproductive health" and is "suitable for submission in a medical journal." In addition, all program participants are responsible for completing at least one reproductive health clinical elective during their third or fourth years.

To earn credit for the SC, "student projects must meet the criteria for scholarship and be disseminated via a national presentation or a peer-reviewed publication," Nothnagle and colleagues noted. Fourth-year students also must submit a portfolio of their work and make a presentation to their peers and the mentors, who evaluate it and provide written feedback.

Program Evaluation Methods and Participation

The reproductive health SC began in 2007. Twenty-one students entered the program and by 2012, three classes -- or 10 students -- had finished the program.

The analysis by Nothnagle and colleagues was based on interviews with participants in the first two classes and their mentors, as well as collected feedback, presentations, portfolios and publications for all three of the classes that had completed the program.

Results

Overall, satisfaction with the course was "uniformly positive," the researchers found. Students also said it reinforced their interest in reproductive health, strengthened their knowledge of the subject and improved their research skills.

By the end of the program, most of the graduates from the two analyzed classes had become involved in projects related to reproductive health because of the connections they made with their mentors. Their accomplishments during the program included nine peer-reviewed publications and 24 presentations at national conferences.

Upon completion, four students pursued ob-gyn careers, one entered family medicine, one went into surgery and one entered pediatrics. Although students said the SC had "little effect" on their choice of specialty, they "plan[ned] to remain involved in reproductive health in their chosen field and viewed their experience as beneficial," the researchers found.

The study found that students cited three main factors to explain why the program was beneficial: strong connections with their mentors, a sense of community from relationships with others involved in the program, and "the 'freedom to pursue a wide range of interests and activities.'"

Discussion and Conclusion

"Nurturing students who are interested in this area and preparing them with skills to succeed in academic medicine should produce academic faculty who could improve education and advance clinical science in reproductive health," according to Nothnagle and colleagues.

In particular, "longitudinal mentoring" could be key to "supporting students who are interested in reproductive health," especially for subjects like abortion, family planning, unintended pregnancy and other areas that are "often addressed in a limited way if not avoided entirely in traditional medical curricula."

Overall, the researchers found that the SC enhanced students' research skills and "nurtured [their] values and interests that may promote academic careers in reproductive health." They concluded, "This model holds promise for producing future leaders in the field."

Datapoints: ACA Ends Birth Control Copays for Many, States Delay Abortion Access & More

Thu, 09/25/2014 - 18:23

This week, we feature an infographic highlighting the impact of the Affordable Care Act's birth control benefit, as well as maps depicting state-mandated delays in abortion care and progress in reducing teen birth rates.

Datapoints: 'Bad Medicine' in the States, Myths About Abortion Providers & More

September 25, 2014 — This week, we feature an infographic highlighting the impact of the Affordable Care Act's birth control benefit, as well as maps depicting state-mandated delays in abortion care and progress in reducing teen birth rates.

ACA Ends Birth Control Copays for Increasing Number of Women



Women with private health insurance are increasingly paying nothing out of pocket for their contraceptive method of choice, according to a Guttmacher Institute infographic and accompanying study.

Guttmacher researchers found that the impact of the Affordable Care Act's (PL 111-148) contraceptive coverage benefit has been "substantial and rapid," but they noted that gaps in coverage remain, in part because of the grandfathered status of some health plans, insurers improperly charging copayments or deductibles in some cases, and exemptions for certain employer-sponsored plans on religious grounds (Guttmacher release, 9/18).


States Mandate Delays in Abortion Care



Missouri this month joined North Dakota and Utah in mandating that a woman wait at least 72 hours between when she first seeks an abortion and when she may obtain the procedure, although the specific requirements of the laws vary in each state.

Nationwide, 26 states have laws mandating delays of various lengths before a woman can obtain abortion care, according to this map from the Washington Post's "Gov Beat," based on Guttmacher Institute data as of Sept. 1. Some states also mandate that women receive in-person counseling, which can require an additional trip to the clinic and further complicate access. Mandatory delay laws on the books in Massachusetts and Montana are not enforced due to court orders, "Gov Beat" notes (Chokshi, "Gov Beat," Washington Post, 9/11).


Animation Shows Declining Teen Birth Rates by State



Nationwide, the teen birth rate has been on the decline for years, reaching record lows in 2012. However, as shown in this animation from @MetricMaps -- a Twitter and Reddit account specializing in "visualizing behavioral health data" -- the decrease in birth rates progressed more rapidly in some states and regions than others. Specifically, progress in southern states lagged behind other regions.

According to Mic, states that teach abstinence-only sex education also tend to have higher teen pregnancy rates (Essert, Mic, 9/15).


Judge Dismisses Criminal Charges Against Pregnant Woman for Allegedly Endangering Fetus

Thu, 09/25/2014 - 16:48

A Montana judge on Monday dismissed charges of felony child endangerment filed against a woman for allegedly ingesting drugs while 12 weeks pregnant, USA Today reports.

Judge Dismisses Criminal Charges Against Pregnant Woman for Allegedly Endangering Fetus

September 25, 2014 — A Montana judge on Monday dismissed charges of felony child endangerment filed against a woman for allegedly ingesting drugs while 12 weeks pregnant, USA Today reports.

According to USA Today, some observers viewed the case as a test to a 2013 state law that amended the state's homicide laws to include the "fetus of another" as a potential victim.

Case Details

Last month, prosecutors in Ravalli County, Mont., charged Casey Allen with placing her fetus at "substantial risk of serious bodily injury or death" by taking benzodiazepines, opiates and tetrahydrocannabinol, which is the psychoactive compound found in marijuana.

County Deputy Attorney Thorin Geist argued in the case that the state Legislature's intent when amending the homicide laws was "to criminalize conduct related to killing -- and by logical extension injuring -- a fetus." He added in the court briefing that the law protects a woman's right to an abortion but that state lawmakers did not mean to "shield a woman from harming her own fetus through the use of illicit drugs."

Meanwhile, Allen's attorney in court filings said that the state's intent in charging Allen was part of a wider plan to pursue the "slippery slope of arresting and filing charges against early term pregnant women for engaging in any behavior deemed unhealthy to the fetus, which might include ingesting drugs (legally prescribed or not), drinking alcohol, smoking, failing to wear seat belts in a vehicle, not eating well, and exercising too little or too much."

Ruling Details

In dismissing the charges on Monday, Hamilton District Judge Jeffrey Langton wrote that the case was "insufficient to support a finding of probable cause to support a charge of criminal endangerment."

Further, Langton noted that the term "fetus" is not referenced in the statute and that it is not the court's place to insert such language "[i]n order to construe the criminal endangerment offense to include a fetus as a potential victim."

He added that the state's position in the case is "contrary to the plain language of the criminal endangerment statute, is contrary to the rules of statutory construction, and runs counter to common sense" (Adams, USA Today, 9/23).


Mich. Lawmakers Propose Bill To Require Insurers To Offer Abortion Riders

Thu, 09/25/2014 - 16:47

Michigan Democratic lawmakers this week are introducing a bill that would require all insurers in the state to offer riders for women who want abortion coverage, the Detroit Free Press reports.

Mich. Lawmakers Propose Bill To Require Insurers To Offer Abortion Riders

September 25, 2014 — Michigan Democratic lawmakers this week are introducing a bill that would require all insurers in the state to offer riders for women who want abortion coverage, the Detroit Free Press reports (Gray, Detroit Free Press, 9/24).

Background

The state last year enacted a law that requires women who want abortion coverage to purchase a separate rider. The law bars women who are already pregnant from purchasing the riders, but it does not apply when a woman's life is in danger or to Medicaid, which must cover abortion in cases of rape, incest and life endangerment (Women's Health Policy Report, 6/17). Companies that self-insure -- which provide coverage for about three million state residents -- are not subject to the law (Detroit Free Press, 9/24).

Only seven of Michigan's 42 health insurers offer the abortion coverage riders (Lawler, MLive, 9/24). The riders cost between 12 cents to $3.84 annually (Detroit Free Press, 9/24). Further, state Rep. Jeff Irwin (D) said that the riders are currently only available through employer-based health plans, and not through any plans sold through the individual market.

State lawmakers have introduced legislation to repeal the law (MLive, 9/24). However, the repeal legislation is not likely to receive a hearing in the Republican-led state Legislature (Women's Health Policy Report, 6/17).

Comments

State Rep. Pam Faris (D) said, "I still oppose this law and would like to see it repealed. But we never told insurance companies that they had to sell [abortion riders]. Many of the women around the state who want to safeguard their health and buy the coverage they need simply can't" (Detroit Free Press, 9/24).

Irwin added, "I think that women should be able to choose what kind of health care they need and they should have available to them a full range of products to choose from" (MLive, 9/24).

Separately, Michigan Right To Life spokesperson Ed Rivet -- whose organization spearheaded the initiative to enact the law -- criticized the proposal, arguing that consumers who would like abortion coverage can "look for another insurance company if it's important" to them (Detroit Free Press, 9/24).


Blogs Discuss Telemedicine Abortion Ruling, Miscarriage Care, Helms Amendment, More

Thu, 09/25/2014 - 16:24

Read the week's best commentaries from bloggers at RH Reality Check, the Reproductive Health Access Project and more.

Blogs Discuss Telemedicine Abortion Ruling, Miscarriage Care, Helms Amendment, More

September 19, 2014 — Read the week's best commentaries from bloggers at RH Reality Check, the Reproductive Health Access Project and more.

ABORTION ACCESS: "Iowa's Telemedicine Abortions Can Continue -- for Now," Jessica Mason Pieklo, RH Reality Check: "Telemedicine abortions can continue in Iowa for now, the Iowa Supreme Court ruled Tuesday, blocking a rule by the Iowa Board of Medicine that threatened to shut down the use of video-conferencing technology to help rural Iowans access abortion care," Mason Pieklo writes. According to Mason Pieklo, abortion-rights supporters have said the rule, if permitted to take effect, would mean that abortion access in the state would be limited "to Des Moines and Iowa City, with some patients in rural and medically under-served areas forced to travel more than 500 miles round-trip, multiple times, to access care." She writes that while opponents of the rule consider the decision a victory for women in the state, the decision only blocks the requirements while an appeal of a lower court's ruling -- which "would have allowed the rule to take effect" -- is reviewed (Mason Pieklo, RH Reality Check, 9/17).

What others are saying about abortion access:

~ "'I Feel Like I Was Tricked': New Documentary Uncovers How Crisis Pregnancy Centers Lie to Women," Jenny Kutner, Salon.

PREGNANCY CARE: "'I Was Treated Better When I Had an Abortion,'" Linda Prine, Reproductive Health Access Project blog: Prine, medical director of the Reproductive Health Access Project, says she was "shocked" by a patient's account of "the care she received in the previous weeks when she started to have some vaginal bleeding early in her pregnancy." She notes that the woman was told to visit a hospital emergency room, where "she waited more than six hours before she saw a doctor, another three hours until she got an ultrasound, and then another four hours before anyone told her what was happening." After learning that her fetus no longer had a heartbeat, the woman called her ob-gyn's office, where she was "treated like she didn't matter at all and that her pregnancy 'didn't matter,'" Prine continues. She writes that miscarriages "should not be marginalized," adding that women should not be made to feel as if they are receiving "special treatment to be respected, to have [their] worries addressed and to have [their] grieving acknowledged." She also calls for "family medicine [to] step up to the plate and own miscarriage care," which rarely constitutes a visit to the ER (Prine, Reproductive Health Access Project blog, 9/16).

GLOBAL: "Why is the U.S. Standing Between Women and Health Care?" Nina Besser, International Women's Health Coalition's "Akimbo": Because of longstanding federal restrictions on abortion funding under the Helms Amendment, the U.S. government is essentially "complicit" in the number of maternal deaths that result globally from unsafe abortions, but President Obama has the authority to mitigate some of this harm by clarifying how the amendment should be interpreted, Besser argues. Besser writes that while the Helms Amendment prohibits U.S. funds from being used to provide abortions overseas "as a method of family planning," it does not "apply to abortions provided in the cases of rape, incest, or to save the life of the woman"; it does "not bar the U.S. government from purchasing the medical equipment and drugs needed for complete post-abortion care"; and it "does not prevent U.S. government-funded [non-governmental organizations] from providing counseling, education, and referrals for women with unwanted pregnancies." Besser notes, "The Helms Amendment is bad enough; it's time to end the unnecessarily restrictive interpretation of the law that keeps women in some of the poorest areas of the world from accessing critical health services" (Besser, "Akimbo," IWHC, 9/16).

What others are saying about global issues:

~ "Why the Health of Mothers and Newborns is Inseparable," Esther Sharma, Huffington Post blogs.

~ "Why We Need to #LiftTheBan on Abortion in War Zones," Anita Little, Ms. Magazine blog.

ADOLESCENT HEALTH: "Teens' Check-Ups Need To Include More Conversations About Sex," Tara Culp-Ressler, Center for American Progress' "ThinkProgress": Physicians need to "spend more time addressing issues of sexuality with teenage patients," according to recent research, Culp-Ressler writes. She notes that few "pediatricians offer regular screening, counseling, and vaccination for sexually transmitted infections," and that this "lack of doctor-patient interaction isn't helping address the country's high rates of teen pregnancy or low rates of [the human papillomavirus] vaccination." Culp-Ressler also discusses the "pervasive attitude" among some adults that "providing kids with sexual health resources will encourage them to become sexually active or make riskier choices," when in fact "kids who receive medically accurate sexual health education in school are more likely to delay sex." Physicians "have an important role to play" in providing this information, particularly given that "a patchwork of state laws" on sex education "ensures that many teens don't get those classes early enough," Culp-Ressler writes (Culp-Ressler, "ThinkProgress," Center for American Progress, 9 /17).

CONTRACEPTION: "Millions of Women Don't Have To Pay a Dollar When They Pick Up Their Birth Control," Culp-Ressler, Center for American Progress' "ThinkProgress": There has been a "substantial increase in the proportion of women benefiting from no-cost contraception" under the Affordable Care Act (PL 111-148) "between the fall of 2012, right before the health law began taking effect, and the spring of 2014," according to a recent study by the Guttmacher Institute, Culp-Ressler writes. However, she also notes that "there's a chance that some people may not be able to access these benefits," such as women with employer-sponsored health plans through certain companies with religious objections to contraception. Meanwhile, litigation over the benefit has "created an environment in which some women remain confused about whether their insurance plans should be offering them birth control without a co-pay," she writes (Culp-Ressler, "ThinkProgress," Center for American Progress, 9/18).


Insured Women Increasingly Pay Nothing Out of Pocket for Contraceptives, Guttmacher Survey Finds

Thu, 09/25/2014 - 16:23

Sixty-seven percent of U.S. women with private health coverage paid no out-of-pocket costs for oral contraceptives this spring, compared with 15% of women in fall 2012, before the Affordable Care Act's (PL 111-148) contraceptive coverage benefits took effect, according to a new Guttmacher Institute study, the Seattle Times' "Healthcare Checkup" reports.

Insured Women Increasingly Pay Nothing Out of Pocket for Contraceptives, Guttmacher Survey Finds

September 19, 2014 — Sixty-seven percent of U.S. women with private health coverage paid no out-of-pocket costs for oral contraceptives this spring, compared with 15% of women in fall 2012, before the Affordable Care Act's (PL 111-148) contraceptive coverage benefits took effect, according to a new Guttmacher Institute study, the Seattle Times' "Healthcare Checkup" reports.

The proportion of insured women who paid nothing out of pocket also rose substantially for other methods, like the vaginal ring and intrauterine device, the study found (Stiffler, "Healthcare Checkup," Seattle Times, 9/18).

Background on Contraceptive Coverage Benefit

Federal guidance on the contraceptive coverage rules under the ACA states that insurers must cover the full range of FDA-approved methods without cost sharing.

In addition, some plans qualify for an exemption to the rules because they have "grandfathered" status or are for certain religious employers (Women's Health Policy Report, 8/22). Court rulings also currently allow some private businesses to deny the benefits (Women's Health Policy Report, 9/18).

Study Details

For the study, Guttmacher researchers conducted an online survey of U.S. women ages 18 to 39 who responded to questions four times over an 18-month period. The women all had private insurance and were using prescription contraceptives.

This spring, 74% of women paid no out-of-pocket costs for the vaginal ring, compared with 20% in fall 2012, while 59% of women paid nothing out-of-pocket for injectable contraceptives this spring, up from 27% in fall 2012. Further, 62% of women paid no out-of-pocket costs for IUDs in spring 2014, compared with 45% in fall 2012.

Reasons for Findings

The researchers outlined several reasons why some privately insured women were still paying out-of-pocket costs for FDA-approved contraceptives this spring, including the grandfathered status of some health plans, insurers being permitted to charge copayments for brand-name contraceptives when generic versions are available in some cases, and exemptions for employer-sponsored plans on religious grounds.

Further, the researchers said some insurers also are improperly imposing cost-sharing requirements on women for contraceptives that should be covered, as Guttmacher has previously found.

Researchers: Coverage 'Working as Intended'

The researchers wrote, "By guaranteeing that women have coverage for a wide range of contraceptive choices without cost sharing, the federal requirement may help them overcome financial barriers to choosing a contraceptive method they will be able to use consistently and effectively, thus increasing their likelihood of avoiding unplanned pregnancies."

Adam Sonfield -- lead study author and senior public policy associate at Guttmacher -- added in a statement that the study "shows that the contraceptive coverage guarantee under the ACA is working as intended" ("Healthcare Checkup," Seattle Times, 9/18).