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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Blogs Discuss 'Real Way To Improve Contraceptive Access,' Profile Abortion Provider, More

Fri, 08/01/2014 - 17:07

We've compiled some of the most thought-provoking commentaries from around the Web. Catch up on the conversation with bloggers from The Hill, RH Reality Check and more.

Blogs Discuss 'Real Way To Improve Contraceptive Access,' Profile Abortion Provider, More

August 1, 2014 — We've compiled some of the most thought-provoking commentaries from around the Web. Catch up on the conversation with bloggers from The Hill, RH Reality Check and more.

CONTRACEPTION: "The Real Way To Improve Contraceptive Access," Kelly Blanchard et al., The Hill's "Congress Blog": Some Republican lawmakers have "voice[d] support for moving the birth control pill over the counter," but "it's a political maneuver to circumvent the contraceptive coverage guarantee under the Affordable Care Act," according to Blanchard, Daniel Grossman and Britt Wahlin, all of Ibis Reproductive Health. Simply "removing the prescription barrier to birth control is a narrow fix," the authors argue, adding that "cost will continue to be an obstacle for many women" if the pill is not covered by their insurance. "The movement to bring an oral contraceptive over the counter" should be about "increasing access to contraception for all women, not taking contraception out of the political arena or excluding it from insurance coverage," they conclude (Blanchard et al., "Congress Blog," The Hill, 7/30).

What others are saying about contraception:

~ "Hobby Lobby Allegedly Fired Employee Due to Pregnancy," Sofia Resnick, RH Reality Check.

~ "Ruth Bader Ginsburg: Male Justices Don't Understand What Hobby Lobby Meant for Women," Nicole Flatow, Center for American Progress' "ThinkProgress."

~ "New Legislation Would Cover Contraception for Military Servicewomen," Emily Crockett, RH Reality Check.

ABORTION RESTRICTIONS AND ACCESS: "Mass. Governor Signs Abortion Clinic Access Bill Into Law," Rachel Walden, Our Bodies Ourselves' "Our Bodies, Our Blog": Massachusetts Gov. Deval Patrick (D) on Wednesday signed a bill (S 2281) into law "to protect access to health clinics where abortions are performed," Walden writes. The law, which "will be implemented immediately," was "passed quickly through the legislative process following" the Supreme Court decision striking down the state's "buffer zone" law, which the "[j]ustices said ... went too far in restricting free speech," Walden explains. "Under the new law, protesters may not block access to a clinic entrance or driveway," and it "prohibits the use of force, physical act or threat of force to injure or intimidate someone attempting to enter or leave a reproductive health care facility," she adds (Walden, "Our Bodies, Our Blog," OurBodies, Ourselves, 7/30).

What others are saying about abortion restrictions and access:

~ "Good News: Mississippi's Only Abortion Clinic Can Remain Open," Callie Beusman, Jezebel.

~ "Putting More Restrictions on Abortions Doesn't Magically Inspire Women To Embrace Their Pregnancies," Amanda Marcotte, Slate's "XX Factor."

ABORTION-RIGHTS MOVEMENT: "'It's Hard for Them To Accept That I Do Abortions Because I'm a Christian,'" Maya Dusenbery, Feministing: Willie Parker is "one of the two doctors who flies in from out-of-state to work at Mississippi's sole embattled abortion clinic," and his "decision to become an abortion provider is deeply rooted in his Christian faith," Dusenbery writes. She recommends and excerpts a recent Esquire profile that describes Parker as a practical physician who gave up a "'fancy career to become an abortion provider.'" The profile "captures Dr. Parker's motivation for doing this work and the great care and empathy he brings to it," Dusenbery writes (Dusenbery, Feministing, 7/31).

What others are saying about the abortion-rights movement:

~ "We're Fighting for Access, Not Choice," Dawn Laguens, Huffington Post blog.

SEXUAL AND GENDER-BASED VIOLENCE: "Senators Introduce Bipartisan Bill To Address Campus Sexual Assault," Crockett, RH Reality Check: "A bipartisan group of eight senators introduced legislation [S 2692] on Wednesday that aims to improve how college campuses respond to sexual assault," Crockett writes. According to the senators, "the bill is necessary because one in five college women experience sexual assault, and young women are more likely to be sexually assaulted if they are in college than if they are not," Crockett adds. She notes that too often, college sexual assault "survivors are re-traumatized ... because colleges fail to take their claims seriously or do enough to address them" (Crockett, RH Reality Check, 7/30).

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

~ "Why Do We Still Insist Women Share Responsibility for 'Provoking' Their Abuse?" Syreeta McFadden, Feministing.

~ "Gripping New Ad Shows What Happens When You Mix Guns With Domestic Violence," Flatow, Center for American Progress' "ThinkProgress."

~ "Meet Carolina, Who Brought Her Daughters 1,500 Miles to the U.S. So They Wouldn't Be Raped," Jack Jenkins/Esther Yu-Hsi Lee, Center for American Progress' "ThinkProgress."

SUPPORTING WORKING FAMILIES: "Moms Leave the Workforce Because They're Rational Actors, Not Maternal Softies," Jessica Grose, Slate's "XX Factor": "There's an insidious undercurrent of thought in the American corporate world" that "[m]others just don't make good workers" because "[t]heir brains get hormonally addled when they have children, and they take their eyes off the prize and onto their newborns," Grose writes, adding that similar thinking also "often lurks behind public discussions" about the issue. "But the truth is women are rational economic actors, just like men are," she continues, adding that new research shows "that women who get paid maternity leave are less likely to leave their jobs." Grose explains that "more American women are knocked out of the workforce when they have biological children: not because of some magical mind-meld between mother and child, but because having a baby is exhausting and requires a measure of physical recovery," meaning that women have "to take a break ... whether it's paid or not, while a male partner can get by without time off unless he's paid to take it" (Grose, "XX Factor," Slate, 7/29).

What others are saying about supporting working families:

~ "Congress Should Explore Greater Flexibility in the Workplace," Bradford Fitch, Roll Call.


Ohio Orders Closure of Only Abortion Clinic in Toledo

Fri, 08/01/2014 - 16:12

An Ohio health official on Wednesday signed an adjudication order revoking the license of Toledo's last abortion clinic, effective Aug. 12, the Toledo Blade reports.

Ohio Orders Closure of Only Abortion Clinic in Toledo

August 1, 2014 — An Ohio health official on Wednesday signed an adjudication order revoking the license of Toledo's last abortion clinic, effective Aug. 12, the Toledo Blade reports.

Ohio Department of Health Interim Director Lance Himes signed the order on a recommendation issued in June by a state hearing examiner. The examiner said the clinic, Capital Care Network, should be closed because it does not have a valid emergency transfer agreement with a nearby hospital, which is required by state law.

The clinic has 15 days after the notice is postmarked to appeal the order and ask a court to stay the order pending the appeal.

Clinic's Response

Clinic owner Terrie Hubbard said she would appeal the order and contact every nearby hospital to request an emergency transfer agreement. According to the Blade, Hubbard reached such an agreement with the University of Michigan, but the state rejected it. She has been unable to find another hospital that will sign an agreement with the clinic.

Hubbard's attorney, Jennifer Branch, said, "I'm not surprised by the ruling because the [state] Department of Health seems to be making decision[s] that are not based on medicine or health care but based on politics" (Toledo Blade, 7/30).


Hysterectomy Device Recalled Amid Cancer Warnings

Fri, 08/01/2014 - 16:12

Johnson & Johnson on Wednesday asked surgeons to stop using its laparoscopic power morcellator amid growing concerns about the device's potential to unintentionally spread deadly cancers during hysterectomies, the AP/USA Today reports.

Hysterectomy Device Recalled Amid Cancer Warnings

August 1, 2014 — Johnson & Johnson on Wednesday asked surgeons to stop using its laparoscopic power morcellator amid growing concerns about the device's potential to unintentionally spread deadly cancers during hysterectomies, the AP/USA Today reports (AP/USA Today, 7/31).

The company -- which suspended sales of the device in April after FDA advised doctors not to use it -- is sending customers a letter asking them to return the morcellators (Kamp/Levitz, Wall Street Journal, 7/30).

Background

Laparoscopic power morcellation was developed as an alternative to invasive surgery for women with symptomatic uterine fibroids, which are responsible for about 40% of the 500,000 hysterectomies performed each year in the United States. It uses a power device to grind uterine tissue so it can be removed through a tiny incision and is used in about 50,000 procedures annually in the United States.

The technique has come under fire for its potential to spread a type of cancer -- known as a uterine sarcoma -- within the body. A study published last week in the Journal of the American Medical Association estimated that one in 368 women undergoing morcellation had uterine cancer that was undetected until after the procedure.

Earlier this month, an FDA advisory panel said that there are no proven ways to use morcellation for hysterectomies and fibroid removal without risking the spread of malignant cancers to other parts of the body. FDA takes its panelists' recommendations into account when making regulatory decisions, but it has not announced a timeline for making a determination about the use of morcellation (Women's Health Policy Report, 7/24).

Details of J&J Recall

Johnson & Johnson's Ethicon unit, the world's largest manufacturer of laparoscopic morcellators, decided to pull the device from the global market because of the "continued uncertainty" surrounding its use, according to spokesperson Matthew Johnson.

"Ethicon believes that a market withdrawal of Ethicon morcellation devices is the appropriate course of action at this time until further medical guidelines are established and/or new technologies are developed to mitigate the risk," he says (Fay Cortez, Bloomberg, 7/31).

Smaller manufacturers of morcellators, which include German companies Karl Storz GmbH and Richard Wolf GmbH, have not announced plans for the devices (Wall Street Journal, 7/30).


Advocates Call for Better Emergency Contraception Access, One Year After Milestone Victory

Fri, 08/01/2014 - 16:12

Emergency contraception became available over-the-counter without proof-of-age requirements one year ago this week, but federal and state policies continue to limit access to it, according to a new paper from the Reproductive Health Technologies Project, Politico's "Pulse" reports.

Advocates Call for Better Emergency Contraception Access, One Year After Milestone Victory

August 1, 2014 — Emergency contraception became available over-the-counter without proof-of-age requirements one year ago this week, but federal and state policies continue to limit access to it, according to a new paper from the Reproductive Health Technologies Project, Politico's "Pulse" reports (Villacorta, "Pulse," Politico, 8/1).

History of OTC EC

Teva Pharmaceuticals began OTC sales of its EC product Plan B One-Step on Aug. 1, 2013. The move came after U.S. District Judge Edward Korman ruled in April 2013 that age and point-of-sale restrictions should be lifted on all EC drugs, although Korman in June of that year approved an FDA plan of compliance to allow OTC sales only for Plan B One-Step (Women's Health Policy Report, 8/23/2013).

However, FDA this spring said that generic drugmakers also may sell approved versions of the drug OTC without a requirement that consumers provider proof of age. FDA decided to lift the market exclusivity because Teva's "interpretation of the scope of its exclusivity was too broad," an agency official said at the time (Women's Health Policy Report, 3/3).

RHTP Paper

In a two-page paper, RHTP outlined several suggestions for improving access to OTC EC. The group called for contraceptive coverage requirements under the Affordable Care Act's (PL 111-148) preventive services provision to include EC when it is obtained without a prescription, wider access to EC at retail pharmacies, protections from state-level restrictions on EC access and further research into the efficacy of EC in women of higher weights.

RHTP added that the Supreme Court's recent ruling on contraceptive coverage should serve as a reminder "that the fight for unfettered access to safe and effective reproductive health products, like EC, is far from over" ("Pulse," Politico, 8/1).


Justice Ginsburg Explains 'Buffer Zone' Ruling, Criticizes Hobby Lobby Decision

Fri, 08/01/2014 - 16:12

Supreme Court Justice Ruth Bader Ginsburg on Thursday defended the high court's decision to overturn a Massachusetts "buffer zone" law and suggested that the court would have ruled differently in the Hobby Lobby contraceptive coverage case if more of the justices were female, the AP/ABC News reports.

Justice Ginsburg Explains 'Buffer Zone' Ruling, Criticizes Hobby Lobby Decision

August 1, 2014 — Supreme Court Justice Ruth Bader Ginsburg on Thursday defended the high court's decision to overturn a Massachusetts "buffer zone" law and suggested that the court would have ruled differently in the Hobby Lobby contraceptive coverage case if more of the justices were female, the AP/ABC News reports.

During an interview with the Associated Press, Ginsburg said that the high court's decision to reject the 35-foot buffer zone around abortion clinics in Massachusetts "was not a compromise decision but a good decision to say yes, you can regulate, but it is speech so you have to be careful not to go too far."

She added that the state's defense of the law was weak. "If you looked at what they had in evidence, it was pitiful compared to some in-your-face demonstrations," she said, noting that the state had since replaced the law.

Ginsburg during the interview also commented on the Supreme Court's decision in the Hobby Lobby case, noting that "if the court had been composed of nine women the result would have been different" (Sherman, AP/ABC News, 8/1).

Ginsburg also discussed the Hobby Lobby ruling in a separate interview with Katie Couric of Yahoo! News. The justice said that while she "certainly respect[s] the belief of the Hobby Lobby owners ... they have no constitutional right to foist that belief on ... hundreds and hundreds" of female employees (Goodwin, Yahoo! News, 8/1).

However, she added, "I am ever hopeful that if the court has a blind spot today, its eyes will be open tomorrow" (Berenson, Time, 7/31).

Comments on Roe v. Wade

During her interview with Couric, Ginsburg also critiqued the high court's ruling in Roe v. Wade, saying that the "problem with Roe v. Wade was, it not only declared the Texas [antiabortion-rights] law, the most extreme law, unconstitutional, but it made every law in the country, even the most liberal, unconstitutional."

She said the ruling, therefore, "gave the right-to-life people a single" and "very effective target" on which to focus (Yahoo! News, 8/1).


Review of Va. Abortion Clinic Rules Prompts Thousands of Public Comments

Thu, 07/31/2014 - 18:40

The Virginia Department of Health at midnight Thursday will close the public comment phase of Gov. Terry McAuliffe's (D) order to review strict abortion clinic regulations passed under his predecessor, Gov. Bob McDonnell (R), the Washington Post reports.

Review of Va. Abortion Clinic Rules Prompts Thousands of Public Comments

July 31, 2014 — The Virginia Department of Health at midnight Thursday will close the public comment phase of Gov. Terry McAuliffe's (D) order to review strict abortion clinic regulations passed under his predecessor, Gov. Bob McDonnell (R), the Washington Post reports.

After the comment period closes, state Health Commissioner Marissa Levine will have until Oct. 1 to finish an evaluation of the regulations.

On Tuesday, abortion-rights groups Progress VA, Planned Parenthood Advocates of Virginia, NARAL Pro-Choice Virginia and the American Civil Liberties Union of Virginia collectively submitted 4,844 comments to the state Department of Health (Portnoy, Washington Post, 7/29). Wendy Klein, a Virginia internist said, "These targeted regulations do nothing to improve safety, but rather create barriers" (WVIR, 7/29).

Meanwhile, comments submitted through the state's online portal are dominated by about 1,880 comments from supporters of the existing rules (Washington Post, 7/29).

Background

The rules specify various building standards -- such as exam room size, hallway width and ceiling height -- and create new requirements for inspections, recordkeeping and medical procedures. The rules were written to specifically apply to health centers that provide abortion services.

In May, McAuliffe appointed five abortion-rights supporters to the state Board of Health and ordered the board to conduct a review, which began in June with a 45-day public comment period (Women's Health Policy Report, 6/9).

Lengthy Process Expected

Although McAuliffe has accelerated the regulatory review process, it "still could take years to complete," according to the Post. The permanent clinic regulations took effect in June 2013 (Washington Post, 7/29). However, the Board of Health has said that abortion clinics in the state may apply for temporary variances if they are unable to comply with the regulations within a two-year grace period permitted by the state (Women's Health Policy Report, 6/9).

If Levine decides to amend or repeal the rules, the health department will prepare a notice to the board, which could include general recommendations or specific changes.

If the board approves the notice, health department officials would write preliminary draft text, which could take 18 to 24 months, followed by another round of public comments (Washington Post, 7/29).


States, Cities Mull 'Buffer Zones' Changes

Thu, 07/31/2014 - 18:39

Various states and cities are evaluating their own abortion clinic security laws after a recent Supreme Court decision, Politico reports.

States, Cities Mull 'Buffer Zones' Changes

July 31, 2014 — Various states and cities are evaluating their own abortion clinic security laws after a recent Supreme Court decision, Politico reports. Sixteen cities and three states have some type of buffer zone law, according to the National Abortion Federation


According to Politico, officials in Burlington, Vt., and Madison, Wis., have stopped enforcing their buffer zone laws, and the Portland, Maine, City Council repealed its 39-foot buffer zone earlier this month. Meanwhile, officials in Pittsburgh, several New York counties and New York City are continuing to enforce their buffer zones (Winfield Cunningham, Politico, 7/30).

New York City Law Draws Attention

In the Supreme Court's ruling, Chief Justice John Roberts identified New York City's law -- which makes it illegal to "follow and harass" patients within a 15-foot area around abortion clinics -- as a measure that "could in principle constitute a permissible alternative."

However, concerns remain about the constitutionality of the New York City measure, which also is "not particularly effective," according to Planned Parenthood League of Massachusetts President Martha Walz.

Abortion-rights supporters note that the law does not include a designated protest-free zone, which still allows protesters to approach and harass patients. For example, some clinic workers said protesters give women food or water so the women unknowingly breach pre-operation protocols against eating and drinking and have to postpone an abortion (Mueller, New York Times, 7/30).


Mass. Enacts New Abortion Clinic Protections

Thu, 07/31/2014 - 18:34

Massachusetts Gov. Deval Patrick (D) on Wednesday signed a bill (S 2281) into law to improve security surrounding the state's abortion clinics, the Boston Globe reports.

Mass. Enacts New Abortion Clinic Protections; Other States Mull 'Buffer Zones' Changes

July 31, 2014 — Massachusetts Gov. Deval Patrick (D) on Wednesday signed a bill (S 2281) into law to improve security surrounding the state's abortion clinics, the Boston Globe reports.

Lawmakers developed the legislation in response to a recent Supreme Court ruling that struck down the state's "buffer zone" law, which had barred protests within 35 feet of clinic entrances (Tietjen, Boston Globe, 7/30).

Law Details

The new law will give law enforcement personnel the authority to give dispersal orders if two or more protesters deliberately prevent patients or staff members from entering a clinic. Individuals who receive such orders will be required to stay at least 25 feet away from the clinic's entrance for up to eight hours.

The law also will prohibit protesters from interfering with vehicles approaching or leaving the area, as well as intimidating or harming people accessing the clinic. In addition, victims of such intimidation will be allowed to seek damages through civil action.

The measure also amends the state's current civil rights act to permit the state attorney general to pursue damages on behalf of individuals who have been blocked from accessing the clinics. The attorney general will be allowed to try to recover litigation costs and pursue civil penalties for individuals whose constitutional rights have been obstructed (Women's Health Policy Report, 7/24).

Reaction

Patrick said, "I am incredibly proud to sign legislation that continues Massachusetts leadership in ensuring that women seeking to access reproductive health facilities can do so safely and without harassment, and that the employees of those facilities can arrive at work each day without fear of harm."

Planned Parenthood Federation of America President Cecile Richards said in a statement, "A woman shouldn't be forced to run through an onslaught of screaming, yelling and bullying to access health care." The new law helps "right the wrong done to women by the Supreme Court," she added (Boston Globe, 7/30).

Video Round Up: Mass. Moves To Protect Clinics, Maddow Reports on Clinic Closure, More

Thu, 07/31/2014 - 18:11

This week's videos include an interview with the sponsor of a Massachusetts bill responding to the Supreme Court's "buffer zone" ruling, a report on an abortion clinic closing in Kansas and concerns from HBO's John Oliver about female genital mutilation.

Video Round Up: Mass. Moves To Protect Clinics, Maddow Reports on Clinic Closure, More

July 31, 2014 — This week's videos include an interview with the sponsor of a Massachusetts bill responding to the Supreme Court's "buffer zone" ruling, a report on an abortion clinic closing in Kansas and concerns from HBO's John Oliver about female genital mutilation.




MSNBC's Melissa Harris-Perry reports on "emboldened activity" by antiabortion-rights activists in New Orleans, a development that "cannot be separated from" the Supreme Court's June decision to strike down a Massachusetts "buffer zone" law that barred protests near clinic entrances. Harris-Perry speaks with Massachusetts state Sen. Harriette Chandler (D) about legislation (S 2281) that gives law enforcement in the state more authority to disperse abortion clinic protesters. The law was crafted "very narrowly" to "balance the freedom of speech issues with the safety issues," Chandler says. Sarah Knight of the American Constitution Society and Igor Volsky of ThinkProgress also join (Harris-Perry, "Melissa Harris-Perry," MSNBC, 7/26).




Rachel Maddow reports on the closing of one of the last abortion clinics in Kansas, where state restrictions have made it increasingly difficult for clinics to remain open. Maddow notes that she spoke to the clinic's manager, who said its workers have grown weary after years of fighting state laws and dealing with protesters. The manager urged young people to vote and work to preserve abortion rights, adding, "Why am I the only one fighting this?" (Maddow, "The Rachel Maddow Show," MSNBC, 7/28).




HBO's John Oliver explains that there was "potentially horrifying" news last week that the extremist group Islamic State of Iraq and Syria was forcing women in Mosul, Iraq, to undergo female genital mutilation. Oliver says, "Thankfully, other reports suggest it could be fake," but notes that "before everyone gets too relieved ... it is worth remembering it is still happening in a shocking number of places," including Egypt (Davies, Jezebel, 7/28).

Video Round Up: Mass. Moves To Protect Clinics, Maddow Reports on Clinic Closure, More

Thu, 07/31/2014 - 18:10

This week's videos include an interview with the sponsor of a Massachusetts bill responding to the Supreme Court's "buffer zone" ruling, a report on an abortion clinic closing in Kansas and concerns from HBO's John Oliver about female genital mutilation.

Video Round Up: Mass. Moves To Protect Clinics, Maddow Reports on Clinic Closure, More

July 31, 2014 — This week's videos include an interview with the sponsor of a Massachusetts bill responding to the Supreme Court's "buffer zone" ruling, a report on an abortion clinic closing in Kansas and concerns from HBO's John Oliver about female genital mutilation.




MSNBC's Melissa Harris-Perry reports on "emboldened activity" by antiabortion-rights activists in New Orleans, a development that "cannot be separated from" the Supreme Court's June decision to strike down a Massachusetts "buffer zone" law that barred protests near clinic entrances. Harris-Perry speaks with Massachusetts state Sen. Harriette Chandler (D) about legislation (S 2281) that gives law enforcement in the state more authority to disperse abortion clinic protesters. The law was crafted "very narrowly" to "balance the freedom of speech issues with the safety issues," Chandler says. Sarah Knight of the American Constitution Society and Igor Volsky of ThinkProgress also join (Harris-Perry, "Melissa Harris-Perry," MSNBC, 7/26).




Rachel Maddow reports on the closing of one of the last abortion clinics in Kansas, where state restrictions have made it increasingly difficult for clinics to remain open. Maddow notes that she spoke to the clinic's manager, who said its workers have grown weary after years of fighting state laws and dealing with protesters. The manager urged young people to vote and work to preserve abortion rights, adding, "Why am I the only one fighting this?" (Maddow, "The Rachel Maddow Show," MSNBC, 7/28).




HBO's John Oliver explains that there was "potentially horrifying" news last week that the extremist group Islamic State of Iraq and Syria was forcing women in Mosul, Iraq, to undergo female genital mutilation. Oliver says, "Thankfully, other reports suggest it could be fake," but notes that "before everyone gets too relieved ... it is worth remembering it is still happening in a shocking number of places," including Egypt (Davies, Jezebel, 7/28).

Study Assesses Impact of Gestational Age Limits, Cost, Harassment on Abortion Access

Thu, 07/31/2014 - 18:08

Researchers from the Guttmacher Institute examined how three factors that affect abortion access -- gestational age limits, levels of harassment and cost of services -- changed from 2008 to 2012. They found there was little change in each factor but noted several variations by region and facility type. They also warned that additional abortion restrictions enacted since the study period could further restrict abortion availability.

Study Assesses Impact of Gestational Age Limits, Cost, Harassment on Abortion Access

July 31, 2014 — Summary of "Secondary Measures of Access to Abortion Services in the United States, 2011 and 2012: Gestational Age Limits, Cost, and Harassment," Jerman/Jones, Women's Health Issues, July 2014.

"Although access to abortion is primarily defined by the presence of a health care facility that provides abortion care, secondary measures of access can influence women's ability to obtain care at these facilities, and include factors such as fees charged, gestational age limits, and harassment," according to Jenna Jerman and Rachel Jones, both of the Guttmacher Institute.

They explained that women might find it more difficult to obtain abortion services if those services "became more expensive, if fewer facilities were performing abortions at various gestational ages, or if increased harassment made women reluctant to go to a clinic."

They devised a study to document changes in these three measures between 2008 and 2012, and to "assess regional differences in abortion access."

Methods

The researchers used data from the Guttmacher Institute's 16th Abortion Provider Census, which collected information via questionnaires that were "sent to all known abortion providing facilities in the U.S." in April 2012, with "data collection efforts continu[ing] through May 2013."

The questionnaire surveyed abortion-providing facilities, including hospitals, about the minimum and maximum gestational age at which they provided "[e]arly medication abortion, surgical abortion, and induction abortion," Jerman and Jones explained. In addition, nonhospital abortion facilities were asked about the "usual charges a self-paying patient would incur for surgical abortions at 10 and 20 weeks and for early medication abortions" and "how frequently they had experienced any of seven types of harassment in 2011: Picketing, picketing with physical contact or blocking, vandalism, picketing of homes of staff members, bomb threats, harassing phone calls, and noise disturbances."

The researchers wrote that they distinguished between four types of abortion facilities: abortion clinics, defined as "nonhospital facilities in which half or more of patient visits were for abortion services"; nonspecialized clinics, defined as "sites in which fewer than half of patient visits were for abortion services"; hospitals; and physician clinics, which perform fewer than 400 abortions per year and "have names suggesting that they are physicians' private practices."

According to the study, the survey resulted in "at least some information on gestational age limits from 54% of all facilities," on cost and charges from 68% of nonhospitals and on exposure to harassment from "80% of clinics."

Findings

Gestational Age Limits

The study found that 95% of abortion facilities offered abortions at eight weeks of gestation, 72% at 12 weeks, 34% at 20 weeks and 16% at 24 weeks. Abortions were available at four weeks of gestation or earlier at 46% of facilities.

Gestational age limits varied significantly by facility type, the researchers noted. For example, slightly more than two-thirds of hospitals offered abortion care at 20 weeks' gestation, compared with 36% of abortion clinics.

Further, the availability of abortion care at nonspecialized clinics and physicians' offices dropped sharply after nine weeks' gestation, "perhaps because these types of facilities were more likely to offer only early medication abortion," the researchers suggested.

Cost

The researchers found that the median charge for a surgical abortion at 10 weeks gestational age in 2011 and 2012 was $495, "suggesting little to no change" from the $503 median cost of abortion in 2009.

However, they noted that the cost varied depending on "facility type and gestational age," with clinics that had the "largest caseloads charg[ing] the least ($450), and those that performed fewer than 30 procedures per year charg[ing] the most ($650)."

The median charge for an early medication abortion was $500, which varied only slightly depending on facility type, with "smaller facilities charg[ing] slightly more and prices decreas[ing] as caseload increased." The researchers found that the median charge for an abortion at 20 weeks' gestation was $1,350, with individual charges ranging from $750 to $5,000.

Harassment

According to the study, 84% of clinics experienced "at least one form of antiabortion harassment in 2011," with exposure to picketing (80%) and receiving harassing phone calls (47%) the most common types. A little over one-quarter of facilities reported picketing with physical contact or the blocking of patients.

The researchers found that abortion clinics were more likely than nonspecialized clinics to experience harassment, as were larger facilities compared with smaller facilities. For example, 94% of facilities that performed 1,000 or more abortions per year experienced picketing, compared with about 25% of those with fewer than 30 abortion patients each year.

The researchers also found that harassment varied by region. Ninety-five percent of clinics located in the Midwest were exposed to harassment, followed by 89% of clinics in the South, 79% in the West and 78% in the Northeast.

Overall, the researchers determined that harassment levels increased from 75% of clinics in 2008 to 80% in 2011.

Regional Distribution of Facilities and Abortions

By region, the South accounted for the largest proportion of abortions (34%), although there were more facilities offering the procedure in the Northeast (453) and the West (737) than in the South (357). Hospitals accounted for the largest percentage of abortion-providing facilities in the Northeast (36%) and the West (42%), while abortion clinics comprised the majority of facilities in the South (40%).

Physicians' offices accounted for fewer than one in 10 facilities in the Midwest and the South, compared with one in five facilities in the Northeast and the West.

Across all regions, abortion clinics provided the majority of abortions, while physicians' offices provided the fewest.

Discussion

"We found relatively few changes in gestational age limits, charges for abortion services or harassment experienced by abortion providing facilities between 2008 and 2009 compared with 2011 and 2012," Jerman and Jones wrote.

However, they noted "it is possible that a number of factors impacting access to services have changed since the study period," citing a Guttmacher report that found that 42 abortion restrictions took effect in 2012, with another 70 enacted in 2013. "As services become more restricted ... and, potentially, more concentrated within facilities vulnerable to anti-abortion harassment and state regulations, barriers may mount," they wrote.

"[O]ngoing monitoring of abortion indicators is necessary to address disparities in access to reproductive health services," Jerman and Jones continued. They urged policymakers to "use this information to remove barriers to abortion care and proactively protect all women's access to reproductive health care."


No-Cost Access to LARC Tied to Rapid Decline in Births Among Young, Low-Income Women

Thu, 07/31/2014 - 17:36

Researchers examined the effects of a program that provided no-cost access to intrauterine devices and implants for low-income women at Title X-funded clinics in Colorado beginning in 2009. Use of the methods among women ages 15 to 24 at the clinics increased sharply by 2011, coinciding with declines in fertility rates, high-risk births, abortion rates, and infant enrollment in the state's Women, Infants and Children program, the researchers found.

No-Cost Access to LARC Tied to Rapid Decline in Births Among Young, Low-Income Women

July 31, 2014 — Summary of "Game Change in Colorado: Widespread Use of Long-Acting Reversible Contraceptives and Rapid Decline in Births Among Young, Low-Income Women," Ricketts et al., September 2014.

The growing acceptance of long-acting reversible contraceptives (LARCs), like intrauterine devices (IUDs) and implants, for adolescents and young women "is fundamentally changing the landscape of reproductive health," according to researchers Sue Ricketts and Greta Klingler -- both of the Colorado Department of Public Health and Environment -- and Renee Schwalberg of the Maternal and Child Health Epidemiology and Statistics Program at the Altarum Institute. However, there are barriers to access, including the methods' high initial costs and low public awareness of their availability, appropriateness and safety.

To determine how increased access to LARC -- particularly, the removal of cost barriers -- affects pregnancy and birth rates among low-income women, the researchers examined results of the Colorado Family Planning Initiative (CFPI), a privately funded program that provides IUDs and implants at no cost through the state's Title X family planning clinics.

Methods

The researchers analyzed the CFPI's effectiveness at the program and population levels among women ages 15 to 24. They assessed caseloads at Title X-funded clinics prior to and after the start of the CFPI, as well as LARC use among patients at the clinics during the same time period.

The researchers also assessed fertility trends among low-income women by comparing observed and expected rates; high-risk births, defined as those to women who were unmarried, under age 25 and did not have a high-school education; abortion rates; and monthly caseloads for Colorado's Women, Infants and Children (WIC) program.

Results

In 2011, Title X-funded clinics in Colorado served 64,938 clients (54,762 women and 10,176 men), a 23% increase from 52,645 (46,348 women and 6,297 men) in 2008. More than half of the female clients were under age 25 in both 2008 and 2011, and most had incomes at or below 150% of the federal poverty level in both years (83% and 92%, respectively).

Prior to the launch of the CFPI, fewer than 5% of women ages 15 to 24 receiving services at Title X-funded clinics in Colorado used LARC. In 2011, 19% were using LARC methods. Specifically, implant use increased by more than 10 times and IUD use increased by nearly three times from 2008 to 2011. During the same time period, use of oral contraceptives decreased from 49% to 36% among the same population.

Cumulatively, 8,435 low-income patients ages 15 to 24 had received a LARC method by 2011, compared with 620 who received one in 2008.

Fertility Rates

Fertility rates among low-income women ages 15 to 19 in counties with clinics receiving CFPI funding were 80 births per 1,000 women in 2010 and 67 per 1,000 in 2011, compared with expected rates of 94 and 95 per 1,000, respectively. "These observed differences of 15% and 29% were statistically significant," the researchers wrote.

Likewise, fertility rates among women ages 20 to 24 in the same counties were 3% and 14% lower than expected in 2010 and 2011, respectively.

The fertility rates declined for all women ages 15 to 24 in Colorado between 2009 and 2011, the researchers noted. They estimated that 74% to 77% of the decline among those ages "can be attributed to the decline in births among low-income women in the CFPI counties."

High-Risk Births

In CFPI counties, high-risk births fell from 4,052 in 2009 to 2,940 in 2011, representing a 24% decline in the proportion of births that were high risk.

Abortion Rates

In 2008, before the CFPI began, there were 11 abortions per 1,000 women ages 15 to 19 and 22 per 1,000 women ages 20 to 24. In 2011, the rate among 15- to 19-year olds dropped by 34%, to seven per 1,000. For women ages 20 to 24, the rate fell by 18% from 2008 levels, reaching 18 per 1,000.

WIC Infant Caseload

The number of infants receiving WIC benefits had increased "steadily" in the two years prior to the CFPI, "[c]ontinuing a decades-long trend," the researchers noted. The number of infants receiving the benefits "leveled off" in 2009, the year the CFPI started, but then rose again by March 2010.

However, the number then "dropped sharply," reaching "a level well below that for any month since early 2005" by March 2013. Overall, the number of infants receiving WIC benefits decreased by 23% in the three-year period starting in March 2010.

Discussion and Conclusions

The researchers found that "increased access" to LARC via the CFPI "was immediately followed by a substantial reduction in the birthrate among" young, low-income women. The observed declines in fertility among the study population were "surprising, given that trends prior to the initiative indicated that small increases in fertility in the low-income group were expected in 2010 and 2011," they wrote.

The researchers noted that these declines were paralleled by "measurable declines ... in abortion rates, births to young unmarried women with limited education and numbers of infants receiving WIC services."

The CFPI "produced a radical game change in the state," the researchers wrote, adding that "the Affordable Care Act (PL 111-148) has the potential to replicate the success of the Colorado experience across the nation" by reducing cost barriers to highly effective contraceptive methods.

In addition, "[t]his fundamental change should help to alleviate the burden of unplanned pregnancy and its associated personal, economic and social costs," the researchers concluded.


Survey: Ob-Gyns Wrongly Think Pelvic Exams are Needed Before Prescribing Hormonal Contraception

Thu, 07/31/2014 - 17:34

Researchers from the University of California-San Francisco surveyed ob-gyns about their beliefs on the importance of pelvic exams for patients seeking hormonal contraception. Although clinical guidelines advise that ob-gyns do not need to perform pelvic exams before prescribing hormonal contraception to asymptomatic women, prior surveys suggest many ob-gyns still conduct such exams. In the new survey, most respondents felt the exams "are of some importance," which "may continue to pose a barrier to contraception provision," the researchers wrote.

Survey: Ob-Gyns Wrongly Think Pelvic Exams are Needed Before Prescribing Hormonal Contraception

July 31, 2014 — Summary of "Obstetrician-Gynecologists' Beliefs on the Importance of Pelvic Examinations in Assessing Hormonal Contraception Eligibility," Yu et al., Contraception, June 30, 2014.

Past surveys have found that many clinicians require pelvic examinations before prescribing hormonal contraception to women, even though the American Congress of Obstetricians and Gynecologists, CDC and the World Health Organization all advise that it is sufficient to assess a patient's medical history and blood pressure before writing such a prescription for asymptomatic women, according to a study led by Jean Yu of the University of California-San Francisco's Department of Obstetrics, Gynecology and Reproductive Sciences.

Yu and colleagues devised a study to examine ob-gyns' beliefs regarding the importance of pelvic exams for determining women's eligibility for hormonal contraception and whether ob-gyns find a particular component of the exam to be especially critical.

Methods

The researchers mailed a questionnaire to a national sample of 1,020 U.S. ob-gyns listed in the American Medical Association's Physician Masterfile, which includes information on AMA and non-AMA members. They collected data from May 2010 to January 2011.

The survey asked about routine gynecologic care, with a focus on pelvic examinations in conjunction with the provision of hormonal contraception.

Ob-gyns were asked to assess the importance of three components of pelvic examinations -- bimanual examination, external genitalia inspection and speculum examination -- in determining whether asymptomatic women are eligible for hormonal contraception. The respondents could rank each component as "very important," "moderately important," "a little important" or "not important."

Results

The response rate was 62%, with a final sample of 521 respondents. Respondents saw an average of 85 gynecologic patients per week, and 70% performed 30 or more gynecologic examinations a week.

Among the respondents, 79% considered at least one of the three components of the pelvic examination to be "very," "moderately" or "a little" important. Among all respondents, 29.7% thought the bimanual examination was unimportant for assessing eligibility for hormonal contraception, 35.1% thought the same about the speculum examination, and 46.8% did not consider the external genital examination to be important.

Meanwhile, 21% of respondents believed all three components of the pelvic examination were "not important," in line with professional recommendations. These ob-gyns, compared with the other respondents, tended to be younger, were more likely to be female and often practiced in "settings other than solo or group private practice."

Discussion

"Despite long-standing guidelines stating pelvic examinations are unnecessary prior to hormonal contraception provision, most [respondents] believed they are of some importance," the researchers wrote.

The findings "raise concern that these beliefs may continue to pose a barrier to contraception provision," the researchers continued. They noted, "Demonstration projects have shown that providing hormonal contraceptives without requiring a pelvic examination increases access to contraception and reproductive health services" and that most women "feel it is important to be able to begin contraception quickly and ... associate pelvic examinations with fear and embarrassment."

The Affordable Care Act's (PL 111-148) expansion of contraceptive coverage creates an "opportunity for obstetrician-gynecologists to provide more women with information [about] and access to reproductive health services," according to the researchers.

They recommended more-widespread "dissemination and visibility of current guidelines," which "can help inform providers as well as patients."


Addressing Gender-Based Violence in Conflict Requires Focus on Prevention

Thu, 07/31/2014 - 17:33

Writing in The Lancet as stakeholders gathered for the Global Summit to End Sexual Violence in Conflict last month, experts from the London School of Hygiene and Tropical Medicine called for prevention measures that "challenge legal, economic, and social structures that uphold and foster gender inequality."

Addressing Gender-Based Violence in Conflict Requires Focus on Prevention

July 31, 2014 — Summary of "Preventing Violence Against Women and Girls in Conflict," Hossain et al., The Lancet, June 14, 2014.

"[T]he international community faces a propitious moment to address the horrors of sexual violence in conflict and other forms of gender-based violence," according to a commentary by Mazeda Hossain, Cathy Zimmerman and Charlotte Watts of the Gender Violence and Health Centre at the London School of Hygiene and Tropical Medicine. They note that stakeholders gathered to discuss the issue at the Global Summit to End Sexual Violence in Conflict in London in June.

New Perspectives on Violence in Conflict Settings

Historically, "most data on sexual violence in conflict have measured rape of women committed by combatants, using information from governmental, humanitarian, or human rights organisations or facility-based reports," Hossain and colleagues explain.

However, more recently, "population-based research is being used to document the wider scope of civilian women's and men's exposures to sexual and other forms of violence in different conflict settings," they write.

One finding that is "quietly emerging" is "that alongside conflict-related rape, violence by intimate partners is also highly prevalent and is likely to continue long after peace agreements have been signed," according to the authors. They cite their own research in 12 rural districts of Côte d'Ivoire that found that about one-third of women had experienced sexual violence since age 15, with 29% identifying a husband or intimate partner as the perpetrator. By contrast, only 0.3% said an armed combatant was the perpetrator.

A larger review that looked at experiences of "female refugees and internally displaced people in complex humanitarian emergencies across 14 countries" found that "21% of women had experienced sexual violence (intimate partner and non-partner rape)," Hossain and colleagues add.

"These patterns of violence against women underline the need for initiatives to respond explicitly to the breadth of sexual and physical violence in conflict settings," they write.

Focus on Prevention

The authors argue that the "scale of violence in conflict-affected settings highlights that alongside strengthened judicial, health, and social responses and accountability measures, we need to invest in prevention." They note, "Rigorous evaluation research from non-conflict settings suggests that violence against women is preventable."

Although "[g]ender-based violence prevention programming is in its relative infancy, ... innovative interventions are taking place," they continue. For example, interventions in Syria and other emergency settings focus on "improving the economic situation of refugees" as a means of "prevent[ing] sexual exploitation and forced marriage of young women."

The authors stress that "prevention measures need to challenge legal, economic, and social structures that uphold and foster gender inequality."

Recommendations

The authors note that "there are currently no robust evidence or consensus on what prevention approaches should be prioritised in conflict settings." Therefore, "[f]urther research is needed to determine what works and where investment is warranted," they add.

International efforts to address gender-based violence should include measures "not only to eliminate impunity for perpetrators, but also to respond to the health and safety needs of all victims," as well as investments in prevention "at all stages of a conflict," Hossain and colleagues argue.

"[R]hetoric must turn into action that not only addresses the immediate consequences of sexual violence in conflict, but also promotes gender equality and protects women from all forms of abuse," they conclude.


One-Third of Pregnancy-Related Deaths in Ill. May Be Preventable, Review Finds

Thu, 07/31/2014 - 17:33

In the first analysis of pregnancy-related deaths in Illinois in over 60 years, researchers from the state Maternal Mortality Review Committee Working Group found that one-third of such deaths were potentially preventable. Noting that their findings are consistent with analyses in other states, the researchers called for "a multi-tiered approach [to] addressing provider, system and patient-related factors" in order to reduce preventable pregnancy-related deaths.

One-Third of Pregnancy-Related Deaths in Ill. May Be Preventable, Review Finds

July 31, 2014 — Summary of "Assessing Preventability of Maternal Mortality in Illinois: 2002-2012," Geller et al., American Journal of Obstetrics & Gynecology, June 20, 2014.

Although the U.S. maternal mortality rate decreased dramatically in the 20th century, it "has nearly tripled over the last quarter century," according to researchers led by Stacie Geller of the University of Illinois College of Medicine's Center for Research on Women and Gender. The researchers serve on the Illinois Department of Public Health Maternal Mortality Review Committee Working Group.

While reasons for the increase in maternal mortality are not completely known, studies suggest that about half of the nearly 650 pregnancy-related deaths in the U.S. each year are from preventable causes, the researchers noted.

Methods

The researchers sought to assess the potential preventability of maternal deaths in Illinois, where the state "require[s] the reporting and review of all deaths to women within a year of pregnancy, regardless of cause of death." The reviews are conducted by the state's network of Regionalized Perinatal Centers, which determine whether the death was possibly preventable. The state defines maternal deaths as those "caused by direct or indirect complications of pregnancy."

Specifically, the researchers examined records on maternal deaths from the Illinois Department of Public Health's Maternal Mortality Review Form database for 2002 to 2012. The database "includes demographics, characteristics of the pregnancy and delivery/termination, determination of cause of death as related to pregnancy, and an assessment of the potential preventability of the death and identification of avoidable factors (patient, provider or systems)," the researchers explained.

For the study, maternal mortality ratio was defined as the number of women who died from a pregnancy-related cause during pregnancy or within 42 days afterward, "divided by the number of live births multiplied by 100,000." The researchers noted that deaths directly related to pregnancy -- such as those resulting from obstetrical complications -- and deaths indirectly related to pregnancy -- such as those stemming from a pre-pregnancy condition -- are both considered pregnancy-related deaths.

The researchers then analyzed associations between the causes of death and possible preventability of pregnancy-related deaths.

Results

The study identified 610 maternal deaths in Illinois from 2002 to 2012.

One-third (210) of the deaths were pregnancy-related, 7.1% (43) were possibly related, and 52.6% (321) were not related to pregnancy. The researchers calculated a maternal mortality ratio of 10.5 maternal deaths per 100,000 live births.

More than 80% of all maternal deaths (509) occurred in women ages 20 to 39. Almost 50% of the deaths occurred among non-Hispanic white women, 35.3% occurred among non-Hispanic black women and 11.5% were among Hispanic women.

About two-thirds of the deaths occurred at hospitals, while the others occurred at women's residences or "other locations such as the site of a car accident," the researchers wrote. Twenty-one percent of the women died while pregnant and two-thirds died postpartum, mostly at more than 42 days postpartum.

The most common cause of pregnancy-related death was vascular issues, followed by cardiac causes and hemorrhage. One-third of pregnancy-related deaths were possibly preventable. Deaths associated with hemorrhage or psychiatric causes were most commonly deemed preventable, "while cancer and vascular-related deaths were generally not considered preventable," the researchers wrote.

Discussion

According to Geller and colleagues, their findings in Illinois are similar to analyses in other states.

"In order to reduce maternal mortality and morbidity, states should review the causes and preventability of pregnancy-deaths," the researchers wrote. They noted that previous research has found that "30-50% of these cases are potentially preventable," which is consistent with their findings in Illinois.

Reducing "preventable pregnancy-related deaths can be achieved through the use of a multi-tiered approach addressing provider, system and patient-related factors," according to the researchers.

They concluded, "Efforts aimed at addressing these factors have the greatest potential to improve the delivery and coordination of obstetric care, possibly leading to improved overall maternal health in the state of Illinois."


Roe v. Wade 'Effectively Undone' in Much of Texas, Washington Post Editorial Argues

Thu, 07/31/2014 - 17:08

"[P]ro-life groups and lawmakers are negating" the effects of Roe v. Wade with restrictive state laws, including a "frontal assault" on abortion providers in Texas, a Washington Post editorial argues.

Roe v. Wade 'Effectively Undone' in Much of Texas, Washington Post Editorial Argues

July 29, 2014 — "[P]ro-life groups and lawmakers are negating" the effects of Roe v. Wade with restrictive state laws, including a "frontal assault" on abortion providers in Texas, a Washington Post editorial argues.

The Texas legislation (HB 2) has reduced the number of the state's clinics by more than half, and many "of the surviving clinics are expected to close this fall" after more provisions take effect, according to the Post.

"The new requirements have nothing to do with improving women's health or enhancing the safety of clinics, which are already quite safe," the editorial argues. Rather, "their sole purpose is to burden the clinics with expenses that force them to shut their doors," it adds.

"In the absence of adequate numbers of legal and accessible abortion providers, many women will resort to unsafe and unsanitary options closer to home," according to the editorial.

"Very possibly, some women will die as a result; most of these will be poor," the editorial says, concluding that Roe "has been effectively undone by the [Texas] legislature" in much of the state (Washington Post, 7/28).


Senate Hearing Spotlights Lack of Paid Family Leave for Many in U.S.

Thu, 07/31/2014 - 17:07

Senate Democrats on Wednesday held a subcommittee hearing to draw attention to the lack of paid family leave for many workers in the U.S., McClatchy/Miami Herald reports.

Senate Hearing Spotlights Lack of Paid Family Leave for Many in U.S.

July 31, 2014 — Senate Democrats on Wednesday held a subcommittee hearing to draw attention to the lack of paid family leave for many workers in the U.S., McClatchy/Miami Herald reports.

Senate Health, Education, Labor and Pensions Subcommittee on Children and Families Chair Kay Hagan (D-N.C.), who called the hearing, said it aimed to "encourage more companies and small businesses" to recognize that adopting paid leave programs "really will benefit their bottom line."

No legislation was presented at the meeting, but several witnesses shared testimony about the need for paid family leave.

Vicki Shabo, vice president of the National Partnership for Women & Families, noted in her testimony that the U.S. is only one of two countries that does not guarantee paid maternity leave (Schoof, McClatchy/Miami Herald, 7/30).

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, 6/23).

Shabo said that only about 60% of the workforce has access to leave under FMLA, in part because small-business employees and part-time workers are excluded.

Senate Budget Committee Chair Patty Murray (D-Wash.) said paid family leave would positively affect the federal budget. Women who have access to paid leave are 39% less likely to need public assistance during the year after birth, according to Murray.

Others testified at the hearing that offering paid leave to workers would benefit businesses financially. Kevin Trapani, CEO of North Carolina-based Redwoods Group, said, "Paid leave users are more likely to return, which saves us the cost of interviewing, hiring and retraining" (McClatchy/Miami Herald, 7/30).


Court Blocks Miss. Law Threatening State's Sole Abortion Clinic

Thu, 07/31/2014 - 17:07

A federal appeals court on Tuesday blocked a Mississippi law (HB 1390) that would have shut down the state's only abortion clinic, ruling that it illegally shifted Mississippi's constitutional obligations to other states, the New York Times reports.

Court Blocks Miss. Law Threatening State's Sole Abortion Clinic

July 30, 2014 — A federal appeals court on Tuesday blocked a Mississippi law (HB 1390) that would have shut down the state's only abortion clinic, ruling that it illegally shifted Mississippi's constitutional obligations to other states, the New York Times reports (Robertson/Eckholm, New York Times, 7/29).

The Mississippi law, like a Texas law (HB 2) with similar provisions, would require that physicians performing abortions have admitting privileges at nearby hospitals. The 5th U.S. Circuit Court of Appeals previously ruled that the Texas law does not impose an unconstitutional burden on women because abortion access would still be available in the state (Women's Health Policy Report, 4/29).

Tuesday's Ruling

In Tuesday's ruling, a different three-judge panel on the 5th Circuit ruled in a 2-1 decision that the impact of the law in Mississippi, with just one abortion clinic, makes it constitutionally distinct from the law in Texas. Judge Grady Jolly wrote in the majority opinion that the Mississippi law "effectively extinguishes" a woman's constitutional right to abortion in the state and illegally shifts the burden of ensuring that right to neighboring states. "A state cannot lean on its sovereign neighbors to provide protection of its citizens' federal constitutional rights," Jolly wrote (New York Times, 7/29).

Meanwhile, Judge Emilio Garza issued a dissenting opinion, writing, "The sole act of crossing a state border cannot, standing alone, constitute an unconstitutional undue burden of the abortion right because the Constitution envisions free mobility of persons without regard to state borders" (Winfield Cunningham, Politico, 7/29).

Legal Impact

The ruling did not overturn the law or assess whether the admitting privileges requirement is a justified safety measure. Rather, the ruling preserved an existing stay against the law and leaves the lower courts to consider the measure under the now-clarified principle of state responsibility, the Times reports (New York Times, 7/29).

According to legal experts, the ruling only applies to the one clinic, meaning that if another clinic opened in the state, it would have to try to comply with the law (Le Coz, Reuters, 7/29). The physicians at the Mississippi clinic sought admitting privileges at multiple hospitals but were denied, prompting the state to order the clinic to close for violating the law (Politico, 7/29).

Broader Implications

The new ruling, combined with the legal challenges against similar laws in other states, could "set the stage" for a Supreme Court challenge, the Wall Street Journal reports (McWhirter, Wall Street Journal, 7/29).

According to the Times, federal courts have temporarily blocked admitting privileges laws in Alabama, Kansas and Wisconsin, while similar laws are in effect in Missouri, North Dakota, Tennessee, Texas and Utah (New York Times, 7/29).

Julie Rikelman -- director of litigation for the Center for Reproductive Rights, which argued the case on behalf of the Mississippi clinic -- said that while the 5th Circuit's ruling was narrow, it could have implications for other states in similar situations. For example, officials in Wisconsin and Alabama have both argued that women could cross state lines to access abortion if needed (Wagster Pettus, AP/U-T San Diego, 7/30).

Reaction

Mississippi Gov. Phil Bryant (R) expressed disappointment with the ruling and indicated that the state would try to appeal to the full 5th Circuit (Reuters, 7/29).

CRR President Nancy Northup said the ruling "ensures women who have decided to end a pregnancy will continue, for now, to have access to safe, legal care in their home state." However, she added that there is "still only one clinic in the entire state, and it is still threatened by a law advanced by politicians over the opposition of respected medical associations, with the sole intent of closing that clinic permanently" (Politico, 7/29).

Similarly, Elizabeth Nash of the Guttmacher Institute said that while "[t]he fact that the Mississippi clinic can stay open is good news," there "are a lot of other cases pending in federal courts, and it's impossible to know if those laws will be upheld or struck down" (New York Times, 7/29).


Lack of Awareness, Uneven Implementation Hamper Laws Aiming To Prevent Shackling of Imprisoned Pregnant Women, Column Ar

Thu, 07/31/2014 - 17:05

Shackling pregnant inmates during and after labor can be a "threat to the health of both mother and child," yet it remains "a multistate problem," Audrey Quinn, a multimedia journalist who covers health, science and the economy, writes in a New York Times opinion piece.

Lack of Awareness, Uneven Implementation Hamper Laws Aiming To Prevent Shackling of Imprisoned Pregnant Women, Column Argues

July 28, 2014 — Shackling pregnant inmates during and after labor can be a "threat to the health of both mother and child," yet it remains "a multistate problem," Audrey Quinn, a multimedia journalist who covers health, science and the economy, writes in a New York Times opinion piece. The practice "is common," Quinn argues, citing a Correctional Association of New York study to be released in September that found 23 of 27 surveyed women reported being shackled before, during or after their delivery.

Twenty-one states have laws preventing shackling, but they vary, and Quinn writes there is "evidence of negligence in the implementation of these laws across the country" and that "isn't the only problem."

"The language of some of the laws gives wide latitude to corrections officers to use restraints if they identify security risks," which "creates opportunities for the continuation of shackling," Quinn writes.

Quinn cites several examples of pregnant inmates who had been wrongfully shackled during labor in states that have anti-shackling laws like California, Illinois, New York and Pennsylvania. According to Quinn, "in many correctional systems, doctors, guards and prison officials simply are not told about anti-shackling laws, or are not trained to comply."

Most prominent, she writes, is a case involving Nevada inmate Valerie Nabors. Nevada prohibits restraints during labor and delivery. When Nabors went into labor, she was taken to a hospital via ambulance with her hands cuffed and ankles shackled together. The ambulance supervisor had protested the shackling, noting that medical personnel would not be able to help Nabors if there were complications during transport, and a nurse at the hospital also questioned the use of restraints.

Nabors' restraints were removed only after a delivery room nurse insisted, but within 10 minutes of having an emergency caesarean section, her ankles were shackled and she was restrained to the hospital bed. Nabors "suffered several pulled muscles" and "X-rays revealed a separation of her pubic bones," which her physician said "were a direct result of the restraints."

Nabors, who was awarded $130,000 in a settlement after suing the state, is a rare case as "[v]ictims of illegal shackling rarely litigate, often because of feelings of shame or fear of repercussions," Quinn cautions (Quinn, New York Times, 7/26).


N.Y. Will Allow Medicaid Reimbursements for Long-Acting Reversible Contraceptives for New Mothers

Thu, 07/31/2014 - 17:04

New York has joined five other states in making it easier for new mothers in the Medicaid program to access long-acting reversible contraceptives after giving birth, NPR's "Shots" reports.

N.Y. Will Allow Medicaid Reimbursements for Long-Acting Reversible Contraceptives for New Mothers

July 25, 2014 — New York has joined five other states in making it easier for new mothers in the Medicaid program to access long-acting reversible contraceptives after giving birth, NPR's "Shots" reports. Under a policy change announced last week, women participating in the fee-for-service portion of the program can receive coverage for LARCs immediately after giving birth.

According to "Shots," most states' Medicaid programs will not reimburse physicians for delivering a newborn and administering LARCs during a single visit. Women can receive Medicaid coverage for LARCs at a six-week post-partum appointment, but "Shots" reports that many women are much less likely to obtain contraception at that point.

New York City Assistant Health Commissioner Deborah Kaplan said the state's "bottom line priority" is to get rid of barriers to contraceptive access. Kaplan added, "We want women to have the options and then [work] with their provider to make the best decision with all the information available" (Farrington, "Shots," NPR, 7/23).