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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Addressing Neonatal Mortality Also Requires Focus on Adolescent Pregnancy, Editorial States

Fri, 03/28/2014 - 18:05

Citing a report from Save the Children that outlines eight interventions to end preventable neonatal deaths worldwide, an editorial in The Lancet argues that a ninth area "deserves more attention": adolescent pregnancy. The editorial argues that investing in girls -- including through education and prevention of child marriage -- will produce "not only an acceleration of progress towards ending maternal, neonatal, and child mortality, but also a better educated future generation of women who will contribute to the skilled workforce and so the economic development of their countries."

Addressing Neonatal Mortality Also Requires Focus on Adolescent Pregnancy, Editorial States

March 28, 2014 — Summary of "Every Newborn, Every Mother, Every Adolescent Girl," The Lancet, March 1, 2014.

When it comes to reducing neonatal mortality rates, "the 'N' in the reproductive, maternal, neonatal, and child health (RMNCH) agenda needs to be more than just a letter," according to an editorial in The Lancet, which adds that it is also "time to add the letter 'A'" -- for adolescents, who account for millions of pregnancies worldwide each year.

Citing a Save the Children report -- part of the organization's No Child Born to Die Campaign -- as a "powerful reminder of the reasons for neonatal deaths," the editorial calls for "concerted and integrated action plans, political will, and dedicated funding" to implement the recommendations. In addition to the eight areas of interventions outlined in the report, the editorial notes that pregnancy among adolescent girls "deserves more attention" in efforts to improve neonatal outcomes.

Neonatal Mortality Causes and Prevalence

The editorial notes that deaths among children younger than age five are almost 50% lower than in 1990, but "progress in the reduction of neonatal deaths has been much slower than that of children older than 4 weeks."

Currently, 44% of deaths among children younger than five are neonatal deaths, compared with 38% in 2005. About 2.9 million newborns died within 28 days of birth in 2012, and an additional 1.2 million stillbirths occurred just before or during labor. The editorial notes that the most common causes of infant mortality include prematurity-related complications (34%); intrapartum-related complications (24%); sepsis, meningitis or pneumonia (22%); and inherited abnormalities (9%).

Suggested Interventions

The Save the Children report suggests eight areas of intervention, which were developed from The Lancet's 2005 Neonatal Survival Series and the Every Newborn Bottleneck Analysis Tool.

The eight interventions include "skilled care at birth and emergency obstetric care"; "management of preterm births"; "basic neonatal care," such as immediate breastfeeding and general hygiene practices; "neonatal resuscitation"; "kangaroo mother care"; prompt identification and antibiotic treatment of serious infections; "inpatient care for small and sick newborns"; and "prevention of mother-to-child transmission of HIV," according to the editorial.

Focus on Adolescent Girls

In addition, the editorial urges "dedicated and targeted intervention" to address births among adolescents girls, an area that is only "mentioned in passing" in the report.

Pregnant adolescents are "in fact children bearing children," the editorial states. Adolescent girls have a "higher risk of adverse maternal and birth outcomes, including stillbirths, neonatal deaths, preterm births, small-for-gestational-age babies, and complications during birth" than women who give birth at ages 19 or older, the editorial adds.

The "prevention of child marriage and unwanted births, comprehensive access to sexual and reproductive education (including contraception), keeping girls in secondary education and therefore delaying age at the birth of the first child, and empowerment to make the right choices for health and wellbeing" should all be included in interventions aimed at reducing pregnancies and births among adolescent girls, the editorial states.

The editorial argues that investing in girls will produce "not only an acceleration of progress towards ending maternal, neonatal, and child mortality, but also a better educated future generation of women who will contribute to the skilled workforce and so the economic development of their countries." It adds, "The continuum of care needs to become a lifecycle of care."

"Prevention of stillbirths and neonatal mortality and morbidity must include greater attention to adolescent girls in particular" the editorial continues, concluding, "It is time to add the letter 'A' to RMNCH."

Featured Blogs

Fri, 03/28/2014 - 17:19

"Kansas Moves To Defund Planned Parenthood and Force Doctors To Report Every Miscarriage," (Marcotte, "XX Factor," Slate, 3/26); "Two Anti-Choice Candidates in Colorado Rescind Support for 'Personhood,' (Salzman, RH Reality Check, 3/26).

March 28, 2013

FEATURED BLOG

 "Kansas Moves To Defund Planned Parenthood and Force Doctors To Report Every Miscarriage," Amanda Marcotte, Slate 's "XX Factor": While "conservative attacks on insurance coverage of contraception have been garnering a lot of attention," Marcotte notes that "it's important to remember that this is just one small part of a larger push from the right to do as much damage as possible to women's reproductive rights." She explains, "A couple of stories out of Kansas demonstrate this [push] quite well." For example, she cites a recent federal appeals court's decision to allow "lawmakers to deprive low-income women of access to contraception and other reproductive health services by allowing Kansas to immediately start defunding" Planned Parenthood of Kansas and Mid-Missouri. Marcotte also points to a "bill [HB 2613] winding its way through the state's legislature," with an amendment that "would require doctors to report all miscarriages to the state health department, no matter how early they occur in a pregnancy" (Marcotte, "XX Factor," Slate, 3/26).

What others are saying about abortion restrictions:

~ "Federal Court Extends Order Temporarily Blocking Alabama Admitting Privileges Law," Jessica Mason Pieklo, RH Reality Check.

~ "Fact-Checking a Texas Republican's Claims on Women's Health 'Advances,'" Andrea Grimes, RH Reality Check.

~ "Federal Appeals Court Refuses To Overturn Texas' Stringent New Abortion Law," Tara Culp-Ressler, Center for American Progress' "ThinkProgress."

FEATURED BLOG

"Two Anti-Choice Candidates in Colorado Rescind Support for 'Personhood,'" Jason Salzman, RH Reality Check: Two Republicans from Colorado -- U.S. Reps. Cory Gardner and Mike Coffman -- who are running for the state's "most hotly contested congressional seats have withdrawn their support for a 'personhood' amendment," Salzman writes. Gardner is trying to unseat U.S. Sen. Mark Udall (D), while Coffman is running for re-election against Democrat Andrew Romanoff. In the blog post, Salzman explains the amendment "would ban all abortion and give legal rights to fertilized human eggs, also called zygotes." According to Salzman, a Coffman spokesperson has said that "this year's [ballot] measure, which would redefine the definition of 'child' in the Colorado criminal code, isn't as broad as previous personhood measures, depending on how it would be interpreted by the courts." Meanwhile, Salzman notes, Gardner "has yet to clarify what his new abortion stance is" and whether "he supports an abortion ban, Roe v. Wade, or another policy" (Salzman, RH Reality Check, 3/26).

What others are saying about politics and elections:

~ "In Unprecedented Assault, Koch Brothers Aim for Anti-Choice Senate in 2014," Adele Stan, RH Reality Check.

~ "We Need an Act of Congress to Get More Women in Congress," Crystal Shepeard, Care2.

Planned Parenthood To Develop N.C. Abortion Clinic in Compliance With Potential Regulations

Fri, 03/28/2014 - 17:11

Raleigh, N.C.-based Planned Parenthood Health Systems announced it will open a new abortion clinic that will comply with a new state law (SB 353) that authorizes making ambulatory surgery center rules applicable to clinics, the Carolina Public Press reports.

Planned Parenthood To Develop N.C. Abortion Clinic in Compliance With Potential Regulations

March 28, 2014 — Raleigh, N.C.-based Planned Parenthood Health Systems announced it will open a new abortion clinic that will comply with a new state law (SB 353) that authorizes making ambulatory surgery center rules applicable to clinics, the Carolina Public Press reports. The move comes despite a recent state report suggesting there will be a delay in releasing the rules designed to enforce that law (Elliston, Carolina Public Press, 3/27).

An expansive antiabortion-rights measure, signed by North Carolina Gov. Pat McCrory (R) in July, allows the state Department of Health and Human Services to "apply any requirement" for ambulatory surgical centers to abortion clinics, so long as the regulations do not impede access to abortion.

DHHS was required to provide an update on its progress in developing the rules by Jan. 1, but there is no deadline to create the rules for abortion clinics (Women's Health Policy Report, 12/17/13).

DHHS Interim Report

In an interim report submitted to the state Legislature in December 2013, DHHS said that it would work to develop permanent rules, rather than spend time creating and implementing temporary regulations. The report also outlined the numerous steps required to finalize the permanent rules, suggesting that it could be some time before the final regulations are released.

Specifically, DHHS will first create a set of draft rules, which will then be submitted for approval to the state Office of Administrative Hearings and the Office of State Management and Budget. DHHS would then review the rules again, resubmit them to OAH for approval and then publish them in the North Carolina Register for public consideration.

DHHS at that time will invite stakeholders to comment on the regulations via the register notice, a public hearing and a public comment process. Once cleared, the rules would be formally adopted by the agency and submitted to the state's Rules Review Commission for final approval before being implemented.

The report did not specify how long the entire process would take.

Ashville Clinic Plans

PPHS said it would open a new abortion clinic in Ashville to replace Femcare, a clinic also based in Ashville that is the only abortion provider of the state's 15 clinics that would currently be able to meet the ambulatory surgical center standards. Femcare is scheduled to close.

PPHS Vice President of Communications Melissa Reed said, "It's certainly what we felt we needed to do in anticipation of what may come, so that was why we decided to build to that [ambulatory surgical center] standard." She said the new clinic is scheduled to open by summer.

Comments

NARAL Pro-Choice North Carolina Executive Director Suzanne Buckley said that while it is unknown when the final rules will be published, "The rule-making process is certainly a long one, and there are a lot of turning points along the way where things could change. But our hope is that folks let the process play out as it is designed to, to take into account sound science and medicine and make rules based on that and the practical implications of these laws, and let politics stay out of it."

Reed said, "We're anxious to see what" DHHS proposes, adding, "They did include a group of people that included experts on women's health care that are providers, and we felt that that showed a good faith effort." She continued, "They indicated that their primary concern was patient safety and not putting unnecessary building requirements on providers. We're hoping that that continues to be the focus, and that that's what we'll see when they reveal the draft regulations" (Carolina Public Press, 3/27).


Ala. Could Consider Bill Extending Mandatory Delay Period for Abortion Next Week

Fri, 03/28/2014 - 17:09

While there is less than a week before the Alabama Legislature's 2014 session ends, lawmakers still could vote on a bill (HB 489) that would extend the state's mandatory delay period before an abortion from 24 to 48 hours, WHNT News reports.

Ala. Could Consider Bill Extending Mandatory Delay Period for Abortion Next Week

March 28, 2014 — While there is less than a week before the Alabama Legislature's 2014 session ends, lawmakers still could vote on a bill (HB 489) that would extend the state's mandatory delay period before an abortion from 24 to 48 hours, WHNT News reports.

The bill has passed the state House and was approved by a state Senate committee earlier this month.

According to sponsor state Rep. Ed Henry (R), the bill would give a woman time "to think about what she's fixing to do, for some type of intervention, for somebody to come in her life and maybe speak a word to her that encourages her not to end the life of that child" (Banaszak, WHNT News, 3/26).


Appeals Court Upholds Texas Admitting Privileges, Medication Abortion Law

Fri, 03/28/2014 - 17:08

The 5th U.S. Circuit Court of Appeals on Thursday upheld two contested provisions in a Texas antiabortion-rights law (HB 2), ruling that the restrictions do not unduly burden women, the New York Times reports.

Appeals Court Upholds Texas Admitting Privileges, Medication Abortion Law

March 28, 2014 — The 5th U.S. Circuit Court of Appeals on Thursday upheld two contested provisions in a Texas antiabortion-rights law (HB 2), ruling that the restrictions do not unduly burden women, the New York Times reports (Eckholm, New York Times, 3/27).

In October, the appeals court ruled that a provision in the law requiring abortion providers to have admitting privileges at a nearby hospital, as well as a second provision that would require a physician to be present when administering medication abortion, could take effect while the case was appealed. The next month, the Supreme Court declined an emergency application filed by women's health care providers to block the law (Women's Health Policy Report, 1/7).

Thursday's Ruling

A three-judge panel issued a unanimous decision in favor of the state, finding that the rules are constitutional because the state's objective was to protect abortion patients' health and the plaintiffs did not adequately demonstrate that the rules excessively burdened women.

The judges wrote that the state's "articulation of rational legislative objectives, which was backed by evidence placed before the state legislature, easily supplied a connection between the admitting-privileges rule and the desirable protection of abortion patients' health" (Aaronson, Texas Tribune, 3/27).

The judges added that the admitting privileges rule "would also promote the continuity of care in all cases, reducing the risk of injury caused by miscommunication and misdiagnosis when a patient is transferred from one health care provider to another."

However, the judges did decide to allow clinics that have applied for admitting privileges but not yet received confirmation to continue offering abortion care (Herskovitz, Reuters, 3/27).

The ruling in favor of the state was not surprising because the 5th Circuit is a conservative court and previously signaled it likely would uphold the law, the Times reports (New York Times, 3/27).

Clinic Closures

According to the Texas Tribune, there were 40 licensed abortion providers in the state in August, before the rules took effect. There are now 28 licensed abortion providers, but just 24 still offer abortion care.

The law also includes other provisions that have not been challenged in court, including a 20-week abortion ban and requirements that all abortion facilities meet ambulatory surgical center requirements.

The number of operational abortion clinics in the state likely will drop to six when those provisions take effect in September, according to the Tribune.

Reaction

Texas Gov. Rick Perry (R) said in a statement, "Today's court decision is good news for Texas women and the unborn, and we will continue to fight for the protection of life and women's health in Texas."

Planned Parenthood Federation of America President Cecile Richards pledged to continue fighting the legislation, stating, "We will combat these laws in the courts, and our separate political arm will mobilize voters to replace lawmakers who champion these dangerous laws in the first place."

Brigitte Amiri, a senior staff attorney at the American Civil Liberties Union's Reproductive Freedom Project, said the law is having a "devastating impact" on Texas women. "Texas women deserve better than to have extremist politicians endanger their health and safety by preventing them from accessing safe and legal abortion," she added (Texas Tribune, 3/27).

Meanwhile, Center for Reproductive Rights President Nancy Northup said admitting privileges, in Texas or other states, "is an issue that is hurtling its way toward the Supreme Court" (New York Times, 3/27).


Blogs Comment on Family Planning Funding, Supreme Court Gun Ruling, More

Fri, 03/28/2014 - 16:29

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

Blogs Comment on Family Planning Funding, Supreme Court Gun Ruling, More

March 28, 2014 — We've compiled some of the most thought-provoking commentaries from around the Web. Catch up on the conversation with bloggers from Slate, RH Reality Check and more.

ABORTION RESTRICTIONS: "Kansas Moves To Defund Planned Parenthood and Force Doctors To Report Every Miscarriage," Amanda Marcotte, Slate's "XX Factor": While "conservative attacks on insurance coverage of contraception have been garnering a lot of attention," Marcotte notes that "it's important to remember that this is just one small part of a larger push from the right to do as much damage as possible to women's reproductive rights." She explains, "A couple of stories out of Kansas demonstrate this [push] quite well." For example, she cites a recent federal appeals court's decision to allow "lawmakers to deprive low-income women of access to contraception and other reproductive health services by allowing Kansas to immediately start defunding" Planned Parenthood of Kansas and Mid-Missouri. Marcotte also points to a "bill [HB 2613] winding its way through the state's legislature," with an amendment that "would require doctors to report all miscarriages to the state health department, no matter how early they occur in a pregnancy" (Marcotte, "XX Factor," Slate, 3/26).

What others are saying about abortion restrictions:

~ "Federal Court Extends Order Temporarily Blocking Alabama Admitting Privileges Law," Jessica Mason Pieklo, RH Reality Check.

~ "Fact-Checking a Texas Republican's Claims on Women's Health 'Advances,'" Andrea Grimes, RH Reality Check.

~ "Federal Appeals Court Refuses To Overturn Texas' Stringent New Abortion Law," Tara Culp-Ressler, Center for American Progress' "ThinkProgress."

RELIGION: "Jimmy Carter Says Pope Francis Promised 'Women Should Have a Greater Role,'" Michelle Boorstein, Washington Post's "Post Local": Recapping President Carter's recent visit to the Post, Boorstein writes that "it wasn't surprising ... to hear" that the former president "typed out and mailed a letter to Pope Francis challenging the pontiff on the status of women in the Catholic church," given that Carter is known for being outspoken. Carter said Francis had promised him that "he thought women should have a greater role" in the Catholic Church. Carter also discussed "the intersection of religion and gender in a wide range of contexts, including prostitution, scripture and abortion," Boorstein adds (Boorstein, "Post Local," Washington Post, 3/26).

POLITICS AND ELECTIONS: "Two Anti-Choice Candidates in Colorado Rescind Support for 'Personhood,'" Jason Salzman, RH Reality Check: Two Republicans from Colorado -- U.S. Reps. Cory Gardner and Mike Coffman -- who are running for the state's "most hotly contested congressional seats have withdrawn their support for a 'personhood' amendment," Salzman writes. Gardner is trying to unseat U.S. Sen. Mark Udall (D), while Coffman is running for re-election against Democrat Andrew Romanoff. In the blog post, Salzman explains the amendment "would ban all abortion and give legal rights to fertilized human eggs, also called zygotes." According to Salzman, a Coffman spokesperson has said that "this year's [ballot] measure, which would redefine the definition of 'child' in the Colorado criminal code, isn't as broad as previous personhood measures, depending on how it would be interpreted by the courts." Meanwhile, Salzman notes, Gardner "has yet to clarify what his new abortion stance is" and whether "he supports an abortion ban, Roe v. Wade, or another policy" (Salzman, RH Reality Check, 3/26).

What others are saying about politics and elections:

~ "In Unprecedented Assault, Koch Brothers Aim for Anti-Choice Senate in 2014," Adele Stan, RH Reality Check.

~ "We Need an Act of Congress to Get More Women in Congress," Crystal Shepeard, Care2.

VIOLENCE AGAINST WOMEN: "Man Convicted of Domestic Violence Can't Possess a Gun, Supreme Court Rules," Nicole Flatow, Center for American Progress' "ThinkProgress": The Supreme Court in a unanimous ruling on Wednesday said that people who have been convicted of domestic violence, "even pushing or grabbing," are subject to a federal ban on possessing a gun, Flatow writes. "The ruling could have significant implications in interpreting which state domestic violence laws bar gun possession," she writes, noting that "domestic violence is one of the biggest risks associated with gun ownership." Flatow explains, "Because of this relationship ... federal law bars those convicted of a misdemeanor domestic violence offense from possessing a gun. But state crimes dubbed 'domestic violence' come with different definitions in different states." She also notes that "several bills introduced in Congress aim to fill ... gaps" in the current federal law, which only covers misdemeanors and "omits several other types of domestic violence offenses, including temporary protective orders and stalking offenses" (Flatow, "ThinkProgress," Center for American Progress, 3/26).

What others are saying about violence against women:

~ "A Year After VAWA, Still More Work To Be Done," Mark Kirschenbaum, Huffington Post blogs.

~ "From Dee to Patti: Transgender Women Fighting Back Against Sexual Assault in Detention," Chase Strangio, American Civil Liberties Union's "Blog of Rights."

~ "Feminists Take to Twitter To Explain That Rape Culture is Alive and Well," Culp-Ressler, Center for American Progress' "ThinkProgress."

~ "Survivors of Domestic Violence Now Have Better Access to Obamacare Benefits," Culp-Ressler, Center for American Progress' "ThinkProgress."

NEED FOR SAFE ABORTION: "Unsafe Abortions Have Killed 1 Million and Injured 100 Million in the Last Two Decades," Maya Dusenbery, Feministing: "[L]awmakers and public health leaders from over 30 countries have released a new declaration calling for the world's nations to repeal all criminal abortion laws and 'make safe, legal abortion universally available and accessible to all women regardless of age, income, or where they live,'" Dusenbery writes. The declaration represents a substantial update from the 1994 International Conference on Population and Development, where global leaders said that "abortion should be made 'safe where legal,'" she notes. Dusenberry adds, "As everyone -- except, of course, anti-choicers with their heads in the sand -- knows, outlawing the procedure does not stop people from getting abortions -- it just makes them less safe." She notes that 21 million women undergo unsafe abortions every year, adding that since 1994, more than one million have died from the procedures and 100 million more have sustained "often life-long" injuries (Dusenbery, Feministing, 3/27).

What others are saying about the need for safe abortion:

~ "UMich Exhibit Celebrates 4000 Years of Reproductive Choice," Callie Beusman, Jezebel.


Appeals Court Upholds Texas Admitting Privileges, Medication Abortion Law

Fri, 03/28/2014 - 15:14

The 5th U.S. Circuit Court of Appeals on Thursday upheld two contested provisions in a Texas antiabortion-rights law (HB 2), ruling that the restrictions do not unduly burden women, the New York Times reports.

Appeals Court Upholds Texas Admitting Privileges, Medication Abortion Law

March 28, 2014 — The 5th U.S. Circuit Court of Appeals on Thursday upheld two contested provisions in a Texas antiabortion-rights law (HB 2), ruling that the restrictions do not unduly burden women, the New York Times reports (Eckholm, New York Times, 3/27).

In October, the appeals court ruled that a provision in the law requiring abortion providers to have admitting privileges at a nearby hospital, as well as a second provision that would require a physician to be present when administering medication abortion, could take effect while the case was appealed. The next month, the Supreme Court declined an emergency application filed by women's health care providers to block the law (Women's Health Policy Report, 1/7).

Thursday's Ruling

A three-judge panel issued a unanimous decision in favor of the state, finding that the rules are constitutional because the state's objective was to protect abortion patients' health and the plaintiffs did not adequately demonstrate that the rules excessively burdened women.

The judges wrote that the state's "articulation of rational legislative objectives, which was backed by evidence placed before the state legislature, easily supplied a connection between the admitting-privileges rule and the desirable protection of abortion patients' health" (Aaronson, Texas Tribune, 3/27).

The judges added that the admitting privileges rule "would also promote the continuity of care in all cases, reducing the risk of injury caused by miscommunication and misdiagnosis when a patient is transferred from one health care provider to another."

However, the judges did decide to allow clinics that have applied for admitting privileges but not yet received confirmation to continue offering abortion care (Herskovitz, Reuters, 3/27).

The ruling in favor of the state was not surprising because the 5th Circuit is a conservative court and previously signaled it likely would uphold the law, the Times reports (New York Times, 3/27).

Clinic Closures

According to the Texas Tribune, there were 40 licensed abortion providers in the state in August, before the rules took effect. There are now 28 licensed abortion providers, but just 24 still offer abortion care.

The law also includes other provisions that have not been challenged in court, including a 20-week abortion ban and requirements that all abortion facilities meet ambulatory surgical center requirements.

The number of operational abortion clinics in the state likely will drop to six when those provisions take effect in September, according to the Tribune.

Reaction

Texas Gov. Rick Perry (R) said in a statement, "Today's court decision is good news for Texas women and the unborn, and we will continue to fight for the protection of life and women's health in Texas."

Planned Parenthood Federation of America President Cecile Richards pledged to continue fighting the legislation, stating, "We will combat these laws in the courts, and our separate political arm will mobilize voters to replace lawmakers who champion these dangerous laws in the first place."

Brigitte Amiri, a senior staff attorney at the American Civil Liberties Union's Reproductive Freedom Project, said the law is having a "devastating impact" on Texas women. "Texas women deserve better than to have extremist politicians endanger their health and safety by preventing them from accessing safe and legal abortion," she added (Texas Tribune, 3/27).

Meanwhile, Center for Reproductive Rights President Nancy Northup said admitting privileges, in Texas or other states, "is an issue that is hurtling its way toward the Supreme Court" (New York Times, 3/27).


President Obama, Vatican Leaders Touch on Contraception, Religious Freedom in Talks

Fri, 03/28/2014 - 14:43

President Obama on Thursday briefly touched on contraception and religious freedom rights during a visit to the Vatican, but he said his conversations with Pope Francis and Cardinal Pietro Parolin -- the Vatican's secretary of state -- focused primarily on global conflicts and economic opportunity, Politico reports.

President Obama, Vatican Leaders Touch on Contraception, Religious Freedom in Talks

March 28, 2014 — President Obama on Thursday briefly touched on contraception and religious freedom rights during a visit to the Vatican, but he said his conversations with Pope Francis and Cardinal Pietro Parolin -- the Vatican's secretary of state -- focused primarily on global conflicts and economic opportunity, Politico reports (Budoff Brown/Epstein, Politico, 3/27).

Obama said his 52-minute meeting with the Pope was a "wide-ranging session" that focused mostly on the "challenges of conflict and how elusive peace is around the world." Obama said that the conversation did not include "a whole lot about social schisms," adding, "I think His Holiness and the Vatican have been clear about their position on a range of issues, some of them I differ with, most I heartily agree with."

Contraception, Religious Freedom Discussed

However, Obama said his conversation with Cardinal Parolin delved more deeply into the subjects of contraception and religious freedom. Obama said he told the cardinal he would "continue to dialogue with the U.S. Conference of [Catholic] Bishops to make sure we can strike the right balance, making sure that not only everybody had health care but families, and women in particular, are able to enjoy the kind of health care coverage that the (health care law) offers, but that religious freedom is still observed" (Clark, Miami Herald, 3/27).

Meanwhile, the Vatican issued a short statement on Obama's visit, saying that the talks were "cordial" and touched on "rights to religious freedom, life and conscientious objection," which was a reference to the federal contraceptive coverage rules, according to the AP/U-T San Diego (Winfield, AP/U-T San Diego, 3/27).


Federal Judge Sides With Ga. Catholic Groups in Contraceptive Coverage Case

Fri, 03/28/2014 - 14:39

A federal judge in Georgia on Wednesday ruled that certain not-for-profit groups in the state do not have to comply with the federal contraceptive coverage rules, the AP/Augusta Chronicle reports.

Federal Judge Sides With Ga. Catholic Groups in Contraceptive Coverage Case

March 28, 2014 — A federal judge in Georgia on Wednesday ruled that certain not-for-profit groups in the state do not have to comply with the federal contraceptive coverage rules, the AP/Augusta Chronicle reports (Brumback, AP/Augusta Chronicle, 3/27).

The contraceptive coverage rules, which are being implemented under the Affordable Care Act (PL 111-148), require most health plans to offer contraceptive coverage in their employer-sponsored health plans. Houses of worship are exempt from the requirement, and religiously affiliated not-for-profits are eligible for an accommodation that ensures they do not have to pay for or directly provide the coverage to their employees.

The U.S. Supreme Court on Tuesday heard oral arguments in separate cases challenging the rules that were brought by two private companies whose owners object to providing contraceptive coverage because of their religious beliefs (Women's Health Policy Report, 3/26).

Georgia Case Details

The case was filed in October 2013 by two independent not-for-profits -- Catholic Education of North Georgia and Catholic Charities of the Archdiocese of Atlanta -- that are affiliated with the Catholic Church. CENG implements the archdiocese's educational agenda in five independent Catholic schools, according to court filings. CCAD provides social services to the community.

The groups argued that requiring them to fill out a form to avoid providing contraceptive coverage directly makes them complicit in providing the coverage (AP/Augusta Chronicle, 3/27).

Religiously affiliated not-for-profits that object to contraceptive coverage must complete a form that states their objection. Doing so requires the organizations' insurers or a third-party administrator to organize and pay for the birth control coverage options for the organizations' employees (Women's Health Policy Report, 3/13). "Catholic groups have argued signing such a form makes them complicit in providing contraception coverage," which they oppose on religious grounds, according to the AP/Chronicle.

Ruling

U.S. District Judge William Duffey permanently prohibited the federal government from enforcing the contraceptive coverage rules on the plaintiffs on the grounds that the requirements violate the Religious Freedom Restoration Act of 1993 (PL 103-141). RFRA prohibits the government from implementing rules that substantially burden a person's religious practice.

Duffey ruled that because the archdioceses are "entirely exempt" from the rules, the groups and schools that they manage also are exempt.

According to the AP/Chronicle, a lawyer for the U.S. Department of Justice did not respond to after-hours requests for comment (AP/Augusta Chronicle, 3/27).


Ala. Could Consider Bill Extending Mandatory Delay Period for Abortion Next Week

Fri, 03/28/2014 - 14:35

While there is less than a week before the Alabama Legislature's 2014 session ends, lawmakers still could vote on a bill (HB 489) that would extend the state's mandatory delay period before an abortion from 24 to 48 hours, WHNT News reports.

Ala. Could Consider Bill Extending Mandatory Delay Period for Abortion Next Week

March 28, 2014 — While there is less than a week before the Alabama Legislature's 2014 session ends, lawmakers still could vote on a bill (HB 489) that would extend the state's mandatory delay period before an abortion from 24 to 48 hours, WHNT News reports.

The bill has passed the state House and was approved by a state Senate committee earlier this month.

According to sponsor state Rep. Ed Henry (R), the bill would give a woman time "to think about what she's fixing to do, for some type of intervention, for somebody to come in her life and maybe speak a word to her that encourages her not to end the life of that child" (Banaszak, WHNT News, 3/26).


Planned Parenthood To Develop N.C. Abortion Clinic in Compliance With Potential Regulations

Fri, 03/28/2014 - 14:31

Raleigh, N.C.-based Planned Parenthood Health Systems announced it will open a new abortion clinic that will comply with a new state law (SB 353) that authorizes making ambulatory surgery center rules applicable to clinics, the Carolina Public Press reports.

Planned Parenthood To Develop N.C. Abortion Clinic in Compliance With Potential Regulations

March 28, 2014 — Raleigh, N.C.-based Planned Parenthood Health Systems announced it will open a new abortion clinic that will comply with a new state law (SB 353) that authorizes making ambulatory surgery center rules applicable to clinics, the Carolina Public Press reports. The move comes despite a recent state report suggesting there will be a delay in releasing the rules designed to enforce that law (Elliston, Carolina Public Press, 3/27).

An expansive antiabortion-rights measure, signed by North Carolina Gov. Pat McCrory (R) in July, allows the state Department of Health and Human Services to "apply any requirement" for ambulatory surgical centers to abortion clinics, so long as the regulations do not impede access to abortion.

DHHS was required to provide an update on its progress in developing the rules by Jan. 1, but there is no deadline to create the rules for abortion clinics (Women's Health Policy Report, 12/17/13).

DHHS Interim Report

In an interim report submitted to the state Legislature in December 2013, DHHS said that it would work to develop permanent rules, rather than spend time creating and implementing temporary regulations. The report also outlined the numerous steps required to finalize the permanent rules, suggesting that it could be some time before the final regulations are released.

Specifically, DHHS will first create a set of draft rules, which will then be submitted for approval to the state Office of Administrative Hearings and the Office of State Management and Budget. DHHS would then review the rules again, resubmit them to OAH for approval and then publish them in the North Carolina Register for public consideration.

DHHS at that time will invite stakeholders to comment on the regulations via the register notice, a public hearing and a public comment process. Once cleared, the rules would be formally adopted by the agency and submitted to the state's Rules Review Commission for final approval before being implemented.

The report did not specify how long the entire process would take.

Ashville Clinic Plans

PPHS said it would open a new abortion clinic in Ashville to replace Femcare, a clinic also based in Ashville that is the only abortion provider of the state's 15 clinics that would currently be able to meet the ambulatory surgical center standards. Femcare is scheduled to close.

PPHS Vice President of Communications Melissa Reed said, "It's certainly what we felt we needed to do in anticipation of what may come, so that was why we decided to build to that [ambulatory surgical center] standard." She said the new clinic is scheduled to open by summer.

Comments

NARAL Pro-Choice North Carolina Executive Director Suzanne Buckley said that while it is unknown when the final rules will be published, "The rule-making process is certainly a long one, and there are a lot of turning points along the way where things could change. But our hope is that folks let the process play out as it is designed to, to take into account sound science and medicine and make rules based on that and the practical implications of these laws, and let politics stay out of it."

Reed said, "We're anxious to see what" DHHS proposes, adding, "They did include a group of people that included experts on women's health care that are providers, and we felt that that showed a good faith effort." She continued, "They indicated that their primary concern was patient safety and not putting unnecessary building requirements on providers. We're hoping that that continues to be the focus, and that that's what we'll see when they reveal the draft regulations" (Carolina Public Press, 3/27).


Datapoint: Do Female Voters Support Religious Exemptions for Corporations That Oppose Contraceptive Coverage?

Fri, 03/28/2014 - 13:21

As the Supreme Court considers businesses' requests for religious exemptions from the federal contraceptive coverage rules, a new poll shows that the vast majority of female voters oppose such an exemption.

Datapoint: Do Female Voters Support Religious Exemptions for Corporations That Oppose Contraceptive Coverage?

March 28, 2014 — The vast majority of female voters do not believe that corporations should be able to claim religious exemptions from a federal requirement to cover prescription birth control in their employee health plans, according to a recent poll from Hart Research Associates.

The national survey found that opposition to the idea of granting such exemptions to private businesses was strong across most demographic and attitudinal groups. Only Republican respondents were evenly divided on the issue.

Other Findings

The poll also asked respondents a broader question about whether "corporations should be exempt from any law because of their religious beliefs." Seventy-two percent of respondents said businesses should not be permitted any religious exemptions.

On another question, 81% of respondents said pharmacies should not be permitted to refuse to fill a customer's birth control prescription for religious reasons. Similar percentages said that businesses should not be allowed to cite religious objections to homosexuality to refuse service to people (81%) or to refuse to hire gays or lesbians (79%).

Data source: "Memorandum: Women Voters' Reaction to Religious Exemptions," Hart Research Associates, March 24, 2014.

Datapoint: Do Female Voters Support Religious Exemptions for Corporations That Oppose Contraceptive Coverage?

Thu, 03/27/2014 - 17:06

As the Supreme Court considers businesses' requests for religious exemptions from the federal contraceptive coverage rules, a new poll shows that the vast majority of female voters oppose such an exemption.

Datapoint: Do Female Voters Support Religious Exemptions for Corporations That Oppose Contraceptive Coverage?

March 27, 2014 — The vast majority of female voters do not believe that corporations should be able to claim religious exemptions from a federal requirement to cover prescription birth control in their employee health plans, according to a recent poll from Hart Research Associates.

The national survey found that opposition to the idea of granting such exemptions to private businesses was strong across most demographic and attitudinal groups. Only Republican respondents were evenly divided on the issue.

Other Findings

The poll also asked respondents a broader question about whether "corporations should be exempt from any law because of their religious beliefs." Seventy-two percent of respondents said businesses should not be permitted any religious exemptions.

On another question, 81% of respondents said pharmacies should not be permitted to refuse to fill a customer's birth control prescription for religious reasons. Similar percentages said that businesses should not be allowed to cite religious objections to homosexuality to refuse service to people (81%) or to refuse to hire gays or lesbians (79%).

Data source: "Memorandum: Women Voters' Reaction to Religious Exemptions," Hart Research Associates, March 24, 2014.

Federal Appeals Court Upholds Fla. City Ordinance Banning 'Targeted' Picketing

Thu, 03/27/2014 - 16:28

In a case spurred by antiabortion-rights protests outside the home of a Planned Parenthood official, a federal appeals court upheld a Winter Park, Fla., ordinance that prohibits "targeted" picketing within 50 feet of a city resident's home, but it struck down another rule that more broadly banned loitering in the 50-foot zone, the Orlando Sentinel reports.

Federal Appeals Court Upholds Fla. City Ordinance Banning 'Targeted' Picketing

March 27, 2014 — In a case spurred by antiabortion-rights protests outside the home of a Planned Parenthood official, a federal appeals court upheld a Winter Park, Fla., ordinance that prohibits "targeted" picketing within 50 feet of a city resident's home, but it struck down another rule that more broadly banned loitering in the 50-foot zone, the Orlando Sentinel reports.

The Winter Park City Council enacted the ordinance in 2012, after antiabortion-rights protesters picketed with graphic signs in front of the home of Planned Parenthood of Greater Orlando President and CEO Jenna Tosh. The council also enacted another ordinance that allowed residents to place a "no loitering" sign in their front yards and thereby create a 50-foot zone around their homes in which all protests would be prohibited. Police would be authorized to arrest anyone who violated the loitering ordinance.

Three Christian women -- Winnifred Bell, Avulla Lightfoot and Deanne Waller -- filed a lawsuit challenging the ordinances, arguing that they violated their constitutionally protected rights to free speech and the expression of religion.

Eleventh Circuit Ruling

A three-judge panel of the 11th U.S. Circuit Court of Appeals upheld the first ordinance, ruling that it ensures that residents "feel free in their own homes and safe from protests and picketing activity that targets them."

However, the judges struck down the anti-loitering measure, ruling that it "goes beyond simply allowing a private citizen to control the speech he allows on his property" but rather "permits private citizens to control the speech of other private citizens by calling the police." They added that granting private citizens such "unbridled discretion" to ban any speech near their residences was "unprecedented."

Clarissa Howard, a spokesperson for City Attorney Usher Brown, said that an amended ordinance would soon be introduced to the City Council to address the loitering provision (Hudak, Orlando Sentinel, 3/25).


Court Weighs Ariz. Medication Abortion Restrictions

Thu, 03/27/2014 - 16:27

A federal judge on Wednesday heard arguments over Arizona's restrictions on medication abortion, which would be among the harshest in the nation if allowed to take effect, the New York Times reports.

Court Weighs Ariz. Medication Abortion Restrictions

March 27, 2014 — A federal judge on Wednesday heard arguments over Arizona's restrictions on medication abortion, which would be among the harshest in the nation if allowed to take effect, the New York Times reports (Santos, New York Times, 3/26).

The medication abortion rules -- which are among several abortion-related regulations mandated under a 2012 state law (HB 2036) -- bar physicians from administering abortion-inducing drugs beyond seven weeks of pregnancy. Physicians also would be required to administer both drugs in the medication abortion regimen on site and at the FDA-approved dosage, which is higher than the dosage typically used in practice.

The rule and other regulations are scheduled to take effect on April 1 (Women's Health Policy Report, 1/29).

According to Planned Parenthood Arizona, four states have similarly attempted to restrict the use of medication abortion. Federal courts have upheld such measures in Texas and Ohio, while state courts have rejected similar laws in North Dakota and Oklahoma.

PPAZ sued Arizona over the proposed rules, asking the court to issue an injunction before the law takes effect. On Wednesday, U.S. District Court Judge David Bury heard arguments from PPAZ and the state over the law's constitutionality, but he did not immediately issue a ruling on the injunction request.

Plaintiffs' Arguments

Alice Clapman, an attorney with Planned Parenthood, said that the law is "unconstitutionally vague" and could potentially "keep some women from obtaining an abortion all together" (Ingram, Reuters, 3/26). She said some women would be "forced to carry an unwanted pregnancy to term because they'd have to travel hundreds of miles" to obtain a medication abortion, while women who fear surgery "would carry an unwanted pregnancy to term if they couldn't get a medication abortion."

Clapman added that the rules could force women to undergo unnecessary surgical abortions and keep some women -- particularly in Northern Arizona, where the sole abortion clinic offers only medication abortion -- from accessing abortion at all (New York Times, 3/26).

The plaintiffs have also argued that the protocols used in much of the country for administering medication abortion are less costly and less burdensome than the proposed rules, and that they have been used safely and effectively for at least 700,000 women (Reuters, 3/26).

State's Arguments

Arizona Assistant Attorney General Michael Tryon argued that the law "doesn't ban abortions at all; it regulates medical abortions" (New York Times, 3/26).

He added that allowing the law to go into effect would not harm the plaintiffs, saying, "At most, these [rules] are inconveniences ... We all go through inconveniences, but this law doesn't burden women" (Reuters, 3/26).


Blogs Comment on Criminalization of Pregnant Women, Vandalism at Abortion Clinics, More

Thu, 03/27/2014 - 16:24

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

Blogs Comment on Criminalization of Pregnant Women, Vandalism at Abortion Clinics, More

March 21, 2014 — We've compiled some of the most thought-provoking commentaries from around the Web. Catch up on the conversation with bloggers from Feministing, RH Reality Check and more.

CRIMINALIZATION OF PREGNANT WOMEN: "A Mississippi Teen is Facing Life in Prison for Using Cocaine During Her Pregnancy," Maya Dusenbery, Feministing: A wave of "'fetal harm'" cases across the country "has already started working the principal of fetal personhood into the legal system," and "affecting women -- primarily those who ... are young, poor, and Black -- who used illegal drugs during their pregnancies," Dusenbery writes, citing the case of Rennie Gibbs, a black teenager in Mississippi who was charged with causing the death of her fetus after traces of cocaine were found during an autopsy after a stillbirth. Dusenbery notes that "concerns about cocaine exposure in utero -- popularized during widespread panic about 'crack babies' in the '80s and '90s -- have been 'wildly overstated.'" Dusenbery argues that cases like Gibbs' are not "really about protecting fetuses," but are "about asserting a state interest in protecting 'fetal personhood' at the direct cost of actual people's personhood" (Dusenbery, Feministing, 3/19).

ABORTION PROVIDERS: "As Susan Cahill Faces a Vandalized Clinic, a Reminder of Her Contribution to Abortion Access," Carole Joffe, RH Reality Check: While news of the recent vandalism of All Families Healthcare -- "the family medicine practice of Susan Cahill, a physician assistant," that also provides abortions -- has become well-known, lesser known "is Cahill's important role, more than 20 years ago, in a consequential event in U.S. abortion care history -- an event that continues to resonate today," Joffe writes. Joffe notes that Cahill, who "had been trained in abortion care in her PA program right after" the Roe v. Wade decision and "amassed an impressive safety record by 1990," participated in a symposium at the time on the then-shortage of abortion providers. Cahill's presentation "made an enormous impression on the attendees," stemming a recommendation that "certified nurse midwives, nurse practitioners, and physician assistants" be trained to provide abortions, Joffe explains (Joffe, RH Reality Check, 3/18).

HEALTH DISPARITIES: "Stress Kills: Economic Insecurity and Black Women's Maternal Health Outcomes," Elizabeth Dawes Gay, Echoing Ida/RH Reality Check: "The chronic stress of living in poverty -- of knowing a missed paycheck could leave you in dire straits, of not having enough to make ends meet -- is killing Black women who choose to become pregnant and give birth," writes Dawes Gay, a senior associate for programs and policy at the Reproductive Health Technologies Project. She notes, "Economic inequality ... takes a toll on health, even when people have health insurance coverage and access to important health care services." For example, "[r]esearch shows that chronic stress causes cardiovascular changes that increase blood pressure, which must remain stable during pregnancy and labor," because high blood pressure "is a risk factor for pregnancy complications such as preeclampsia, low birth weight, pre-term birth, and damage to the mother's internal organs and other adverse conditions." Dawes Gay concludes that "if we want to see better maternal health outcomes for Black women, reproductive health and justice advocates must also work to achieve economic justice" (Dawes Gay, RH Reality Check, 3/19).

CONTRACEPTION: "If Hobby Lobby Wins, It Will Be Even Worse for Birth Control Access Than You Think," Tara Culp-Ressler, Center for American Progress' "ThinkProgress": There is "much more at stake than prescription drug coverage" in Hobby Lobby and Conestoga Wood Specialties' legal challenge to the contraceptive coverage rules, Culp-Ressler writes, noting that the two for-profit companies "object not just to covering specific types of birth control, but also to providing counseling about that birth control." She explains that this additional facet to the legal challenge means that if the companies win, "they'll win the right to refuse to extend coverage for doctor's visits that include discussion about certain forms of contraception," such as intrauterine devices and emergency contraception. As a result, employees of these companies will either have to visit a doctor and risk a "potential health burden" by not discussing birth control fully, or instead risk a "potential financial burden" by paying out-of-pocket, Culp-Ressler writes. She also notes that "companies that withhold coverage for some types of services often resist full disclosure" to those who are covered (Culp-Ressler, "ThinkProgress," Center for American Progress, 3/19).

What others are saying about contraception:

~ "Catholic Nuns Come Out in Support of Obamacare Contraception Access," Callie Beusman, Jezebel.

~ "Are You There God? It's Me, Hobby Lobby," Stephanie Mencimer, Mother Jones.

'BUFFER ZONES': "One City's 6 Month Quest To Take Its Sidewalks Back from Anti-Abortion Protesters," Robin Marty, Center for American Progress' "ThinkProgress": The Englewood, N.J., City Council on Tuesday "unanimously passed an ordinance requiring an eight-foot buffer zone around all Englewood health care facilit[ies'] entrances, exits and driveways," Marty writes. She adds that the ordinance was adopted after increasingly aggressive protests outside of an abortion clinic in the city, Metropolitan Medical Associates, which "has been a longtime target for abortion opponents both locally and nationally." Marty writes that the buffer zone "is a much smaller distance than the one in place in Massachusetts, which is currently being reviewed by the Supreme Court -- a factor that buffer [zone] supporters hope might allow an Englewood version to stay intact, even if the Massachusetts one ends up being overturned" (Marty, "ThinkProgress," Center for American Progress, 3/19).

ANTIABORTION-RIGHTS MOVEMENT: "Women on the Side: Why Anti-Choicers Won't Win," Jessica Valenti, The Nation: "Republicans will never truly win women over" because abortion-rights opponents "cannot escape the truth of their movement: despite rhetorical efforts to the contrary, the foundation of fighting against abortion accessibility is the idea that women are less important than the pregnancies they can carry," Valenti writes. She adds that despite the Republican Party's "strategic shift from calling women murder[er]s to labeling them victims of abortion ... we understand in that in either case our health and rights are beside the point." She cites various examples of this sort of tactic, such as a bill in Iowa that would allow patients to sue abortion providers "after the procedure for 'pain and suffering,'" as well as abortion-rights opponents' "veneration of women who die for their pregnancies." Valenti writes, "The anti-choice movement cannot erase us from our own lives by insisting that abortion isn't necessary," adding, "The more they try, the stronger we'll get" (Valenti, The Nation, 3/18).

ABORTION RESTRICTIONS: "Louisiana House Committee Passes Admitting Privileges Bill," Teddy Wilson, RH Reality Check: "The Louisiana House Committee on Health and Welfare voted unanimously Wednesday to pass a bill [HB 388] that ... would require abortion providers to gain admitting privileges at a hospital within 30 miles of where they perform abortions," Wilson writes, adding that reproductive health advocates "say it would immediately close three of [the state's] clinics, leaving only the clinics that provide abortions in Shreveport." Wilson writes that the bill also would "impose restrictions on medication abortion, requiring a 24-hour waiting period before an abortion can be induced with medication, and implementing a reporting requirement for providers" that would require "some physicians in private practice to register with the state, making their names, location and status as an abortion provider all publicly available information." Wilson adds that the legislation, which is "reportedly backed by Republican Gov. Bobby Jindal, has now moved to the house for a floor vote," where "it is expect[ed] to pass" (Wilson, RH Reality Check, 3/20).


Lawsuit Against Catholic Bishops Marks 'New Front' in Religious, Women's Health Care Debates

Thu, 03/27/2014 - 16:22

A lawsuit alleging that the U.S. Conference of Catholic Bishops' directives for Catholic hospitals impede proper medical care for pregnant women is "a new front" in the debate "over religious liberty, gender equality and reproductive care," ProPublica reports.

Lawsuit Against Catholic Bishops Marks 'New Front' in Religious, Women's Health Care Debates

March 24, 2014 — A lawsuit alleging that the U.S. Conference of Catholic Bishops' directives for Catholic hospitals impede proper medical care for pregnant women is "a new front" in the debate "over religious liberty, gender equality and reproductive care," ProPublica reports (Martin, ProPublica, 3/20).

Lawsuit Background

The American Civil Liberties Union and ACLU of Michigan filed the suit last year on behalf of Tamesha Means, who in 2010 was rushed to the nearest hospital -- Mercy Health Partners in Muskegon, Mich. -- after her water broke when she was 18 weeks pregnant. The fetus had virtually no chance of surviving, and doctors in such a situation typically induce labor or surgically remove the fetus to reduce the woman's chance of infection.

According to the suit, the doctors at Mercy Health did not admit Means for observation or inform her that the fetus was in danger and her own health could be at risk. Means also alleges that she was in "excruciating pain" but was sent home twice without being offered appropriate medical treatment or informed of her options. She returned a third time, at which point she had developed an infection, and began to miscarry as the hospital was preparing her discharge paperwork. The child was pronounced dead two-and-a-half hours after delivery.

The suit argues that USCCB places its religious beliefs ahead of the health and welfare of patients. It also alleges that USCCB is ultimately responsible for the unnecessary trauma and harm suffered by Means and other women in similar situations at other Catholic hospitals (Women's Health Policy Report, 12/3/13).

Bishops' Arguments

The bishops and their lawyers have filed a motion to dismiss the case, according to ProPublica. A hearing on the motion to dismiss is scheduled for May.

In the motion, the bishops have mostly avoided addressing the constitutional issues, instead focusing on procedural details. For example, the bishops stated that ACLU chose the incorrect venue in which to file the case and also should have sued individual bishops in their own dioceses instead of USCCB as a whole.

According to ProPublica, the arguments echo some legal experts' observations that the lawsuit "is at best a long-shot."

Mergers Compound Problems

The issue at the center of the suit -- access to reproductive health services at Catholic facilities -- has been a concern for ACLU and other women's rights advocates since the 1990s. However, the increase in mergers between Catholic hospitals and health systems with secular hospitals has brought more attention to the issue. Some providers have faced challenges complying with the church's directives on contraception, abortion and end-of-life care while still providing professional care to their patients.

According to ProPublica, "[t]he Means case touched a nerve because it seemed to bring together many of the issues that have worried women's advocates the most." In addition, the impact of the mergers is especially significant in places like Muskegon, which only has Catholic hospitals (ProPublica, 3/20).


Tax Change Announced To Help Domestic Abuse Survivors Access ACA Insurance Subsidies

Thu, 03/27/2014 - 16:21

The Treasury Department on Wednesday released new guidance that allows domestic abuse survivors who live separately from their spouses to file for government subsidies to offset the cost of health plans through the Affordable Care Act's (PL 111-148) insurance marketplaces, the Washington Post reports.

Tax Change Announced To Help Domestic Abuse Survivors Access ACA Insurance Subsidies

March 27, 2014 — The Treasury Department on Wednesday released new guidance that allows domestic abuse survivors who live separately from their spouses to file for government subsidies to offset the cost of health plans through the Affordable Care Act's (PL 111-148) insurance marketplaces, the Washington Post reports (Goldstein, Washington Post, 3/26).

Previously, married couples had to file joint tax returns to be eligible for the subsidies. However, filing joint taxes could put women in danger if they had to reconnect with an abusive spouse.

Earlier this month, a group of House Democrats -- led by Reps. Louise Slaughter (N.Y.) and Lloyd Doggett (Texas) -- in a letter urged Treasury Secretary Jacob Lew to issue guidance on the matter "now," along with proposed regulations "to prevent ongoing confusion in future open enrollment periods" (Women's Health Policy Report, 3/19).

New Rules, Extended Deadline

In a letter to the lawmakers, Treasury Assistant Secretary Mark Mazur wrote that the Treasury Department and the Internal Revenue Service would permit married couples who live separately and cannot file joint tax returns because of domestic abuse situations to file as "married filing separately" to claim ACA subsidies for 2014 (Attias, CQ Roll Call, 3/26).

The guidance states, "For victims of domestic abuse, contacting a spouse for purposes of filing a joint return may pose a risk of injury or trauma or, if the spouse is subject to a restraining order, may be legally prohibited" (Washington Post, 3/26).

Mazur added that the two agencies in the spring would release proposed regulations that address the issue and detail how people qualify for domestic abuse status.

In addition, HHS on Wednesday specified in special enrollment guidance that survivors of domestic abuse will have through May 31 to enroll in marketplace plans, rather than the original March 31 deadline (CQ Roll Call, 3/26).

Meanwhile, a government official noted that officials at the Treasury Department have privately questioned whether they have the legal authority to make such a change to the federal tax rules, although some have noted that similar rules have been made for other programs (Washington Post, 3/26).

House Democrats Respond

Slaughter said in a statement, "Survivors of domestic violence should not have to depend on their abuser to gain access to affordable health care, and I'm glad the Treasury Department will ensure that no longer happens" (Winfield Cunningham, Politico Pro, 3/26).

Doggett said in a statement that while he "appreciate[s] the prompt response to [lawmakers'] congressional request," Treasury "now needs to move forward more expeditiously to get final regulations adopted this year" (CQ Roll Call, 3/26).

Other Stakeholders React

Dania Palanker, senior health policy adviser for the National Women's Law Center, praised the new guidance but added that she hopes the rules will be extend to apply to other situations, such as abandoned spouses.

Brian Haile, senior vice president for health policy at Jackson Hewitt, said that it would be "daunting" to spread awareness about the policy change with only a two-month extension. "Domestic violence survivors deserve more than two months to relearn everything that the marketplace taught them about their eligibility," he said (Politico Pro, 3/26).


Study: Racial Disparities in Breast Cancer Mortality Widening

Thu, 03/27/2014 - 16:18

Over the past 20 years, breast cancer mortality rates in several of the largest U.S. cities have decreased far less for black women than for white women, according to a study published in the journal Cancer Epidemiology, Reuters reports.

Study: Racial Disparities in Breast Cancer Mortality Widening

March 25, 2014 — Over the past 20 years, breast cancer mortality rates in several of the largest U.S. cities have decreased far less for black women than for white women, according to a study published in the journal Cancer Epidemiology, Reuters reports.

To analyze changes in breast cancer death rates on a national scale, epidemiologist Bijou Hunt of Mount Sinai Hospital and colleagues examined data from 41 of the largest U.S. cities during four different time periods: 1990-1994, 1995-1999, 2000-2004 and 2005-2009.

During the 20-year period, the researchers found that breast cancer mortality decreased by 27% for white women and 13% for black women.

The disparity between the two rates was present in the 1990s and continued to widen as time went on. In 1990-1994, breast cancer mortality rates were 17% higher among black women than white women, which steadily rose to a 40% difference by the last time period studied.

The study attributed the increasing disparity in breast cancer mortality rates to differences in quality of and accessibility to health care, noting that genetic and health factors alone could not explain the difference in rates.

Author's Comments

Hunt wrote in an email to Reuters, "The advancements in screening tools and treatment which occurred in the 1990's were largely available to White women, while Black women, who were more likely to be uninsured, did not gain equal access to these life-saving technologies."

She noted, "If genetics were responsible ... we would not have seen the rates go from being nearly equal in most places at the first time point to being so much worse" for black women compared with white women during the 2005-2009 time period (Huggins, Reuters, 3/21).


Advocates Work To Renew Funding for Maternal, Child Home Visiting Program

Thu, 03/27/2014 - 16:16

Maternal and child health advocates are urging Congress to extend funding for an expiring maternal and child home visiting program by attaching a reauthorization to legislation that would reform how Medicare reimburses physicians, CQ Roll Call reports.

Advocates Work To Renew Funding for Maternal, Child Home Visiting Program

March 26, 2014 — Maternal and child health advocates are urging Congress to extend funding for an expiring maternal and child home visiting program by attaching a reauthorization to legislation that would reform how Medicare reimburses physicians, CQ Roll Call reports.

Program's History

The Maternal, Infant and Early Childhood Home Visiting Program was established in 2010 under the Affordable Care Act (PL 111-148) and authorized for funding through Sept. 30, 2014. The program provides grants to states to support voluntary home visit programs designed to provide parenting help to teenage parents, low-income households and other high-risk families. Program volunteers also help connect families with counseling services for domestic violence or substance misuse, medical services, shelters and other resources.

Under the program, states are required to use 75% of the federal funding on one of 13 evidence-backed programs, while the remaining 25% can be spent on new programs. States that do not have any of the approved programs can disburse the money to not-for-profit groups.

Programs that receive funding have to demonstrate success on several measures, including improved maternal and infant health; prevention of child abuse, injuries and neglect; a reduction in the number of child visits to hospital emergency rooms; improved school preparedness and achievement; reduced rates of crime and domestic violence; improved rates of economic self-sufficiency among participating families; and improved coordination with other community resources.

Carrie Fitzgerald, senior policy adviser for health at First Focus, said the program has widespread support among physicians, educators and business leaders. In addition, law enforcement tends to support the program because research has demonstrated that participants are less likely to be abused or commit crimes, CQ Roll Call reports.

Renewal Efforts

According to CQ Roll Call, advocates are hoping to attach a five-year renewal of the program to legislation to change Medicare's physician reimbursement policies, known as the "doc fix."

Advocates said they also would be satisfied if a temporary extension were included in a short-term "patch" for the Medicare payment system, particularly because it seems increasingly unlikely that Congress will pass a comprehensive "doc fix" bill in the near future. House and Senate leaders have agreed on a policy that would reform the payment system, called the sustainable growth rate formula, but they have not agreed on a way to fund it. Supporters of the home visiting program are targeting the SGR efforts because it is considered to be one of the few health-related measures that lawmakers need to pass this year. Advocates have argued that waiting for other legislation -- such as the fiscal year 2015 continuing resolution, likely to be debated in August -- would lead states to start winding down their MIECHV programs either by rejecting new applicants or curtailing services to current participants (Phenicie, CQ Roll Call, 3/25).