Daily Women's Health Policy Report

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Daily Women's Health Policy Report by the National Partnership for Women & Families
Updated: 29 min 45 sec ago

Ohio House Passes 'Heartbeat' Bill That Could Ban Abortion as Early as Six Weeks

Thu, 03/26/2015 - 20:20

The Ohio House on Wednesday voted 55-40 to approve a bill (HB 69) that would ban abortion if a fetal heartbeat is detectable, which can be as early as six weeks into pregnancy, the Cleveland Plain Dealer reports.

Ohio House Passes 'Heartbeat' Bill That Could Ban Abortion as Early as Six Weeks

March 26, 2015 — The Ohio House on Wednesday voted 55-40 to approve a bill (HB 69) that would ban abortion if a fetal heartbeat is detectable, which can be as early as six weeks into pregnancy, the Cleveland Plain Dealer reports.

The bill now heads to the state Senate for consideration (Higgs, Cleveland Plain Dealer, 3/25). According to the AP/San Francisco Chronicle, the chamber will have the rest of the Ohio Legislature's two-year session to consider the measure (Carr Smyth, AP/San Francisco Chronicle, 3/25).

Similar bills have failed in two previous state legislative sessions.

Bill Details

State Reps. Christina Hagan (R) and Ron Hood (R) proposed this year's bill, which would make it a fifth-degree felony for a provider to perform an abortion if a fetal heartbeat can be detected. It includes exemptions if an abortion is needed to save a woman's life or prevent serious health complications (Women's Health Policy Report, 3/5). It does not include exemptions for cases of rape or incest (Cleveland Plain Dealer, 3/25).

Individuals who violate the ban could face up to a year in prison and fines of up to $2,500.

The measure also would create a legislative committee to encourage adoption (Women's Health Policy Report, 3/5).

Vote Details

The bill was approved mostly along party lines (Cleveland Plain Dealer, 3/25). According to the Columbus Dispatch, most of the chamber's Republicans and one Democrat voted in favor of the bill, while most Democrats and 10 Republican lawmakers voted against it.

Conservatives during debate over the measure rejected several amendments, including one that would have added exemptions for cases of incest and rape (Candisky, Columbus Dispatch, 3/26).

According to the Plain Dealer, abortion-rights supporters in the state House voiced several reasons why the bill should be rejected, including concerns that it would violate both the state and U.S. constitutions and only would make abortion more dangerous for Ohio residents (Cleveland Plain Dealer, 3/25).

State Rep. Michael Curtin (D) said the bill is "a profound abuse of power," noting, "This legislation unequivocally states that government ... knows better" than physicians and those involved with the pregnancy.

State Rep. Teresa Fedor (D), who also opposed the bill, revealed that she had been raped and had an abortion. She called the bill "fundamentally inhuman" and "unconstitutional," adding, "How dare government get in my business" (Columbus Dispatch, 3/26).

Separately, Hagan argued that individuals should not be allowed to stop a fetus' beating heart (Palmer, Reuters, 3/25).

Chances of Becoming Law Dim

According to the Columbus Dispatch, the measure faces potential opposition from some members of the state Senate and Gov. John Kasich (R). The lawmakers have expressed concern that the measure would be found unconstitutional if challenged in court.

Ohio Senate President Keith Faber (R) said the state Senate would hold hearings on the measure "at some point" (Columbus Dispatch, 3/26). However, he added, "I'm still waiting for that legal scholar to come forward and say that the heartbeat bill is constitutional."

Meanwhile, antiabortion-rights groups said they plan to increase lobbying efforts on the state Senate to pass the bill (Cleveland Plain Dealer, 3/25).


Datapoints: Supreme Court Case Puts Women's Coverage at Risk, State Abortion Bans Restrict Care

Thu, 03/26/2015 - 19:52

In today's graphics, we look at the nationwide reach of a Supreme Court case that could threaten women's access to affordable health insurance under the Affordable Care Act. We also spotlight the spread of 20-week and telemedicine abortion bans in the states.

Datapoints: Supreme Court Case Puts Women's Coverage at Risk, State Abortion Bans Restrict Care

March 26, 2015 — In today's graphics, we look at the nationwide reach of a Supreme Court case that could threaten women's access to affordable health insurance under the Affordable Care Act. We also spotlight the spread of 20-week and telemedicine abortion bans in the states.

Women's Coverage at Risk



An interactive map from the National Women's Law Center highlights how King v. Burwell -- a challenge to the Affordable Care Act (PL 111-148) recently heard by the Supreme Court -- would impact the millions of women enrolled in health coverage through the federal insurance marketplace. The case tests whether individuals and families in states that use the federal marketplace can continue to receive tax credits for the purchase of health coverage.

NWLC's analysis details how many women are eligible for tax credits in each state that uses the federal marketplace, as well as the number of women of color affected in each state (NWLC, 2/18).


States Target Telemedicine Abortion



Conservative state lawmakers are increasingly moving to ban telemedicine in abortion care, including in states where such services are not even offered. A USA Today map shows where states have imposed such bans by requiring doctors to be present in the room when administering medication abortion drugs to a patient. Iowa's telemedicine ban is being challenged in court and is the only state that has passed a ban but continues to have such a program in place, through Planned Parenthood of the Heartland (USA Today, 3/17).


GIF Shows Spread of 20-Week Bans



Anti-choice state politicians have increasingly prioritized unconstitutional bans on abortion at 20 weeks of pregnancy. Planned Parenthood's GIF, updated as of March 4, shows the status of such efforts, including ongoing court challenges (Planned Parenthood Action Fund, 3/4).


Datapoints: Supreme Court Case Puts Women's Coverage at Risk, State Abortion Bans Restrict Care

Thu, 03/26/2015 - 19:51

In today's graphics, we look at the nationwide reach of a Supreme Court case that could threaten women's access to affordable health insurance under the Affordable Care Act. We also spotlight the spread of 20-week and telemedicine abortion bans in the states.

Datapoints: Supreme Court Case Puts Women's Coverage at Risk, State Abortion Bans Restrict Care

March 27, 2015 — In today's graphics, we look at the nationwide reach of a Supreme Court case that could threaten women's access to affordable health insurance under the Affordable Care Act. We also spotlight the spread of 20-week and telemedicine abortion bans in the states.

Women's Coverage at Risk



An interactive map from the National Women's Law Center highlights how King v. Burwell -- a challenge to the Affordable Care Act (PL 111-148) recently heard by the Supreme Court -- would impact the millions of women enrolled in health coverage through the federal insurance marketplace. The case tests whether individuals and families in states that use the federal marketplace can continue to receive tax credits for the purchase of health coverage.

NWLC's analysis details how many women are eligible for tax credits in each state that uses the federal marketplace, as well as the number of women of color affected in each state (NWLC, 2/18).


States Target Telemedicine Abortion



Conservative state lawmakers are increasingly moving to ban telemedicine in abortion care, including in states where such services are not even offered. A USA Today map shows where states have imposed such bans by requiring doctors to be present in the room when administering medication abortion drugs to a patient. Iowa's telemedicine ban is being challenged in court and is the only state that has passed a ban but continues to have such a program in place, through Planned Parenthood of the Heartland (USA Today, 3/17).


GIF Shows Spread of 20-Week Bans



Anti-choice state politicians have increasingly prioritized unconstitutional bans on abortion at 20 weeks of pregnancy. Planned Parenthood's GIF, updated as of March 4, shows the status of such efforts, including ongoing court challenges (Planned Parenthood Action Fund, 3/4).


OTC Oral Contraception Access With Little or No Copay Could Increase Use, Curb Unintended Pregnancy

Thu, 03/26/2015 - 19:22

In this study, researchers examined how over-the-counter access to oral contraceptive pills could affect health care costs, unintended pregnancy rates, contraceptive use and other factors. They concluded that "it is in the financial interest of public healthcare programs to cover a large portion of the cost of [OTC] contraceptive pills," after finding that OTC access to the pills "could increase the use of effective methods of contraception and reduce unintended pregnancy and healthcare costs."

OTC Oral Contraception Access With Little or No Copay Could Increase Use, Curb Unintended Pregnancy

March 26, 2015 — Summary of "Potential Public Sector Cost-Savings From Over-the-Counter Access to Oral Contraceptives," Foster et al., Contraception, Feb. 27, 2015.

"[T]he need for a prescription to obtain a reliable contraceptive method is a barrier to use" for many women, according to researchers led by Diana Foster of the University of California-San Francisco's Bixby Center for Global Reproductive Health and Department of Obstetrics, Gynecology and Reproductive Science.

They noted that "inconsistent or lack of contraceptive use, rather than contraceptive method failure" is the leading cause of unintended pregnancy in the U.S. About half of U.S. pregnancies are unintended, a rate that "has remained steady ... for the past 2 decades," Foster and colleagues wrote.

According to the researchers, making oral contraceptive pills (OCPs) available over the counter (OTC) potentially could "increase contraceptive use and continuation rates by facilitating continuity of use and encouraging OCP use among women who currently do not use any method or use less effective methods."

In their study, Foster and colleagues examined the effects OTC OCPs would have on "use, unintended pregnancies and associated pregnancy and contraceptive costs."

Methods

Researchers used state and national data to predict how OTC OCPs could affect contraceptive use among low-income women who are at risk of unintended pregnancy.

Specifically, the researchers considered two possible scenarios -- high OCP adoption and low OCP adoption -- and predicted OCP adoption based on the out-of-pocket costs of each pill pack. They also predicted the number of unintended pregnancies in each scenario and "estimate[d] the public sector cost of providing OCPs and medical care for pregnancy under each scenario (no OTC access, low OTC use, high OTC use), effect on contraceptive failure rates (none, 50% reduction, 50% increase) and out-of-pocket costs for a pack of pills (from $0 to $50)."

Results

The researchers found that among low-income women at risk of unintended pregnancy:

~ 21% reported being very likely to use OCPs if they were available OTC at drug or grocery stores;

~ 15% reported being somewhat likely to use OCPs in those circumstances;

~ 26% reported being unsure or not likely to use OCPs if they were available OTC; and

~ 39% reported having no interest in OCPs.

Further, the researchers found that "[t]he likelihood of using OCPs among low-income women who are somewhat or very interested in OTC OCPs varie[d] by price," ranging from 100% of women saying they would use the pills if a pack were available at no cost, to just 4% if a pack cost $50. As a result, Foster and colleagues concluded that making OCPs available OTC "would have almost no effect on the contraceptive method distribution if the out-of-pocket cost for an OTC pill pack is $50 and the most widespread adoption of OCPs if the OTC pack is entirely covered by insurance."

In addition, the researchers found that making OCPs available OTC without copayments would:

~ Decrease the share of low-income women using less-effective contraceptive methods from 31% to 18% under the high OCP adoption model and from 31% to 24% under the low-OCP adoption model;

~ Decrease the share of low-income women using no contraceptive methods from 18% to a range of 14% to 15%; and

~ Decrease the share of women using contraceptive methods more effective than OCPs from 17% to a range of 14% to 15%.

Low OCP Adoption Model

Under the low OCP adoption model with no copays, the number of OCP users would increase from 31% to 42%, with 63% of the new adopters switching from using a less effective method, 25% switching from using no contraception and 13% switching from a more effective method.

Further, the number of unintended pregnancies among low-income women would decrease by 11% (from 251 per 1,000 women annually to 223 per 1,000 women annually) if there are no changes to the OCP failure rate; by 15% (213 per 1,000 women) if OTC access reduced the failure rate; and by 7% (233 per 1,000 women) if OTC access increased the failure rate.

In addition, under the low OCP adoption model, contraception- and pregnancy-related medical costs covered by insurance would decrease by 1% without any change to the OCP failure rate and by 4% if the OCP failure rates decreased by 50%, while the amount would increase by 3% if the OTC access increased the OCP failure rate.

High OCP Adoption Model

Meanwhile, the researchers found that under the high OCP adoption model with no copays the number of OCP users would increase from 31% to 52%, with 62% switching from a less effective contraceptive method, 22% switching from using no contraception and 16% switching from a more effective method.

Further, the number of unintended pregnancies among low-income women "would decrease by 18% (204 per 1,000 women) with no changes to the pill failure rate, 25% (187 per 1,000 women) if the failure rate reduces by half and 12% (221 per 1,000 women) if the failure rate increases by half," they wrote.

Contraception- and pregnancy-related costs to insurers would decrease by 6% if there were no improvement in OCP failure rates, by 12% if OTC access decreased OCP failure rates by 50% and by less than 1% if such access increased OCP failure rates by 50%.

Overall, the researchers found, "Savings are maximized at an out-of-pocket cost per pack of $10-20 -- the price point where pill costs are offset by the copay but the copay is not so high as to discourage use." Specifically, the researchers wrote that a $10 copay would incur savings for insurers of "3-10% (low to high use models) on pregnancy and pill costs if there is no change in OCP failure rate, 6-15% if the OCP failure rate decreases and 0-5% if the OCP failure rate increases."

Discussion

According to Foster and colleagues, the study shows "that OTC access to oral contraceptives is likely to increase low-income women's use of more effective contraceptive methods." In addition, if OCPs were available OTC without out-of-pocket costs, "there would be a significant drop in the number of low-income women at risk of unintended pregnancy using no method or a less effective method" of contraception. Accordingly, the rate of unintended pregnancy among low-income women would decline by 11% to 18% if OTC access did not affect OCP failure rates, by 15% to 25% if it decreased failure rates and by 7% to 12% if it increased failure rates.

Foster and colleagues suggested that "it is in the financial interest of public healthcare programs to cover a large portion of the cost of contraceptive pills." However, they noted that while "projected savings are maximized at $10-20 copay, the number of pregnancies averted is maximized at no out-of-pocket costs." Specifically, they wrote that "the proportion of women using OTC OCPs is directly correlated with out-of-pocket cost of the product," with "little advantage" conferred from OTC access among low-income women if the copays are more than $10.

Foster and colleagues concluded, "Removing the prescription barrier, particularly if pill packs are available at small or zero out-of-pocket cost, could increase the use of effective methods of contraception and reduce unintended pregnancy and healthcare costs."


Commentary Stresses Importance of Setting Appropriate Family Planning Quality Measures

Thu, 03/26/2015 - 19:22

Researchers note that while it is important to develop standard quality measures related to family planning, metrics based solely on increasing the uptake of long-acting reversible contraceptive methods "may not be appropriate in the setting of a decision as complex and contextualized as the choice of a contraceptive method." They offer several recommendations for "measures that better capture the quality of contraceptive care in the context of women's needs and preferences."

Commentary Stresses Importance of Setting Appropriate Family Planning Quality Measures

March 26, 2015 —Summary of "Performance Measures for Contraceptive Care: What are We Actually Trying To Measure?" Dehlendorf et al., Contraception, Feb. 9, 2015.

While there has been an increasing push to measure "quality in specific areas of health care," which "can drive quality improvement and influence the degree to which these areas are prioritized" by stakeholders, no such performance measures have been developed for family planning, write Christine Dehlendorf of the University of California-San Francisco and colleagues.

Meanwhile, "the reproductive health community is increasingly directing research and interventions towards the perceived underuse of highly effective" contraceptive methods, particularly long-acting reversible contraception (LARC), such as intrauterine devices and implants, they write.

As a result, some stakeholders have urged using measures to help encourage LARC use. The authors write that one option would be "to simply measure the percentage of women receiving family planning care who decide to use a highly effective method, with higher uptake being equated with higher quality of care," or to use an approach weighting methods by their effectiveness and taking into account their level of use in the population.

'Cause for Concern'

At first glance, using measures that prioritize "the uptake of higher efficacy methods" appears logical when considering the desire to reduce unintended pregnancies and combat provider misconceptions about LARCs, the researchers write.

However, Dehlendorf and colleagues add that "there is cause for concern that this focused, outcome-based measure may not be appropriate in the setting of a decision as complex and contextualized as the choice of a contraceptive method."

They explain that the selection of a birth control method "is highly preference-sensitive due to the large number of available options and women's varied preferences for method characteristics," such as efficacy, bleeding patterns and whether methods contain hormones.

In addition, they note that method selection is connected "to intimate issues related to fertility, relationships and sexuality," including whether women want to get pregnant and their comfort level with a device inside their body, among other considerations. They add, "Protecting women's reproductive autonomy therefore requires the recognition that women's preferences need to be paramount in the choice of a contraceptive method even if they are not consistent with the public health goal of decreasing unintended pregnancies."

Further, the researchers argue that "quality measures that focus only on the short-term outcome of choice of a [LARC] method are problematic" because they encourage providers to promote or emphasize certain "methods at the expense of attention to patient preferences." There are also potentially negative effects on "long-term outcomes, such as patient satisfaction and method continuation," which have been shown to be linked to each other.

Consideration of Vulnerable Populations

Dehlendorf and colleagues add that "[i]ncentivizing counseling ... focused on LARC methods could be particularly problematic among" groups of women who have historically experienced "reproductive coercion," such as low-income women, "women of color, women with disabilities, young women and those in the correctional system."

Thus, "counseling that is biased towards [LARCs], rather than focused on women's needs and preferences, has the potential to amplify existing biases and disparities within the US health care system and worsen preexisting distrust among communities of color and other vulnerable populations," the authors explain.

They add that such a quality measure "may be problematic even if it did not influence counseling, as its mere existence could be perceived negatively by communities sensitized to these issues as evidence of a focus on controlling women's reproduction, rather than on empowering women."

Potential Solutions

Dehlendorf and colleagues suggest that a "combination of measures" likely will be needed to capture "the multidimensional nature of quality, including interpersonal quality, availability of information and access to services," as well as "the importance of both the patient experience of counseling and whether each woman is able to choose the appropriate contraceptive method for her."

Specifically, patient experience measures are "of particular value in the assessment of contraceptive care" because of "the personal nature and complex context of contraceptive decision making," they argue.

Meanwhile, the authors state that process metrics based on the availability of contraceptive choice could help combat "provider resistance to provision of [LARC] methods and the resulting limitation on women's ability to choose these methods -- while avoiding [the] pitfalls" of uptake-based measures. They write that such measures could include "a measure that incentivizes the provision of information about LARC methods," as implemented by the United Kingdom's National Health Services. Another option, they write, could be "a performance measure based on whether ... women are offered LARC methods," as recommended by the American College of Obstetricians and Gynecologists.

In addition, another approach could be to use claims data on LARC uptake to "identify practices that are well below the mean" of LARC use "in order to provide the opportunity to address" related barriers, without setting an explicit benchmark for providers to reach. A similar option could be to establish "a minimum 'floor' standard ... in order to differentiate providers who offer these methods at all from those who do not." The researchers caution that "care would need to be taken" with such an approach "to ensure that [the] intent [of the measure] was clear in order to avoid the interpretation that promotion of LARC methods was being incentivized."

Further, the researchers also raise the possibility of having "an intermediate-outcome measure" that "focuses on use of any" contraceptive method "considered to be either moderately or highly effective." They add that while such an approach "allows for greater consideration of patient preferences," it could also "incentivize providers to deemphasize counseling about condoms," resulting in negative effects for patient preferences and sexually transmitted infection risk.

Conclusion

Dehlendorf and colleagues continue, "Measurement of quality in contraceptive care may ensure that family planning services are prioritized in our evolving health care system and that attention is paid to continuous quality improvement in order to ensure that women receive the best possible care."

They add that "[m]easures that, either individually or in combination, reward the quality of contraceptive care from both a patient and systems perspective, while protecting women's autonomy, should be prioritized by those developing performance measures."

The researchers also stress that organizations that formally endorse quality measures, including the National Quality Forum, "can help to ensure that the preference-sensitive nature of contraceptive decision making is reflected in measures designed to incentivize quality family planning care."


Resources Aim To Address Implementation Gaps in ACA's Well-Woman Visit Benefit

Thu, 03/26/2015 - 19:22

Access to well-woman visits without cost-sharing is one of the preventive care services available to women under the Affordable Care Act (PL 111-148), but a lack of information and outreach about the benefit has left many women unaware that it is available to them. To address the issue, a group of women's health experts has created a consumer guide, a toolkit for providers and consumer advocates, and an issue brief describing the benefit itself, key components of well-woman visits, and how such visits can improve women's health.

Resources Aim To Address Implementation Gaps in ACA's Well-Woman Visit Benefit

March 26, 2015 — Summary of "Well-Woman Visits: Guidance and Monitoring Are Key in This Turning Point for Women's Health," Fitzgerald et al., Women's Health Issues, March 2015.

Although the Affordable Care Act's (PL 111-148) preventive services provision requires insurers to cover at least one annual well-woman visit (WWV) without cost-sharing, there is a dearth of "guidance, education, and outreach associated with implementation of WWVs," leaving "many women ... unaware of the benefit," according to Therese Fitzgerald of the Mary Horrigan Connors Center for Women's Health and Gender Biology and colleagues from the Connors Center, National Women's Law Center and Brigham & Women's Hospital's Division of Women's Health. They note that the issues have "jeopardize[d] women's access to key preventive care services."

For example, research has shown that 40% of women do not know about the ACA's WWV benefit and that 20% of women delayed preventive care because of cost. Such findings "are not surprising given the lack of education and outreach on WWVs," according to the authors. For instance, some HHS fact sheets about women's health services do not mention WWVs, an omission the authors call "as objectionable as [the sheets'] failure to include contraceptive services and supplies."

To address implementation issues related to the WWV benefit, Fitzgerald and colleagues' associated groups, along with Pfizer, have created "resources for consumers, providers and policymakers on WWVs to ensure that women are able to understand and access" the preventive care services offered under the ACA.

Consumer Guide to WWVs

The groups consulted with an advisory panel comprised of health and policy experts to draft a "consumer-friendly resource that can be used to educate women about this new benefit." The guide is offered in two languages and is "health literacy-appropriate."

Fitzgerald and colleagues explain that the guide includes information on "what to expect at a WWV," as well as answers to frequent questions about the visits, such as:

~ What is a WWV?;

~ How much do WWVs cost?; and

~ What happens during WWVs?

The guide also includes information on how women should prepare for a WWV, as well as links to other resources.

In addition, the groups created a toolkit for consumer advocates and providers on WWVs to help them educate women about the visits and "what they mean for women's health." The toolkit has:

~ Factsheets and other resources about WWV best practices; and

~ Information about how WWVs can help to improve women's health throughout their lives.

Policy Issue Brief

The groups also created "an issue brief for primary care providers and policymakers" about ways that "changes in health care delivery can improve the availability and use of education and counseling" through routine visits. The brief also describes ways to "improve the successful integration of education and counseling services into women's primary care," the authors wrote.

Conclusion

Fitzgerald and colleagues note that "WWVs are a key component and gateway to the constellation of preventive care now consistently available to women under the ACA." They write that additional resources for "consumers, providers and policymakers on WWVs will empower more women to access comprehensive, personalized, preventive care."

Further, they call for HHS to "monitor the utilization of preventive" services "by collecting, analyzing and reporting data" on how women are using WWVs and the effects of such visits on the "receipt of recommended preventive care." Such data are important to gauge whether the ACA preventive care provisions have "been fully implemented and to determine if there are barriers for women, particularly marginalized subgroups of women, in gaining access to this valuable preventive resource," Fitzgerald and colleagues conclude.


Study Links Abortion Legalization, Decreases in Infant Mortality in the U.S.

Thu, 03/26/2015 - 19:22

In this study, researchers examined changes in infant mortality in relation to the legal status of abortion and found that the fastest declines in infant mortality from 1970 to 1973 occurred in states where abortion was legalized in 1970. According to the researchers, the findings suggest more research is warranted about current abortion restrictions and their effect on infant mortality, as well as racial and economic inequities in infant mortality rates.

Study Links Abortion Legalization, Decreases in Infant Mortality in the U.S.

March 26, 2015 — Summary of "Reproductive Justice and the Pace of Change: Socioeconomic Trends in US Infant Death Rates by Legal Status of Abortion, 1960-1980," Krieger et al., American Journal of Public Health, April 2015.

"As restrictions increase on access to abortion in the United States, it is timely to revisit and build on previous research that examined whether US infant mortality rates were affected by 1960s and 1970s policies that expanded access to abortion," according to a study by Nancy Krieger of the Harvard T.H. Chan School of Public Health and colleagues.

The researchers "hypothesized that between 1960 and 1980, the steepest annual percentage declines in the infant death rate would occur" in "states that legalized abortion in 1970, relative to states that decreased restrictions or kept abortion strictly illegal prior to national legalization of abortion in 1973." As a corollary, they hypothesized that "state abortion law status would be less associated with mid- to late-1960s declines in infant mortality" that previous research connected to "beneficial economic and social changes" related to the Civil Rights Act and the "War on Poverty."

Methods

The researchers used national mortality data from 1960 to 1967 and from 1968 to 1980 to calculate the infant death rate.

Specifically, the researchers "stratified the individual-level mortality records and census denominator data by age, gender and race/ethnicity and aggregated them to the county level." The findings were broken down by "state legal status and income quintile, for the total US, Black, and White population."

States were classified into three groups for the analysis:

~ States where abortion was legalized in 1970 (four states);

~ States where "a model penal code enacted between 1967 and 1972" made abortion laws "less stringent" (14 states); and

~ States where abortion remained illegal until Roe v. Wade in 1973 (32 states and Washington, D.C.).

Results

The researchers found that all three sets of states saw "the fastest decline in rates" from 1970 to 1973 and that "these declines were evident in the bottom 3 and top 2 income quintiles." However, the researchers noted that the "largest decline" was seen among "the lowest 3 income quintiles in the states that legalized abortion."

According to the researchers, "[t]he only other period" when the annual percentage change in infant mortality rates declined in both the bottom three and top two income quintiles was during the mid-1960s. During that time period, the "declines were smaller and did not vary by state abortion law status," but they "were especially evident for Black and White infants in the lowest 3 income quintiles," the researchers wrote.

Discussion

The researchers wrote that their "descriptive analysis newly extends and integrates previous strands of research that separately examined US trends in infant mortality rates in the 1960s and 1970s in relation to legalization of abortion, abolition of Jim Crow laws, and the War on Poverty."

They added that their findings offer a "reverse mirror to" current abortion restrictions, "conjoined with rising economic inequality and voter intimidation," and concluded that the findings "imply that research is warranted on how currently rising restrictions on abortions may be affecting US infant mortality rates and racial/ethnic and economic inequities in these rates."


Study Outlines Strategies To Recruit, Retain Nurses for Abortion Care

Thu, 03/26/2015 - 19:21

A study based on interviews with registered nurses found that exposure to abortion care was integral to recruiting them into the field, while providing flexibility was integral for their retention. The researchers concluded that the study demonstrates "that a clear trajectory exists for development of expert nurses in abortion care provision," and they offered several recommendations on how to further promote such a trajectory.

Study Outlines Strategies To Recruit, Retain Nurses for Abortion Care

March 26, 2015 — Summary of "Recruitment and Retention Strategies for Expert Nurses in Abortion Care Provision," McLemore et al., Contraception, Feb. 20, 2015.

While registered nurses (RNs) "have a strong tradition of participating in sexual and reproductive health care ... the participation of nurses is considered to be one of many current barriers to abortion care provision," according to a study by Monica McLemore of the University of California-San Francisco School of Nursing and colleagues.

According to the researchers, "expert RNs" are "'those who do not exclusively rely on analytical principles (rules, guidelines or maxims) to connect their understanding of a situation to an appropriate action'" and "'who can zero in on the accurate region of a problem without wasteful consideration of a large range of unfruitful possible problem situations.'"

In their study, McLemore and colleagues aimed "to explore perspectives and experiences of recruitment, retention and career development of expert RNs in abortion care provision."

Methods

The researchers analyzed a subset of data from a larger study of RNs from 14 sites in the San Francisco Bay Area. The subset included 16 RNs, all of whom "had to have exposure to women needing or seeking abortions in the last [five] years" to be included in the study.

For the study, researchers conducted 25- to 90-minute interviews between November 2012 and August 2013. The interviewers asked the RNs "to discuss their careers in nursing, summarizing their work experiences"; "think of a time when a woman needing an abortion presented to their unit and to recount that day"; and answer various follow-up questions.

Results

The study participants were about evenly divided between RNs with fewer than five years of experience and RNs with more than 10 years of experience.

Recruitment

The researchers wrote that exposure to abortion care "quickly emerged as a dominant theme relevant to recruitment," with sub-themes of "exposure through education" and "through previous employment."

In terms of education, the researchers said many of the study participants volunteered or did non-nursing jobs "in abortion care to meet the volunteer requirements/pre-requisites for their RN school applications." However, they wrote that many study participants attested as to how "educational exposure to providing abortion care is optional in most schools of nursing."

Regarding exposure through employment, the researchers found that going from being a student to an employee provides RNs with the chance to choose an employer based on their interests. Further, they noted that employees who had "had a personal history of abortion or sought out professional opportunities to participate in abortion care during their training ... were more likely to seek work in abortion care."

Retention

The researchers found that "[o]nce RNs have been successfully recruited, on the job orientation and training must occur given the disparities in basic knowledge regarding abortion care provision."

Respondents said a key aspect of retention was "the need for personal flexibility," in the context of their attitude toward their work and other personnel, as well as in "their reactions to the unpredictable nature of abortion care," according to the researchers. In particular, researchers found that designated staff RNs emphasized the importance of flexibility in patient advocacy "in the context of needing to provide space for the agency of women, especially when negotiating with others for care provision."

The researchers also found that respondents identified "'growing our own'" as another key aspect of retention. According to the study, the concept refers to "an employer-based commitment to providing RNs with on the job knowledge and skill acquisition that allows them to develop into expert RNs."

Career Development

The researchers also found that there is little "infrastructural support for career development in nursing outside of acute care settings," noting that many of the study participants indicated a "need for employers to assist in the development of these opportunities."

Specifically, the RNs cited the need for "[e]ngaging in activities of legitimacy," such as "participation in professional meetings, membership in societies, developing quality and process improvement projects, acknowledgement as full members of a team, engagement with clinic leadership and policy and procedure development."

Further, some respondents said employers should provide RNs with more skill-advancement opportunities, such as through advanced education.

Discussion

McLemore and colleagues write the data "show that a clear trajectory exists for development of expert nurses in abortion care provision." However, the researchers also wrote that "[t]here are several infrastructural barriers to RN participation in abortion care," including;

~ A "lack of visibility of the RN workforce in abortion care";

~ A "lack of professional certification" and "access to competency development"; and

~ "[O]utdated assumptions that the peri-operative or labor and delivery ... skill set is adequate for gaining expertise in abortion care."

The researchers offered several recommendations, including that "future workforce development efforts ... include and engage nursing education institutions and employers to design structured support for [the expert nurse] trajectory" and "integrate values clarification exercises and observational rotations for RN students in abortion care provision."

In addition, they wrote that "[i]n the abortion care provision context, the infrastructure within nursing" to retain staff via the concept of growing our own "needs to be built and does not currently exist." Further, they noted that efforts to assist RNs' career development should include integrating them "in more traditional nursing professional organizations to increase the visibility of RNs doing abortion care, and to expand the pool of future providers."

In summary, McLemore and colleagues wrote that their findings "should encourage employers to provide opportunities for exposure to abortion care, develop activities to recruit and retain nurses, and to support career development." The findings also "highlight approaches to support trajectories to develop expert nurses in abortion care provision," they concluded.


School Health Centers Linked To Greater Exposure to Repro Health Education, Services

Thu, 03/26/2015 - 19:21

Researchers compared reproductive health measures among students at a large, urban high school that has a school health center (SHC) with those of students at a similar school without such a center. Students at the SHC school reported higher levels of sexuality education, health care provider counseling and hormonal contraception use. The "positive impact" of SHCs on reproductive health measures suggests they can be an effective tool for addressing teen pregnancy, the researchers wrote.

School Health Centers Linked To Greater Exposure to Repro Health Education, Services

March 26, 2015 —Summary of "Reproductive Health Impact of a School Health Center," Minguez et al., Journal of Adolescent Health, March 2015.

School health centers (SHCs) can help prevent teen pregnancy in several ways by providing access to reproductive health services such as "contraceptive counseling" and "sexuality education," according to a team of researchers led by Mara Minguez of the Mailman School of Public Health at Columbia University.

Prior research has found that there is "high acceptance" of SHCs among parents, students and schools, including "strong" parental support for the centers' reproductive health services and "considerable student utilization" of such services. Moreover, "no studies" have shown SHCs to have "adverse" impacts, such as "increases in sexual activity," the researchers wrote.

Nonetheless, they noted that "evidence remains limited of the impact of SHCs." In this study, the researchers sought to "address this lack of evidence-based research" by comparing experiences of students at a school with an SHC that offered reproductive health services with those of students at a school without an SHC.

Methods

The researchers compared New York City high schools with ethnically and socioeconomically similar student bodies. The final sample consisted of 1,365 students from the intervention school and 711 students from the comparison school.

At the intervention school, "services were similar to the self-care model, which combined reproductive health care, counseling in the health center, and classroom education." Specifically, the SHC offered primary care and reproductive health services, with a clinical staff of two or three physicians or nurse practitioners and two fulltime mental health care providers. The intervention school also offered classroom education on pregnancy and sexually transmitted infections/HIV prevention. Meanwhile, the comparison school provided HIV education and a condom availability program, in addition to employing a fulltime nurse who offered referrals to community care and first aid.

Data were collected using a 64-item questionnaire that was "modeled after the 2007 NYC Youth Risk Behavior Survey." Along with the YRBS questions about sexual behaviors, drug use and demographics, the researchers asked about "immigration, general health status, contraceptive use, use of health services, clinical counseling and sexuality education, and willingness to use the SHC."

The researchers used three statistical models to assess data. The primary method -- the "interaction method" -- "examined the statistical significance of school x grade interaction terms, using ninth graders as baseline subjects." The second model -- the "stratification method" -- compared the ninth graders and the older students "between the two schools, controlling for demographic factors," while the third model "compared SHC users and nonusers in the intervention schools to students in the comparison school," the researchers explained.

Results

The analyses focused on four factors:

~ Students' willingness to visit the SHC for reproductive health care;

~ The receipt of health care provider counseling and classroom education;

~ Contraceptive use; and

~ Source of contraception.

Willingness to Use SHC

The researchers found that "similar percentages" of students at both schools were willing to use the SHC at the ninth-grade baseline, "but differences between schools increased sharply by grade." Specifically, 81% of 12th graders at the intervention school were willing to use the SHC, compared with 35% of their peers at the comparison school. Within the intervention school, more than 80% of SHC users said they were willing to use the center for reproductive health services, compared with 57% of students at that school who did not use the SHC and 37% of students at the comparison school.

Receipt of Education, Counseling

As students progressed through the grades, the percentage who reported "that someone other than a teacher talked with them about abstinence, condoms, and HIV/AIDS in class" increased at both schools, although "the increase by grade was greater in the intervention school," the researchers wrote.

Further, students' receipt of provider counseling about birth control and emergency contraception also increased by grade at both schools, "but the increase with grade was greater in the intervention school," the researchers found.

Contraceptive Use

Among sexually experienced female students, the proportion who had ever used hormonal contraception was similar in both schools at ninth-grade baseline. By grade 12, ever-use of hormonal contraception among this population had risen to 71% at the intervention school and 50% at the comparison school.

Meanwhile, among young men, the interaction method and stratification method analyses showed that those at the intervention school were "more likely" than their counterparts at the comparison school "to have ever used condoms." At the comparison school, 52% of male students reported having ever used a condom, compared with 70% of SHC users and 54% of SHC nonusers.

Further, 30% of 10th through 12th graders at the intervention school reported using hormonal contraception at last intercourse, compared with 20% at the comparison school. At the intervention school, 34% of SHC users reported hormonal contraceptive use at last intercourse, compared with 22% of SHC nonusers.

Sources of Contraception

The students reported various sources of contraception, including but not limited to:

~ Clinics and health care providers (60% of respondents);

~ Families, friends and bodegas (16%); and

~ Sources in both categories (6%).

Meanwhile, "29% reported no source of contraceptive supplies."

Among SHC users, 80% of women and 41% of men said it was their "usual source" of contraception.

Discussion

In summary, the researchers wrote that the "study demonstrates a pattern of improved reproductive health care and education among students in high schools with an SHC providing sexual and reproductive health care compared with students in a school without an SHC."

Specifically, the researchers noted that the SHC was tied to:

~ Better access to classroom health education;

~ More provider and student discussions; and

~ Greater contraceptive use.

The researchers highlighted the "increases in contraceptive use among SHC students as measured by ever use, at the first intercourse, and use at the last intercourse," adding that "[c]ontraception is the most important proximate determinant of teen pregnancy among sexually active youth."

Noting that many restrictions exist on SHCs, the researchers wrote that "[t]o be maximally effective in reducing teen pregnancy, SHCs must be allowed to prescribe and dispense a full range of contraception, including hormonal and long-acting reversible methods." However, ensuring such policies "will mean addressing political and cultural barriers to providing such care," they added.


Blogs Discuss College Presidents' Handling of Sexual Assault, Why 'It's Still Pretty Hard' To Access No-Cost Birth Control

Thu, 03/26/2015 - 18:22

Read some of the best commentaries from bloggers at Ms. Magazine, the Huffington Post and more.

Blogs Discuss College Presidents' Handling of Sexual Assault, Why 'It's Still Pretty Hard' To Access No-Cost Birth Control, More

March 20, 2015 — Read the week's best commentaries from bloggers at Ms. Magazine, the Huffington Post and more.

SEXUAL AND GENDER-BASED VIOLENCE: "Why are University Presidents Leaving Campus Rape Survivors Out in the Cold?" Caroline Heldman, Ms. Magazine blog: A "major factor among many" universities as to why "so little [has] been done" to address campus sexual assault is "failed leadership at the top of the academy," Heldman writes, citing a recent Inside Higher Ed survey that "reveals that [university] presidents are a key part of the problem." According to the survey, studies show that while "1 in 5 female students face sexual assault, only 1 in 3 college presidents agree with the statement 'sexual assault is prevalent on college campuses'" and 77% of them report that "their schools are doing a 'good job' addressing the problem," Heldman writes. Heldman writes, "The truth is that almost no schools expel rapists or take other basic measures to prevent assaults on their campuses due to institutional fears about being sued by perpetrators or losing alumni donations if a problem is exposed." Heldman urges college presidents to "[a]dmit there's a problem" and take action, such as by "establish[ing] an affirmative consent policy, institut[ing] an expulsion policy for students found responsible," "mandat[ing] ongoing annual bystander training" and working with law enforcement (Heldman, Ms. Magazine blog, 3/18).

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

~ "It's Time To Change the Narrative on Sexual Assault in Our High Schools," Malika Saada Saar, Huffington Post blogs.

CONTRACEPTION: "It's Still Pretty Hard for Women To Get Free Birth Control," Emily Cohn, Huffington Post: Women can still face out-of-pocket costs for birth control under the Affordable Care Act (PL 111-148) "because health care companies are allowed to dictate how you get your care, even if that conflicts with the original intent of the [ACA]," Cohn writes. Cohn explains that after she was charged $20 when picking up her birth control prescription, which she had previously obtained at no cost under the ACA, she called the National Women's Law Center and learned that insurers "are allowed to employ 'reasonable medical management techniques' to encourage customers to get care at a lower cost." For Cohn, the provision meant that she could order her birth control for free via mail, but her insurer legally could charge her for picking up her prescription at CVS. She writes that while the situation was "kind of a hassle" for her, it "will be more than a hassle" for women who "don't want to have birth control delivered because they don't want other people living with them to know they're using contraception." Cohn outlines several suggestions on how women can address potential charges on their birth control, but she concludes that "[t]here's still a lot of work women need to do to ensure that they get the legal protections they're guaranteed under the law" (Cohn, Huffington Post, 3/19).

What others are saying about contraception:

~ "'A Redneck Republican Wearing an IUD': Colorado Lawmakers Use Birth Control Earrings To Push for Family Planning," Jenny Kutner, Salon.

ABORTION RESTRICTIONS: "Louisiana Women May Have To Travel Even Longer Than You Think for an Abortion," Robin Marty, Care 2: Marty writes about how a contested admitting privileges law (Act 620) in Louisiana, if permitted to take effect, could close down all of the state's abortion clinics, noting that a study found that such a situation could increase the average travel time for Louisiana women to have an abortion from "58 miles each way ... to 208 miles each way." However, Marty explains "that would be the best case scenario." She writes that "[t]he researchers admit that the distances could be worse because of" 24-hour and 48-hour mandatory delay "laws in the nearby states ... which could cause a patient to need multiple trips," but she notes that the researchers did not consider "that because there are so few clinics, many are already at capacity and stretched to their breaking points as is." As a result, what "on paper" might be "a 200 mile drive ... could be over six hours long in just one direction," at which point "abortion is no longer an accessible choice for many of those who would seek it," Marty writes, adding that this "is just what abortion opponents intend" (Marty, Care 2, 3/18).

What others are saying about abortion restrictions:

~ "Wisconsin City Asks Gov. Walker To Remove Abortion Funding Bans," Liss-Schultz, RH Reality Check.

~ "Tennessee's Amendment 1 May Not Be Enough To Reinstate Unconstitutional Informed Consent Law," Imani Gandy, RH Reality Check.

ABORTION-RIGHTS ACCESS AND PROTECTIONS: "Four States That Are Actually Working To Protect Abortion Rights," Tara Culp-Ressler, Center for American Progress' "ThinkProgress": Culp-Ressler writes that while "it can be hard to see any progress" in advancing abortion rights, given the growing number of state restrictions on the procedure, "[m]ore lawmakers than ever before are standing up to fight for reproductive rights, helping to pioneer a growing state movement to push for proactive legislation to safeguard abortion access." For example, Culp-Ressler notes that Oregon state lawmakers this year introduced "pro-choice legislation that would make the state the first in the country to ensure that every resident has coverage for abortion procedures under every form of insurance." Meanwhile, she writes that "the city of Madison," Wis., this week "unanimously passed a resolution affirming that it's critical to fund reproductive health care" and urging state lawmakers to restore "insurance coverage for abortion ... for public employees" and Medicaid beneficiaries. In addition, Oakland, Calif., lawmakers this week passed a "resolution [14-0614] denouncing sex-selective abortion bans" after San Francisco's Board of Supervisors approved a similar resolution last year. Further, Culp-Ressler also praises Washington state lawmakers for re-introducing a bill (HB 1647) this month "that would require insurers to achieve 'reproductive parity' and offer coverage for abortion services alongside other types of common women's health care" (Culp-Ressler, "ThinkProgress," Center for American Progress, 3/19).

What others are saying about abortion-rights access and protections:

~ "Cisgender Women Aren't the Only People Who Seek Abortions, and Activists' Language Should Reflect That," Cheryl Chastine, RH Reality Check.


Survey: Many Religious Women Supportive of Contraceptive Coverage Rules

Thu, 03/26/2015 - 18:21

Although Catholic Church leaders remain opposed to the Affordable Care Act's (PL 111-148) contraceptive coverage requirements, a majority of lay Catholic women support the policy, according to a study by University of Michigan researchers, The Atlantic reports.

Survey: Many Religious Women Supportive of Contraceptive Coverage Rules

March 24, 2015 — Although Catholic Church leaders remain opposed to the Affordable Care Act's (PL 111-148) contraceptive coverage requirements, a majority of lay Catholic women support the policy, according to a study by University of Michigan researchers, The Atlantic reports.

Background

The Catholic Church was an early critic of the federal requirement that employer-sponsored health plans include contraceptive coverage at no cost to beneficiaries. Other conservative-leaning Christian groups, such as the National Association of Evangelicals, soon joined the opposition to the rules. Many religious leaders have said that the Obama administration should exempt employers that hold themselves out as having religious ties, such as certain hospitals and universities, from the requirements, and some entities that hold themselves out as religious have taken the issue to court.

For opponents of the contraceptive coverage rules, a central argument has been that they violate not only the rights of religiously affiliated employers but also those of individuals who purchase their health plans, The Atlantic reports.

Study Findings

The new study examined views on contraceptive coverage among religiously affiliated women ages 18 to 55. According to The Atlantic, it is the first study to specifically assess opinions on the issue among women with religious affiliations in that age group -- women who are of reproductive age or just beyond and are most affected by birth control access.

The researchers found support for having employers provide no-cost contraception was highest among mainline Protestant women, at 66%, followed by Catholic women, at 63%. Further, the rate of support among these two groups was higher than among the general population. According to a previous Public Religion Research Institute study, 61% of U.S. residents believe that public corporations should have to offer no-cost contraceptive coverage, while 57% think private corporations should have to do so.

Meanwhile, women in the most conservative-leaning Christian denominations, including Baptists, non-denominational Christians, Pentecostals and Mormons, were least likely to support the requirement. The Atlantic reports that support among these groups was lower than 50%.

Implications

Study researcher Elizabeth Patton, an ob-gyn and health-services researcher at the University of Michigan, said, "People tend to view this as very black and white, but this conversation is more complicated and nuanced."

The researchers also noted that support for abortion coverage was considerably lower than support for contraceptive coverage. Specifically, about 25% of Catholic and mainline Protestant women thought employer plans should offer abortion coverage.

"What this tells us is that women are able to distinguish between the two," Patton said.

Patton noted that Pew Research Center data show that 80% of women have a religious affiliation. "That's why we need to understand the complexity of their views -- because if we don't, we aren't going to have policies that are meaningful for women," she said (Miller, The Atlantic, 3/22).


President Obama Tells Senate Leaders To Stop 'Playing Politics' Over Trafficking Bill, Confirm AG Nominee

Thu, 03/26/2015 - 18:21

In his weekly address on Saturday, President Obama urged Congress to "stop playing politics with law enforcement and national security" and hold a confirmation vote on U.S. attorney general nominee Loretta Lynch, which conservative lawmakers have said they will not do until they pass a trafficking bill mired in a dispute over an antiabortion-rights provision, the Washington Post's "Post Politics" reports.

President Obama Tells Senate Leaders To Stop 'Playing Politics' Over Trafficking Bill, Confirm AG Nominee

March 23, 2015 — In his weekly address on Saturday, President Obama urged Congress to "stop playing politics with law enforcement and national security" and hold a confirmation vote on U.S. attorney general nominee Loretta Lynch, which conservative lawmakers have said they will not do until they pass a trafficking bill mired in a dispute over an antiabortion-rights provision, the Washington Post's "Post Politics" reports (Itkowitz, "Post Politics," Washington Post, 3/21).

Background

Obama nominated Lynch, a career prosecutor who is currently a U.S. attorney in New York, in November, and she has already had a confirmation hearing before the Senate Judiciary Committee (Flores, CBS News, 3/21). However, Senate Majority Leader Mitch McConnell (R-Ky.) has said that the full Senate will not hold a confirmation vote until the chamber passes the human trafficking bill, which stalled amid a dispute over antiabortion-rights language that is included in the legislation.

Supporters of abortion rights who object to the language said it would expand existing restrictions on abortion funding by permanently applying the Hyde Amendment to a human trafficking survivors' compensation fund, which is financed by fines and penalties paid by convicted federal offenders.

Meanwhile, lawmakers who oppose abortion rights have so far refused to remove the language from the bill. Several procedural votes to advance the bill failed last week (Women's Health Policy Report, 3/20). Democrats have said that Lynch deserves a confirmation vote regardless of the trafficking bill impasse (Jackson, USA Today, 3/21).

Obama Address

In his address, Obama noted that Lynch has waited for a confirmation vote "longer than the seven previous attorneys general combined." He added that she has support from senators of both parties and that "[n]o one can claim she's unqualified." The delay "is purely about politics," the president said. Conservative lawmakers initially delayed Lynch's confirmation because of opposition to Obama's executive actions on immigration, and "[n]ow they're denying her a vote until they can figure out how to pass a bill on a completely unrelated issue," he said (CBS News, 3/21).

Timeline

Senators this week are expected to focus on the budget, and then they will recess for two weeks ("Post Politics," Washington Post, 3/21). Without a vote soon, Lynch's confirmation could languish until mid-April, according to USA Today (USA Today, 3/21).


Blogs Comment on 'Five Years of Progress' Under ACA, Ruling Against Wis. Antiabortion-Rights Law, More

Thu, 03/26/2015 - 18:21

Read the some of the best commentaries from bloggers from the National Partnership for Women & Families, Ms. Magazine and more.

Blogs Comment on 'Five Years of Progress' Under ACA, Ruling Against Wis. Antiabortion-Rights Law, More

March 24, 2015 — Read the week's best commentaries from bloggers from the National Partnership for Women & Families, Ms. Magazine and more.

AFFORDABLE CARE ACT ANNIVERSARY: "The Affordable Care Act: Five Years of Progress, and More To Come," Debra Ness, National Partnership for Women & Families blog: On this week's "fifth anniversary of the Affordable Care Act [PL 111-148], millions of women and families across our country finally have affordable health coverage and the peace of mind that comes with knowing that your health and the health of your family is secure," National Partnership President Ness writes. Ness explains that the law has made "enormous progress ... with respect to improving access to coverage and care," noting that about "16.4 million previously uninsured individuals have gained coverage" since the law took effect. Further, she outlines several ways the ACA has improved health coverage for women, including that "women can no longer be denied coverage because of a pre-existing condition or chronic illness and cannot be charged more than men for their health insurance simply because of gender." In addition, she notes that women who enroll in coverage through the ACA's marketplace are now "guaranteed maternity care services, amongst other key health services," and that "[m]ost private insurance plans ... are required to cover a wide range of preventive health services without cost-sharing," such as well-woman visits, screenings for various cancers and contraception (Ness, National Partnership blog, 3/23).

What others are saying about the ACA's anniversary:

~ "The 5 Best Things Obamacare Has Done for Women," Stephanie Hallet, Ms. Magazine blog.

ABORTION RESTRICTIONS: "Judge Strikes Down Scott Walker's Anti-Abortion Law," Igor Volsky, Center for American Progress' "ThinkProgress": A judge on Friday struck down a Wisconsin law (Act 37) "that requires doctors performing abortions to secure admission privileges to nearby hospitals, temporarily blocking it," Volsky writes. According to Volsky, the judge ruled that the law violated the 14th Amendment, stating in his decision that "'[t]he marginal benefit to women's health of requiring hospital admitting privileges, if any, is substantially outweighed by the burden this requirement will have on women's health outcomes due to restricted access.'" Volsky explains that the judge's opinion noted "that there is no medical need for doctors to maintain admitting privileges and pointed out that 'less than 0.65% of patients experienced a complication after an abortion and that only 0.06% required hospitalization as a result.'" However, "a spokesperson for [Wisconsin Gov. Scott] Walker [R] promised to appeal the decision," he adds (Volsky, "ThinkProgress," Center for American Progress, 3/21).

What others are saying about abortion restrictions:

~ "Illinois Bill Would Subject Abortion Clinics to Medically Unnecessary Restrictions," Nina Liss-Schultz, RH Reality Check.

~ "Arkansas GOP Makes Obtaining Abortions for Teen Rape Survivors More Burdensome," Teddy Wilson, RH Reality Check.

HYDE AMENDMENT: "New Hyde Amendment Controversy Brews in Congress Over Medicare Funding Bill," Emily Crockett, RH Reality Check: Congress is again debating the inclusion of Hyde Amendment language in a bipartisan bill, this time over a measure aimed at resolving a problematic formula that Medicare uses to set physician reimbursement rates, Crockett writes, noting that congressional lawmakers recently were debating the inclusion of antiabortion-rights language in a human trafficking measure (S 178). According to Crockett, the latest debate centers on a "compromise plan in the House to fix the broken formula [that] also includes Hyde Amendment language that prohibits funding for abortion at community health clinics." Crockett notes that many lawmakers who support abortion rights have criticized the provision, as have abortion-rights groups such as the National Latina Institute for Reproductive Health and the Planned Parenthood Action Fund. According to Crockett, advocates are concerned that including the language "would set an alarming precedent for expanding Hyde even further" (Crockett, RH Reality Check, 3/20).

CPCs: "Michigan Senate Approves Bill To Fund Crisis Pregnancy Centers," Liss-Schultz, RH Reality Check: "Michigan state senators on Wednesday approved a bill [SB 84] to increase state support for so-called crisis pregnancy centers, anti-choice organizations that seek to deter pregnant people from going through with abortions," Liss-Schultz writes. Specifically, she notes that the bill "would create a state-run program in which the money raised from the sale of license plates reading 'Choose Life' would be allocated to nonprofit organizations that promote alternatives to abortion," including CPCs. Liss-Schultz cites a NARAL Pro-Choice California report that found CPCs used "deceptive tactics" to dissuade women from having abortions, adding that "abortion access advocates have noted that the centers, which often intentionally disguise themselves as abortion clinics, do anything but ... support women." Further, Liss-Schultz notes that conservative Michigan lawmakers "shot down amendments to SB 84 that would have mitigated the proposal's effects, including one to create a 'Women's Health' license plate, and another to use the proceeds from the 'Choose Life' plates to fund infant mortality reduction efforts in the state" (Liss-Schultz, RH Reality Check, 3/20).


Federal Judge Strikes Down Wis. Admitting Privileges Law

Thu, 03/26/2015 - 18:21

A federal judge on Friday struck down as unconstitutional a Wisconsin law (Act 37) that requires physicians who perform abortions to have admitting privileges at a nearby hospital, Reuters reports.

Federal Judge Strikes Down Wis. Admitting Privileges Law

March 23, 2015 — A federal judge on Friday struck down as unconstitutional a Wisconsin law (Act 37) that requires physicians who perform abortions to have admitting privileges at a nearby hospital, Reuters reports (Reuters, 3/21).

Background

The law states that doctors who provide abortions in Wisconsin must have admitting privileges at a hospital located within 30 miles of the facility where they practice. U.S. District Judge William Conley placed a temporary hold on the law in July 2013, after Planned Parenthood Federation of America and the American Civil Liberties Union challenged it in court (Women's Health Policy Report, 6/3/14).

Planned Parenthood of Wisconsin and Affiliated Medical Services, two abortion providers involved in the challenge, said that the law would restrict access to abortion in Wisconsin (AP/LaCrosse Tribune, 3/21). The plaintiffs argued that the admitting privileges requirement would cause the largest of the state's four abortion providers to close immediately and that the other three facilities would not be able to handle the increased demand (Peters, Wall Street Journal, 3/22).

In defending the law, attorneys for the state said it would ensure that there is continuity of care if a woman requires hospitalization for abortion-related complications (AP/Lacrosse Tribune, 3/21).

Ruling Details

On Friday, Conley ordered a permanent injunction against the law. In a 91-page opinion, he said it violated the 14th Amendment.

"The marginal benefit to women's health of requiring hospital admitting privileges, if any, is substantially outweighed by the burden this requirement will have on women's health outcomes due to restricted access to abortions in Wisconsin," the judge wrote, adding, "While the court agrees with the State that sometimes it is necessary to reduce access to insure safety, this is decidedly not one of those instances" (Reuters, 3/21).

Further, Conley noted there is no rational basis for treating physicians who perform abortions differently than those who perform other outpatient procedures that are equally or more risky. "The court is, if anything, more convinced that the admitting privileges requirement in Act 37 'remains a solution in search of a problem,' unless that problem is access to abortion itself," he wrote (Wall Street Journal, 3/22).

Reaction

Laurel Patrick, a spokesperson for Gov. Scott Walker (R), said, "Our office will work with the attorney general to appeal this ruling, and we believe the law will ultimately be upheld" (Bice/Spivak, Milwaukee Journal Sentinel, 3/20).

Similar admitting privileges laws have faced court challenges in other states. Renee Paradis, an American Civil Liberties Union senior staff attorney, said that while the Wisconsin case adds to abortion-rights supporters' victories in court challenges to such laws, the issue likely will remain unsettled until the Supreme Court rules on the topic (Wall Street Journal, 3/22).

The Supreme Court last June denied Wisconsin's request to consider the law (Women's Health Policy Report, 6/24/14).

Planned Parenthood of Wisconsin CEO Teri Huyck in a statement said, "We all want to protect patient safety -- this law doesn't do that. Politicians passed this law in order to make it extremely difficult for women in Wisconsin to get safe and legal abortions, plain and simple" (Reuters, 3/21).


Medicare Legislation Could Contain Abortion Restrictions

Thu, 03/26/2015 - 18:21

Abortion-rights advocates are raising concern that a House plan to address Medicare physician payments includes abortion restrictions in a provision that would fund community health centers, Politico reports.

Medicare Legislation Could Contain Abortion Restrictions

March 23, 2015 — Abortion-rights advocates are raising concern that a House plan to address Medicare physician payments includes abortion restrictions in a provision that would fund community health centers, Politico reports.

The Medicare legislation aims to put in place a long-term solution to a problematic formula that Medicare uses to determine physician reimbursements. Congress has been addressing the issue with short-term fixes for years (Pradhan/Mershon, Politico, 3/21). The House plan also includes $7.2 billion over two years for community health centers, which provide care for low-income U.S. residents (Cornwell, Reuters, 3/20).

Politico reports that the community health centers provision includes Hyde Amendment language that restricts federal funding for abortion (Politico, 3/20). As of Friday, the antiabortion-rights language had yet to be released, so the details remain unclear (Reuters, 3/20).

Groups Condemn Efforts To Include Abortion Restrictions

NARAL Pro-Choice America in a statement on Friday urged House members "who say they stand for women to reject any anti-choice legislation, including Hyde."

Further, Planned Parenthood Action Fund President Cecile Richards said in a statement, "Congress should be expanding women's access to basic, preventive health care. Instead, women's health care access is being ignored while some politicians instead continue their fixation on blocking the most vulnerable women's access to abortion."

Referring to a human trafficking bill (S 178) that also contains abortion restrictions, Richards said, "It is outrageous that for the second time in two weeks, some politicians are using important legislation to advance their anti-abortion agenda on the backs of the most vulnerable" (Politico, 3/21).

Lawmakers Comment

Senate Minority Leader Harry Reid (D-Nev.) and Sen. Ron Wyden (D-Ore.), ranking member on the Senate Finance Committee, also expressed concern about the abortion restrictions.

Wyden called the antiabortion-rights provision "a complete non-starter that has no place in a bill about access to care for America's seniors and children," while a spokesperson for Reid said that "Republicans are trying to slowly but systematically expand the scope of Hyde" (Reuters, 3/20).


Vandalism at Miss. Abortion Clinic Will Not Deter Services, Director Says

Thu, 03/26/2015 - 18:21

The only abortion clinic in Mississippi is continuing to see patients after the building was vandalized this weekend, according to the clinic's director, the Jackson Clarion-Ledger reports.

Vandalism at Miss. Abortion Clinic Will Not Deter Services, Director Says

March 25, 2015 — The only abortion clinic in Mississippi is continuing to see patients after the building was vandalized this weekend, according to the clinic's director, the Jackson Clarion-Ledger reports.

Incident Details

Over the weekend, one of the security cameras at the Jackson Women's Health Organization was pulled down from the building. Clinic employees were able to view surveillance videos that showed the intruder on the premises.

JWHO Director Shannon Brewer said the cord to the camera had been cut and that there were signs of tampering on a second camera.

Jackson Police Department spokesperson Colendula Green said police are reviewing security tapes and investigating the incident as malicious mischief.

Clinic Response

Brewer said that intimidation tactics will not deter clinic workers from providing services. "I think whoever it was is trying to disrupt our seeing patients this week," she said.

Brewer said that national antiabortion-rights groups are in town for the next few weeks and plan to protest at the clinic on Thursday, although it is not clear if there is any connection to the vandalism. An official from one of the groups said its protesters are not in town yet, while the other group did not return requests for comment, the Clarion-Ledger reports (Apel, Jackson Clarion-Ledger, 3/24).


N.C. Asks Supreme Court To Consider Ultrasound Law That Was Found Unconstitutional

Thu, 03/26/2015 - 18:21

North Carolina on Monday requested that the Supreme Court consider a federal appeals court's decision to strike down part of a 2011 state law (SL 2011-45) that would require physicians to perform ultrasounds prior to abortions and describe the images to patients, the Raleigh News & Observer reports.

N.C. Asks Supreme Court To Consider Ultrasound Law That Was Found Unconstitutional

March 24, 2015 — North Carolina on Monday requested that the Supreme Court consider a federal appeals court's decision to strike down part of a 2011 state law (SL 2011-45) that would require physicians to perform ultrasounds prior to abortions and describe the images to patients, the Raleigh News & Observer reports.

Background

The law requires physicians to display and describe the ultrasound images to women seeking abortions, even if the women object. According to the News & Observer, women are permitted to avert their eyes or cover their ears (Jarvis, Raleigh News & Observer, 3/23). The requirement has never taken effect because of ongoing court challenges, although other provisions of the law remain in place.

Last year, a three-judge panel of the 4th U.S. Circuit Court of Appeals unanimously upheld a lower court's ruling that struck down the narrated ultrasound requirement. In the 4th Circuit ruling, Judge Harvie Wilkinson wrote for the panel that the provision is an unconstitutional violation of physicians' free-speech rights. Wilkinson wrote, "The state cannot commandeer the doctor-patient relationship to compel a physician to express its preference to the patient," adding that "this compelled speech provision" violates the First Amendment.

Similarly, in the earlier ruling that struck down the requirement, U.S. District Judge Catherine Eagles said that it violates physicians' free-speech rights because the state does not have "the power to compel a health care provider to speak, in his or her own voice, the state's ideological message in favor of carrying a pregnancy to term" (Women's Health Policy Report, 12/23/14).

Appeal Details

The Supreme Court in the past declined to hear a case involving a similar law in Oklahoma that the state's highest court declared unconstitutional, the News & Observer reports.

Nancy Northup, president and CEO of the Center for Reproductive Rights, one of the plaintiffs in the North Carolina case, said in a statement, "The only purpose for this invasive and unconstitutional law is to shame and demean women who have made the very personal, private decision to end a pregnancy," adding, "We will continue to take all steps necessary to protect the First Amendment and ensure doctors are never forced to serve as mouthpieces for politicians" (Raleigh News & Observer, 3/23).


Ohio House Passes 'Heartbeat' Bill That Could Ban Abortion as Early as Six Weeks

Thu, 03/26/2015 - 18:21

The Ohio House on Wednesday voted 55-40 to approve a bill (HB 69) that would ban abortion if a fetal heartbeat is detectable, which can be as early as six weeks into pregnancy, the Cleveland Plain Dealer reports.

Ohio House Passes 'Heartbeat' Bill That Could Ban Abortion as Early as Six Weeks

March 26, 2015 — The Ohio House on Wednesday voted 55-40 to approve a bill (HB 69) that would ban abortion if a fetal heartbeat is detectable, which can be as early as six weeks into pregnancy, the Cleveland Plain Dealer reports.

The bill now heads to the state Senate for consideration (Higgs, Cleveland Plain Dealer, 3/25). According to the AP/San Francisco Chronicle, the chamber will have the rest of the Ohio Legislature's two-year session to consider the measure (Carr Smyth, AP/San Francisco Chronicle, 3/25).

Similar bills have failed in two previous state legislative sessions.

Bill Details

State Reps. Christina Hagan (R) and Ron Hood (R) proposed this year's bill, which would make it a fifth-degree felony for a provider to perform an abortion if a fetal heartbeat can be detected. It includes exemptions if an abortion is needed to save a woman's life or prevent serious health complications (Women's Health Policy Report, 3/5). It does not include exemptions for cases of rape or incest (Cleveland Plain Dealer, 3/25).

Individuals who violate the ban could face up to a year in prison and fines of up to $2,500.

The measure also would create a legislative committee to encourage adoption (Women's Health Policy Report, 3/5).

Vote Details

The bill was approved mostly along party lines (Cleveland Plain Dealer, 3/25). According to the Columbus Dispatch, most of the chamber's Republicans and one Democrat voted in favor of the bill, while most Democrats and 10 Republican lawmakers voted against it.

Conservatives during debate over the measure rejected several amendments, including one that would have added exemptions for cases of incest and rape (Candisky, Columbus Dispatch, 3/26).

According to the Plain Dealer, abortion-rights supporters in the state House voiced several reasons why the bill should be rejected, including concerns that it would violate both the state and U.S. constitutions and only would make abortion more dangerous for Ohio residents (Cleveland Plain Dealer, 3/25).

State Rep. Michael Curtin (D) said the bill is "a profound abuse of power," noting, "This legislation unequivocally states that government ... knows better" than physicians and those involved with the pregnancy.

State Rep. Teresa Fedor (D), who also opposed the bill, revealed that she had been raped and had an abortion. She called the bill "fundamentally inhuman" and "unconstitutional," adding, "How dare government get in my business" (Columbus Dispatch, 3/26).

Separately, Hagan argued that individuals should not be allowed to stop a fetus' beating heart (Palmer, Reuters, 3/25).

Chances of Becoming Law Dim

According to the Columbus Dispatch, the measure faces potential opposition from some members of the state Senate and Gov. John Kasich (R). The lawmakers have expressed concern that the measure would be found unconstitutional if challenged in court.

Ohio Senate President Keith Faber (R) said the state Senate would hold hearings on the measure "at some point" (Columbus Dispatch, 3/26). However, he added, "I'm still waiting for that legal scholar to come forward and say that the heartbeat bill is constitutional."

Meanwhile, antiabortion-rights groups said they plan to increase lobbying efforts on the state Senate to pass the bill (Cleveland Plain Dealer, 3/25).


Supreme Court Sides With Former UPS Worker in Pregnancy Discrimination Case

Thu, 03/26/2015 - 18:21

In a 6-3 decision, the Supreme Court on Wednesday ruled that UPS was wrong to deny a pregnant worker accommodations it offers to other employees, USA Today reports.

Supreme Court Sides With Former UPS Worker in Pregnancy Discrimination Case

March 25, 2015 — In a 6-3 decision, the Supreme Court on Wednesday ruled that UPS was wrong to deny a pregnant worker accommodations it offers to other employees, USA Today reports (Wolf, USA Today, 3/25).

Peggy Young, the former UPS driver who brought the case, had sued for pregnancy discrimination but had her claims rejected in lower courts (Sherman, AP/ABC News, 3/25).

According to USA Today, the case is of "critical importance" for pregnant workers. More than six in 10 women who give birth were employed during the 12 months prior to giving birth, USA Today reports (USA Today, 3/25).

Case Background

While pregnant with her daughter more than seven years ago, Young presented UPS with notes from her doctor and midwife stating that she should not lift heavy objects during her pregnancy. However, UPS denied Young a light-duty assignment that would have allowed her to continue working.

Young then took an unpaid leave of absence, during which she lost her employer-sponsored health insurance and pension benefits, and returned to her job after giving birth. She later sued UPS under the 1978 Pregnancy Discrimination Act (PL 95-555) and left the company in 2009.

A federal district court ruled against Young, granting summary judgment for UPS rather than conducting a trial. The 4th U.S. Circuit Court of Appeals affirmed the district court's decision. Young appealed to the Supreme Court, which heard the case in December (Women's Health Policy Report, 12/4/14).

Ruling Details

The justices in the majority said that Young's case should go back to the lower courts for a possible trial that would center on why the company refused to accommodate her request for a temporary assignment but allowed such accommodations for injured workers.

Justice Stephen Breyer wrote the majority opinion, joined by Chief Justice John Roberts and Justices Ruth Bader Ginsburg, Elena Kagan and Sonia Sotomayor. Justice Samuel Alito also sided with the majority but wrote a separate opinion.

UPS had argued that the PDA permitted employer policies that gave special preferences to workers injured on the job. However, Breyer said the lower courts should have taken into account the company's reasoning for accommodating non-pregnant workers. "Why, when the employer accommodated so many, could it not accommodate pregnant workers as well?" Breyer wrote (Stohr, Bloomberg, 3/25).

Specifically, Breyer said the lower courts should determine if UPS had "legitimate, nondiscriminatory, nonpretextual justification" for the different treatment of pregnant employees. He added that there is a "genuine dispute as to whether UPS provided more favorable treatment to at least some employees whose situation cannot reasonably be distinguished from Young's."

Dissent

In a dissent, Justices Anthony Kennedy, Antonin Scalia and Clarence Thomas said the majority went beyond the scope of the PDA. The majority's decision could make it more difficult for employers to justify workplace policies that could potentially burden pregnant women, the dissent argued (Hurley, Reuters, 3/25).

Reaction

Young's attorney, Samuel Bagenstos, said, "The Court made clear that employers may not refuse to accommodate pregnant workers based on considerations of cost or convenience when they accommodate other workers. It's a big step forward towards enforcing the principle that a woman shouldn't have to choose between her pregnancy and her job" (Carmon, MSNBC, 3/25).

National Partnership for Women & Families Senior Advisor Judith Lichtman praised the ruling, saying it "is good news for Peggy Young and for all pregnant workers." She added that the decision "issues a clear and welcome message to employers that accommodating most non-pregnant workers with injuries or disabilities while refusing to accommodate most pregnant workers is against the law. All employers should now re-examine their policies to ensure that pregnant women will not face discrimination on the job" (National Partnership statement, 3/25).


Two Antiabortion-Rights Bills Advance in Tenn. House

Thu, 03/26/2015 - 17:03

A Tennessee House subcommittee on Tuesday voted to advance two bills that would place new restrictions on abortion in the state, the Tennessean reports.

Two Antiabortion-Rights Bills Advance in Tenn. House

March 26, 2015 — A Tennessee House subcommittee on Tuesday voted to advance two bills that would place new restrictions on abortion in the state, the Tennessean reports (Wadhwani, Tennessean, 3/25).

According to the AP/Rock Hill Herald, the bills aim to implement abortion restrictions previously struck down by the state Supreme Court. The Tennessee House Health Subcommittee approved the new measures with voice votes (Johnson, AP/Rock Hill Herald, 3/24).

Bill Details

According to the Tennessean, one of the bills would impose a mandatory delay before a woman can obtain an abortion and require that she be provided with biased counseling prior to the procedure.

The other measure (HB 1368) would require all facilities that perform more than 50 abortions annually to be certified as ambulatory surgical centers. According to the Tennessean, the requirement could force some clinics to close (Tennessean, 3/25).

The AP/Herald reports that companion bills for both measures are before the state Senate Judiciary Committee (AP/Rock Hill Herald, 3/24).

Debate

State Rep. Matthew Hill (R) said the mandatory delay is intended to provide a woman seeking an abortion with a chance "to consider other options for the well-being of herself and her unborn child."

However, state Rep. John Ray Clemmons (D) said, "There seems to be a misunderstanding that a lady who decides to get an abortion ... can simply wake up and have an abortion." He noted that the measure would require women to incur additional expenses by having to make two trips to an abortion clinic, adding, "I do have concerns we are placing substantial obstacles" in the way of women's access to abortion (Tennessean, 3/25).