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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Abortion Providers Must Delve Into Context of Stigma Surrounding Their Profession

2 hours 46 min ago

In a commentary, University of California-San Francisco's Carole Joffe writes about the stigma surrounding abortion providers and their marginalization in relation to other physicians. She discusses such issues in the context of both historical developments and recent increases in abortion restrictions throughout the U.S., concluding that one way to address abortion stigma is to explore the difference between stigma, marginality and controversy.

Abortion Providers Must Delve Into Context of Stigma Surrounding Their Profession

November 25, 2014 —Summary of "Commentary: Abortion Provider Stigma and Mainstream Medicine," Joffe, Women & Health, September 2014.

"[A]bortion provision has been highly regulated in the United States, and abortion providers have been subjected to unacceptable levels of violence and harassment -- with some researchers referring to this violence as an 'epidemic,'" writes Carole Joffe, a professor at the Bixby Center for Global Reproductive Health at the University of California-San Francisco. She cites several examples of this harassment and regulatory restriction, including the deaths of several members of the "abortion-providing community," congressional interference in the practice of abortion medicine and the "[h]undreds of 'TRAP laws'" adopted by states that are "widely acknowledged to have little to do with safety and everything to do with forcing clinics to close," among other antiabortion-rights legislation.

Roots of Abortion Stigma

According to Joffe, the stigmatism that comes with being an abortion provider likely originates from the era before Roe v. Wade, "when illegal abortions were plentiful and supplied by a wide range of providers." She writes that although some of the physicians who provided abortions during this time "were trained and competent" doctors "who risked imprisonment and loss of license" for performing the procedures, others "were far less competent, and often unethical -- the infamous 'back alley abortionists' or 'butchers' as they have been named."

These incompetent providers "became the face of abortion providers" because their patients were "disproportionately seen in hospital emergency rooms," Joffe argues, adding that as a result, obstetrics and gynecology departments were very hesitant to "normaliz[e] abortion care within their hospitals."

According to Joffe, this hesitation was "one of several factors that led to freestanding clinics becoming the major site for abortion services in the U.S." However, in turn, this development led to some positive results, such as lowering abortion care costs compared with hospital-provided care and allowing clinics "to hire nursing and counseling staff who -- unlike many hospital nurses -- support women's abortion decisions," Joffe writes, adding that clinics have also "amassed an impressive safety record -- according to researchers, ... about 14 times safer than childbirth."

However, Joffe writes that this development also made abortion more detached from mainstream medicine and more susceptible to restrictive legislation and harassment from abortion opponents. In response to these restrictions, providers "have expended huge amounts of resources on legal fees to try to challenge various restrictions, or failing that, to figure out how to best comply with them without compromising patient care," she writes. Meanwhile, providers concerned about ongoing harassment have installed security features such as "bullet-proof glass, video cameras, and so on" both at their homes and their offices, Joffe adds.

Role of Medical Community

Joffe asks, "But what about the response from elsewhere in medicine?" She notes that others in the medical community during the years since Roe have offered "little overt defense" of abortion providers, likely because of "a combination of still-lingering memories of the pre-Roe era, wariness about the potential of retribution from the anti-abortion movements, and perhaps most significantly, the medical profession's longstanding aversion to controversy of any kind."

However, Joffe acknowledges that "[i]n recent times ... as the number of restrictions on abortion has multiplied, and grown ever more extreme, more individual physicians and medical organizations have protested this treatment." For example, "Marcia Angell, the former editor of the New England Journal of Medicine and currently a professor at Harvard Medical School, and Michael Greene, a professor of obstetrics and gynecology, also at Harvard," recently penned a "blistering essay in USA Today" protesting physicians' comparatively silent reaction to this "'legal assault.'" Further, she notes that "other physician groups, such as medical societies in Pennsylvania, Wisconsin, Texas, and Arizona, have begun to speak out against abortion restrictions," as has the American College of Obstetricians and Gynecologists, which, historically, maintained "relative silence about abortion."

Overcoming Stigma

"The path to overcoming the stigma facing abortion providers is not clear-cut," Joffe writes. According to Joffe, the establishment of the "privately-funded Fellowship in Family Planning and Abortion for post-residency ob-gyns interested in specialized training" has helped to normalize the procedure within mainstream medicine. Still, abortions will likely "continue to take place in freestanding clinics, and the problems discussed here will remain" for the foreseeable future.

Although there are no "easy answers -- either practical or theoretical to the dilemmas facing abortion providers," Joffe argues that "[s]tudents of stigma need to push further to distinguish analytically between 'stigma' and two related concepts that are often applied to abortion providers: 'marginality' and 'controversy.'" She writes, "Pushing further on these distinctions is a fruitful way for our work to proceed."

Common Methods for Estimating Chlamydia Screening Rates Inaccurate, Study Finds

2 hours 48 min ago

Inconsistent methods for calculating chlamydia screening rates have made it difficult to accurately assess how many women undergo annual testing, which is recommended for all sexually active women under age 26. In this study, University of Washington-Seattle researchers compared methods that rely on self-reports and insurance data, finding that neither method alone is sufficient to accurately estimate screening rates.

Common Methods for Estimating Chlamydia Screening Rates Inaccurate, Study Finds

November 25, 2014 —Summary of: "Estimating Chlamydia Screening Coverage: A Comparison of Self-Report and Health Care Effectiveness Data and Information Set Measures," Khosropour et al., Sexually Transmitted Diseases, November 2014.

Professional medical associations and U.S. government health organizations recommend that all sexually active women younger than age 26 undergo annual chlamydia screening, but "efforts to monitor the uptake of the testing recommendations have been problematic," according to a study by Christine Khosropour of the University of Washington-Seattle's Department of Epidemiology and colleagues.

The problems stem from "inconsistencies" in the definitions of and methods for calculating the sexually active population and the number of women who have had annual testing, the researchers explained. These inconsistencies have resulted in estimates of screening rates that "vary widely," they wrote.

Existing Estimation Methods

"[O]ne of the most widely used and cited methods" to estimate chlamydia testing rates is the Healthcare Effectiveness Data and Information Set (HEDIS) measure, which uses administrative and claims data from private and Medicaid health plans to estimate how many sexually active women undergo annual testing.

However, the HEDIS measure does not incorporate women who were tested out of plan and also "may misestimate the number of women who are truly sexually active and require screening," the researchers explained. To address this, CDC researchers use self-reported data from the National Survey of Family Growth when calculating their screening estimates, although the "validity of self-reported chlamydia testing has not been well studied," they noted.

Khosropour and colleagues developed a study that aimed to gauge the validity of both the HEDIS measure and self-reports for estimating chlamydia screening rates among sexually active women.

Study Methods

Beginning in July 2010, Khosropour and colleagues surveyed a random sample of women ages 18 to 25 who were enrolled in Group Health Cooperative, a managed care system in Washington state, in 2009. The survey consisted of a two-page, self-administered questionnaire that asked women about their demographics, sexual activity and use of health care services in 2009. The researchers also requested the women's permission to link their survey responses to their electronic medical records from Group Health Cooperative.

The researchers used the survey responses to gauge self-reported sexual activity and chlamydia testing, while the EMR databases were used to calculate the HEDIS measures of those factors.

Women with self-reported sexual activity included those who answered affirmatively to a survey question asking whether they had had vaginal intercourse with a man in 2009, while women were classified as meeting the HEDIS definition of sexual active "if they had diagnosis, prescription, or laboratory codes" from 2009 for services related to Pap testing, pelvic exams, contraception, pregnancy, or screening or treatment for a sexually transmitted infection.

Among women with self-reported sexual activity, the researchers compared rates of self-reported chlamydia testing and HEDIS-determined chlamydia testing, which was defined as women with at least one chlamydia test in their health record in 2009. They also compared rates of women who self-reported that they were sexually active and not tested with the HEDIS measure of untested women in this population.

Results

Out of an initial sample of 1,000 women, the analysis included 377 women who returned the questionnaire and agreed to grant access to their EMR data.

Of those, 269 (71%) self-reported being sexually active in 2009, including 142 (52.8%) who self-reported being tested for chlamydia, although only 108 had a chlamydia test in their record. In addition, 51 of the 269 women indicated that they were tested out of plan, but only 14 of them had a test noted in their record.

Meanwhile, based on the HEDIS definitions of sexual activity and testing, 239 of the 377 women were considered sexually active, 113 (47.3%) of whom were tested for chlamydia.

Discussion

The findings demonstrate "that, for different reasons, neither the HEDIS measure nor self-report is likely to be an accurate measure of chlamydial screening and suggest the need for new approaches to estimate population-level chlamydia screening coverage," according to the researchers.

For example, "HEDIS somewhat overestimated" the sexually active population, compared with the self-report figure, the researchers wrote. This "could lead to an underestimation of the proportion of women screened," they added, noting that the HEDIS measure classified nearly 40% of women who said they had not had sex as sexually active.

Another limitation of the HEDIS measure is that about one-fifth of sexually active respondents said they underwent chlamydia testing out of plan. Many of these women had no record of the test in their EMR, and about one-fourth "were excluded from the HEDIS estimate completely," the researchers wrote.

Meanwhile, nearly 30% of women whose medical records showed that they had been tested said that they had not been screened, "indicating that self-report is not a highly accurate approach for estimating population-level screening coverage," while 26% of those who said they had been tested in plan had no record of such tests in their record, according to the study. "This finding is particularly important for health care providers who rely on patient self-report to assess chlamydia testing history," the researchers wrote.

The researchers predicted that "estimates of chlamydia testing will likely become more accurate" as more people gain health insurance and data sharing across EMR systems improves.

"However, given the additional complexity of defining the sexually active population, the most appropriate method to estimate screening coverage almost certainly involves combining data sources to separately estimate the components of the screening coverage estimate," they wrote, concluding that doing so would enable implementation of "a standardized, population-based testing coverage estimate" that could "provide the best possible estimates of chlamydia screening coverage in the United States."

Parent-Daughter Communication Affects Teens' Likelihood of Discussing Abortion Decisions

2 hours 49 min ago

Researchers at the University of Chicago examined the effect of parent-daughter communication about sexual health, pregnancy and abortion on teens' abortion decisions and whether they would tell their parents about those decisions. The researchers recommended efforts that focus on providing parents with the necessary tools to discuss sexual health with their daughters, rather than on parental involvement laws mandating such communication during pregnancy.

Parent-Daughter Communication Affects Teens' Likelihood of Discussing Abortion Decisions

November 25, 2014 —Summary of "Parent-Daughter Communication About Abortion Among Nonpregnant African-American Adolescent Females," Sisco et al., Journal of Adolescent Health, December 2014.

"[T]here is strong evidence associating parent-daughter communication [about sexual health] with improved sexual health outcomes such as less favorable attitudes toward risky sexual behaviors, higher rates of contraceptive use, avoidance of sexually transmitted infections (STIs), and effective communication with sexual partners" among nonpregnant teenagers, according to Katherine Sisco and colleagues at the University of Chicago's Department of Obstetrics and Gynecology. Further, they noted that evidence shows that parental communication and the perception of parental support affects whether adolescents will disclose suspected pregnancies to their parents.

By contrast, "there are no such data supporting the value of parent-daughter communication" for pregnant adolescents, the researchers wrote, adding that despite this lack of research, "most states legislate communication between abortion-seeking minors and their parent(s) via [parental involvement (PI)] laws." In fact, the researchers noted that "[s]tudies dating back to the 1980s and 1990s demonstrate that parents are often involved in a minor's decision to have an abortion independent of the legal requirement," but that when teenagers opt not to involve a parent, they often "cite fear of negative parental reactions, lack of or fragile relationships with parents, and desire to avoid parental pressure in the decision-making process."

The researchers conducted a study from May 2010 to March 2011 of "nonpregnant African-American adolescents to better understand parent-daughter communication about abortion."

Methods

For the study, the researchers reviewed "the extant literature ... to identify knowledge and knowledge gaps regarding African-American parent-daughter abortion communication." The researchers then identified and surveyed focus groups of 23 African-American girls ages 14 to 17. According to the study, the focus groups "primarily focused on [four] topics: language adolescents use to discuss abortion, parent-daughter communication, parental attitudes toward abortion, and cultural perspectives on abortion and abortion stigma."

The researchers used information gathered from the focus groups to create a survey that focused on four areas: sociodemographic characteristics; parental relationship variables; parental communication about abortion and sexual health; and parents' perceived attitudes of and reactions to adolescent sex, pregnancy and abortion. According to the study, survey participants were African American, nonpregnant, female adolescents, ages 14 to 17, recruited from three charter high schools in Chicago.

Results

The researchers assessed responses from 265 survey respondents. They found that while 75% of respondents reported having generally discussed sex with their main parent, just 43% said they talked specifically about abortion.

The study also found that:

~ 19.2% of respondents said they thought their parent "would hurt, punish, or kick them out of the house" if they became pregnant and decided to have an abortion, including 21.6% of those who had talked to their parent about abortion and 17.3% who had not;

~ 79.1% said they thought their parent would be supportive, provide monetary support or go along with them to an abortion clinic, including 75% of those who had spoken to their parent about abortion and 82.1% who had not; and

~ 24.7% of respondents said they would not voluntarily tell their parent if they decided to have an abortion, including 23.9% who had talked to their parent about abortion and 25.2% of those who had not.

Further, the researchers found that whether respondents had communicated with their parent about abortion "was significantly associated" with:

~ Having a mother who had experienced a teen pregnancy;

~ Being a supporter of abortion-rights;

~ Having talked about STIs or contraceptives with their parent; and

~ Whether they thought their parent would approve of adolescent sexual activity.

By contrast, the researchers found that discussing abortion with a parent was inversely associated with being experienced sexually or thinking a parent would be supportive of abortion decisions. The researchers wrote that communicating with a parent about abortion "was not significantly associated with parental monitoring or relationship satisfaction."

Discussion

The researchers wrote that the study "has important implications for PI laws," including that the"finding that the vast majority of youth would tell a parent appears to obviate the need for these laws" and how "almost a quarter of those who would not tell often had communicated about abortion and knew the risk that telling a parent would entail."

In addition, the study demonstrates the complexity of parent-daughter communication about sexual health, the researchers argued. Specifically, they wrote that such communication is "not associated with sexual experience" and that abortion communication in particular "is associated with a host of attitudes that the daughter herself holds or perceives to be held by her parent and parent-daughter relationship factors."

In summary, the findings "suggest that it would be prudent to focus efforts on giving parents and families the tools and resources to hold conversations about sexual and reproductive health with their nonpregnant daughters," while "[p]olicies that force communication at the time of abortion seem misplaced," the researchers concluded.

Study: Most Women Can Self-Assess Pregnancy Test Results After Early Medication Abortions

2 hours 52 min ago

Researchers at the Royal Infirmary of Edinburgh examined whether women could reliably self-assess the results of pregnancy tests after undergoing early medication abortions. They found that that "most women ... neither want nor need scheduled telephone contact from a provider" after an early medication abortion and "feel comfortable with taking the responsibility for interpreting the result of [a pregnancy] test" after their abortions.

Study: Most Women Can Self-Assess Pregnancy Test Results After Early Medication Abortions

November 25, 2014 —Summary of "Can Women Determine the Success of Early Medical Termination of Pregnancy Themselves?" Cameron et al., Contraception, Sept. 18, 2014.

Follow-up appointments to determine the success of early medical termination of pregnancies (TOPs) "traditionally [have] involved a routine clinic visit for ultrasound," which "can lead to unnecessary medical or surgical intervention" and "may limit the number of new referrals that can be seen," according to S.T. Cameron of the Royal Infirmary of Edinburgh, United Kingdom, and colleagues. Further, the researchers noted that patients in an alternative telephone follow-up program instituted by Edinburgh's TOP service in 2011 increasingly requested "not to receive a routine call."

In April 2012, Edinburgh's TOP service began allowing women who had early medication abortions to not receive the telephone call if they chose a self-assessment option, "provided that they understood how to conduct and interpret [a] urinary pregnancy test and signs and symptoms that indicated the need to contact the TOP service," the researchers explained.

Cameron and colleagues conducted a study to determine how many women selected the self-assessment option, how many of them later contacted the abortion provider and the time frame until any women presented with an ongoing pregnancy (failed TOP).

Methods

The researchers conducted a "retrospective review of the TOP service databases ... for all women choosing self-assessment" within the study period at a hospital outpatient clinic and a community sexual and reproductive health (SRH) clinic in Edinburgh.

According to the study, the medication abortion regimen used by Edinburgh's TOP service was a 200 milligram dose of mifepristone, with women taking an 800 microgram dose of misoprostol 24 to 48 hours later.

All women who underwent early medication abortions were provided with a low sensitivity pregnancy (LSUP) test during their clinic visit and instructed on when and how to self-administer the test. Clinic staff members also informed the women of signs or symptoms "that might indicate an ongoing pregnancy and for which they should contact the [TOP] service," the researchers wrote. The women were also offered no-cost contraceptives to start on the same day they received the misoprostol.

Women selecting the self-assessment option signed a form indicating that they wished to do so and understood that they were responsible for contacting Edinburgh's TOP service if:

~ The pregnancy test was positive, invalid or they were not certain of the result; or

~ The pregnancy test was negative and they had bleeding for fewer than four days, persisting pregnancy symptoms or their next period did not arrive within one month post-treatment.

Results

The researchers analyzed data on 1,791 women between April 2012 and October 2013 who had an early medication abortion and selected to expel the pregnancy at home, including 1,726 (96%) who chose the self-assessment option. While all women from the SRH clinic selected the self-assessment option, 42 of the women from the hospital opted to receive a follow up by telephone and 23 opted to schedule a clinic visit to administer an ultrasound as a follow up.

Cameron and colleagues found that 220 (13%) of the women who opted for self-assessment contacted the TOP service after their abortion. Of those, 188 (11%) made primary contact by telephone and 32 (2%) made an unscheduled or emergency visit to a hospital outpatient clinic or SRH.

Of the 188 women who called the TOP service, 120 scheduled clinic visits and 100 cited reasons flagged by the self-assessment instructions. Specifically:

~ 43 were because of less bleeding than expected;

~ 28 were for an invalid LSUP test result;

~ 17 were for a positive LSUP test result;

~ Seven were because of concerns about persisting pregnancy symptoms; and

~ Five were because they had not had a period post-treatment.

Overall, the researchers found that eight of the women who opted for self-assessment had an ongoing pregnancy, or failed TOP. All of those patients underwent subsequent, successful TOPs.

Discussion

"This study showed that when given the option, most women who are planning to go home to expel a pregnancy following an early medical TOP choose not to receive a phone call from the TOP service," Cameron and colleagues wrote, noting that the findings suggest "most women feel comfortable with taking the responsibility for interpreting the result of LSUP test."

Further, the researchers noted that the study found "relatively few women (approximately 1 in 10) actually do make contact with the TOP service with a concern related to the procedure" and also "confirmed the low rate of ongoing pregnancy with early medical TOP."

The researchers acknowledged that some providers might be concerned about the added patient responsibility to assess the LSUP test and follow up, as needed, with the TOP service, especially if late detection of an ongoing pregnancy occurs in an area where "midtrimester abortion is not legal or not available." However, the researchers noted that their "study provides some reassurance in this respect, since the delay between medical TOP and presentation at clinic with diagnosis of ongoing pregnancy did not appear to differ" from research reviews of other follow-up methods.

"The evidence now clearly shows that the pathway for women requesting an early medical TOP who are certain of their decision could consist of a single clinic visit," the researchers concluded.

Featured Blogs

6 hours 11 min ago

"Ohio Republicans Use Extreme Measures To Advance Radical Six Week Abortion Ban" (Culp-Ressler, "ThinkProgress," Center for American Progress, 11/21); "Nevada Teen Rallies Students To Fight for Comprehensive Sex Ed" (Ramirez, Care2, 11/22).

November 25, 2014

FEATURED BLOG

"Ohio Republicans Use Extreme Measures To Advance Radical Six Week Abortion Ban," Tara Culp-Ressler, Center for American Progress' "ThinkProgress": Culp-Ressler discusses how "Republican lawmakers in Ohio pulled out all the stops to advance an extreme anti-abortion bill [HB 248] in the state's lame duck session" that would ban abortion once a fetal heartbeat is detectable, which can be as early as six weeks of pregnancy. She points out that the lawmakers "added the legislation to the schedule at the last minute ... and even restructured a House committee -- replacing the legislators who oppose the measure with different legislators who support it -- to ensure the bill's passage." Culp-Ressler notes that, as has been the case in several other states, Ohio abortion-rights opponents are split over the measure, with some "argu[ing] it's better to advance an incremental strategy to limit access to abortion that won't trigger immediate court challenges." Meanwhile, "[r]eproductive rights groups are frustrated that abortion opponents would waste taxpayer dollars on risking a lawsuit," Culp-Ressler writes (Culp-Ressler, "ThinkProgress," Center for American Progress, 11/21).

What others are saying about abortion restrictions:

~ "Anti-Choice Activists in Alabama Equate Abortion Clinics With Sex Offenders," Culp-Ressler, Center for American Progress' "ThinkProgress."

~ "What It's Like To Run the Only Abortion Clinic in Your State," Robin Marty, Cosmopolitan.

FEATURED BLOG

"Nevada Teen Rallies Students To Fight for Comprehensive Sex Ed," Ximena Ramirez, Care2: Ramirez writes about Caitlyn Caruso, a high school student who "rallied her classmates to demand a comprehensive and medically accurate [sex education] curriculum" in a Nevada school where students "overwhelmingly reported" that their current sex education course was "'extremely vague and too conservative.'" Caruso, a sexual assault survivor, "believes that sex ed programs need to address identity formation, healthy relationships, and ways to prevent rape and sexual assault in addition to contraception," Ramirez writes. Ramirez adds that Caruso has also formed the Nevada Teen Health & Safety Coalition, which shares "compelling videos," that support "comprehensive, medically accurate, and age appropriate" sex education (Ramirez, Care2, 11/22).


Abortion-Rights Opponents Push Bill To Close Sole North Ala. Clinic

6 hours 17 min ago

A group of abortion-rights opponents in Huntsville, Ala., aims to close North Alabama's only abortion clinic through legislative efforts after a judge dismissed the group's lawsuit against the clinic, the Huntsville Times reports.

Abortion-Rights Opponents Push Bill To Close Sole North Ala. Clinic

November 25, 2014 — A group of abortion-rights opponents in Huntsville, Ala., aims to close North Alabama's only abortion clinic through legislative efforts after a judge dismissed the group's lawsuit against the clinic, the Huntsville Times reports (Lawson, Huntsville Times, 11/23).

Background

The Huntsville Women's Clinic in October reopened in a new location after closing in June because its old location did not comply with a state law (HB 57) that requires abortion clinics to meet the same building standards as ambulatory surgical centers (Women's Health Policy Report, 10/24).

The Christian Coalition of Alabama filed suit against the clinic, arguing that it should not be allowed to open unless it applies to be zoned as a surgical center. According to the Times, the clinic was granted a zoning variance previously given to other medical clinics in that space.

Madison County Circuit Judge Alan Mann last week denied CCA's request for a temporary injunction and dismissed the case. He said the plaintiffs did not have standing to bring the lawsuit because none of them were affected by the clinic's location. Mann also found that the zoning board acted in its normal capacity when it zoned the clinic.

CCA Pushes School Zoning Bill

James Henderson, executive director of CCA, said it was unlikely that his organization would appeal the ruling. Instead, Henderson, who is also a member of the Alabama Republican Party's executive committee, said the group will ask local lawmakers to support a measure that would require a 2,000-foot minimum barrier between a school and an abortion clinic.

According to the Times, the clinic is located "almost directly across" from a school.

Henderson said David Byrne, chief legal adviser for Gov. Robert Bentley (R), has encouraged the school-barrier effort. In a letter provided to the Times, Byrne wrote that he told Henderson in June he would be "happy to assist" lawmakers "closely associated with" CCA to pre-file any legislation for 2015. However, Byrne in the letter also noted the Governor's Legal Office is prohibited from doing legal work for a private group, according to the Times (Huntsville Times, 11/23).


Studies: Violence Against Women, Girls a Worldwide 'Problem of Epidemic Proportions'

6 hours 41 min ago

Violence against women and girls is a "global public health and clinical problem of epidemic proportions," and countries need to enact significant policy and financial changes to help curb such violence, according to a five-part series of studies published in The Lancet, Time reports.

Studies: Violence Against Women, Girls a Worldwide 'Problem of Epidemic Proportions'

November 25, 2014 — Violence against women and girls is a "global public health and clinical problem of epidemic proportions," and countries need to enact significant policy and financial changes to help curb such violence, according to a five-part series of studies published in The Lancet, Time reports (Alter, Time, 11/21).

Key Findings

According to the series, one in three women worldwide have experienced physical or sexual violence by a partner, and 7% of women are assaulted during their lifetimes by a non-partner.

In addition, between 100 million and 140 million women and girls have been subjected to female genital mutilation, and more than three million African girls are at risk of FGM annually. Further, about 70 million girls have been married before age 18, according to the series.

WHO's Claudia Garcia-Moreno and colleagues wrote, "The full extent of abuse is even greater, with multiple different forms of violence around the world often remaining uncounted and under-researched" (Boseley, The Guardian, 11/20).

Causes, Impact of VAW

The series noted that a large portion of existing research on violence against women has focused on response, rather than prevention, and on high-income countries. The researchers found that a lack of gender equality is a key contributor to violence against women in low- and middle-income countries.

They added that the root causes of such inequality, including the economic, educational and political marginalization of women, must be addressed to decrease violence against women (Time, 11/21). They also said more needs to be done to address other root causes of violence, including wars and humanitarian crises (Bushak, "The Grapevine," Medical Daily, 11/22).

Meanwhile, Garcia-Moreno said in a statement that the findings demonstrate that health care providers are "missing important opportunities to integrate violence programming meaningfully into public health initiatives on HIV/AIDS, adolescent health, maternal health, and mental health" (Time, 11/21). WHO added the series shows that "[d]espite increased global attention to violence perpetrated against women and girls, and recent advances in knowledge about how to tackle these abuses, levels of violence against women ... remain unacceptably high, with serious consequences for victims' physical and mental health."

Recommendations

The series' authors provided five key recommendations to reduce violence against women.

The authors said that governments worldwide should allocate additional funding to protect survivors and prioritize raising awareness about violence against women; change laws and policies that contribute to gender inequality, such as virginity tests; put more effort toward combatting negative cultural mindsets about women; do more to promote education, health, security and justice; and fund further research on effective ways to prevent and respond to violence against women ("The Grapevine," Medical Daily, 11/22).

Series co-leader Charlotte Watts said, "No magic wand will eliminate violence against women and girls. But evidence tells us that changes in attitudes and behavior are possible, and can be achieved within less than a generation" (Time, 11/21).


Blogs Comment on 'Radical Six Week Abortion Ban,' Localization of 'Personhood' Movement, More

6 hours 41 min ago

Read the week's best commentaries from bloggers at the Center for American Progress, RH Reality Check and more.

Blogs Comment on 'Radical Six Week Abortion Ban,' Localization of 'Personhood' Movement, More

November 25, 2014 — Read the week's best commentaries from bloggers at the Center for American Progress, RH Reality Check and more.

ABORTION RESTRICTIONS: "Ohio Republicans Use Extreme Measures To Advance Radical Six Week Abortion Ban," Tara Culp-Ressler, Center for American Progress' "ThinkProgress": Culp-Ressler discusses how "Republican lawmakers in Ohio pulled out all the stops to advance an extreme anti-abortion bill [HB 248] in the state's lame duck session" that would ban abortion once a fetal heartbeat is detectable, which can be as early as six weeks of pregnancy. She points out that the lawmakers "added the legislation to the schedule at the last minute ... and even restructured a House committee -- replacing the legislators who oppose the measure with different legislators who support it -- to ensure the bill's passage." Culp-Ressler notes that, as has been the case in several other states, Ohio abortion-rights opponents are split over the measure, with some "argu[ing] it's better to advance an incremental strategy to limit access to abortion that won't trigger immediate court challenges." Meanwhile, "[r]eproductive rights groups are frustrated that abortion opponents would waste taxpayer dollars on risking a lawsuit," Culp-Ressler writes (Culp-Ressler, "ThinkProgress," Center for American Progress, 11/21).

What others are saying about abortion restrictions:

~ "Anti-Choice Activists in Alabama Equate Abortion Clinics With Sex Offenders," Culp-Ressler, Center for American Progress' "ThinkProgress."

~ "What It's Like To Run the Only Abortion Clinic in Your State," Robin Marty, Cosmopolitan.

ANTIABORTION-RIGHTS MOVEMENT: "'Personhood' Leader: Localize the Fight Against Abortion Rights," Jason Salzman, RH Reality Check: After voters recently rejected "personhood" measures in Colorado and North Dakota, Personhood Alliance Policy Director Gualberto Garcia Jones is urging other abortion-rights opponents to "forgo statewide votes and place personhood proposals on municipal ballots," Salzman writes. According to Salzman, "ardent anti-abortion activists from around the country" launched the Personhood Alliance "to insert anti-choice language in local 'ordinances and codes'" and cite "local efforts in Alabama, New Hampshire, and Mississippi as examples of what its future activism might look like." However, Salzman notes that "[p]ro-choice activists" -- such as Cathy Alderman, vice president of public affairs for Planned Parenthood of the Rocky Mountains, and Cristina Aguilar, executive director of the Colorado Organization for Latina Opportunity and Reproductive Rights -- "said they are preparing for the ultra-local fight about to be waged by personhood extremists, and they're confident that voters will strike down ballot initiatives in municipalities as readily as they did on the state level" (Salzman, RH Reality Check, 11/24).

SEX EDUCATION: "Nevada Teen Rallies Students To Fight for Comprehensive Sex Ed," Ximena Ramirez, Care2: Ramirez writes about Caitlyn Caruso, a high school student who "rallied her classmates to demand a comprehensive and medically accurate [sex education] curriculum" in a Nevada school where students "overwhelmingly reported" that their current sex education course was "'extremely vague and too conservative.'" Caruso, a sexual assault survivor, "believes that sex ed programs need to address identity formation, healthy relationships, and ways to prevent rape and sexual assault in addition to contraception," Ramirez writes. Ramirez adds that Caruso has also formed the Nevada Teen Health & Safety Coalition, which shares "compelling videos," that support "comprehensive, medically accurate, and age appropriate" sex education (Ramirez, Care2, 11/22).

SUPPORTING PREGNANCY DECISIONS: "U.S. Law and Policy Should Uphold and Support a Woman's Personal Decisions About Her Pregnancy," Ann Starrs, Huffington Post blogs: An upcoming Supreme Court case examining whether UPS "violated the 1978 Pregnancy Discrimination Act [PL 95-555]" by "fail[ing] to make reasonable accommodation for a pregnant employee" highlights "the often hostile legal and policy environment U.S. women confront on issues surrounding pregnancy," writes Starrs, president and CEO of the Guttmacher Institute. Starrs writes, "Rather than making it more difficult for women to achieve their pregnancy goals, U.S. law and regulations should" implement "policies that allow women and their partners to decide whether and when to become pregnant, to have healthy pregnancies, to raise their families with dignity, and to obtain abortion care to end an unwanted pregnancy." Specifically, Starrs calls on courts and federal and state lawmakers to ensure women are provided "with the contraceptive services, counseling and supplies they need," have "access to affordable, timely and safe abortion care" and -- if they chose to become pregnant -- "are reasonably accommodated by their employers without sacrificing their economic security" (Starrs, Huffington Post blogs, 11/24).

SEXUAL AND GENDER-BASED VIOLENCE: "Why I Never Reported My Sexual Assault," Talia Lavin, Huffington Post blogs: "In recent days, media outlets of every description have been engaged in a long-overdue conversation about rape and sexual assault" because of an "explosion of [sexual assault] allegations against Bill Cosby," but the coverage has also included "backlash ... against Cosby's alleged victims," Lavin writes. She notes, "This all-too-familiar combination -- recrimination for delays in coming forward, coupled with doubt and vitriol -- comes along with the same tired scrutiny of their every action (why did she go to his hotel room? Why did she take a drink, and pills, that he offered her?)" that results in "only 26% of sexual assaults" being "reported to authorities" and just "3 out of every 100 rapes" resulting in conviction. Noting that concerns about such backlash kept her from sharing her own sexual assault story, Lavin notes that sexual assault survivors can "regain some of that sovereignty over [their] own voice[s]" by sharing their stories and by being believed (Lavin, Huffington Post blogs, 11/24).

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

~ "Map: How Long Does Your State Give Rape Survivors To Pursue Justice?" Jordan Smith/AJ Vicens, Mother Jones.

~ "What Bill Cosby and the University of Virginia Can Teach Us," Jennifer Williams, Ms. Magazine blog.


Abortion-Rights Opponents Push Bill To Close Sole North Ala. Clinic

6 hours 42 min ago

A group of abortion-rights opponents in Huntsville, Ala., aims to close North Alabama's only abortion clinic through legislative efforts after a judge dismissed the group's lawsuit against the clinic, the Huntsville Times reports.

Abortion-Rights Opponents Push Bill To Close Sole North Ala. Clinic

November 25, 2014 — A group of abortion-rights opponents in Huntsville, Ala., aims to close North Alabama's only abortion clinic through legislative efforts after a judge dismissed the group's lawsuit against the clinic, the Huntsville Times reports (Lawson, Huntsville Times, 11/23).

Background

The Huntsville Women's Clinic in October reopened in a new location after closing in June because its old location did not comply with a state law (HB 57) that requires abortion clinics to meet the same building standards as ambulatory surgical centers (Women's Health Policy Report, 10/24).

The Christian Coalition of Alabama filed suit against the clinic, arguing that it should not be allowed to open unless it applies to be zoned as a surgical center. According to the Times, the clinic was granted a zoning variance previously given to other medical clinics in that space.

Madison County Circuit Judge Alan Mann last week denied CCA's request for a temporary injunction and dismissed the case. He said the plaintiffs did not have standing to bring the lawsuit because none of them were affected by the clinic's location. Mann also found that the zoning board acted in its normal capacity when it zoned the clinic.

CCA Pushes School Zoning Bill

James Henderson, executive director of CCA, said it was unlikely that his organization would appeal the ruling. Instead, Henderson, who is also a member of the Alabama Republican Party's executive committee, said the group will ask local lawmakers to support a measure that would require a 2,000-foot minimum barrier between a school and an abortion clinic.

According to the Times, the clinic is located "almost directly across" from a school.

Henderson said David Byrne, chief legal adviser for Gov. Robert Bentley (R), has encouraged the school-barrier effort. In a letter provided to the Times, Byrne wrote that he told Henderson in June he would be "happy to assist" lawmakers "closely associated with" CCA to pre-file any legislation for 2015. However, Byrne in the letter also noted the Governor's Legal Office is prohibited from doing legal work for a private group, according to the Times (Huntsville Times, 11/23).


Bill Overhauling Campus Sexual Assault Rules Unlikely To See Action in Lame Duck Session

8 hours 41 min ago

Although legislation changing how college campuses handle sexual assault investigations is unlikely to see congressional action by the end of the year, supporters are optimistic about its chances in 2015, CQ Roll Call reports.

Bill Overhauling Campus Sexual Assault Rules Unlikely To See Action in Lame Duck Session

November 25, 2014 — Although legislation changing how college campuses handle sexual assault investigations is unlikely to see congressional action by the end of the year, supporters are optimistic about its chances in 2015, CQ Roll Call reports.

Sen. Claire McCaskill (D-Mo.) has authored legislation (S 2692) that would require all colleges to use the same disciplinary procedures when handling sexual assault cases. The legislation also would allow the Department of Education to fine schools that do not comply with federal regulations regarding such incidents.

McCaskill said the bill has "such a good group of bipartisan co-sponsors" that she is not concerned about a lack of further action on it this year. She added, "I believe we've done the really hard work of getting the agreement of a number of Republicans before we filed the bill. So I feel pretty good about it moving forward in the new Congress." McCaskill noted that she is also working to make a few "improvements" to the bill, but that the "basics will be the same."

American Association of University Women Vice President of Government Relations Lisa Maatz added that advocates are involving the bill's Republican co-sponsors in the modifications to ensure they still support it. For example, Sen. Lamar Alexander (R-Tenn.), who before criticized the measure, said this week that he has been working with McCaskill "for several months" to ensure the new rules would be effective and not duplicative. Maatz noted, "There are some powerful people on both sides who want it to get done."

Further, some advocates have said they would like to postpone action on the bill until they can assess how colleges and universities are responding to updated rules on campus sexual assault included in the Violence Against Women Act (PL 113-4). Maatz said lawmakers should assess the impact of those changes before updating the bill (Phenicie, CQ Roll Call, 11/24).


Priests Group Plans Supreme Court Appeal Over Contraceptive Coverage Rules

8 hours 52 min ago

Priests for Life plans to ask the Supreme Court to overturn a federal appeals court's ruling that rejected a challenge from the group and other Catholic organizations to the federal contraceptive coverage rules, the Baptist Joint Committee for Religious Liberty Blog reports.

Priests Group Plans Supreme Court Appeal Over Contraceptive Coverage Rules

November 25, 2014 — Priests for Life plans to ask the Supreme Court to overturn a federal appeals court's ruling that rejected a challenge from the group and other Catholic organizations to the federal contraceptive coverage rules, the Baptist Joint Committee for Religious Liberty Blog reports.

PFL's Frank Pavone announced the appeal in an editorial posted on Aleteia (Byrd, Baptist Joint Committee for Religious Liberty Blog, 11/24).

Background on PFL Case

The Catholic organizations are challenging an accommodation to the contraceptive coverage rules for not-for-profits that hold themselves out as religious and oppose contraception. The accommodation aims to ensure that enrollees in health plans for such not-for-profits still have access to contraceptive coverage benefits under the Affordable Care Act (PL 111-148).

The accommodation enables such not-for-profits to notify their insurers or third-party administrators of their objection so the insurers or third-party administrators can facilitate contraceptive coverage for members of their health plans. To claim the accommodation, the not-for-profits may either complete a form to send to the insurers or third-party administrators or send a letter to HHS stating that they object to offering contraceptive coverage in their health plans. HHS announced the latter option in August in an effort to address ongoing court challenges over the rules.

However, the Roman Catholic Archbishop of Washington and PFL challenged the latest accommodation in court, arguing that the accommodation process continues to force "religious believers to violate their sincere religious beliefs." Last week, a three-judge panel of the U.S. Court of Appeals for the District of Columbia Circuit unanimously ruled that the accommodation does not substantially burden the religious beliefs of the plaintiffs in violation of the Religious Freedom Restoration Act (PL 103-141).

Pavone, PFL's national director, said the organization would not comply with the court's ruling and would refuse to offer contraceptive coverage or request an accommodation from HHS (Women's Health Policy Report, 11/17).


Wash. Defends Emergency Contraception Stocking Rules in Long-Running Lawsuit

Mon, 11/24/2014 - 18:32

The 9th U.S. Circuit Court of Appeals on Thursday heard arguments in a lawsuit challenging Washington state regulations (WAC 246-869-010) that require pharmacies to provide timely access to emergency contraception, the Oregonian reports.

Wash. Defends Emergency Contraception Stocking Rules in Long-Running Lawsuit

November 24, 2014 — The 9th U.S. Circuit Court of Appeals on Thursday heard arguments in a lawsuit challenging Washington state regulations (WAC 246-869-010) that require pharmacies to provide timely access to emergency contraception, the Oregonian reports (Wang, Oregonian, 11/20).

The hearing is the latest step in a long-running case that dates back to a 2007 state decision that prohibits pharmacies from refusing to sell lawful products because of religious beliefs (AP/CBS Seattle, 11/20).

Background

The plaintiffs -- two pharmacists and the owners of an Olympia, Wash., pharmacy -- allege that state regulations known as the stocking and delivery rules violate pharmacists' First Amendment right to religious freedom by requiring them to sell EC (Oregonian, 11/20). They argue that EC is similar to an abortion, although the drug does not have abortifacient properties (AP/CBS Seattle, 11/20).

The stocking rule, which has been in place for decades, requires pharmacies to stock all legally prescribed drugs that are in demand among their "patient population." Under the delivery rule, put in place in 2007, pharmacists must provide patients with such drugs or an equivalent in a timely fashion. The delivery rule is especially significant in the context of EC access because it must be taken within a certain time frame to prevent pregnancy, the Oregonian notes (Oregonian, 11/20).

The state permits individual pharmacists who have moral objections to providing a certain drug to ask another employee to complete the order, if doing so would not delay delivery.

Plaintiffs' Arguments

The plaintiffs argued that pharmacists with moral objections should be permitted to refer patients elsewhere and that a patient does not suffer when one pharmacy does not provide EC. They noted that there are many other pharmacies close by (AP/CBS Seattle, 11/20).

Alliance Defending Freedom attorney Kristen Waggoner, who represents the plaintiffs, said that granting one pharmacy in a city exception from selling EC "wouldn't create a health care crisis." She has asked for her clients to be granted accommodations to the rules in the same way that the state permits niche and boutique pharmacies to not keep large drug inventories (Oregonian, 11/20).

State: Exemptions Would Have Fallout

Attorneys for the state argued that relying on referrals would be problematic, particularly in rural areas, and that granting special exemptions would set a potentially dangerous precedent for religious refusals in health care.

"There is a very serious problem and it goes beyond one pharmacy in Olympia," said state attorney Tom Bader, adding that granting the pharmacists' request could result in other pharmacies delaying treatment to patients with AIDS (AP/CBS Seattle, 11/20).


Ohio Grants Sole Cincinnati Clinic Exemption Under Antiabortion-Rights Law

Mon, 11/24/2014 - 18:30

The last abortion clinic in the Cincinnati area on Thursday announced that it had been granted an exemption from an Ohio law that could have resulted in its closure and was dropping its lawsuit challenging the measure, the AP/SF Gate reports.

Ohio Grants Sole Cincinnati Clinic Exemption Under Antiabortion-Rights Law

November 24, 2014 — The last abortion clinic in the Cincinnati area on Thursday announced that it had been granted an exemption from an Ohio law that could have resulted in its closure and was dropping its lawsuit challenging the measure, the AP/SF Gate reports (AP/SF Gate, 11/21).

Background

The law requires clinics to have a transfer agreement in place with a local hospital.

Previously, the clinic had such an agreement with the University of Cincinnati Medical Center. However, a budget provision that took effect last year requires abortion clinics to secure the transfer agreements with private hospitals and prohibits them from making such arrangements with public hospitals.

The Ohio Department of Health in October warned the Cincinnati clinic that it risked closure if it did not comply with the transfer agreement requirement. Last week, Planned Parenthood Southwest Ohio Region filed a lawsuit challenging the law (Women's Health Policy Report, 11/13).

According to PPSWO, all of Cincinnati's private hospitals refused to enter into transfer agreements with the clinic, with many citing religious objections. PPSWO had requested a variance from the law more than one year ago, according to the Cincinnati Enquirer.

Details of Exemption

ODH Director Richard Hodges on Thursday granted PPSWO a variance, but he warned the clinic that he maintains authority under state law to revoke the exemption for any reason and at any time.

ODH spokesperson Melanie Amato said that the health department takes each variance request "on a case by case basis" and that PPSWO's "variance request has been granted because it meets the legal requirements and medical expectations for patient health and safety."

According to the Cincinnati Enquirer, PPSWO has reached agreements with four physicians who have said they will treat patients from the clinic at local hospitals in the case of an emergency.

PPSWO CEO Jerry Lawson said, "This ruling will ensure that women in Southwest Ohio continue to have access to safe and legal abortion."

Other Clinic in Limbo

In related news, NARAL Pro-Choice Ohio Executive Director Kellie Copeland called on ODH to grant a similar exemption to a Women's Med clinic in Dayton, which also has been unable to obtain a hospital transfer agreement. According to the Enquirer, the clinic has not yet received a response from ODH to its variance request.

The state previously denied a variance request made by a Women's Med clinic located in Sharonville, Ohio (Thompson, Cincinnati Enquirer, 11/21).


Ohio Grants Sole Cincinnati Clinic Exemption Under Antiabortion-Rights Law

Mon, 11/24/2014 - 16:52

The last abortion clinic in the Cincinnati area on Thursday announced that it had been granted an exemption from an Ohio law that could have resulted in its closure and was dropping its lawsuit challenging the measure, the AP/SF Gate reports.

Ohio Grants Sole Cincinnati Clinic Exemption Under Antiabortion-Rights Law

November 24, 2014 — The last abortion clinic in the Cincinnati area on Thursday announced that it had been granted an exemption from an Ohio law that could have resulted in its closure and was dropping its lawsuit challenging the measure, the AP/SF Gate reports (AP/SF Gate, 11/21).

Background

The law requires clinics to have a transfer agreement in place with a local hospital.

Previously, the clinic had such an agreement with the University of Cincinnati Medical Center. However, a budget provision that took effect last year requires abortion clinics to secure the transfer agreements with private hospitals and prohibits them from making such arrangements with public hospitals.

The Ohio Department of Health in October warned the Cincinnati clinic that it risked closure if it did not comply with the transfer agreement requirement. Last week, Planned Parenthood Southwest Ohio Region filed a lawsuit challenging the law (Women's Health Policy Report, 11/13).

According to PPSWO, all of Cincinnati's private hospitals refused to enter into transfer agreements with the clinic, with many citing religious objections. PPSWO had requested a variance from the law more than one year ago, according to the Cincinnati Enquirer.

Details of Exemption

ODH Director Richard Hodges on Thursday granted PPSWO a variance, but he warned the clinic that he maintains authority under state law to revoke the exemption for any reason and at any time.

ODH spokesperson Melanie Amato said that the health department takes each variance request "on a case by case basis" and that PPSWO's "variance request has been granted because it meets the legal requirements and medical expectations for patient health and safety."

According to the Cincinnati Enquirer, PPSWO has reached agreements with four physicians who have said they will treat patients from the clinic at local hospitals in the case of an emergency.

PPSWO CEO Jerry Lawson said, "This ruling will ensure that women in Southwest Ohio continue to have access to safe and legal abortion."

Other Clinic in Limbo

In related news, NARAL Pro-Choice Ohio Executive Director Kellie Copeland called on ODH to grant a similar exemption to a Women's Med clinic in Dayton, which also has been unable to obtain a hospital transfer agreement. According to the Enquirer, the clinic has not yet received a response from ODH to its variance request.

The state previously denied a variance request made by a Women's Med clinic located in Sharonville, Ohio (Thompson, Cincinnati Enquirer, 11/21).


CMS Releases Draft Guidance To Clarify ACA Abortion Coverage Rules for Insurers

Mon, 11/24/2014 - 15:42

CMS on Friday released a draft regulation that would provide additional guidance to insurers on the Affordable Care Act's (PL 111-148) rules for abortion coverage in health plans offered through the law's insurance marketplaces, The Hill reports.

CMS Releases Draft Guidance To Clarify ACA Abortion Coverage Rules for Insurers

November 24, 2014 — CMS on Friday released a draft regulation that would provide additional guidance to insurers on the Affordable Care Act's (PL 111-148) rules for abortion coverage in health plans offered through the law's insurance marketplaces, The Hill reports (Viebeck, The Hill, 11/21).

Background

The ACA does not prohibit abortion coverage and lets insurers determine whether they will offer it. However, the law requires health plans to segregate money collected for abortion coverage from other premiums. Insurers are not required to segregate the money for abortion coverage in cases of rape, incest or endangerment to the life of the woman.

In September, GAO released a report on how insurers were handling the ACA's abortion coverage rules for marketplace plans. The report found that insurers varied in how they handled abortion coverage and the information they provided to consumers about such coverage. HHS noted that "additional clarification may be needed" on the issue for insurers (Women's Health Policy Report, 9/16).

CMS Guidance Details

In its draft guidance, part of a larger proposed rule on the operation of the ACA marketplaces in 2016, CMS reiterated that insurers that cover abortion services are required to collect a minimum of $1 a month for abortion coverage and deposit it into a "separate allocation account," which is meant to ensure that federal insurance subsidies do not pay for the coverage (The Hill, 11/21).

In addition, the draft guidance included clarification on how insurers should bill consumers for abortion coverage. According to the guidance, insurers may send separate invoices for abortion and other coverage, send one bill that itemizes the costs of abortion coverage separately or inform consumers upon enrollment that their monthly premium invoice includes a separate payment for abortion coverage (Jost, Health Affairs Blog, 11/22).

CMS is now taking comments on the draft rule (The Hill, 11/21).


Wash. Defends Emergency Contraception Stocking Rules in Long-Running Lawsuit

Mon, 11/24/2014 - 15:39

The 9th U.S. Circuit Court of Appeals on Thursday heard arguments in a lawsuit challenging Washington state regulations (WAC 246-869-010) that require pharmacies to provide timely access to emergency contraception, the Oregonian reports.

Wash. Defends Emergency Contraception Stocking Rules in Long-Running Lawsuit

November 24, 2014 — The 9th U.S. Circuit Court of Appeals on Thursday heard arguments in a lawsuit challenging Washington state regulations (WAC 246-869-010) that require pharmacies to provide timely access to emergency contraception, the Oregonian reports (Wang, Oregonian, 11/20).

The hearing is the latest step in a long-running case that dates back to a 2007 state decision that prohibits pharmacies from refusing to sell lawful products because of religious beliefs (AP/CBS Seattle, 11/20).

Background

The plaintiffs -- two pharmacists and the owners of an Olympia, Wash., pharmacy -- allege that state regulations known as the stocking and delivery rules violate pharmacists' First Amendment right to religious freedom by requiring them to sell EC (Oregonian, 11/20). They argue that EC is similar to an abortion, although the drug does not have abortifacient properties (AP/CBS Seattle, 11/20).

The stocking rule, which has been in place for decades, requires pharmacies to stock all legally prescribed drugs that are in demand among their "patient population." Under the delivery rule, put in place in 2007, pharmacists must provide patients with such drugs or an equivalent in a timely fashion. The delivery rule is especially significant in the context of EC access because it must be taken within a certain time frame to prevent pregnancy, the Oregonian notes (Oregonian, 11/20).

The state permits individual pharmacists who have moral objections to providing a certain drug to ask another employee to complete the order, if doing so would not delay delivery.

Plaintiffs' Arguments

The plaintiffs argued that pharmacists with moral objections should be permitted to refer patients elsewhere and that a patient does not suffer when one pharmacy does not provide EC. They noted that there are many other pharmacies close by (AP/CBS Seattle, 11/20).

Alliance Defending Freedom attorney Kristen Waggoner, who represents the plaintiffs, said that granting one pharmacy in a city exception from selling EC "wouldn't create a health care crisis." She has asked for her clients to be granted accommodations to the rules in the same way that the state permits niche and boutique pharmacies to not keep large drug inventories (Oregonian, 11/20).

State: Exemptions Would Have Fallout

Attorneys for the state argued that relying on referrals would be problematic, particularly in rural areas, and that granting special exemptions would set a potentially dangerous precedent for religious refusals in health care.

"There is a very serious problem and it goes beyond one pharmacy in Olympia," said state attorney Tom Bader, adding that granting the pharmacists' request could result in other pharmacies delaying treatment to patients with AIDS (AP/CBS Seattle, 11/20).


Walker v. Jesson

Fri, 11/21/2014 - 22:57

Demand for declaratory and injunctive relief against the state Department of Human Services (DHS), accusing DHS of using public funds to pay for non-therapeutic abortions for indigent women.

Walker v. Jesson

Demand for declaratory and injunctive relief against the state Department of Human Services (DHS), accusing DHS of using public funds to pay for non-therapeutic abortions for indigent women. In Minnesota, public funds may be expended to cover therapeutic abortions for indigent women; Plaintiffs alleged that non-therapeutic procedures have been covered, as well. Plaintiffs requested that the court enjoin all public coverage of abortions until the state can demonstrate that only therapeutic abortions will be covered and then to only allow a narrow subset of circumstances to qualify as “therapeutic.” On May 2, 2013, the state district court dismissed the case with prejudice, meaning that the case cannot be re-filed. Plaintiffs appealed the decision to the Minnesota Court of Appeals. On May 5, 2014, the state Court of Appeals upheld the lower court’s dismissal. Plaintiffs petitioned the Minnesota Supreme Court to review the case. Final Outcome: On August 5, 2014, the Minnesota Supreme Court denied Plaintiffs’ appeal, and the state continues to cover therapeutic abortion care for indigent women. (See the dismissal order here. See the Court of Appeals opinion here. Read more about the case here.)

Choice, Inc. of Texas v. Greenstein

Fri, 11/21/2014 - 22:33

Federal court challenge to Louisiana law that expands the state’s authority to suspend or revoke the licenses of outpatient abortion facilities, thus restricting access to care for Louisiana women.

Choice, Inc. of Texas v. Greenstein

Federal court challenge to Louisiana law that expands the state’s authority to suspend or revoke the licenses of outpatient abortion facilities, thus restricting access to care for Louisiana women. In February 2011, the U.S. District Court for the Middle District of Louisiana dismissed Plaintiff's case as not ripe. Final Outcome: In August 2012, the 5th Circuit Court of Appeals upheld the district court decision. (See the law here. See the complaint here. See the district court opinion here. See the 5th Circuit opinion here. Read more about the case here.)

Hodes & Nauser v. Moser

Fri, 11/21/2014 - 22:17

Federal court challenge to temporary regulations and licensing process adopted and implemented by the Kansas Department of Health and Environment.

Hodes & Nauser v. Moser

Federal court challenge to temporary regulations and licensing process adopted and implemented by the Kansas Department of Health and Environment. In July, 2011, the U.S. District Court for the District of Kansas granted Plaintiffs’ motion for preliminary injunction. Final Outcome: The temporary regulations at issue in this case were superseded by permanent regulations. The permanent regulations were challenged in state court in a case also captioned Hodes & Nauser v. Moser. (See the regulations here. Read more about the case here.)

ACLU of Kansas and Western Missouri v. Praeger

Fri, 11/21/2014 - 22:05

Federal court challenge to a Kansas law that prohibits insurance coverage of abortion and abortion-related services.

ACLU of Kansas and Western Missouri v. Praeger

Federal court challenge to a Kansas law that prohibits insurance coverage of abortion and abortion-related services. In September 2011, the U.S. District Court for the District of Kansas denied a motion for preliminary injunction. In March 2012, the court denied a motion to dismiss and allowed the lawsuit to go forward. Final Outcome: In January 2013, the court ruled that the law was not enacted for the illegitimate purpose of infringing on a woman’s right to abortion. (See the law here. See the 2011 court opinion here. See the 2013 court opinion here.)