Daily Women's Health Policy Report
W.Va. Panel Sends Ultrasound Abortion Bill to Full House
March 11, 2010 — The West Virginia House Judiciary Committee on Wednesday approved a bill (HB 4517), including two new amendments, that would alter an existing state abortion law by requiring that providers offer women a chance to view an ultrasound before an abortion, the Charleston Daily Mail reports (Rivard, Charleston Daily Mail, 3/11). The requirement would only apply in cases in which the provider has determined that an ultrasound is medically necessary. The bill now proceeds to the full House (AP/Charleston Gazette, 3/11).
The bill would add to a law, which was approved several years ago, that requires abortion providers to notify a woman at least one day before an abortion that she could be eligible for public assistance, that the father is liable to help support the child and that she has the right to review printed materials about fetal development (Charleston Daily Mail, 3/11). Abortion providers also must offer patients information on pregnancy, prenatal care, risks of abortion and alternatives to the procedure. In most cases, providers are permitted to provide that information by telephone (Women's Health Policy Report, 3/10).
On Wednesday, the committee amended the bill to eliminate criminal penalties in the existing law for physicians who violate its requirements. Physicians could still be reprimanded by the state's medical licensing board.
Abortion-rights advocates had fought for the removal of the sanctions. Margaret Chapman Pomponio -- executive director of West Virginia FREE, an abortion-rights group -- said that despite the amendment, the bill "continues the state's interference in private medical decisions." She added, "The penalties were pretty hard fought at that point, so, frankly, I was surprised the [antiabortion] lobby agreed to that amendment."
The committee also approved an amendment that would require women to sign a form stating that they have been informed of the option to view the ultrasound image (Charleston Daily Mail, 3/11).
W.Va. Panel Sends Ultrasound Abortion Bill to Full House
March 11, 2010 — The West Virginia House Judiciary Committee on Wednesday approved a bill (HB 4517), including two new amendments, that would alter an existing state abortion law by requiring that that women be able to view an ultrasound image of their fetus before an abortion, the Charleston Daily Mail reports (Rivard, Charleston Daily Mail, 3/11). According to the bill text, an ultrasound would be available when "the standard of care dictates" (Bill text, 2/16). The requirement would only apply in cases in which the provider has determined that an ultrasound is medically necessary. The bill now proceeds to the full House (AP/Charleston Gazette, 3/11).
The bill would add to a law, which was approved several years ago, that requires abortion providers to notify a woman at least one day before an abortion that she could be eligible for public assistance, that the father is liable to help support the child and that she has the right to review printed materials about fetal development (Charleston Daily Mail, 3/11). Abortion providers also must offer patients information on pregnancy, prenatal care, risks of abortion and alternatives to the procedure. In most cases, providers are permitted to provide that information by telephone (Women's Health Policy Report, 3/10).
On Wednesday, the committee amended the bill to eliminate criminal penalties in the existing law for physicians who violate its requirements. Physicians could still be reprimanded by the state's medical licensing board.
Abortion-rights advocates had fought for the removal of the sanctions. Margaret Chapman Pomponio -- executive director of West Virginia FREE, an abortion-rights group -- said that despite the amendment, the bill "continues the state's interference in private medical decisions." She added, "The penalties were pretty hard fought at that point, so, frankly, I was surprised the [antiabortion] lobby agreed to that amendment."
The committee also approved an amendment that would require women to sign a form stating that they have been informed of the option to view the ultrasound image (Charleston Daily Mail, 3/11).
Abortion-Rights Advocates Have 'Right To Hate' Woman's Decision To Describe Abortion on Twitter, Opinion Piece Says
March 11, 2010 — Abortion-rights supporters "who came from generations where women had no legal abortion choices understand how precious the right to choose is," Mary Ann Sorrentino -- who served as executive director of Planned Parenthood of Southern New England from 1977 to 1987 -- writes in a Salon opinion piece. However, 27-year-old Angie Jackson's decision "to use Twitter as a public stage for her private decision to terminate a pregnancy" through medical abortion, is "[a]t its worst, ... self-serving, exhibitionist and selfish," Sorrentino says. "At best, it has 'bad judgment' written all over it," she adds. Sorrentino notes that Jackson has said she has about 800 Twitter followers and is hoping to publish a book.
Jackson has said she decided not to continue the pregnancy because of the difficult pregnancy she experienced with her now-four-year-old son, who has special needs, Sorrentino writes. "If this is true, and her decision about ending her childbearing is solid and responsible, one has to wonder why she didn't just have a tubal ligation," which would have "sav[ed] the rest of the universe the anguish of assisting at such a personal and difficult moment," according to Sorrentino.
Jackson "ha[s] the right to choose" medical abortion and write about the process, but "many of us who have spent our lives on the front lines of the abortion debate also have the right to hate the fact that she chose to do this," Sorrentino writes. The "right we were fighting so hard for ... was based on what the Supreme Court called 'privacy," she continues. "We wanted a woman to be able to make personal decisions about their pregnancies in the privacy of their most intimate circles, ... if she chose," or "she could decide as a panel of one and discuss it with no one," Sorrentino says (Sorrentino, Salon, 3/9).
Home-Administered Misoprostol Safe Abortion Option for Women Up to 63 Days Pregnant, Study Finds
March 11, 2010 — A team of Swedish researchers concludes that taking misoprostol at home as part of a medical abortion regimen is a safe option for women who are 50 to 63 days pregnant, according to a study published in the journal Human Reproduction, Reuters reports. The study's authors said that their research is the first published report to examine at-home medical abortion in women who were more than 49 days pregnant.
In the U.S., women have been permitted to take physician-prescribed misoprostol at home since 2000. Mifepristone -- the first drug in the medical abortion regimen, which is taken three to four days prior to misoprostol -- is administered at a clinic, physician’s office or hospital. Most European countries require that women take both drugs in a clinic, doctor's office or hospital, although home administration is permitted in Sweden, Reuters reports.
For the study, Helena Kopp Kallner of the Karolinska Institutet in Stockholm and colleagues followed about 3,000 medical abortion patients at their clinic in Sweden from January 2004 through April 2007. Of the women, 395 opted for home administration of misoprostol. Of those 395 women, 203 were fewer than 50 days pregnant and 192 were 50 to 63 days pregnant. The home-administration group took mifepristone orally at the clinic and was given four misoprostol tablets to administer vaginally up to two days later.
Among women who were fewer than 50 days pregnant, 199 experienced complete abortions, while 186 of the women who were between 50 and 63 days pregnant experienced complete abortions. Ten women required surgery. About six in 10 women in both groups needed extra pain medication. The study concluded that home administration of misoprostol is "safe and highly acceptable also to women with a gestational length of 50-63 days as compared with shorter gestations" (Reuters, 3/9).
House Dems Discuss Abortion, Other Non-Budget Issues While Awaiting CBO Score on Health Reform
March 11, 2010 — On Wednesday, House Speaker Nancy Pelosi (D-Calif.) said lawmakers are focusing on resolving issues that fall outside the scope of the budget reconciliation bill -- legislation Democrats are drafting that would include changes to the Senate health reform bill (HR 3590), CQ Today reports. While Democrats are waiting for the Congressional Budget Office to score the various provisions in the budget reconciliation bill, lawmakers are "meeting on an ongoing basis to discuss non-CBO issues," she said. She added that she did not know when the CBO score would be available. According to CQ Today, the list of non-CBO issues "presumably" includes the matter of abortion-coverage language (Adams, CQ Today, 3/10).
Abortion coverage is not likely to be included in the budget reconciliation bill because procedural rules for using the budget reconciliation process do not allow inclusion of provisions that do not have a budgetary impact (Women's Health Policy Report, 3/10). Because budget reconciliation bills require only a simple majority, the process effectively shields it from a filibuster in the Senate.
Under the strategy being discussed, House Democrats are expected to try to approve the health care reform bill passed by the Senate in December. Both chambers would then pass the budget reconciliation bill, which would include changes to the Senate health care reform bill (Werner, AP/Yahoo! News, 3/11).
The Senate bill would allow health plans that receive government subsidies to offer abortion coverage but to ensure that only private funds are used to pay for abortion coverage customers would be required to make two monthly payments -- one to pay for abortion coverage and one for everything else. Rep. Bart Stupak (D-Mich.) is leading some antiabortion-rights lawmakers in a push to include his more-restrictive abortion amendment, which is included in the House bill (HR 3962). The amendment would prohibit health plans in the health care exchange receiving federal subsidies from offering abortion coverage.
Stupak claims that there are about one dozen House Democrats -- including James Oberstar (Minn.) and Daniel Lipinski (Ill.) -- who will vote against the Senate bill if the abortion-coverage language is not changed. However, Rep. Dale Kildee (D-Mich) on Tuesday said he believes he can support the Senate bill's approach to abortion coverage, despite his initial opposition to the language.
Rep. Marcy Kaptur (D-Ohio), who voted for the Stupak amendment in the House, said the Senate bill's language is "unacceptable" but stopped short of saying abortion would be the deciding factor in her vote. "I would not easily give over my vote for the bill if they don't fix that," Kaptur said, though she added that she also objects to the Senate bill's approach to costs and other issues.
On Wednesday, Stupak said that he is not sure what an abortion compromise would look like or whether abortion-related changes could be considered under budget reconciliation rules. Stupak added that his next step is to meet with House Energy and Commerce Committee Chair Henry Waxman (D-Calif.). Waxman on Tuesday indicated that he and Stupak have discussed the issue of abortion coverage but have not discussed the process of how the Senate bill's language could be changed (Benson, CQ Today, 3/10).
Stupak Primary Challenge Fueled by Abortion Stance
Although Stupak "has never been in serious danger" of losing his congressional seat, some Democrats in his district "are so angry" about his antiabortion efforts in the health reform debate "that he's facing a rare and long-shot primary challenge," the AP/Atlanta Journal-Constitution reports. Stupak's district comprises Michigan's entire Upper Peninsula and a significant area of its Lower Peninsula. The region has a significant Catholic population, and Stupak says his stance on abortion rights "reflects adequately" his constituency's views on abortion rights.
However, according to the AP/Journal-Constitution, the region's views on abortion rights are "mixed," and some critics have accused Stupak of trying to impose his religious beliefs on the larger U.S. population. On Tuesday, Connie Saltonstall -- a former Charlevoix County, Mich., commissioner -- announced that she would challenge Stupak for the Democratic nomination. Saltonstall said that Stupak's priorities are not in line with those of his constituents (Flesher, AP/Atlanta Journal-Constitution, 3/11).
'Rachel Maddow' Reports Only Four to Five House Members Back Stupak
MSNBC's "The Rachel Maddow Show" on Wednesday examined Stupak's claims that about one dozen lawmakers say they will oppose the Senate bill. Maddow reports that she spoke with a senior House leadership aide "whose job is ... to actually fact check what [Stupak] says, to see if he really does have those 12 votes he says he has." Maddow continued that "it turns out when Bart Stupak says 'at least 12,' what he really means is not really 12 at all." According to the senior leadership aide, an informal whip count revealed that no more than four or five House members are willing to support Stupak, Maddow said (Maddow, "The Rachel Maddow Show, MSNBC, 3/10).
Kaiser Health News Profiles USCCB's Doerflinger
Richard Doerflinger -- associate director of the U.S. Conference of Catholic Bishops' Secretariat of Pro-Life Activities -- "has emerged as a major player in the health care debate, one likely to play a pivotal role in the outcome," Kaiser Health News reports. Doerflinger is leading USCCB's opposition to the Senate bill's abortion-coverage language. Although the Catholic Church has a long history of supporting universal health care, Doerflinger is "sending a clear message: If Democrats want to succeed, they must include the House provision, or something equally restrictive, on abortion," according to KHN.
Some abortion-rights groups have accused Doerflinger and USCCB of using their abortion agenda to derail health care reform. Laurie Rubiner, vice president for public policy for the Planned Parenthood Federation of America, said, "No one else drew a line in the sand" (Parker, Kaiser Health News, 3/10).
Newsweek Examines Role of New Female Condom in Efforts To Combat Spread of HIV in D.C.
March 11, 2010 — Women's health experts are watching closely to see whether a recent grant to provide no-cost female condoms in Washington, D.C., will "really make a difference" in the area's HIV/AIDS rate among women, Newsweek's Kate Dailey writes. The goal of the program is to empower women to take control of their own health and safety. The $500,000 grant from the MAC AIDS Fund will allow health centers in the district to promote and distribute the latest version of the female condom, FC2, which FDA approved in March 2009. The female condom can be inserted several hours before intercourse, allowing a woman to protect herself without having to persuade the man with whom she's sleeping to change his behavior. The program aims to reduce the district's HIV transmission rate, particularly among women. HIV is the leading cause of death among black women ages 24 through 39 in D.C. About three percent of black women in D.C. have HIV, compared with a rate of 0.7% for the U.S. population.
FC2 "offers several advantages over the original," including a lower cost of 82 cents per condom, Dailey writes. Shannon Hader, director of the HIV/AIDS administration at the D.C. Department of Health, said the lower cost "reduced wholesale prices to about a third of the initial price, which made it feasible to add onto our condom-distribution program," even after the MAC grant ends. The new female condom also is expected to be quieter and more comfortable than the original.
According to Dailey, although female condoms "have proved to be one of the best ways of reducing HIV transmission among women," their use "never took off." A 2002 Centers for Disease Control and Prevention study found that only 2% of women in the U.S. had ever used the female condom, and experts believe the rate has not changed significantly in the years since, Dailey writes. Vanessa Cullins, medical director for the Planned Parenthood Federation of America, said, "More than likely, giving out the condoms and making them easily available is not going to be enough for a lot of people." Cullins added, "Some people will take advantage of the fact that the condoms are easily available, but others will need to have a conversation, not only with partners and potential partners, but also with friends about female condoms."
Dailey continues, "It won't be immediately apparent as to whether this partnership will lower HIV rates in the district," but the Department of Health "has established some short-term benchmarks of progress." Hader said, "We hope that by adding yet another tool, not just more people will be using female condoms, but that people will become more regular users of any condom in general" (Dailey, Newsweek, 3/10).
Gonorrhea Cases Rise Sharply in Alaska
March 11, 2010 — Alaska health officials have reported that the state's gonorrhea rates increased by 69% in 2009 after remaining steady for years, the Anchorage Daily News reports. Susan Jones of the Alaska Department of Health and Social Services said the increase is the biggest one-year jump since the 1970s.
Gonorrhea is sexually transmitted and can lead to pelvic inflammatory disease, infertility and miscarriages in women; eye problems in newborns; and infections in men. It is frequently accompanied by chlamydia and can be treated with antibiotics (Shinohara, Anchorage Daily News, 3/10). Many people who are infected with gonorrhea have no symptoms or symptoms that do not appear for about 30 days. In women, the initial symptoms can include painful urination, increased vaginal discharge or vaginal bleeding between periods. In men, symptoms include a burning sensation during urination, discharge from the penis or painful, swollen testicles.
Details of Report
There were 997 cases of gonorrhea reported in 2009, an increase from 578 in 2008 (Joling, AP/Connecticut News-Times, 3/10). The rate of gonorrhea infections was 144 cases per 100,000 residents, up from 85 cases per 100,000 residents in 2008. According to Jones, gonorrhea rates increased in every area of the state except for Interior Alaska (Anchorage Daily News, 3/10). Men and women ages 20 through 24 had the highest infection rates. Women accounted for slightly more than half of the cases (AP/Connecticut News-Times, 3/10).
Jones said Alaska's gonorrhea rate has been in the middle range of all states in recent years. The 2009 rates could place Alaska among the top 10 states with the highest rates of sexually transmitted infections, according to Jones.
Reasons for Increase Unclear
State officials said there is no known explanation for the sharp increase. Jones said the rise is not the result of increased testing because the number of tests has been consistent. She also said some health providers have noted that the type of gonorrhea that is most prevalent throughout the state has milder symptoms than in past outbreaks (Anchorage Daily News, 3/10). "In some cases, the symptoms are mild enough, or not annoying enough, that people are not coming in to seek care, or delaying coming in," Jones said, adding, "So that means they have gonorrhea for a long period of time and are able to transmit it more"(AP/Connecticut News-Times, 3/10).
Antiabortion Amendments Stalling Unrelated Bills in Ky. House
March 11, 2010 — Two Republican members of Kentucky's House are attaching antiabortion-rights amendments to several unrelated bills that are awaiting a chamber vote, a move that is threatening to derail changes related to children's Medicaid coverage, among other things, the Lexington Herald-Leader reports. The amendments -- sponsored by Reps. David Floyd and Tim Moore -- would require abortion providers to conduct an ultrasound and show the woman the image. The amendments also would require counseling prior to an abortion.
As of Tuesday evening, at least six bills were stalled because of the amendments. Democratic leaders are sending bills back to committee to avoid floor fights over the abortion amendments. Floyd, the House minority whip, previously sponsored a bill (HB 373) with the same language as the amendments. That bill did not make it out of a February House Health and Welfare Committee hearing, the Herald-Leader reports. He claims that if the House were allowed to vote on the amendments, they would pass by a five-to-one margin.
Backers of the derailed bills say that Floyd and Moore are using the amendments to stall legislation that has broad support. Terry Brooks, executive director of Kentucky Youth Advocates, said, "I find it sadly ironic that the same voices that want to protect unborn children are willing to put children as risk after they are born." In addition, some antiabortion-rights groups are criticizing Floyd and Moore's strategy. Robert Castagna, executive director of the Catholic Conference of Kentucky, said that the amendments "are not something that we would be endorsing" (Cheves, Lexington Herald-Leader, 3/10).
CDC Analysis Shows Genital Herpes Rates Remain High
March 10, 2010 — Roughly 16% of U.S. residents ages 14 through 49 are infected with genital herpes, making it one of the nation's most common sexually transmitted infections, according to a Centers for Disease Control and Prevention analysis released on Tuesday, Reuters reports.
CDC noted that infection rates for the lifelong and incurable infection varied by gender and race. Twenty-one percent of U.S. women are infected with genital herpes, compared with 11.5% of men. Blacks have a 39% infection rate, compared with 12% among whites. Forty-eight percent of black women are infected with genital herpes, the analysis showed. According to CDC, biological factors, not behavioral patterns, likely are responsible for the variations in infection rates between genders and races. Women are biologically more susceptible to the virus, and black communities tend to have higher infection rates, according to John Douglas of CDC.
Eighty percent of people infected with genital herpes are unaware of their status, the report said. Douglas said, "Because herpes is so prevalent it becomes ... a really important reason to use condoms on a consistent and correct basis with all of your partners."
Genital herpes can cause recurrent, painful genital sores. Although there is no cure, several medications are available to control symptoms and outbreaks. Infection with genital herpes also increases the likelihood of acquiring and transmitting HIV. CDC estimates that the U.S. health care system spends roughly $16 billion annually on STIs and that 19 million new people acquire STIs each year (Allen, Reuters, 3/9).
Ga. Bill To Ban Abortions Based on Race, Gender Fuels Debate Among Advocates
March 10, 2010 — A Georgia bill (HB 1155) that would ban abortions based on race or gender is further fueling claims by antiabortion-rights groups that minority populations are being "targeted" by abortion providers, the Washington Times reports. The Georgia bill would make it illegal to knowingly solicit, perform or accept funding for abortions based on race or gender. The state Judiciary Non-Civil Committee has scheduled a hearing on the bill for Wednesday (Wetzstein, Washington Times, 3/10).
The debate comes amid controversy surrounding an Atlanta antiabortion-rights billboard campaign sponsored by Georgia Right to Life and the Radiance Foundation that features an image of a black child with the message, "Black children are an endangered species" at the top.
Blacks make up about 30% of the state's population. Federal data show that black women obtained 57.4% of abortions in Georgia in 2006. However, Centers for Disease Control and Prevention data show that the fertility rate among black women -- the number of births per 1,000 women of childbearing age -- is higher than the national average and has increased in recent years (Women's Health Policy Report, 2/9).
Loretta Ross, the national coordinator of SisterSong, said, "The wording of the campaign is offensive," She added, "[T]o many of us, it compares our children to exotic animals. Our children are not animals."
Melissa Gilliam, an associate professor for obstetrics and gynecology at the University of Chicago Medical Center, said it is "absurd" to allege that abortion providers target women of color. She said that unintended pregnancies and lack of access to health care and contraception contribute to the higher abortion rate among blacks.
Vanessa Cullins, vice president for medical affairs for the Planned Parenthood Federation of America, said the organization has been wrongly pegged as racist through "race-baiting phone calls" from antiabortion-rights advocates who pose as callers claiming they would like to donate money earmarked for abortions of minorities (Wetzstein, Washington Times, 3/10).
W.Va. House Panel Approves Bill Requiring Information About Ultrasounds Before Abortions
March 10, 2010 — The West Virginia House Health and Human Resources Committee on Monday voted 16-9 to approve a bill (HB 4517) that would require physicians to give women the opportunity to view an ultrasound image at least one hour before performing an abortion, the Charleston Gazette reports. According to the Gazette, the rule would only apply to cases where ultrasound technology already is being used. The Senate passed the bill last week (Knezevich, Charleston Gazette, 3/8). The bill now proceeds to the House Judiciary Committee (AP/Charleston Gazette, 3/8).
Under current state law, abortion providers are required to offer patients information on pregnancy, prenatal care, risks of abortion, alternatives to the procedure and other topics (Charleston Gazette, 3/8). In most cases, providers are permitted to provide that information by telephone (Bill text, 2/16). The committee rejected an amendment by state Rep. Barbara Fleischauer (D) that would have eliminated the requirement for physicians to tell patients about the availability of ultrasounds and added the information to the current list of disclosures. The committee also rejected an amendment that would have allowed physicians to retain their licenses if they failed to meet the bill's requirements (Charleston Gazette, 3/8).
Hoyer Pledges To Work with Stupak To Address Abortion Coverage in Health Reform
March 10, 2010 — House Majority Leader Steny Hoyer (D-Md.) on Tuesday pledged to work with Rep. Bart Stupak (D-Mich.) to resolve the dispute over abortion-coverage language in the Senate health reform bill (HR 3590), CQ Today reports. Hoyer said the issue "has to be resolved," adding, "I think it will be resolved one way or the other, and the bill will be passed."
Stupak claims that there are about one dozen antiabortion-rights Democrats -- including himself -- who will vote against a final health reform bill if it includes the Senate reform bill's abortion-coverage language. The Senate bill would allow health plans in proposed insurance exchanges to offer abortion coverage but require customers to make two monthly payments -- one to pay for abortion coverage and one for everything else (Epstein, CQ Today, 3/9). Only private funds would be used to cover abortion care. No federal funds would be used for that purpose (Women's Health Policy Report, 3/9). Stupak is advocating for more-restrictive language that is similar to an amendment he sponsored in the House bill (HR 3962) that would prohibit all health plans receiving federal subsidies from offering abortion coverage (CQ Today, 3/9).
Stupak spokesperson Michelle Begnoche on Tuesday said that Stupak "has not reached an agreement on abortion funding in the health care legislation" but has had "meaningful discussions" with several House leaders, including Hoyer and Energy and Commerce Committee Chair Henry Waxman (D-Calif.). Begnoche added that Stupak "expects further meetings this week and remains optimistic that language can be worked out" (O'Connor, Politico, 3/10). Hoyer said that he has not sat down with Stupak to discuss the issue. He said Stupak recently approached him on the House floor to request a meeting (Epstein, CQ Today, 3/9).
Resolving the issue likely will "cause a major headache for all concerned" because of the strategy Democrats are expected to use to enact the health overhaul, CQ Today reports. The strategy would involve the House passing the Senate bill in its current form. Both chambers would then take up a separate "corrections" bill that would make changes to the Senate bill. The Senate would pass the corrections bill through the budget reconciliation process, which requires only a simple majority in the Senate and therefore would help Democrats avoid a filibuster. However, abortion is not likely to be included in the corrections bill because it is not a tax or spending issue, which are the only issues that may be included in bills passed through budget reconciliation, CQ Today reports (Benson/Epstein, CQ Today, 3/9).
White House press secretary Robert Gibbs on Tuesday said President Obama will work with Democrats on the abortion issue. Gibbs also noted that the bill "is not a bill about abortion; this is about health care reform." He added, "I think there's no doubt that we can come to a solution that maintains the rules that are in place" (Khan, ABC News, 3/9).
Three Options Possible
Roll Call reports that House Democratic leaders are "wrestling" with three options to resolve the abortion-coverage issue. One option would be for Democrats to include changes to the abortion language in the budget reconciliation bill or draft a third piece of legislation to deal with the issue. A third bill would require 60 votes in the Senate to overcome procedural hurdles.
A second option would be to include a permanent ban on abortion coverage in any public insurance plan but hold an annual vote on abortion-coverage restrictions on private insurers. Stupak has said that he reached such an agreement with House Speaker Nancy Pelosi (D-Calif.) last year but that the deal fell through, prompting him to offer the amendment that ultimately was included in the House bill. Rep. Diana DeGette (D-Colo.), co-chair of the Congressional Pro-Choice Caucus, said an annual vote is not an option she would support. "We're not going to have an annual vote on anything," she said, adding, "We're not going to cross our fingers and hope we can fix this later."
The third option would be for Pelosi to gather enough votes to pass the Senate bill with its current restrictions. According to Roll Call, this is the option Pelosi prefers. It would require her to offset any "no" votes Stupak collects with "yes" votes from House members who originally voted against the House bill (Dennis/Newmyer, Roll Call, 3/10). On Tuesday, Rep. Dale Kildee (D-Mich.) -- who previously supported Stupak's language -- said he intends to vote for health reform. Kildee said he is satisfied with the Senate bill's abortion-coverage language, adding that it "keeps the purpose of" current federal restrictions (Dennis, Roll Call, 3/9).
Women's Coalition Opposes Senate Language
A coalition of more than 50 women's rights groups is calling for major changes to the Senate bill's language, Politico reports. In a letter Tuesday to Obama, Pelosi and Senate Majority Leader Harry Reid (D-Nev.), the groups said the bill's current abortion-coverage restrictions place "unacceptable obstacles for women who wish to purchase insurance that includes abortion coverage and for plans that wish to offer it." They added, "We are calling on you to make improvements that would ensure that under reform, women will not lose the private health insurance coverage for abortion that they now have" (Politico, 3/10).
Pelosi said she expects the House to vote on the Senate bill before a two-week recess that begins March 26 (Epstein et al., CQ Today, 3/9). Despite earlier claims from the White House, Hoyer said that the House will not pass legislation by a March 18 deadline (Allen, "Blog Briefing Room," The Hill, 3/9).
Former Mich. County Official To Challenge Stupak
Connie Saltonstall -- a former Charlevoix County, Mich., commissioner -- on Tuesday announced plans to challenge Stupak in the Democratic primary, the Detroit Free Press reports. Saltonstall said that Stupak's efforts to block health reform because of abortion-related issues contributed to her decision to run. "I believe that he has a right to his personal religious views, but to deprive his constituents of needed health care reform because of those views is reprehensible," Saltonstall said in a statement. Saltonstall's supporters are working to collect the 1,000 signatures required for her name to appear on the August primary ballot.
Stupak has held the seat since 1993, the Free Press reports. Saltonstall made an unsuccessful run for state representative in 2008 (Spangler, Detroit Free Press, 3/9).
Broadcast Coverage
~ NPR's "Morning Edition" on Wednesday featured a discussion with NPR health policy correspondent Julie Rovner and Catholic priest Thomas Reese of Georgetown University's Woodstock Theological Center. Rovner and Reese discussed the significance of abortion as an obstacle to enacting health reform. They also discussed the influence of the National Right to Life Committee and U.S. Conference of Catholic Bishops on the debate, the procedural obstacles to further compromises, and the absence of trust on all sides (Inskeep, "Morning Edition," NPR, 3/10).
~ MSNBC's "The Rachel Maddow Show" on Tuesday included a discussion with DeGette about Stupak's claims and whether a compromise is possible. DeGette also discussed why abortion-rights supporters are resisting any further restrictions beyond current law (Hayes, "The Rachel Maddow Show," MSNBC, 3/9).
NYT Editorial Calls on Abortion-Rights Supporters 'To Make Their Voices Heard'
March 10, 2010 — In the "three years since the Supreme Court's conservative majority abruptly departed from precedent to uphold a federal ban on a particular method of abortion, ... foes of reproductive freedom are pressing new attacks on women's rights and health," a New York Times editorial states.
Utah Gov. Gary Herbert (R) "has signed a bill (HB 462) that would criminalize certain behavior by women that results in miscarriage," the editorial notes. It adds, "The measure exempts lawful abortions, and particularly worrisome language about 'reckless' acts has been removed." However, "the law still raises concern about zealous prosecutors using a woman's difficult choices to open an investigation," the editorial says.
Meanwhile, in Oklahoma, the Center for Reproductive Rights "succeeded last week in blocking a burdensome measure (SB 1878) designed to discourage abortions by requiring pre-procedure sonograms and exempting physicians from liability for failing to disclose fetal abnormalities," the editorial states. It notes that "the ruling turned on a technical flaw in the law, and its supporters are expected to try again."
In Nebraska, an "even more ominous assault on reproductive freedom is looming," the editorial continues. "A blatantly unconstitutional measure (LB 1103) moving through the state Legislature would ban abortions at 20 weeks' gestation -- before viability and earlier than constitutionally allowed," according to the editorial. It adds, "Indeed, the bill prohibits doctors from performing an abortion to avoid a serious risk that the woman may commit suicide."
The "obvious goal here is to present the Supreme Court with a new vehicle for further watering down Roe v. Wade," the editorial says. While that is "troubling enough, ... lately another tactic is being deployed to demonize abortion and abortion providers and further polarize the nation," the editorial states. It adds, "Citing the disproportionately high numbers of African-American women who undergo abortions, ... abortion foes are hurling baseless charges of genocide and racial discrimination."
The editorial concludes, "Even in this charged debate, phony accusations of genocide should be out of bounds, but political forces that oppose abortion are pursuing a focused, often successful campaign." It concludes, "Americans who support women's reproductive rights need to make their voices heard" (New York Times, 3/10).
Men's 'Barbarity' Should Not Be Used To Justify Mistreatment of Women, Opinion Piece Argues
March 10, 2010 — "'Feminism' is a loaded word in the United States," but the "simple fact is that 'the feminists' are absolutely right when it comes to the treatment of women in much of the developing world," Los Angeles Times columnist Jonah Goldberg writes. He adds that a recent Washington Post opinion piece on the Cameroonian practice of "breast ironing" is just one of the many examples of women and girls "pay[ing] the price for the barbarity of boys." Goldberg explains that in Cameroon, some mothers "iron" their daughters' breasts with hot rocks, kerosene or hot plantain peels because of the belief that it will make them less likely to attract sexual attention from boys and men.
Goldberg describes several other examples of societies that attempt to justify mistreatment of women by asserting that it protects them from men. He writes, "[H]eaven forbid that anyone expect anything like self-restraint from the boys." According to Goldberg, "The worst cases of female-phobia appear to be in the Muslim world, but the problem is hardly unique to Islam." He continues, "Across Southeast Asia and throughout Africa, in Christian, animist and Muslim countries alike, women are asked to pay for male inadequacies." Goldberg argues, "If women were seen as a religious or racial minority," then the injustice of such practices "would be glaringly obvious."
He continues, "As a general rule, men will only be as civilized as female expectations and demands will allow." Goldberg concludes, "'Liberate' men from those expectations, and Lord of the Flies logic kicks in. Liberate women from this barbarism, and male decency will soon follow" (Goldberg, Los Angeles Times, 3/9).
Research Shows Removing Healthy Breast Does Not Improve Breast Cancer Survival, NYT Columnist Writes
March 10, 2010 — Recent studies show that more women with cancer in one breast are opting for removal of both breasts, even though removal of the healthy breast does little to improve survival rates, New York Times columnist Tara Parker-Pope writes. In 2006, roughly 6% of women who underwent surgery for breast cancer chose to remove both the cancerous and healthy breasts, a procedure known as contralateral prophylactic mastectomy, Pope says. According to a University of Minnesota study presented last week at the annual meeting of the Society of Surgical Oncology, 10% of women in their 40s who underwent breast cancer surgery chose to have both breasts removed. A 2009 study in the Journal of Clinical Oncology found that among women who had surgery for ductal carcinoma in situ -- one of "the earliest, most curable forms of cancer" -- the rate of double mastectomy increased from 2.1% in 1998 to 5.2% in 2005, Parker-Pope writes.
According to Parker-Pope, although removing two healthy breasts can reduce the risk of breast cancer in women with a genetic predisposition to the disease, "for most women given a diagnosis of breast cancer, cutting off a healthy breast does not improve the odds of survival." For example, a new study in the Journal of the National Cancer Institute examining data on 108,000 women who underwent mastectomy -- including 9,000 women who opted to remove both a healthy and a cancerous breast -- found that a survival benefit only occurred in a small group of women who were younger than age 50 and diagnosed with early-stage estrogen-receptor-negative tumors that were unresponsive to treatment with risk-lowering drugs. Isabelle Bedrosian, a surgical oncologist at M.D. Anderson Cancer Center and a study researcher, said, "Part of the reason women are frightened is we haven't given them good information," adding, "Part of my hope with this study is to tell most breast cancer patients that it's O.K. not to do this."
Parker-Pope writes that many "women who have opted for the procedure say it's not about the statistics" but about a desire to never relive the stress of undergoing a mammogram or breast biopsy. Some patients also say they have chosen to remove both breasts so their breasts are symmetrical after their operations, she adds (Parker-Pope, "Well," New York Times, 3/8).
U.S. Maternal Mortality Rate Increases Over Last Decade
March 10, 2010 — The maternal mortality rate in the U.S. appears to have risen over the past 10 years, reaching a rate that is four times higher than the federal government's 2010 goal, the AP/Yahoo! News reports. In 2006, the last year for which nationwide data are available, about 13.3 maternal deaths occurred for every 100,000 live births, compared with around seven deaths per 100,000 births one decade before. U.S. officials had hoped to decrease the rate to about 3.3 deaths in 2010. In California, the state that most closely tracks maternal mortality data, there were about 16.9 maternal deaths per 100,000 live births in 2006, an increase from 5.6 maternal deaths per 100,000 births in 1996.
Mark Chassin of the Joint Commission called U.S. maternal mortality rates "unacceptable." He added, "Maybe as many as half of these [deaths] are preventable."
Maternal deaths are classified as those that occur within 42 days after delivery and are directly related to pregnancy or childbirth. The most common causes are deep vein thrombosis-caused pulmonary emboli, hemorrhage and uncontrolled blood pressure. For reasons that are unclear, black women are at least three times more likely to die from pregnancy complications than white women. For every maternal death, about 50 additional women experience serious complications during pregnancy or delivery, according to University of Louisville's Jeffrey King, a spokesperson from the American College of Obstetricians and Gynecologists.
Although it is unclear what is driving the overall increase, possible explanations include an increase in caesarean-section deliveries and a greater number of pregnancies among women older than age 30, the AP/Yahoo! News reports. One in five pregnant women is obese, which can lead to complications such as higher blood pressure and diabetes. In addition, the way maternal deaths are counted and tracked has changed over the last 10 years. However, only about 30% of the increase is likely due to changes in reporting methods, according to Elliott Main of the California Maternal Quality Care Collaborative (Neergaard, AP/Yahoo! News, 3/9).
New York Times Examines Factors Affecting VBAC Rates as NIH Conference Begins
March 9, 2010 — The New York Times on Tuesday examined efforts to increase rates of vaginal births after caesarean sections at the Tuba City Regional Health Care Corporation, a small hospital run by the Navajo Nation and financed partially by the Indian Health Services. According to the Times, the hospital "prides itself" on having higher VBAC rates and lower overall c-section rates than wealthier, more renowned hospitals.
This week, NIH is hosting a conference to evaluate factors affecting the nation's low VBAC rate, which dropped significantly since a peak of 28.3% of births in 1996. Tuba City, with about 500 births annually, "could probably teach the rest of the country a few things about obstetrical care," the Times reports.
For years, health experts advised women who had given birth via c-section during a first pregnancy to have c-sections in subsequent labors because of concerns that a vaginal birth could cause the c-section scar on the uterus to rupture. In 1980, an expert panel announced that women who had c-sections for a first pregnancy could safely give birth vaginally for later pregnancies, prompting a rise in VBACs. However, after a series of ruptures, deaths and lawsuits related to VBACs, the American College of Obstetricians and Gynecologists issued stricter VBAC guidelines, and the rate fell below 10%.
The national c-section rate has been rising for the past 11 years and now stands at 31.8%, driven largely by cases of repeat c-sections. The World Health Organization recommends a target c-section rate of 15% for low-risk women, though there is no consensus about an ideal U.S. c-section rate. Many health experts -- including ACOG -- believe doctors overuse c-sections. They argue that unnecessary c-sections expose too many women and infants to the risks of the surgical procedure and accumulate several billion dollars annually in excess medical costs.
Differences From Other Hospitals
At Tuba City, the 2009 VBAC rate was 32%, and the overall c-section rate was 13.5%. The favorable rates are partially due to Tuba City's use of nurse midwives to staff the labor ward, the Times reports. Nurse midwives focus on coaching pregnant women through labor, and they often will wait longer than obstetricians before advising a c-section. Nurse midwives also are less likely to induce pregnancy before a woman's due date, a practice that can also increase the chance of needing a c-section. Nationally, nurse midwives attend roughly 10% of vaginal births, though the American College of Nurse Midwives hopes to raise that rate to 20% by 2020.
For other hospitals to replicate Tuba City's model, it would require "fundamental changes in medical practice, like allowing midwives to handle more deliveries and removing the profit motive for performing surgery," the Times reports. ACOG recommends that obstetricians and anesthesiologists be "immediately available" in case complications arise during VBACs, and many hospitals ban the procedure because they cannot meet the recommendation. According to the Times, Tuba City's physicians live on the hospital grounds to ensure they are immediately available during a VBAC. In addition, Tuba City is insured by the federal government, meaning private insurers cannot threaten to raise premiums or withdraw coverage if the hospital allows VBACs (Grady, New York Times, 3/6).
Washington Post, 'Marketplace' Examine Issues Related to HPV Vaccines
March 9, 2010 — The Washington Post on Tuesday published a list of questions and answers from a Consumer Reports review of the safety and efficacy of Merck's human papillomavirus vaccine, Gardasil. A new report from the Centers for Disease Control and Prevention and FDA found that a few women and girls vaccinated with Gardasil experienced serious complications but that the rates and severity of most side effects appear to be consistent with those of other vaccines, the Post reports. FDA approved the vaccine in 2006 for women and girls ages nine through 26.
The Q&A states that studies of about 21,000 girls and women who were not infected with HPV at the time of vaccination found that Gardasil was highly effective in preventing cervical, vaginal and vulvar cancers, as well as in preventing genital warts (Washington Post, 3/9). The vaccine is designed to protect against HPV types 16 and 18, which cause about 70% of all cervical cancer cases, and HPV types 6 and 11, which cause genital warts (Women's Health Policy Report, 6/3/09).
'Marketplace' Examines Cervarix Ad
Also on Tuesday, America Public Media's "Marketplace" reported on a marketing campaign for GlaxoSmithKline's HPV vaccine, Cervarix, that includes a commercial designed to resemble a public-service announcement rather than an advertisement. The ad shows a woman in what at first appears to be a perfume commercial, but when the woman looks at a perfume bottle, the label reads "cervical cancer." "Marketplace" reports that "[b]y creating go-to information sites and online communities, companies can create strong relationships with consumers" (Vanek-Smith, "Marketplace," American Public Media, 3/8).
Blogs Comment on Abortion Coverage in Health Reform, International Women's Day, Other Topics
March 9, 2010 — The following summarizes selected women's health-related blog entries.
~ "Stupak's Abortion Argument: Still More About Class Than Choice": Washington Post's "Ezra Klein": The "practical effect" of Rep. Bart Stupak's (D-Mich.) position on abortion-related language in health reform legislation "is not that the federal government will not subsidize abortion by subsidizing health care insurance" but that "it will not subsidize abortion by subsidizing health care insurance for poor women," Klein writes. Klein includes an excerpt from Post colleague Matt Miller's recent blog post on the subject. Miller wrote, "This entire debate is ridiculous, because the feds already subsidize abortions massively, via the giant tax subsidy for employer-provided care. Today the feds devote at least $250 billion a year to subsidizing employer-based coverage, a subsidy that skews incentives horribly (but which big business and big labor wouldn't let the politicians touch this year)." Miller also noted that data from the Guttmacher Institute show that 87% of typical employer plans cover abortion services. According to Klein, Stupak's amendment -- which would bar all insurance plans that receive federal subsidies from covering abortion -- "is as much about class as it is choice." Klein writes that "the poorer women who will be using subsidies on [health insurance exchanges] are a much easier target" than wealthier women with employer-provided coverage (Klein, "Ezra Klein," Washington Post, 3/5).
~ "International Women's Day: The Enormous Benefits of Investing in Family Planning and Pregnancy Related Care," Sharon Camp, Huffington Post blogs: International Women's Day this year "coincides with the 15th anniversary of the adoption of the Beijing Declaration and Platform for Action, a historic pledge to make the recognition and fulfillment of women's rights a global priority," Camp, president and CEO of the Guttmacher Institute, writes. She adds, "The declaration makes clear that reproductive health is critical to the well-being of women and men, asserts all people's right to have access to family planning information and services, and underscores the importance of maternal and newborn health care." According to Camp, "Approximately 215 million women who want to avoid pregnancy are not using an effective method of contraception, and only about half of the 123 million women who give birth each year receive the antenatal, delivery and newborn care they need." She adds, "Millions of those women who experience major complications get no treatment and either die or suffer from severe and debilitating conditions, such as obstetric fistula." She continues, "It is clear that investing in women has vast benefits, not just for individuals and families, but for societies as a whole," concluding, "It can truly transform the future of developing nations" (Camp, Huffington Post blogs, 3/9).
~ "This International Women's Day, Let's Aim To End Maternal Deaths," Tamar Abrams, Huffington Post blogs: A December 2009 report from the Guttmacher Institute and the United Nations Population Fund shows that "[m]aternal deaths in developing countries could be slashed by 70% and newborn deaths cut nearly in half if the world doubled investment in family planning and pregnancy-related care," Abrams writes. She adds that the report "found that investments in family planning boost the overall effectiveness of every dollar spent on the provision of pregnancy-related and newborn health care." According to Abrams, delegates who plan to attend June's Women Deliver conference in Washington, D.C., "are determined to put maternal health high up on the agendas of leaders of nations large and small, developed and getting there." The delegates plan to ask for "$10 billion in additional funding for global maternal health annually, increasing to an additional $20 billion by 2015," Abrams says. She concludes, "We mustn't let this critical discussion get bogged down in ideology about abortion or contraceptives or politics" (Abrams, Huffington Post blogs, 3/5).
~ "Dirty Dozen: Does Stupak Really Have the Votes Needed To Sink Health Care?": Brian Beutler, Talking Points Memo's "TPMDC": Stupak is currently "holding health care reform hostage over the issue of abortion" and says "he can flip about a dozen 'yes' votes on health care (including his own) to 'no' votes if nothing is done about" abortion language in the Senate bill (HR 3590), Beutler writes. It is difficult to definitively identify these lawmakers, "[b]ut it is possible to whittle down a list of likely suspects," according to Beutler. He concludes that with Democratic leaders and "the White House teaming up to twist arm[s], it's hard to imagine all of Stupak['s] supporters will stick together" (Beutler, "TPMDC," Talking Points Memo, 3/8).
~ "Wreckonciliation": Rebecca Sive, RH Reality Check: Sive writes, "We, the women of America, are being told by those on-high, starting with those who might have been at the White House on International Women's Day, including Nancy Pelosi -- the most important woman in America right about now -- that American women's most fundamental right, our right to control our reproductive destiny, should be of no consequence in the effort to reform health care." Sive criticizes Pelosi for insisting that the health reform debate is "'not about abortion,' ... when even the most politically untrained, outside-the-Beltway bystander knows otherwise." Sive writes, "The future of ... health care reform has come down to this: can [Pelosi] and the White House come to a winning plan on how to deal with access to abortion?" Sive adds that regardless of how much ground Pelosi concedes to antiabortion-rights forces today, "they'll just ask for more tomorrow. That's how Washington works; that's how men in power work; that's how women in power who don't care about women work." Sive concludes, "That's wreckonciliation" (Sive, RH Reality Check, 3/9).
~ "Trouble for Mitt Romney? Mass. Health Plan Covers Abortion": Brian Montopoli, CBS News' "Political Hotsheet": "Mitt Romney's role in overseeing passage of a universal health care plan in Massachusetts appears likely to cause headaches for the former Republican governor should he make his widely expected run for the White House in 2012," Montopoli writes. He notes that other commentators are drawing attention to the fact that "all of the government-subsidized health care plans offered to low-income Massachusetts residents, under a program called Commonwealth Care, cover abortion." David Axelrod, a White House senior adviser, has called the Massachusetts health insurance law the "template" for Obama's reform plans. Montopoli writes, "All this appears to leave Romney on the wrong side of the issue." In response to criticism over the abortion issue, Romney spokesperson Eric Fehrnstrom said, "Court rulings in Massachusetts require state-subsidized health plans to offer abortion services. It's not something that Gov. Romney agrees with, but it's longstanding court precedent that predates his administration" (Montopoli, "Political Hotsheet," CBS News, 3/8).
~ "Abortion Will NOT Be a Deal Breaker," Linda Bergthold, Huffington Post blogs: Health policy consultant Bergthold writes, "If you only watched TV or surfed the net, you would think health reform hangs by a thread over abortion," when in fact it "does not." Bergthold says this misrepresentation occurs because abortion is "controversial" and abortion-rights opponents -- such as Rep. Bart Stupak (D-Mich.) -- "are the loudest voices" in the debate. Bergthold writes, "I do not believe that in the final analysis Stupak will have the votes to destroy health reform over the abortion issue. At least I want to believe that. " She adds, "But the media likes to play it up because it attracts an audience" (Bergthold, Huffington Post blogs, 3/6).
GOP Candidate for Calif. Gov. Switches Positions on Abortion-Related Issues
March 9, 2010 — California Insurance Commissioner Steve Poizner, who is seeking the Republican gubernatorial nomination, took liberal positions on abortion-rights issues when he unsuccessfully ran for state Assembly in 2004, the Los Angeles Times reports. Poizner's past statements supporting abortion-right issues contradict the conservative stance he has taken in his current campaign. On Friday, the Poizner campaign sent an e-mail claiming that he is "the only Republican candidate for governor who is against taxpayer-funded abortion." Poizner's opponent for the GOP nomination, Meg Whitman, generally supports abortion rights but also supports parental notification for minors, according to the Times. In another release, the campaign said Poizner supports a proposed ballot initiative that would require parental notification before a minor can receive an abortion. The release also said that a Poizner supporter praised him for taking "a clear stand on issues that matter to social conservatives."
However, in a 2004 questionnaire completed for Planned Parenthood Mar Monte and obtained by the Times, Poizner said he supports sex education that includes information on contraception, government funding for abortion services and expanded access to emergency contraception. He also indicated that he would support confidential services for minors and would oppose legislation requiring parental notification. Poizner also said he would fight efforts to restrict certain types of abortion procedures.
Poizner's responses on the questionnaire prompted PPMM to issue him a 100% rating on abortion rights. Deborah Ortiz, a spokesperson for the organization, said that the "100% ranking shows that he supported all of our issues in 2004." She added, "When he changed his position is certainly a question for Mr. Poizner" (Rothfeld, Los Angeles Times, 3/6).
Poizner in 2004 also identified himself as a supporter of abortion rights in a separate questionnaire for the Wish List, a Republican group that backs candidates who support abortion-rights, Politico's "Ben Smith" reports. For that survey, Poizner checked boxes in support of Roe v. Wade and government funding for abortion services for low-income women (Smith, "Ben Smith," Politico, 3/5).
Poizner spokesperson Jarrod Agen said Poizner believes abortion should be legal but wants to "drive the number of abortions down to zero." He added that Poizner had "matured his position" on government funding for the procedure "as he has studied it more, talked to more people and realized that one way to drive abortion down to zero is to eliminate state funding" and require parental notification for minors (Los Angeles Times, 3/6).