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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Video Round Up: Anti-Choice Agenda Advancing on State, Federal Level; Abortion Providers Face Ongoing Harassment

Thu, 05/21/2015 - 18:02

In today's clips, Democracy Now's Amy Goodman discusses the 20-week abortion ban that passed in the House last week. Elsewhere, MSNBC's Melissa Harris-Perry examines the continued harassment affecting abortion providers as they try to do their jobs.

Video Round Up: Anti-Choice Agenda Advancing on State, Federal Level; Abortion Providers Face Ongoing Harassment

May 21, 2015 — In today's clips, Democracy Now's Amy Goodman discusses the 20-week abortion ban that passed in the House last week. Elsewhere, MSNBC's Melissa Harris-Perry examines the continued harassment affecting abortion providers as they try to do their jobs.



Democracy Now's Amy Goodman and Cecile Richards, president of Planned Parenthood Federation of America, discuss the 20-week abortion ban (HR 36) that recently passed the House, as well as the onslaught of state restrictions demonstrating abortion rights opponents "remain determined to advance an anti-choice agenda on the national level, as they do so in the states."

According to Richards, state restrictions, which are being introduced in "record numbers ... all across the country," are even "worse" than what is happening on the federal level, including "not only 20-week bans ... but [also] restrictions on abortion providers [and] waiting periods for women as if they can't make their own decisions without the intervention of politicians." She adds, "[I]t's very, very difficult. I think we're really seeing the results of the midterm elections" (Goodman, Democracy Now, 5/19).




MSNBC's Melissa Harris-Perry in "Lean Forward" interviews authors David Cohen and Krysten Connon about their book, "Living in the Crosshairs," which details the harassment experienced by abortion providers.

In the interview, Cohen notes that the harassment is "an ongoing problem for abortion providers across the country," adding that some providers "are living ... in fear of having people come to their home; ... their children being stalked at schools; death threats through the mail, on the phone; being followed to and from work." Further, Cohen and Connon compare the acts of antiabortion-rights protesters to terrorism, with Cohen noting that extremists, who seek the "complete abolition of abortion," turn to "extra-legal means and these intimidation means to try and accomplish what they can't in the political arena, and that is one of the definitions of terrorism" (Harris-Perry, MSNBC, 5/9).


Calif. Law Could Improve Birth Control Access; Oregon Considers Similar Measure

Thu, 05/21/2015 - 17:39

A 2013 California law (SB 493) is scheduled to take effect in the next few weeks that will allow pharmacists in the state to distribute contraception without requiring a prescription from a physician, Governing reports.

Calif. Rule Change Could Increase Birth Control Access; Oregon Considers Similar Measure

May 21, 2015 — A 2013 California law (SB 493) is scheduled to take effect in the next few weeks that will allow pharmacists in the state to distribute contraception without requiring a prescription from a physician, Governing reports.

Under the law, women will be able to request contraception from a pharmacist, who could then write the prescription after following certain screening protocols. Specifically, a woman would be required to complete a brief health questionnaire, undergo a blood pressure test and consult with the pharmacist on dosage and other information before receiving the contraception.

According to Governing, the California Board of Pharmacy established the protocols earlier this year. They soon will be filed officially with state regulators.

The service can be provided by any pharmacist. Further, the law does not allow insurers to refuse to cover FDA-approved contraceptives because they are prescribed by a pharmacist rather than a physician. Under the Affordable Care Act (PL 111-148), insurers have to cover all forms of FDA-approved contraceptives.

Implications

The American Congress of Obstetricians and Gynecologists and other medical groups have expressed support for making contraception available over the counter. In addition, a study published last year in Contraception found that the practice could lower unintended pregnancies by one-quarter.

According to Governing, the policy also could help uninsured women access contraception because the pharmacist consultation will likely be less costly and take less time than a physician visit.

California Pharmacists Association CEO Jon Roth said consumer awareness will be a key factor in the measure's success. He noted that while major retail chains will be able to advertise the service, consumers likely will take some time to notice how pharmacists' role has changed (Kardish, Governing, 5/19).

Oregon Considers Similar Measure

In related news, the Oregon House Rules Committee has revived a proposal that would, like the California law, allow women to obtain contraception without a physician prescription, the AP/KTVZ News reports (AP/KTVZ News, 5/20).

An Oregon House committee last month rejected a proposal to revise the contraceptive prescribing rules when it was proposed by state Rep. Knute Buehler (R) as an amendment (HB 2028-5) to a bill (HB 2028) that addressed pharmacists' scope of practice. The proposal was assigned to a workgroup (Women's Health Policy Report, 4/21).

According to AP/KTVZ, the committee has assigned the provision as an amendment (HB 2879-4) to a different bill (HB 2879). The committee will consider the bill on Wednesday (AP/KTVZ News, 5/20).


Abortion Restrictions Vary by ZIP Code, 'Create One Barrier After Another for Women,' Op-Ed States

Thu, 05/21/2015 - 17:39

"[I]f you're a woman counting on a constitutional right to an abortion, your access to one may increasingly depend on your county or zip code, and whether you can drive to the only open clinic in your state or to a nearby state where abortion care is still widely accessible," columnist Rebecca Ruiz writes in a Mashable opinion piece.

Abortion Restrictions Vary by ZIP Code, 'Create One Barrier After Another for Women,' Op-Ed States

May 21, 2015 — "[I]f you're a woman counting on a constitutional right to an abortion, your access to one may increasingly depend on your county or zip code, and whether you can drive to the only open clinic in your state or to a nearby state where abortion care is still widely accessible," columnist Rebecca Ruiz writes in a Mashable opinion piece.

For example, Ruiz notes that while the Supreme Court's Roe v. Wade decision "made ... clear" that "[t]he right to an abortion is a right protected by the United States constitution," the "right may as well not exist" for women in Tennessee. Tennessee Gov. Bill Haslam (R) recently signed two measures -- one (SB 1222) imposing a 48-hour mandatory delay before abortions, and another (SB 1280) imposing what opponents note are "medically unnecessary" clinic building regulations, she writes.

"Such laws make abortion nearly or completely impossible to obtain, and they don't just affect Tennessee women," Ruiz writes, citing data from the Guttmacher Institute that found state lawmakers have introduced more than 300 abortion restrictions in the first three months of 2015. Moreover, according to Guttmacher, the percentage of women living in states "considered hostile to abortion rights" has increased from 31% in 2010 to 57% in 2014, she writes.

Ruiz also cites Amanda Allen, state legislative counsel for the Center for Reproductive Rights, who noted that such disparate access to abortion "'is not the promise of our constitution. Everyone should have equal constitutional rights,'" but the "'way these state laws have been working, (access) really depends on where you live.'"

For example, Ruiz writes that mandatory delay laws vary by state, with differing delay periods and required counseling provisions. While some states -- such as Alaska, California or Colorado -- do not prevent women "from immediately seeking an abortion," others require a 72-hour delay. Meanwhile, "[m]ore than two dozen states have forbidden state-regulated health insurance plans, available through the Affordable Care Act (PL 111-148), to cover abortion" and more than 20 states impose admitting privilege requirements or stringent clinic building requirements, Ruiz notes.

She writes, "Taken together, these restrictions create one barrier after another for women who seek a constitutionally-protected medical procedure."

Ruiz notes that as lawsuits over these restrictions move through the courts, often with "different outcomes depending on geography, it has become clear that only the Supreme Court can truly address the growing disparities in access to abortion." The high court will likely weigh whether such restrictions constitute an "undue burden" on women's access to abortion, but Ruiz notes that the soonest the court could rule on such a case is 2016. "Until then, women across the country will find themselves subject to wildly different abortion laws," with women who are low-income or living in the South or Midwest being "most dramatically affected," Ruiz writes (Ruiz, Mashable, 5/20).


Blogs Comment on 'Cruel' Texas Judicial Bypass Bill, Debunk Rationale Behind Admitting Privileges Laws, More

Thu, 05/21/2015 - 17:04

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

Blogs Comment on 'Cruel' Texas Judicial Bypass Bill, Debunk Rationale Behind Admitting Privileges Laws, More

May 19, 2015 — Read the week's best commentaries from the Center for American Progress' "ThinkProgress," RH Reality Check and more.

ABORTION RESTRICTIONS: "Texas Lawmakers Want Women To Present IDs Before They Get Abortions," Tara Culp-Ressler, Center for American Progress' "ThinkProgress": Culp-Ressler writes about a measure (HB 3994) passed by the Texas House that would "make it extremely difficult for minors to obtain an abortion in a state that's already severely restricted reproductive rights." Among other restrictions, the "omnibus" bill would "requir[e] abortion doctors to assume that all of their patients are minors and request a government-issued ID to verify their age," Culp-Ressler writes, adding that the provision "threatens to pose an especially large burden for younger teens and immigrant women who may not have a drivers license." Culp-Ressler also describes how the bill would tighten a state law that allows pregnant minors to obtain a court's permission to have an abortion instead of obtaining parental consent for the procedure. Citing reproductive-rights proponents, Culp-Ressler notes that the "judicial bypass process is intended to serve as a safety net for vulnerable teens, and it's cruel to place even more restrictions on young women who are in difficult situations" (Culp-Ressler, "ThinkProgress," Center for American Progress, 5/15).

What others are saying about abortion restrictions:

~ "Which State Was the Worst for Women This Week?" Amanda Marcotte, Slate's "The XX Factor."

~ "South Carolina Republican: 20-Week Abortion Ban Isn't Harsh Enough," Nina Liss-Schultz, RH Reality Check.

~ "Anti-Choice Groups Try 'Texas Playbook' in Attempt To Block Health Care Access in California," Jessica Mason Pieklo, RH Reality Check.

TRAP LAWS: "Admitting Privilege Laws: A Solution in Search of a Problem," Stanley Henshaw, RH Reality Check: Henshaw outlines "what everyone should know about" legislation that requires physicians who provide abortion care to have admitting privileges at nearby hospitals. Specifically, he explains that abortions in the U.S. are "very safe" and that if a woman does need emergency services, she should "go to a nearby hospital, not to the one where the provider has privileges." Further, he notes that some hospitals "refuse to grant privileges to any physician who performs abortions" or refuse because the physician does not "reside near the hospital" or likely will admit fewer than one patient annually. Henshaw also notes that in some cities, such restrictions have "forced the only available abortion providers to close," which can lead to more "abortions occur[ing] later in gestation, when they are more risky and expensive." Noting that "[i]t's clear that admitting privilege requirements do not benefit women," Henshaw writes, "It is up to each of us ... to hold our lawmakers accountable when they try to distort the truth by saying admitting privileges are necessary for the health of women" (Henshaw, RH Reality Check, 5/15).

What others are saying about TRAP laws:

~ "Virginia Clinics Navigate Changing TRAP Law: 'I Feel Like I'm Digging a Hole Just to Fill it Back in,'" Liss-Schultz, RH Reality Check.

ANTIABORTION-RIGHTS MOVEMENT: "Exploiting the Black Family: A Divisive Campaign of the Anti-Woman, 'Pro-Life' Movement," Cherisse Scott, RH Reality Check: Scott, founder and CEO of SisterReach, writes about how the placement of "three anti-choice billboards" in underserved and "predominantly Black ... neighborhoods of Memphis, Tennessee ... represent[s] another attempt by the anti-choice movement to guilt Black mothers about their personal reproductive health-care decisions while pitting Black fathers against us." According to Scott, such billboards, used by antiabortion-rights groups since 2010,"com[e] at a time when Black people everywhere are forced to remind the world that Black lives matter, especially the quality of those lives." She adds that "these anti-woman, anti-choice supporters are nowhere to be found when advocates are working to change the lived conditions of Black communities." Further, the antiabortion-rights groups "forego consulting Black communities about what we need in terms of support or resources to change the daily conditions of our lives," Scott writes, noting that "80 percent of Black Americans believe abortion should remain legal." She adds, "If the anti-choice movement is actually concerned about Black lives, they will take the billboards down and instead re-route those resources into productive efforts to achieve the complete health and well-being of Black families in Memphis and throughout the country" (Scott, RH Reality Check, 5/15).

CONTRACEPTION: "Good News for Military Servicemembers Who Use Birth Control," Leila Abolfazli, National Women's Law Center's "Womenstake": "This year, the House and Senate versions of the [National Defense Authorization Act (HR 1735)] include provisions that would improve women servicemembers' access to birth control" by "provid[ing] comprehensive counseling and education about contraception," Abolfazli writes. In addition, she notes that the House version of the measure also "would ensure a woman servicemember has access to the birth control she needs at all times, particularly when she is deployed." Abolfazli explains that the provisions were "taken from a bill [S 358, HR 742] that Senator [Jeanne] Shaheen [D] and Representative [Jackie] Speier [D] introduced earlier this year." She adds that while "their tireless efforts" helped ensure the provisions were included in the NDAA bill, women's health supporters must "make sure these great provisions aren't taken out" of the final bill, and that the provisions are "working" if enacted. In addition, Abolfazli writes that advocates "need to make sure" additional contraceptive benefits from Shaheen and Speier's bill are included in next year's version of the NDAA (Abolfazli, "Womenstake," National Women's Law Center, 5/15).

LGBT: "Physicians' Group: Give LGBT People Full Rights -- It Makes Them Healthier," Jenny Kutner, Salon: Last "week, the American College of Physicians -- the second-largest group of physicians in the country, following the American Medical Association -- issued a position paper recommending specific approaches to improving LGBT health outcomes," Kutner writes. She explains that "LGBT individuals ... face worse health outcomes and disparities in care for a range of reasons," including "hurdles to acquiring insurance coverage" and "the social stigma that so often comes with coming out." However, she notes that while "opponents of LGBT rights have used health disparities to argue against 'leading a homosexual lifestyle' ... a significant proportion of American physicians agree that basic civil rights -- including legalized marriage equality -- can do wonders to reduce the strain on LGBT health." According to Kutner, ACP's recommendations echo that agreement, expressing support for marriage equality; inclusive definitions of family "regardless of ... legal or biological relationship"; and hospital policies that "allow all patients to determine who may visit and who may act on their behalf during their stay" (Kutner, Salon, 5/15).


N.Y. AG Launches Training for State Hospital Staff on Transgender Individuals' Care

Thu, 05/21/2015 - 17:04

New York Attorney General Eric Schneiderman (D) has announced that his office will train state hospital employees on how to ensure transgender individuals have equal access to health services, Modern Healthcare reports.

N.Y. AG Launches Training for State Hospital Staff on Transgender Individuals' Care

May 18, 2015 — New York Attorney General Eric Schneiderman (D) has announced that his office will train state hospital employees on how to ensure transgender individuals have equal access to health services, Modern Healthcare reports.

The office's Civil Rights Bureau and the Greater New York Hospital Association will work together to address the issues that transgender individuals encounter in health care settings and to ensure providers are using best practices when treating transgender patients. The training will be targeted toward hospitals' diversity and quality officers, legal counsels, compliance personnel and other administrators.

Need for Transgender-Focused Policies, Training

According to Modern Healthcare, Lambda Legal, an LGBT-focused civil rights group, has found that few New York City hospitals have policies or training in place to help providers who care for transgender patients. The group worked with New York's AG office to lead a series of briefings for GNYHA's LGBT workgroup.

In addition, a 2011 survey of transgender individuals conducted by the National Center for Transgender Equality and the National Gay and Lesbian Task Force found that 24% of respondents had been denied equal access to care in a physician's office or a hospital.

Comments

Perry Halkitis -- a professor at New York University's Global Institute of Public Health, who studies LGBT health issues -- said hospital leaders must learn about transgender individuals' unique needs and the social difficulties they encounter but also promote an atmosphere of tolerance and acceptance among employees. He said, "We're talking about everything as simple as understanding what it means (to be transgender) and understanding that gender identity is something that exists on a continuum."

Halkitis said provider education is needed, especially given that medical students receive little training on gender identity. However, he noted that some hospitals must consider other issues, such as the need for gender-neutral bathrooms at their facilities and appropriate forms for individuals who may not feel comfortable identifying as "male" or "female."

Separately, M. Dru Levasseur, director of Lambda Legal's Transgender Rights Project, said the initiative marks "the first time [he's] seen a state official have this kind of leadership where he's sending a message to trans[gender] New Yorkers, but also to the nation, that transgender people's treatment in hospital settings and medical settings matters and needs protections" (Rubenfire, Modern Healthcare, 5/15).


Tenn. Governor Signs 48-Hour Mandatory Delay Bill

Thu, 05/21/2015 - 17:03

Tennessee Gov. Bill Haslam (R) on Monday signed a bill (SB 1222) into law that will impose a 48-hour mandatory delay before a woman can obtain an abortion, Reuters reports.

Tenn. Governor Signs 48-Hour Mandatory Delay Bill

May 19, 2015 — Tennessee Gov. Bill Haslam (R) on Monday signed a bill (SB 1222) into law that will impose a 48-hour mandatory delay before a woman can obtain an abortion, Reuters reports.

The law is scheduled to take effect July 1.

According to the Guttmacher Institute, Tennessee is now one of 26 states that impose mandatory delays before an abortion (Ghianni, Reuters, 5/18). Meanwhile, lawmakers in Florida and North Carolina have submitted mandatory delay legislation to their respective governors (Wadhwani, Tennessean/USA Today, 5/18).

Law Details

The law also will require that women receive in-person counseling from a physician prior to having an abortion, forcing women to make an additional trip to the clinic prior to the abortion procedure. In the case of a medical emergency, the counseling requirement will be waived (Women's Health Policy Report, 5/11). Physicians who are found to violate the counseling requirement could be charged with a misdemeanor or felony. They also could have their medical licenses revoked (Tennessean/USA Today, 5/18).

The measure also includes a "spring-back" provision that would reduce the delay to 24 hours if the measure is stayed or struck down by a court. In addition, the remainder of the bill would stay in effect if any portion of the measure is found invalid (Women's Health Policy Report, 5/11).

Reaction

Supporters of the law say it will help protect women's health and welfare, according to the Tennessean/USA Today.

Meanwhile, opponents of the measure note that abortion is now the only medical procedure that will require a mandatory delay. In addition, they note that some women have to travel 100 miles or more to reach one of the seven abortion clinics in the state and that requiring women to make two trips could lead to burdensome expenses.

Planned Parenthood of the Greater Memphis Region said in a statement that the law "is a tool to shame and disgrace women who make the deeply personal decision to end a pregnancy" and that "it creates unnecessary financial and emotional hardships" (Tennessean/USA Today, 5/18).


Wave of Mandatory Delay Legislation Imposing Additional Burdens on Women

Thu, 05/21/2015 - 17:02

Several states are "looking to mandate lengthier and stricter delays for abortion," which can limit women's access to the procedure, Reuters reports.

Wave of Mandatory Delay Legislation Imposing Additional Burdens on Women

May 15, 2015 — Several states are "looking to mandate lengthier and stricter delays for abortion," which can limit women's access to the procedure, Reuters reports.

Background

According to Reuters, the push for mandatory delay measures "comes amid a wave of anti-abortion laws passed by conservative lawmakers over the past few years seeking to chip away at ... Roe v. Wade." Recently, several states have advanced or passed legislation imposing such delays, including Arkansas (Act 1086), Florida (HB 633), North Carolina (HB 465), Oklahoma (HB 1409) and Tennessee (SB 1222).

Mailee Smith, staff counsel at Americans United for Life, said the organization has distributed model legislation enforcing more stringent delays to at least 15 states. She said AUL is working to increase delays already in place in roughly 24 states.

Meanwhile, abortion-rights supporters are considering whether to pursue legal action against the delays, Reuters reports.

Effect of Mandatory Delay Legislation

Christopher Estes -- chief medical officer for Planned Parenthood of South, East and North Florida -- noted such legislation in Florida could "be an additional barrier to those in an already difficult situation, making it even worse." According to Reuters, the 24-hour mandatory delay recently passed by the Florida Legislature requires two office visits, which could, if enacted, impose additional burdens on women in nearby states with few clinics, such as Arkansas or South Carolina.

Similarly, Jennifer Aulwes, a spokesperson for Planned Parenthood Minnesota, North Dakota, South Dakota, said the state's 72-hour mandatory delay resulted in patients having to travel longer distances and created more difficulty in scheduling appointments.

Further, Ted Joyce, a professor focused on reproductive health economics at the City College of New York's Baruch College, said mandatory delays that require multiple office visits can prevent women from obtaining an abortion. According to the Guttmacher Institute, 11 states require women to meet with physicians in person prior to obtaining an abortion, meaning that they must make a minimum of two trips to the clinic to obtain the procedure (Stein/Jenkins, Reuters, 5/13).


Blogs Comment on the 'Worst State' for Repro Rights, New Restrictions in the 20-Week Ban, More

Thu, 05/21/2015 - 17:01

Read the week's best commentaries from bloggers at The Atlantic, the National Women's Law Center's "Womenstake" and more.

Blogs Comment on the 'Worst State' for Repro Rights, New Restrictions in the 20-Week Ban, More

May 15, 2015 — Read the week's best commentaries from bloggers at The Atlantic, the National Women's Law Center's "Womenstake" and more.

ABORTION RESTRICTIONS: "The Worst State for Reproductive Rights," Olga Khazan, The Atlantic: South Dakota is "the worst state in the nation for reproductive rights," followed by Nebraska, Kansas, Idaho and Tennessee, according to a report released by the Institute for Women's Policy Research, Khazan writes. Khazan cites several reasons for South Dakota's poor ranking, including its 72-hour mandatory delay before abortions; requirements that women "undergo in-person counseling that necessitates two trips to the clinic"; and how almost 25% "of women in the state live in a county that doesn't have an abortion provider." Further, according to the report, the state also "does not require insurers to cover infertility treatments"; it does not "mandate sex education in schools"; and it has not expanded Medicaid under the Affordable Care Act (PL 111-148), "which would have increased the number of women eligible to receive family-planning services," Khazan writes. Meanwhile, she notes that the report ranks "Oregon [a]s the best state for reproductive rights ... followed by Vermont, Maryland, New Jersey, and Hawaii." According to the Khazan, Oregon earned its ranking by providing "public funding for abortions ... having a 'pro-choice' governor" and not requiring mandatory delays for women seeking abortions (Khazan, The Atlantic, 5/12).

What others are saying about abortion restrictions:

~ "We're Living in an Anti-Choice Nightmare: 25 Ways Anti-Women Warriors Are Playing Doctor," Katie McDonough, Salon.

20-WEEK BAN: "Another Week, Another Bad Vote on Women's Health," Leila Abolfazli, National Women's Law Center's "Womenstake": Abolfazli, senior counsel for NWLC, outlines "a whole host of new restrictions" included in the House-approved bill that would ban abortion at 20 weeks of pregnancy. For example, she writes that the legislation would "impos[e] a new set of hurdles for adult survivors of rape to navigate, but kept the original set of hurdles for minors who survive rape or incest." Specifically, Abolfazli notes that while "[a]dult survivors can forgo the reporting requirement if they seek medical care or counseling at least 48 hours before the abortion ... the care they seek can't be with the abortion provider, can't be with a provider in any non-hospital facility that performs an abortion, and it can't be with any counselor who is not licensed by the state." Further, the measure would "interfer[e] with the provider-patient relationship," would mandate certain reporting requirements for providers, "and, of course, ... would criminalize providers for providing care that their patients need and that is constitutional," she writes (Abolfazli, " Womenstake," National Women's Law Center, 5/14).

What others are saying about the 20-week ban:

~ "House Passes 20-Week Abortion Ban With Exciting New Hassles for Rape Victims," Amanda Marcotte, Slate's "The XX Factor."

REPRODUCTIVE CARE ACCESS: "The Family Planning Cuts That the Texas Legislature Forced Through Are Having Dire Consequences," Tara Culp-Ressler, Center for American Progress' "ThinkProgress": "[M]ore than half of Texas women have faced at least one barrier to getting the reproductive health services they need" since the state in 2011 "slashed funding for family planning services by two-thirds and dismantled the state's network of family planning providers in an effort to exclude Planned Parenthood," according to a report from the Texas Policy Evaluation Project, Culp-Ressler writes. She notes that "the attacks on ... family planning," which resulted in the closure of 76 women's health clinics, have "left low-income and rural women struggling to access basic preventative services like Pap smears, STD tests, and birth control consultations." According to Culp-Ressler, "[t]he new survey provides some data points" on the situation, finding that women "are struggling to get to a clinic for their gender-based health needs," with many citing difficulties with transportation, childcare, insurance and affordability, among other barriers. "Texas lawmakers have attempted to take some steps to restore the funding for family planning services," she writes, but she adds that "women's health experts in the state say it's not enough, and warn that it will take years for Texas to truly recover" from the cuts (Culp-Ressler, "ThinkProgress," Center for American Progress, 5/12).

SEXUALITY EDUCATION: "California Judge: Abstinence-Only Sex Education Isn't Sex Education at All," Jenny Kutner, Salon: A recent ruling by a California judge "affirms what reproductive health advocates and science have been saying for a long time: Abstinence-only sex education isn't really sex education at all," Kutner writes. She notes that, in the case, Fresno County Superior Court Judge Donald Black ruled that "'access to medically and socially appropriate sexual education is an important public right,' and that state law requires students receive accurate information in public school sex ed courses." Kutner writes that the decision "explicitly excludes abstinence-only curricula, which incorrectly -- and ineffectively -- teach[es] students that remaining celibate until marriage is the only route to avoiding sexually transmitted infections and unintended pregnancy." She adds, "Even if the California ruling doesn't have far-reaching implications for the state of abstinence-only sex education" in other states "just yet, it is a step in the right direction" (Kutner, Salon, 5/13).

ABORTION-RIGHTS MOVEMENT: "Pop-Up Abortion Storytelling Campaigns Showcase the Power of Youth Activism," Katie Klabusich, RH Reality Check: "The power of storytelling to combat stigma and the power of art to open hearts came together last month as students on 95 college campuses around the country participated in the 1 in 3 campaign's 'Week of Artivism,'" Klabusich writes. According to Klabusich, the campaign encouraged activists "[f]rom April 13 through 19" to "pos[t] 'pop-up' displays" that "featured real people's abortion stories in a variety of locations" throughout the schools. She interviewed several students who participated in the campaign, noting that they said "labels like 'pro-choice' and 'pro-life' took a backseat to story-sharing -- perhaps offering insight about ways that young activists, far from being apathetic or disinterested, are engaging their peers about issues of reproductive rights and justice." According to Klabusich, the students were able to see how the campaign "spark[ed] a dialogue on [the] campuses as awareness about the need for reproductive health care access led to widespread, nuanced discussion of views on abortion" (Klabusich, RH Reality Check, 5/13).

CONTRACEPTION: "Feds to Insurance Companies: You Actually Have to Cover Birth Control," Anna Merlan, Jezebel: "Three federal agencies issued a pointed set of 'clarifications' Monday, basically reminding health insurance companies that under the Affordable Care Act [PL 111-148], they really do have to cover birth control without a co-pay or deductible" and "[t]he same goes for 'well woman' exams, preventive services for transgender people and numerous other things insurers have [been] squirreling their way out of paying since the ACA passed," Merlan writes. Specifically, she notes that the guidance details how "insurers must cover 'without cost sharing ... at least one form of contraception in each of the methods (currently 18) that the FDA has identified for women in its current Birth Control Guide.'" Further, she writes that the guidelines make clear that if a woman's health care provider "recommends a specific service or type of birth control and deems it medically necessary," insurers "'must cover that service or item without cost sharing.'" In addition, the guidelines clarify "that [insurers] can't charge higher co-pays or deductibles or refuse coverage based on someone's 'sex assigned at birth, gender identify, or recorded gender,'" she writes. She adds that while not all insurers have to follow the guidance, "at least the new guidelines let patients and medical providers know what their rights are" (Merlan, Jezebel, 5/11).


Moves To Ban Telemedicine Abortion Could Limit Early Access to Abortion

Thu, 05/21/2015 - 17:01

While efforts are underway to advance federal legislation (HR 36) that would ban abortion at 20 weeks of pregnancy, several states already have moved to ban abortion via telemedicine, a method that can help women access the procedure earlier in pregnancy, Kaiser Health News reports.

Moves To Ban Telemedicine Abortion Could Limit Early Access to Abortion

May 20, 2015 — While efforts are underway to advance federal legislation (HR 36) that would ban abortion at 20 weeks of pregnancy, several states already have moved to ban abortion via telemedicine, a method that can help women access the procedure earlier in pregnancy, Kaiser Health News reports.

Background

Generally, according to KHN, a telemedicine abortion involves a woman and a physician meeting via a video connection while the woman is at the clinic. The physician will determine whether it is appropriate to prescribe the woman the two drugs used to induce a medication abortion. Medication abortion can be performed up to nine weeks of pregnancy.

Currently, telemedicine abortions are restricted in 16 states, where physicians are required to be physically present when administering medication abortions. Telemedicine abortions are permitted in Minnesota and Iowa, although the Iowa Supreme Court is currently weighing a rule from the state Board of Medicine that would require in-person medication abortion.

Benefits of Telemedicine Abortion

Supporters of telemedicine abortion have said the procedure increases the chances that a woman who is seeking an abortion can obtain the procedure earlier in pregnancy, when it is safer and less costly, KHN reports.

Further, they said it could help women seeking abortion care in areas with few providers. According to a report from the Guttmacher Institute, as of 2011, nearly 90% of counties in the U.S. do not have abortion clinics, and more than one-third of women of childbearing age resided in one of those counties.

Meanwhile, the overall abortion rate has decreased since 1981, but the rate of medication abortion -- provided in person or via telemedicine -- has increased from 17% in 2008 to nearly 25% as of 2011, according to KHN. Further, a recent study found that in Iowa, where Planned Parenthood of the Heartland provides telemedicine abortions at six locations, women who had abortion were 46% more likely to have the procedure in the first trimester of pregnancy once telemedicine abortion was introduced. The study, which compared the two-year periods before and after telemedicine abortion was offered, also found that the proportion of medication abortions at the PPH clinics increased from 46% to 54%.

Daniel Grossman, the study's lead author and vice president for research at Ibis Reproductive Health, said, "From a public health perspective, even though there was a relatively small decline in second trimester abortions, it's significant. Second trimester abortions have higher complications and are more expensive for women." According to Guttmacher, a first-trimester abortion cost about $500 in 2012, while abortion at 20 weeks had a median cost of $1,350.

Opponents Use Unfounded Safety Claims To Push Restrictions

According to KHN, abortion-rights opponents often try to restrict the procedure, claiming that it is unsafe, and are working to impose restrictions that require physicians to dispense medication abortion in person. However, supporters of abortion rights note that telemedicine abortion is safe and that requiring a physician's presence is not necessary.

For example, Penny Dickey, chief clinical officer at PPH, said patients receive exactly the same care whether the procedure is done with a physician in the room or via telemedicine.

Further, Grossman in a 2011 study found that medication abortions done in person and those done via telemedicine had nearly identical outcomes, with 99% of telemedicine patients and 97% of in-person patients having successful abortions. Grossman said, "Adverse events are no higher with telemedicine. We have looked at this and we have some data that shows it's just as safe as medication abortions provided in person" (Andrews, Kaiser Health News, 5/19).


NYT: 20-Week Ban Marks Another Effort 'To Undercut Women's Constitutionally Protected Reproductive Rights'

Thu, 05/21/2015 - 17:00

"For the second time in two years, the House voted Wednesday to pass legislation that would ban almost all abortions 20 weeks or more after fertilization," marking yet "another attempt by conservative [lawmakers] to undercut women's constitutionally protected reproductive rights," a New York Times editorial states.

NYT: 20-Week Ban Marks Another Effort 'To Undercut Women's Constitutionally Protected Reproductive Rights'

May 15, 2015 — "For the second time in two years, the House voted Wednesday to pass legislation that would ban almost all abortions 20 weeks or more after fertilization," marking yet "another attempt by conservative [lawmakers] to undercut women's constitutionally protected reproductive rights," a New York Times editorial states.

The editorial explains that the 20-week ban not only is "a restriction before fetal viability that violates ... Roe v. Wade" but also is based on medically unsupported claims that a fetus can feel pain at that point of development.

According to the editorial, the measure -- which was revised amid objections to reporting requirements in the rape exception provision -- only "allows [adult] rape victims to obtain an abortion if they've received counseling or medical care at least 48 hours before the procedure." Further, the editorial notes that the bill "does not make an exception for the health of the [woman], as current law requires"; only permits abortion after 20 weeks' gestation "if the [woman's] life is in danger, which could mean a woman with health problems would have to wait until her pregnancy threatened her life"; and "also lacks an exception for fetal [anomalies], some of which are detectable only late in a pregnancy."

However, the bill "is unlikely to pass the Senate," the editorial states, adding that, "[i]f it does, the White House has made it clear that President Obama will veto it."

According to the editorial, "increasingly onerous restrictions imposed on abortion at the state level may actually be causing some women to delay their procedures into the second trimester and beyond." The editorial cites a 2013 study that found that women seeking "abortions after 20 weeks were more than twice as likely as women who sought first-trimester procedures to report that difficulty traveling to a clinic delayed them" and that they also were "delayed by problems with insurance coverage."

"Making it hard to get an abortion early in a pregnancy -- by restricting the use of health insurance for abortion, closing clinics and mandating waiting periods -- and then banning the procedure after 20 weeks would essentially prohibit abortion for those with limited resources," the editorial continues. The editorial adds that while such a result might be the goal of some conservative lawmakers, "it would be disastrous for American women and families, especially those who cannot afford to travel long distances or pay for medical procedures out-of-pocket" (New York Times, 5/14).


Federal Bills Could Improve Contraceptive Access, Quality of Contraceptive Care for Servicewomen

Thu, 05/21/2015 - 17:00

Congressional lawmakers have advanced House and Senate versions of the annual defense bill (HR 1735) that include provisions designed to improve contraceptive access and the quality of contraceptive care for women in the military, the New York Times reports.

Federal Bills Could Improve Contraceptive Access, Quality of Contraceptive Care for Servicewomen

May 20, 2015 — Congressional lawmakers have advanced House and Senate versions of the annual defense bill (HR 1735) that include provisions designed to improve contraceptive access and the quality of contraceptive care for women in the military, the New York Times reports.

Background

The Defense Advisory Committee on Women in the Services in a report last December found that servicewomen encountered "barriers, both informal and formal, to access family planning" and certain forms of contraception. According to the Times, the report recommended several of the changes being advanced in the congressional legislation.

House Bill

The House on Friday approved a version of the defense bill that includes a provision requiring military clinics and hospitals to be able to dispense all FDA-approved methods of contraception. According to the Times, servicewomen have said they sometimes are not able to access their prescribed contraceptives, particularly when serving overseas.

Further, the bill would require that women, when possible, be able to access a supply of contraceptives that will last the duration of their deployment. Servicewomen deployed overseas have said they are sometimes not able to refill their contraceptives because military clinics run out of supplies and they occasionally face slow resupply shipments, the Times reports.

Rep. Jackie Speier (D-Calif.) said she pushed for the contraception provisions because of recent research showing that women in the military face higher rates of unplanned pregnancy than women in the general population. "Servicewomen deserve access to the same array of contraceptive methods available to civilians," she said, adding, "My amendment would ensure that military bases stock a broad range of contraceptive options, so a trip to the pharmacy isn't a game of chance."

Senate Bill

Meanwhile, the Senate Armed Services Committee last week approved a companion bill with a provision that would improve the quality of contraceptive care for servicewomen and other individuals covered by military insurance programs.

According to the Times, the provision, proposed by Sen. Jeanne Shaheen (D-N.H.), would require DOD to provide women in the military with the most current "standard of care" for contraception and related counseling as defined by CDC, the American College of Obstetricians and Gynecologists, and similar organizations.

The proposal also calls for the secretary of defense to create "a uniform standard curriculum" for family planning education programs for all armed service members, both male and female. In addition, the proposal states that the Pentagon in its health surveys should collect data on family planning methods and the unintended pregnancy rate among active-duty military personnel.

Shaheen said, "Almost 15 percent of our military are now women. But the military has not developed a comprehensive program to make sure they have access to family planning, contraception and counseling."

However, Shaheen also noted that DOD has voiced opposition to elements of the proposal. Specifically, DOD has argued that Congress should not "mandate incorporation of specific questions into required surveys" and that it should not legislate education programs or guidance on clinical practice. The department said it needed "maximum flexibility" to adequately care for servicemembers.

Comments

According to the Times, women's health advocates have suggested that lawmakers look to Navy contraception policies. The Navy directs physicians to "screen female sailors for contraceptive needs" before women are sent to sea. However, according to the website of the Navy and Marine Corps' public health center, roughly 25% of servicewomen between ages 21 and 25 reported an unintended pregnancy over the last 12 months.

Meanwhile, Daniel Grossman, a physician and military care expert, said the government could better address female service members' contraceptive needs by ensuring access to long-acting reversible contraceptives, such as intrauterine devices and hormonal implants. He said doing so would reduce the need for contraceptive refills or switches in the type of contraception used while servicewomen are deployed.

Separately, Donna Barry, who co-authored a Center for American Progress report on servicewomen's reproductive health care, said, "We have had an incredible increase in women service members in recent years, but reproductive and sexual health care has not kept up" (Pear, New York Times, 5/19).


S.C. Senate Advances 20-Week Abortion Ban

Thu, 05/21/2015 - 16:29

The South Carolina Senate on Tuesday voted 37-7 to advance a bill (H 3114) that would ban abortions at 20 weeks of pregnancy after adding exemptions for cases of rape, incest and severe fetal anomalies to the measure, the Charleston Post and Courier reports.

S.C. Senate Advances 20-Week Abortion Ban

May 21, 2015 — The South Carolina Senate on Tuesday voted 37-7 to advance a bill (H 3114) that would ban abortions at 20 weeks of pregnancy after adding exemptions for cases of rape, incest and severe fetal anomalies to the measure, the Charleston Post and Courier reports.

Background

Current state law bans abortion at 24 weeks, with an exception for endangerment to a woman's life.

The 20-week legislation is based on the unfounded claim that a fetus can feel pain at that point of development. The American College of Obstetricians and Gynecologists has said there is no legitimate scientific evidence showing that fetuses are capable of feeling pain at 20 weeks.

Further, the bill would require physicians to determine the length of gestation prior to performing abortions, except in cases of endangerment to a woman's life. Physicians convicted of violating the law could face fines of up to $10,000 and potential jail time of up to three years (Women's Health Policy Report, 5/18).

Vote Details

On Tuesday, state Senate lawmakers successfully voted to stop debate on the bill, ending a filibuster threat from state Sen. Lee Bright (R), and proceed with a vote (Charleston Post and Courier, 5/20). According to the Columbia State's "The Buzz," Bright last week began a filibuster of the legislation, citing his opposition to the bill's exceptions (Shain, "The Buzz," Columbia State, 5/19).

The bill requires a third and final vote in the state Senate, after which it will return to the state House (Roldan, Charleston Post and Courier, 5/20). According to the "The Buzz," the state House passed a version of the bill that did not include the exceptions added by the state Senate. The differences likely will "se[t] up a fight in conference committee," "The Buzz" reports.

Reaction

Bright said it is now up to abortion-rights opponents to remove the exemptions in a final bill ("The Buzz," Columbia State, 5/19).

Meanwhile, Victoria Middleton, executive director of the American Civil Liberties Union of South Carolina, said, "The measure [would do] nothing to improve health outcomes for families and could have a chilling effect on doctors seeking to give their patients the best medical care possible."

Separately, state Sen. Marlon Kimpson (D) before the vote said the measure could be unconstitutional and likely would face a court challenge (Charleston Post and Courier, 5/20).


Texas Senate Committee Advances Bill Adding Restrictions to Parental Involvement Law

Thu, 05/21/2015 - 16:17

The Texas Senate Health and Human Services Committee on Tuesday advanced a bill (HB 3994) that would tighten a state law allowing pregnant minors to obtain a court's permission to have an abortion instead of obtaining parental consent for the procedure, AP/KXXV reports.

Texas Senate Committee Advances Bill Adding Restrictions to Parental Involvement Law

May 21, 2015 — The Texas Senate Health and Human Services Committee on Tuesday advanced a bill (HB 3994) that would tighten a state law allowing pregnant minors to obtain a court's permission to have an abortion instead of obtaining parental consent for the procedure, AP/KXXV reports (AP/KXXV, 5/19).

The legislation, which passed the state House last week, now heads to the full state Senate for consideration (Ura, Texas Tribune, 5/19).

Background

Currently, minors can apply for a judicial bypass in any Texas county. Minors seeking judicial bypass must prove at least one of three grounds: that they are well-informed and mature enough to obtain an abortion without parental notification; that it is not in their best interests to notify their parents of the procedure; or that notifying their parents would cause emotional, physical or sexual abuse.

HB 3994 would require minors to apply for bypass in their county of residence, an adjacent county if their home county has fewer than 10,000 residents or in the county in which they plan to have the procedure. In addition, the bill would require physicians to assume pregnant women are minors until they show a "valid government record of identification" showing they are not. Further, the bill would increase the burden of proof that minors face when claiming that obtaining parental consent for abortion would lead to emotional, physical or sexual abuse.

In addition, the bill was amended so that a judge is required to rule on a minor's request within five days, and a request is considered denied if the judge does not issue a ruling in that time frame. By contrast, judges currently are required to rule on such petitions within two days, at which time the request is considered approved absent a judge's ruling.

Meanwhile, the bill also was amended to remove a provision that would have made public the names of judges who decide judicial bypass cases.

Concerns About Legislation

Reproductive health advocates have said that the bill would restrict undocumented immigrant women's access to abortion in the state (Women's Health Policy Report, 5/19).

In addition, both opponents and supporters of abortion rights said the legislation, if enacted, could spur legal challenges (AP/KXXV, 5/19). According to the Texas Tribune, U.S. Supreme Court precedent holds that states can have parental involvement laws if they offer a confidential and timely judicial bypass option that provides an "effective opportunity" for minors to obtain an abortion (Texas Tribune, 5/19).

Joe Pojman, executive director of Texas Alliance for Life, said the provision that would deny a minor's bypass request if the judge does not issue a ruling within five days could be challenged on constitutional grounds "without any realistic benefit" (AP/KXXV, 5/19).

Texas Budget Proposal Would Bar Affiliates of Abortion Providers From Cancer Screening Program

In related news, a Texas House and Senate conference committee on Wednesday reached an agreement on a proposed budget that would prohibit clinics affiliated with abortion providers from participating in a women's cancer screening program, the Texas Tribune reports (Ura, Texas Tribune, 5/20).

Background

The state's Breast and Cervical Cancer Services program uses state and federal funds to provide no-cost cancer screenings and diagnostic tests to low-income women ages 21 to 64 who do not have health insurance or are underinsured.

The Texas Senate budget proposal and Texas House budget proposal both would have reduced or eliminated funding for Planned Parenthood to participate in the BCCS program by creating a tiered system for allocating money.

Under the tiered system, public entities, such as state-funded community clinics, would have received priority for the money, followed by private clinics. Meanwhile, private clinics, such as Planned Parenthood, would have received funding for the screening program only if money was left from the first two tiers (Women's Health Policy Report, 4/24).

Details of Conference Committee Agreement

According to the Tribune, the conference committee scrapped the tiered funding system out of a concern that clinics that do not perform abortions might not have received funding under the arrangement.

Instead, the conference committee's budget agreement would bar all facilities affiliated with abortion providers from receiving funding under the BCCS program. Under state law, Planned Parenthood facilities that perform screenings for cancer are barred from performing abortions if they receive taxpayer funding.

According to the Tribune, the budget provision is intended to target 17 Planned Parenthood clinics in the state. Planned Parenthood clinics in Texas currently serve roughly 10% of women participating in the BCCS program. Specifically, affiliates of Planned Parenthood in fiscal year 2014 served nearly 3,000 women and received about $1.2 million in funding under the program.

Under the agreement, clinics that are affiliated with abortion providers could still receive BCCS funding if the state cannot find other eligible providers for the program in certain areas.

Planned Parenthood Voices Opposition

Yvonne Gutierrez, executive director at Planned Parenthood Texas Votes, said "certain members of the budget conference committee have made clear that they prioritize politics over protecting access to life saving cancer screenings for Texas women" (Texas Tribune, 5/20).


Aetna Agrees To Pay $4.5M for Violating Mo. Abortion, Autism Coverage Requirements

Thu, 05/21/2015 - 15:35

Aetna has agreed to pay $4.5 million for violating Missouri law including paying for abortion care for women who were not eligible for the coverage under their health insurance policies, according to an announcement from Gov. Jay Nixon (D) on Tuesday, AP/U-T San Diego reports.

Aetna Agrees To Pay $4.5M for Violating Mo. Abortion, Autism Coverage Requirements

May 21, 2015 — Aetna has agreed to pay $4.5 million for violating Missouri law including paying for abortion care for women who were not eligible for the coverage under their health insurance policies, according to an announcement from Gov. Jay Nixon (D) on Tuesday, AP/U-T San Diego reports.

According to AP/U-T San Diego, Aetna in the settlement agreement also acknowledged violating state law about coverage for certain autism treatments. The agreement marks the largest insurance penalty in the state's history.

Agreement Details

In documents detailing the agreement, Aetna reported that it had paid for abortion care for women who did not purchase additional coverage for the procedures. Under a 1983 Missouri law (R.S. 376.805), women are required to purchase optional, separate coverage for "elective abortions" (Ballentine, AP/U-T San Diego, 5/19). According to the harmful 1983 law, "'elective abortion' means an abortion for "any reason other than a spontaneous abortion or to prevent the death" of the pregnant woman (R.S. 376.805).

Specifically, Aetna said the company since 2012 has covered nine abortions for women who did not purchase the additional coverage. According to AP/U-T San Diego, the company previously was fined $1.5 million in 2012 for similar violations against state laws on coverage for autism, abortion care and contraception.

As part of the settlement, Aetna will be placed on a three-year monitoring period. In addition, the Missouri Department of Insurance will be able to stop Aetna from doing business in the state for up to one year if the insurer is found to violate the same laws again. According to the agreement, the department will waive $1.5 million of the $4.5 million fine if Aetna follows state law and complies with other stipulations during those three years.

Aetna spokesperson Rohan Hutchings said the company "takes responsibility" for the violations and "take[s] steps to correct ... errors" (AP/U-T San Diego, 5/19).


Abortion Restrictions Vary by ZIP Code, 'Create One Barrier After Another for Women,' Op-Ed States

Thu, 05/21/2015 - 15:25

"[I]f you're a woman counting on a constitutional right to an abortion, your access to one may increasingly depend on your county or zip code, and whether you can drive to the only open clinic in your state or to a nearby state where abortion care is still widely accessible," columnist Rebecca Ruiz writes in a Mashable opinion piece.

Abortion Restrictions Vary by ZIP Code, 'Create One Barrier After Another for Women,' Op-Ed States

May 21, 2015 — "[I]f you're a woman counting on a constitutional right to an abortion, your access to one may increasingly depend on your county or zip code, and whether you can drive to the only open clinic in your state or to a nearby state where abortion care is still widely accessible," columnist Rebecca Ruiz writes in a Mashable opinion piece.

For example, Ruiz notes that while the Supreme Court's Roe v. Wade decision "made ... clear" that "[t]he right to an abortion is a right protected by the United States constitution," the "right may as well not exist" for women in Tennessee. Tennessee Gov. Bill Haslam (R) recently signed two measures -- one (SB 1222) imposing a 48-hour mandatory delay before abortions, and another (SB 1280) imposing what opponents note are "medically unnecessary" clinic building regulations, she writes.

"Such laws make abortion nearly or completely impossible to obtain, and they don't just affect Tennessee women," Ruiz writes, citing data from the Guttmacher Institute that found state lawmakers have introduced more than 300 abortion restrictions in the first three months of 2015. Moreover, according to Guttmacher, the percentage of women living in states "considered hostile to abortion rights" has increased from 31% in 2010 to 57% in 2014, she writes.

Ruiz also cites Amanda Allen, state legislative counsel for the Center for Reproductive Rights, who noted that such disparate access to abortion "'is not the promise of our constitution. Everyone should have equal constitutional rights,'" but the "'way these state laws have been working, (access) really depends on where you live.'"

For example, Ruiz writes that mandatory delay laws vary by state, with differing delay periods and required counseling provisions. While some states -- such as Alaska, California and Colorado -- do not prevent women "from immediately seeking an abortion," others require a 72-hour delay. Meanwhile, "[m]ore than two dozen states have forbidden state-regulated health insurance plans, available through the Affordable Care Act (PL 111-148), to cover abortion" and more than 20 states impose admitting privilege requirements or stringent clinic building requirements, Ruiz notes.

She writes, "Taken together, these restrictions create one barrier after another for women who seek a constitutionally-protected medical procedure."

Ruiz notes that as lawsuits over these restrictions move through the courts, often with "different outcomes depending on geography, it has become clear that only the Supreme Court can truly address the growing disparities in access to abortion." The high court will likely weigh whether such restrictions constitute an "undue burden" on women's access to abortion, but Ruiz notes that the soonest the court could rule on such a case is 2016. "Until then, women across the country will find themselves subject to wildly different abortion laws," with women who are low-income or living in the South or Midwest being "most dramatically affected," Ruiz writes (Ruiz, Mashable, 5/20).


Women's Health Policy Report Will Not Publish on May 22, 25

Thu, 05/21/2015 - 15:20

The Women's Health Policy Report will not publish on Friday, May 22, as well as Monday, Feb. 25, in observance of Memorial Day. The report resumes publication on Tuesday, May 26.

Women's Health Policy Report Will Not Publish on May 22, 25

May 21, 2015 — The Women's Health Policy Report will not publish on Friday, May 22, as well as Monday, Feb. 25, in observance of Memorial Day. The report resumes publication on Tuesday, May 26.

Calif. Law Could Improve Birth Control Access; Oregon Considers Similar Measure

Thu, 05/21/2015 - 14:28

A 2013 California law (SB 493) is scheduled to take effect in the next few weeks that will allow pharmacists in the state to distribute contraception without requiring a prescription from a physician, Governing reports.

Calif. Rule Change Could Increase Birth Control Access; Oregon Considers Similar Measure

May 21, 2015 — A 2013 California law (SB 493) is scheduled to take effect in the next few weeks that will allow pharmacists in the state to distribute contraception without requiring a prescription from a physician, Governing reports.

Under the law, women will be able to request contraception from a pharmacist, who could then write the prescription after following certain screening protocols. Specifically, a woman would be required to complete a brief health questionnaire, undergo a blood pressure test and consult with the pharmacist on dosage and other information before receiving the contraception.

According to Governing, the California Board of Pharmacy established the protocols earlier this year. They soon will be filed officially with state regulators.

The service can be provided by any pharmacist. Further, the law does not allow insurers to refuse to cover FDA-approved contraceptives because they are prescribed by a pharmacist rather than a physician. Under the Affordable Care Act (PL 111-148), insurers have to cover all forms of FDA-approved contraceptives.

Implications

The American Congress of Obstetricians and Gynecologists and other medical groups have expressed support for making contraception available over the counter. In addition, a study published last year in Contraception found that the practice could lower unintended pregnancies by 25%.

According to Governing, the policy also could help uninsured women access contraception because the pharmacist consultation will likely be less costly and take less time than a physician visit.

California Pharmacists Association CEO Jon Roth said consumer awareness will be a key factor in the measure's success. He noted that while major retail chains will be able to advertise the service, consumers likely will take some time to notice how pharmacists' role has changed (Kardish, Governing, 5/19).

Oregon Considers Similar Measure

In related news, the Oregon House Rules Committee has revived a proposal that would, like the California law, allow women to obtain contraception without a physician prescription, the AP/KTVZ News reports (AP/KTVZ News, 5/20).

An Oregon House committee last month rejected a proposal to revise the contraceptive prescribing rules when it was proposed by state Rep. Knute Buehler (R) as an amendment (HB 2028-5) to a bill (HB 2028) that addressed pharmacists' scope of practice. The proposal was assigned to a workgroup (Women's Health Policy Report, 4/21).

According to AP/KTVZ, the committee has assigned the provision as an amendment (HB 2879-4) to a different bill (HB 2879). The committee will consider the bill on Wednesday (AP/KTVZ News, 5/20).


Moves To Ban Telemedicine Abortion Could Limit Early Access to Abortion

Wed, 05/20/2015 - 17:18

While efforts are underway to advance federal legislation (HR 36) that would ban abortion at 20 weeks of pregnancy, several states already have moved to ban abortion via telemedicine, a method that can help women access the procedure earlier in pregnancy, Kaiser Health News reports.

Moves To Ban Telemedicine Abortion Could Limit Early Access to Abortion

May 20, 2015 — While efforts are underway to advance federal legislation (HR 36) that would ban abortion at 20 weeks of pregnancy, several states already have moved to ban abortion via telemedicine, a method that can help women access the procedure earlier in pregnancy, Kaiser Health News reports.

Background

Generally, according to KHN, a telemedicine abortion involves a woman and a physician meeting via a video connection while the woman is at the clinic. The physician will determine whether it is appropriate to prescribe the woman the two drugs used to induce a medication abortion. Medication abortion can be performed up to nine weeks of pregnancy.

Currently, telemedicine abortions are restricted in 16 states, where physicians are required to be physically present when administering medication abortions. Telemedicine abortions are permitted in Minnesota and Iowa, although the Iowa Supreme Court is currently weighing a rule from the state Board of Medicine that would require in-person medication abortion.

Benefits of Telemedicine Abortion

Supporters of telemedicine abortion have said the procedure increases the chances that a woman who is seeking an abortion can obtain the procedure earlier in pregnancy, when it is safer and less costly, KHN reports.

Further, they said it could help women seeking abortion care in areas with few providers. According to a report from the Guttmacher Institute, as of 2011, nearly 90% of counties in the U.S. do not have abortion clinics, and more than one-third of women of childbearing age resided in one of those counties.

Meanwhile, the overall abortion rate has decreased since 1981, but the rate of medication abortion -- provided in person or via telemedicine -- has increased from 17% in 2008 to nearly 25% as of 2011, according to KHN. Further, a recent study found that in Iowa, where Planned Parenthood of the Heartland provides telemedicine abortions at six locations, women who had abortion were 46% more likely to have the procedure in the first trimester of pregnancy once telemedicine abortion was introduced. The study, which compared the two-year periods before and after telemedicine abortion was offered, also found that the proportion of medication abortions at the PPH clinics increased from 46% to 54%.

Daniel Grossman, the study's lead author and vice president for research at Ibis Reproductive Health, said, "From a public health perspective, even though there was a relatively small decline in second trimester abortions, it's significant. Second trimester abortions have higher complications and are more expensive for women." According to Guttmacher, a first-trimester abortion cost about $500 in 2012, while abortion at 20 weeks had a median cost of $1,350.

Opponents Use Unfounded Safety Claims To Push Restrictions

According to KHN, abortion-rights opponents often try to restrict the procedure, claiming that it is unsafe, and are working to impose restrictions that require physicians to dispense medication abortion in person. However, supporters of abortion rights note that telemedicine abortion is safe and that requiring a physician's presence is not necessary.

For example, Penny Dickey, chief clinical officer at PPH, said patients receive exactly the same care whether the procedure is done with a physician in the room or via telemedicine.

Further, Grossman in a 2011 study found that medication abortions done in person and those done via telemedicine had nearly identical outcomes, with 99% of telemedicine patients and 97% of in-person patients having successful abortions. Grossman said, "Adverse events are no higher with telemedicine. We have looked at this and we have some data that shows it's just as safe as medication abortions provided in person" (Andrews, Kaiser Health News, 5/19).


N.M. Committee Report Calls for Greater Investment in Teen Pregnancy Prevention Programs

Wed, 05/20/2015 - 17:18

A New Mexico Legislative Finance Committee report released last week calls on the state Legislature to invest in programs that will reduce teenage pregnancies and support teenage mothers, the Santa Fe New Mexican reports.

N.M. Committee Report Calls for Greater Investment in Teen Pregnancy Prevention Programs

May 20, 2015 — A New Mexico Legislative Finance Committee report released last week calls on the state Legislature to invest in programs that will reduce teenage pregnancies and support teenage mothers, the Santa Fe New Mexican reports.

Report Details

According to the New Mexican, New Mexico has the second-highest rate of teenage pregnancies in the U.S., despite a 35% decline in the rate in New Mexico over the past decade. In 2013, there were nearly 2,980 reported teen pregnancies in the state.

Teenage pregnancy rates in the state varied by county. According to the New Mexican, the birth rate for women between ages 13 and 19 exceeded 15% in many rural counties -- including Eddy, Lea and Roosevelt, among others -- and reached about 9% in the Santa Fe and Bernalillo counties.

Using data from the National Campaign to Prevent Teen and Unplanned Pregnancy, the report found that "children born to teen parents cost the state roughly $75 million annually." The cost estimates factored in taxpayer dollars spent on public programs such as child welfare and public assistance, as well as lost income because of lower education levels among teenage mothers.

Reports Notes Program Gaps

The report noted that there were gaps in the state's implementation of comprehensive sexuality education, which could be a contributing factor to the teenage pregnancy rate.

According to the report, while schools in the state are required to teach students about various ways to prevent pregnancy and reduce sexual behavior risks, "not all schools report implementing these standards." Specifically, the committee found that district and charter high schools did not meet state standards for teaching about pregnancy prevention or sexually transmitted infections.

The report recommended that the New Mexico Legislature continue to invest in "programs and services that support teen parents and their children, including adult basic education, the GRADS program, home visiting, and early childhood education program" as part of a comprehensive teen pregnancy prevention plan.

Comments

Kenny Vigil, spokesperson for New Mexico's Department of Health, said the department will work with other state agencies to develop more comprehensive strategies for teenage pregnancy prevention. Those agencies include the state's Children, Youth and Families Department and the Public Education Department.

Meanwhile, according to the New Mexican, some teenage pregnancy prevention advocates said the report's findings could distort or obscure other factors that influence teenage pregnancy rates.

For example, Stephanie Jackson, a senior research scientist at the University of New Mexico's Public Health Program, said high teenage pregnancy rates are associated with high rates of poverty. "Pinning this spectrum of negative outcomes on parenting status or the age at which you parent buries all these other variables that come out of poverty, that come out of racial and ethnic disparities, and that come out of economic disparities," she said (Wright, Santa Fe New Mexican, 5/16).


Federal Bills Could Improve Contraceptive Access, Quality of Contraceptive Care for Servicewomen

Wed, 05/20/2015 - 15:24

Congressional lawmakers have advanced House and Senate versions of the annual defense bill (HR 1735) that include provisions designed to improve contraceptive access and the quality of contraceptive care for women in the military, the New York Times reports.

Federal Bills Could Improve Contraceptive Access, Quality of Contraceptive Care for Servicewomen

May 20, 2015 — Congressional lawmakers have advanced House and Senate versions of the annual defense bill (HR 1735) that include provisions designed to improve contraceptive access and the quality of contraceptive care for women in the military, the New York Times reports.

Background

The Defense Advisory Committee on Women in the Services in a report last December found that servicewomen encountered "barriers, both informal and formal, to access family planning" and certain forms of contraception. According to the Times, the report recommended several of the changes being advanced in the congressional legislation.

House Bill

The House on Friday approved a version of the defense bill that includes a provision requiring military clinics and hospitals to be able to dispense all FDA-approved methods of contraception. According to the Times, servicewomen have said they sometimes are not able to access their prescribed contraceptives, particularly when serving overseas.

Further, the bill would require that women, when possible, be able to access a supply of contraceptives that will last the duration of their deployment. Servicewomen deployed overseas have said they are sometimes not able to refill their contraceptives because military clinics run out of supplies and they occasionally face slow resupply shipments, the Times reports.

Rep. Jackie Speier (D-Calif.) said she pushed for the contraception provisions because of recent research showing that women in the military face higher rates of unplanned pregnancy than women in the general population. "Servicewomen deserve access to the same array of contraceptive methods available to civilians," she said, adding, "My amendment would ensure that military bases stock a broad range of contraceptive options, so a trip to the pharmacy isn't a game of chance."

Senate Bill

Meanwhile, the Senate Armed Services Committee last week approved a companion bill with a provision that would improve the quality of contraceptive care for servicewomen and other individuals covered by military insurance programs.

According to the Times, the provision, proposed by Sen. Jeanne Shaheen (D-N.H.), would require DOD to provide women in the military with the most current "standard of care" for contraception and related counseling as defined by CDC, the American College of Obstetricians and Gynecologists, and similar organizations.

The proposal also calls for the secretary of defense to create "a uniform standard curriculum" for family planning education programs for all armed service members, both male and female. In addition, the proposal states that the Pentagon in its health surveys should collect data on family planning methods and the unintended pregnancy rate among active-duty military personnel.

Shaheen said, "Almost 15 percent of our military are now women. But the military has not developed a comprehensive program to make sure they have access to family planning, contraception and counseling."

However, Shaheen also noted that DOD has voiced opposition to elements of the proposal. Specifically, DOD has argued that Congress should not "mandate incorporation of specific questions into required surveys" and that it should not legislate education programs or guidance on clinical practice. The department said it needed "maximum flexibility" to adequately care for servicemembers.

Comments

According to the Times, women's health advocates have suggested that lawmakers look to Navy contraception policies. The Navy directs physicians to "screen female sailors for contraceptive needs" before women are sent to sea. However, according to the website of the Navy and Marine Corps' public health center, roughly 25% of servicewomen between ages 21 and 25 reported an unintended pregnancy over the last 12 months.

Meanwhile, Daniel Grossman, a physician and military care expert, said the government could better address female service members' contraceptive needs by ensuring access to long-acting reversible contraceptives, such as intrauterine devices and hormonal implants. He said doing so would reduce the need for contraceptive refills or switches in the type of contraception used while servicewomen are deployed.

Separately, Donna Barry, who co-authored a Center for American Progress report on servicewomen's reproductive health care, said, "We have had an incredible increase in women service members in recent years, but reproductive and sexual health care has not kept up" (Pear, New York Times, 5/19).