Daily Women's Health Policy Report

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Daily Women's Health Policy Report by the National Partnership for Women & Families
Updated: 28 min 42 sec ago

Featured Blogs

Fri, 10/31/2014 - 18:05

"Pennsylvania May Drop Birth Control Coverage for Thousands of Low-Income Women," (Culp-Ressler, "ThinkProgress," Center for American Progress, 10/29); "Abortion Options in North Dakota Are Dwindling," (Culp-Ressler, "Think Progress," Center for American Progress, 10/30).

October 31, 2014

FEATURED BLOG

"Pennsylvania May Drop Birth Control Coverage for Thousands of Low-Income Women," Tara Culp-Ressler, Center for American Progress' "ThinkProgress": Women's health advocates in Pennsylvania are concerned that Gov. Tom Corbett (R) will let a "special Medicaid program" that provides "free reproductive health coverage" to low-income state residents expire on Dec. 31 "without ensuring that [beneficiaries] can maintain uninterrupted access to their birth control," Culp-Ressler writes. The program, SelectPlan for Women, "is essentially an experiment in putting Medicaid dollars toward women of reproductive age, hoping that preventing their unplanned pregnancies will ultimately lower health costs," she writes, noting that it provides "birth control, emergency contraception, breast exams, Pap smears, and STD treatment at no cost to women whose incomes fall below 214 percent of the federal poverty line." However, Corbett has not yet indicated if he will apply for an extension of the program, and, according to media reports, "women's health groups in the state have been told to prepare for SelectPlan's termination," she writes (Culp-Ressler, "ThinkProgress," Center for American Progress, 10/29).

What others are saying about contraception:

~ "Why More Women and Doctors Should Consider This Kind of Birth Control," Marjorie Greenfield, Huffington Post blogs.

FEATURED BLOG

"Abortion Options in North Dakota Are Dwindling," Culp-Ressler, Center for American Progress'  "Think Progress": A North Dakota State Supreme Court decision that requires physicians "to follow the federal recommendations for administering [medication abortion] sounds logical on the surface," but it actually "requires doctors to adhere to the FDA's outdated protocol for administering the abortion pill" even though "women have been safely taking [the off-label version] for years," Culp-Ressler writes. "In reality, this type of requirement often functions as a back-door ban on medication abortion -- which is exactly what's playing out in North Dakota, where women no longer have this option for terminating a first-trimester pregnancy," she writes, noting that the state's sole abortion clinic has stopped providing medication abortion. She writes that other states have enacted medication abortion restrictions that have "sparked similar legal challenges," suggesting that the issue "could make its way up to the Supreme Court" (Culp-Ressler, "Think Progress," Center for American Progress, 10/30).

What others are saying about abortion restrictions:

~ "North Carolina Doubles Down on Shaming Women Who Seek Abortions," Andrew Beck, American Civil Liberties Union's "Blog of Rights."

~ "Tennessee's Amendment 1 is a 'Personhood' Referendum -- for Pregnant Women," Farah Diaz-Tello/Cherisse Scott, RH Reality Check.

~ "Driving to an Abortion Clinic in Texas is Really Expensive," Jenny Kutner, Salon.


Okla. Judge Who Upheld Admitting Privileges Law Known as Vocal Abortion-Rights Opponent

Fri, 10/31/2014 - 18:00

An Oklahoma County District judge who last week upheld a state law (SB 1848) requiring abortion providers to have hospital admitting privileges wrote more than a dozen antiabortion-rights measures while he was a state legislator, the Oklahoman reports.

Okla. Judge Who Upheld Admitting Privileges Law Known as Vocal Abortion-Rights Opponent

October 31, 2014 — An Oklahoma County District judge who last week upheld a state law (SB 1848) requiring abortion providers to have hospital admitting privileges wrote more than a dozen antiabortion-rights measures while he was a state legislator, the Oklahoman reports (Carter, Oklahoman, 10/29).

Judge Bill Graves last Friday ruled that the law can take effect on Nov. 1. The lawsuit challenging the provision was filed by the Center for Reproductive Rights on behalf of physician Larry Burns, owner of the Abortion Surgery Center in Norman, Okla. Burns on Monday appealed to the state Supreme Court to block the law, contending that it will force him to stop providing abortions (Women's Health Policy Report, 10/28).

Judge Likened Roe's Effect to 'Carnage'

Graves served as a state legislator from 1989 to 2004, and he worked on bills between 1997 and 2001 that would have required state-mandated counseling for women seeking abortions and banned medication abortion, among other abortion restrictions.

Further, Graves in a 2001 article for Regent University Law School called the Supreme Court's ruling in Roe v. Wade "a monstrous crime against unborn children." He added, "Since then ... America has exceeded the carnage of both Carthage and Rome -- and even Nazi Germany -- with approximately forty million abortions."

According to the Oklahoman, Graves was also reassigned from criminal cases to probate cases after his 2008 letter criticizing the Oklahoma Bar Association's Judicial Code of Conduct was made public. He said the code, which requires judges to perform their "duties without bias or prejudice," stemmed from the "proposals of the liberal, pro-homosexual American Bar Association" and are "not based on laws enacted by Congress or the state Legislature."

Brady Henderson, a lawyer with the American Civil Liberties Union of Oklahoma, suggested that Grave's public stance on abortion rights could be problematic for people in his courtroom. CRR spokesperson Kate Bernyk said CRR has not asked Graves to recuse himself, although she declined to comment on his position on abortion.

Meanwhile, Graves said he was unbiased in his ruling on the hospital admitting privileges (Carter, Oklahoman, 10/29).


Clinic Fights Ind. Law Mandating Surgical Standards When Only Medication Abortions Are Offered

Fri, 10/31/2014 - 17:59

A federal judge on Thursday heard oral arguments in a lawsuit against an Indiana law (SB 371) that would require clinics that offer only medication abortions to adhere to the same building and equipment standards as those that perform the surgical procedure, the Indianapolis Star reports.

Clinic Fights Ind. Law Mandating Surgical Standards When Only Medication Abortions Are Offered

October 31, 2014 — A federal judge on Thursday heard oral arguments in a lawsuit against an Indiana law (SB 371) that would require clinics that offer only medication abortions to adhere to the same building and equipment standards as those that perform the surgical procedure, the Indianapolis Star reports.

Background

The law, which altered the state's definition of "abortion clinic" to encompass those that do not offer surgical procedures, would affect just one clinic, a Planned Parenthood of Indiana and Kentucky facility in Lafayette, Ind. (Guerra, Indianapolis Star, 10/30).

Last November, U.S. District Judge Jane Magnus-Stinson issued a temporary injunction to block the measure, which had been scheduled to take effect Jan. 1, 2014 (Women's Health Policy Report, 8/21).

State, Clinic Present Oral Arguments

On Thursday, Thomas Fisher, solicitor general for the Office of the Indiana Attorney General, argued that PPINK had not proved that the law would prevent many women from obtaining abortions.

According to Fisher, the law only requires the clinic to be "minimally prepared" for instances in which a woman who is prescribed medication abortion returns to the facility because of emergency complications. In such an instance, Fisher said, the clinic would need to have a setup "that would facilitate what might be needed if a physician decides right then and there" to perform a surgical abortion.

Fisher argued that the measure would not require "overwhelming reconstruction efforts," but rather "marginal changes," such as installing an additional sink.

However, American Civil Liberties Union of Indiana Legal Director Ken Falk argued that the requirements are illogical and would add needless costs by forcing the clinic to meet state building and equipment standards for surgical abortions, even though the state does not require the facility to have a physician who is able to perform such procedures.

Falk said, "You'll have a building that is surgically equipped but doesn't provide or doesn't have to provide surgical procedures. The state's ground for imposing certain requirements is feeble at best." He added that PPINK has not estimated how much the requirements might cost.

Falk noted that there was no information to suggest that any women had returned to PPINK after experiencing complications from medication abortion drugs and that the clinic only prescribed mifepristone -- the drug used to induce abortion -- for 54 women in the one-year period prior to July 1, 2013. By comparison, Falk said, the facility prescribed other medications, such as contraceptives, more than 10,000 times in the same period (Indianapolis Star, 10/30).


Blogs Discuss 'Letting Pregnant Workers Work,' Mattress Protest Over College Sexual Assault Policies, More

Fri, 10/31/2014 - 17:34

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

Blogs Discuss 'Letting Pregnant Workers Work,' Mattress Protest Over College Sexual Assault Policies, More

October 31, 2014 — Read the week's best commentaries from bloggers at ACLU, the Center for American Progress and more.

WORKPLACE POLICIES: "UPS Finally Admits the Obvious -- Letting Pregnant Workers Work is Good for Business," Ariela Migdal, American Civil Liberties Union's "Blog of Rights": UPS has filed a Supreme Court brief, "promis[ing] to give pregnant workers the equal treatment they have been demanding all along," Migdal writes. UPS announced that it will now permit certain accommodations for pregnant workers, which "equally is not only good policy," but also "good business." Still, the company "continues to deny that the law requires such equality of treatment ... and refuses to give back pay to women like Peggy [Young]," the former UPS employee who was forced off the job while pregnant "after she requested light-duty work on the advice of her doctor." However, on Dec. 3, "the Supreme Court has the opportunity [to] make clear once and for all that our civil rights laws require what UPS has already admitted is good business policy: equal treatment for pregnant workers," as Young v. UPS heads to the high court (Migdal, "Blog of Rights," ACLU, 10/28).

CONTRACEPTION: "Pennsylvania May Drop Birth Control Coverage for Thousands of Low-Income Women," Tara Culp-Ressler, Center for American Progress' "ThinkProgress": Women's health advocates in Pennsylvania are concerned that Gov. Tom Corbett (R) will let a "special Medicaid program" that provides "free reproductive health coverage" to low-income state residents expire on Dec. 31 "without ensuring that [beneficiaries] can maintain uninterrupted access to their birth control," Culp-Ressler writes. The program, SelectPlan for Women, "is essentially an experiment in putting Medicaid dollars toward women of reproductive age, hoping that preventing their unplanned pregnancies will ultimately lower health costs," she writes, noting that it provides "birth control, emergency contraception, breast exams, Pap smears, and STD treatment at no cost to women whose incomes fall below 214 percent of the federal poverty line." However, Corbett has not yet indicated if he will apply for an extension of the program, and, according to media reports, "women's health groups in the state have been told to prepare for SelectPlan's termination," she writes (Culp-Ressler, "ThinkProgress," Center for American Progress, 10/29).

What others are saying about contraception:

~ "Why More Women and Doctors Should Consider This Kind of Birth Control," Marjorie Greenfield, Huffington Post blogs.

SEXUAL VIOLENCE: "Students Bring out Mattresses in Huge 'Carry That Weight' Protest Against Sexual Assault," Alexandra Svokos, Huffington Post: "College students around the globe brought out mattresses on Wednesday to support Columbia University student Emma Sulkowicz and raise awareness about sexual assault," Svokos writes. She notes that the demonstration was organized by the group Carrying the Weight Together, which consists of "college students and activists working to support survivors of sexual and domestic violence." According to Svokos, "The group was inspired by Sulkowicz's senior thesis project, 'Carry That Weight,' in which she is hefting her mattress around campus until the student she says raped her is expelled or leaves" (Svokos, Huffington Post, 10/29).

PREGNANCY AND INFERTILITY: "Infertility 101: What NOT To Say When Your Friends Are Trying," Camille Preston, Huffington Post blogs: Preston, founder and CEO of AIM Leadership, recounts the "best practices" she learned from her own two-year struggle with infertility, noting that "[i]nfertility is not rare" and that "almost 12 percent of American women have received some form of fertility treatment in their lifetime." Further, "[o]ne in four pregnancies ends in miscarriage, and an estimated 20 percent of couples have challenges conceiving." For those who know "someone who is on her own journey through infertility," Preston offers six recommendations, such as to avoid sharing stories about others who have gotten pregnant, to "[r]espect all that they are doing to create a family" and to "[e]ducate yourself" on infertility by watching her recent TEDx talk (Preston, Huffington Post blogs, 10/28).

What others are saying about pregnancy and infertility:

~ "Let's Forget 'Pregnancy Brain,'" Katherine McAuliffe, Huffington Post blogs.

ABORTION RESTRICTIONS: "Abortion Options in North Dakota Are Dwindling," Culp-Ressler, Center for American Progress' "Think Progress": A North Dakota State Supreme Court decision that requires physicians "to follow the federal recommendations for administering [medication abortion] sounds logical on the surface," but it actually "requires doctors to adhere to the FDA's outdated protocol for administering the abortion pill" even though "women have been safely taking [the off-label version] for years," Culp-Ressler writes. "In reality, this type of requirement often functions as a back-door ban on medication abortion -- which is exactly what's playing out in North Dakota, where women no longer have this option for terminating a first-trimester pregnancy," she writes, noting that the state's sole abortion clinic has stopped providing medication abortion. She writes that other states have enacted medication abortion restrictions that have "sparked similar legal challenges," suggesting that the issue "could make its way up to the Supreme Court" (Culp-Ressler, "Think Progress," Center for American Progress, 10/30).

What others are saying about abortion restrictions:

~ "North Carolina Doubles Down on Shaming Women Who Seek Abortions," Andrew Beck, American Civil Liberties Union's "Blog of Rights."

~ "Tennessee's Amendment 1 is a 'Personhood' Referendum -- for Pregnant Women," Farah Diaz-Tello/Cherisse Scott, RH Reality Check.

~ "Driving to an Abortion Clinic in Texas is Really Expensive," Jenny Kutner, Salon.


Clinic Fights Ind. Law Mandating Surgical Standards When Only Medication Abortions Are Offered

Fri, 10/31/2014 - 17:33

A federal judge on Thursday heard oral arguments in a lawsuit against an Indiana law (SB 371) that would require clinics that offer only medication abortions to adhere to the same building and equipment standards as those that perform the surgical procedure, the Indianapolis Star reports.

Clinic Fights Ind. Law Mandating Surgical Standards When Only Medication Abortions Are Offered

October 31, 2014 — A federal judge on Thursday heard oral arguments in a lawsuit against an Indiana law (SB 371) that would require clinics that offer only medication abortions to adhere to the same building and equipment standards as those that perform the surgical procedure, the Indianapolis Star reports.

Background

The law, which altered the state's definition of "abortion clinic" to encompass those that do not offer surgical procedures, would affect just one clinic, a Planned Parenthood of Indiana and Kentucky facility in Lafayette, Ind. (Guerra, Indianapolis Star, 10/30).

Last November, U.S. District Judge Jane Magnus-Stinson issued a temporary injunction to block the measure, which had been scheduled to take effect Jan. 1, 2014 (Women's Health Policy Report, 8/21).

State, Clinic Present Oral Arguments

On Thursday, Thomas Fisher, solicitor general for the Office of the Indiana Attorney General, argued that PPINK had not proved that the law would prevent many women from obtaining abortions.

According to Fisher, the law only requires the clinic to be "minimally prepared" for instances in which a woman who is prescribed medication abortion returns to the facility because of emergency complications. In such an instance, Fisher said, the clinic would need to have a setup "that would facilitate what might be needed if a physician decides right then and there" to perform a surgical abortion.

Fisher argued that the measure would not require "overwhelming reconstruction efforts," but rather "marginal changes," such as installing an additional sink.

However, American Civil Liberties Union of Indiana Legal Director Ken Falk argued that the requirements are illogical and would add needless costs by forcing the clinic to meet state building and equipment standards for surgical abortions, even though the state does not require the facility to have a physician who is able to perform such procedures.

Falk said, "You'll have a building that is surgically equipped but doesn't provide or doesn't have to provide surgical procedures. The state's ground for imposing certain requirements is feeble at best." He added that PPINK has not estimated how much the requirements might cost.

Falk noted that there was no information to suggest that any women had returned to PPINK after experiencing complications from medication abortion drugs and that the clinic only prescribed mifepristone -- the drug used to induce abortion -- for 54 women in the one-year period prior to July 1, 2013. By comparison, Falk said, the facility prescribed other medications, such as contraceptives, more than 10,000 times in the same period (Indianapolis Star, 10/30).


Video Round Up: Voters Mull Antiabortion-Rights Ballot Measures, Pregnancy Discrimination Remains Widespread, More

Fri, 10/31/2014 - 15:40

In today's clips, Melissa Harris-Perry and a panel discuss the antiabortion-rights amendments on the ballots in Colorado, North Dakota and Tennessee. Meanwhile, HuffPost Live's Caroline Modarressy-Tehrani explains how an Ohio law could make Cincinnati the largest metropolitan area in the U.S. without an abortion clinic.

Video Round Up: Voters Mull Antiabortion-Rights Ballot Measures, Pregnancy Discrimination Remains Widespread, More

October 30, 2014 — In today's clips, Melissa Harris-Perry and a panel discuss the antiabortion-rights amendments on the ballots in Colorado, North Dakota and Tennessee. Meanwhile, HuffPost Live's Caroline Modarressy-Tehrani explains how an Ohio law could make Cincinnati the largest metropolitan area in the U.S. without an abortion clinic.



MSNBC's Melissa Harris-Perry, Irin Carmon and Joy Reid, along with Cafe.com columnist Carmen Rita Wong, discuss antiabortion-rights ballot measures facing voters next month in Colorado (Amendment 67), North Dakota (Measure 1) and Tennessee (Amendment 1). Harris-Perry explains that all three initiatives ask voters to make "a decision ... regarding a woman's right to maintain dominion over her own body" (Harris-Perry, "Melissa Harris-Perry," MSNBC, 10/18).




Harris-Perry talks about workplace pregnancy discrimination with a panel of commentators, including women's equality advocate Armanda Legros, who was pushed out of her job after giving her employer a doctor's note advising that she avoid heavy lifting during her pregnancy. The panel also reviews the findings of A Better Balance report that found women often face a "pregnancy penalty" that results in "lasting economic disadvantages." Many women, particularly those who are low-income "are put in this terrible situation where they are being asked to choose between their job and the health of their pregnancy, which is a decision nobody should have to make," says Emily Martin of the National Women's Law Center (Harris-Perry, "Melissa Harris-Perry," MSNBC, 10/25).




HuffPost Live host Caroline Modarressy-Tehrani and a panel discuss how an Ohio law that requires each clinic to obtain a transfer agreement with a local hospital could force the last abortion facility in Cincinnati to shut its doors, which would make the city the largest metropolitan area in the U.S. without an abortion clinic. Planned Parenthood Advocates of Ohio Communications Director Celeste Ribbins notes that because antiabortion-rights activists "haven't been successful in reversing Roe v. Wade, ... they're taking every possible opportunity they can to tick off each clinic one-by-one" (Modarressy-Tehrani, HuffPost Live, 10/27).




NBC News profiles a New Mexico teen who gave birth to her son while she was a senior at the state's Valencia High School. In an accompanying news story, NBC highlights a "first of its kind" 2013 New Mexico law that created "an abbreviated parental leave policy for high school students," which the young woman says "changed [her] life" and will allow her to "have a career and ... be a mother" (NBC News, 10/19).

Video Round Up: Voters Mull Antiabortion-Rights Ballot Measures, Pregnancy Discrimination Remains Widespread, More

Fri, 10/31/2014 - 14:52

In today's clips, Melissa Harris-Perry and a panel discuss the antiabortion-rights amendments on the ballots in Colorado, North Dakota and Tennessee. Meanwhile, HuffPost Live's Caroline Modarressy-Tehrani explains how an Ohio law could make Cincinnati the largest metropolitan area in the U.S. without an abortion clinic.

Video Round Up: Voters Mull Antiabortion-Rights Ballot Measures, Pregnancy Discrimination Remains Widespread, More

October 31, 2014 — In today's clips, Melissa Harris-Perry and a panel discuss the antiabortion-rights amendments on the ballots in Colorado, North Dakota and Tennessee. Meanwhile, HuffPost Live's Caroline Modarressy-Tehrani explains how an Ohio law could make Cincinnati the largest metropolitan area in the U.S. without an abortion clinic.



MSNBC's Melissa Harris-Perry, Irin Carmon and Joy Reid, along with Cafe.com columnist Carmen Rita Wong, discuss antiabortion-rights ballot measures facing voters next month in Colorado (Amendment 67), North Dakota (Measure 1) and Tennessee (Amendment 1). Harris-Perry explains that all three initiatives ask voters to make "a decision ... regarding a woman's right to maintain dominion over her own body" (Harris-Perry, "Melissa Harris-Perry," MSNBC, 10/18).




Harris-Perry talks about workplace pregnancy discrimination with a panel of commentators, including women's equality advocate Armanda Legros, who was pushed out of her job after giving her employer a doctor's note advising that she avoid heavy lifting during her pregnancy. The panel also reviews the findings of A Better Balance report that found women often face a "pregnancy penalty" that results in "lasting economic disadvantages." Many women, particularly those who are low-income "are put in this terrible situation where they are being asked to choose between their job and the health of their pregnancy, which is a decision nobody should have to make," says Emily Martin of the National Women's Law Center (Harris-Perry, "Melissa Harris-Perry," MSNBC, 10/25).




HuffPost Live host Caroline Modarressy-Tehrani and a panel discuss how an Ohio law that requires each clinic to obtain a transfer agreement with a local hospital could force the last abortion facility in Cincinnati to shut its doors, which would make the city the largest metropolitan area in the U.S. without an abortion clinic. Planned Parenthood Advocates of Ohio Communications Director Celeste Ribbins notes that because antiabortion-rights activists "haven't been successful in reversing Roe v. Wade, ... they're taking every possible opportunity they can to tick off each clinic one-by-one" (Modarressy-Tehrani, HuffPost Live, 10/27).




NBC News profiles a New Mexico teen who gave birth to her son while she was a senior at the state's Valencia High School. In an accompanying news story, NBC highlights a "first of its kind" 2013 New Mexico law that created "an abbreviated parental leave policy for high school students," which the young woman says "changed [her] life" and will allow her to "have a career and ... be a mother" (NBC News, 10/19).

Okla. Judge Who Upheld Admitting Privileges Law Known as Vocal Abortion-Rights Opponent

Fri, 10/31/2014 - 14:32

An Oklahoma County District judge who last week upheld a state law (SB 1848) requiring abortion providers to have hospital admitting privileges wrote more than a dozen antiabortion-rights measures while he was a state legislator, the Oklahoman reports.

Okla. Judge Who Upheld Admitting Privileges Law Known as Vocal Abortion-Rights Opponent

October 31, 2014 — An Oklahoma County District judge who last week upheld a state law (SB 1848) requiring abortion providers to have hospital admitting privileges wrote more than a dozen antiabortion-rights measures while he was a state legislator, the Oklahoman reports (Carter, Oklahoman, 10/29).

Judge Bill Graves last Friday ruled that the law can take effect on Nov. 1. The lawsuit challenging the provision was filed by the Center for Reproductive Rights on behalf of physician Larry Burns, owner of the Abortion Surgery Center in Norman, Okla. Burns on Monday appealed to the state Supreme Court to block the law, contending that it will force him to stop providing abortions (Women's Health Policy Report, 10/28).

Judge Likened Roe's Effect to 'Carnage'

Graves served as a state legislator from 1989 to 2004, and he worked on bills between 1997 and 2001 that would have required state-mandated counseling for women seeking abortions and banned medication abortion, among other abortion restrictions.

Further, Graves in a 2001 article for Regent University Law School called the Supreme Court's ruling in Roe v. Wade "a monstrous crime against unborn children." He added, "Since then ... America has exceeded the carnage of both Carthage and Rome -- and even Nazi Germany -- with approximately forty million abortions."

According to the Oklahoman, Graves was also reassigned from criminal cases to probate cases after his 2008 letter criticizing the Oklahoma Bar Association's Judicial Code of Conduct was made public. He said the code, which requires judges to perform their "duties without bias or prejudice," stemmed from the "proposals of the liberal, pro-homosexual American Bar Association" and are "not based on laws enacted by Congress or the state Legislature."

Brady Henderson, a lawyer with the American Civil Liberties Union of Oklahoma, suggested that Grave's public stance on abortion rights could be problematic for people in his courtroom. CRR spokesperson Kate Bernyk said CRR has not asked Graves to recuse himself, although she declined to comment on his position on abortion.

Meanwhile, Graves said he was unbiased in his ruling on the hospital admitting privileges (Carter, Oklahoman, 10/29).


FDA Concludes Two-Day Workshop on Female Sexual Dysfunction

Fri, 10/31/2014 - 14:29

Testimony from experts and advocates at a two-day FDA workshop on issues related to the lack of sexual dysfunction drugs left several unanswered questions for the agency as it considers developing guidance for such drugs, MedPage Today's "The Gupta Guide" reports.

FDA Concludes Two-Day Workshop on Female Sexual Dysfunction

October 31, 2014 — Testimony from experts and advocates at a two-day FDA workshop on issues related to the lack of sexual dysfunction drugs left several unanswered questions for the agency as it considers developing guidance for such drugs, MedPage Today's "The Gupta Guide" reports (Gever, "The Gupta Guide," MedPage Today, 10/29).

On the first day of the workshop, several women called on the agency to do more to encourage drugmakers to develop treatments for female sexual dysfunction -- sometimes called hypoactive sexual desire disorder -- while some experts questioned whether a drug is appropriate or even possible to address such issues (Women's Health Policy Report, 10/28).

In addition, some speakers pointed out that many of the speakers urging FDA to take further action were indirectly compensated by Sprout Pharmaceuticals, which is attempting to gain FDA approval for its sexual dysfunction drug. The agency has asked the drugmaker to conduct further clinical trials. FDA previously rejected the drug, but Sprout submitted a new application.

Workshop Discussion

The second day of FDA's workshop, on Tuesday, focused on scientific questions regarding how FDA would evaluate drugs to treat sexual dysfunction in women. The workshop featured a panel of academic and clinical experts specializing in sexual medicine and psychiatry, as well as speakers from academia.

A central issue in Tuesday's discussion was that the current Diagnostic and Statistical Manual of Mental Disorders, or DSM-V, includes a definition of "female sexual interest/arousal disorder" that combines what some experts considered two potentially separate clinical issues: a lack of sexual interest and a lack of sexual arousal. As a result, the experts said it would be difficult to design clinical trials to evaluate drugs to treat FSIAD because some drugs might only treat one of the two issues.

In addition, the experts debated how often women would need to complete questionnaires to evaluate their FSIAD symptoms during potential clinical trials. Several panelists suggested that FDA's typical approach of having participants in such trials complete daily diaries might be overly burdensome and urged an alternative approach ("The Gupta Guide," MedPage Today, 10/29).


Safety Net STD Providers Remain Vital Under ACA, CDC Researchers Write

Thu, 10/30/2014 - 22:25

CDC's Ryan Cramer and colleagues examined changes in access to sexually transmitted disease services under the Affordable Care Act, as well as the role of safety net providers in the provision of such services. Although the ACA "is expected to increase access to STD services," safety net providers will remain an important source of "confidential, high-quality, same-day STD services" for many populations, especially the uninsured, they wrote.

Safety Net STD Providers Remain Vital Under ACA, CDC Researchers Write

October 30, 2014 —Summary of "Are Safety Net Sexually Transmitted Disease Clinical and Preventive Services Still Needed in a Changing Health Care System?" Cramer et al., Sexually Transmitted Diseases, October 2014.

Reforms under the Affordable Care Act (PL 111-148) that are designed to increase access to health care will "likely impact access to sexually transmitted disease (STD) services, including services for the underinsured or uninsured (safety net services)," according to CDC researcher Ryan Cramer and colleagues.

For their analysis, the researchers assessed the impact of the ACA on safety net services for STDs, as well as how the Supreme Court's 2012 decision to permit states to choose whether to expand Medicaid eligibility under the law will affect access to such services. Further, the researchers examined the "complex and unique role that safety net providers have traditionally played in STD prevention."

ACA Reforms Projected To Boost Health Care Access to STD Services

The researchers noted that the ACA "is expected to expand access to health care" in several ways. As written, the law expanded Medicaid eligibility to U.S. residents with incomes up to 133% of the federal poverty level. Further, the law established subsidies and legal requirements to incent U.S. residents who are ineligible for Medicaid to purchase private coverage, the researchers explained.

They also noted that the law "require[s] coverage without cost sharing for U.S. Preventive Services Task Force (USPSTF) Grade A and B services," which include chlamydia screenings for sexually active women under age 25 and screening "all sexually active women for gonorrhea if they are at increased risk for infection."

Safety Net Providers' Role in STD Services

Safety net STD providers are those that "offer confidential STD services free of charge or for reduced fees," typically to individuals who lack access to health care because of financial constraints or other barriers.

According to the researchers, these providers "take a number of forms," such as family planning clinics or STD clinics, but all "serve vulnerable populations -- predominantly low-income men and women, high-risk youth, and minority groups at increased risk for STDs." National data show that these populations frequently seek STD services from these providers, the researchers added.

Reasons Individuals Seek STD Services at Safety Net Clinics

The researchers outlined several reasons why insured and uninsured individuals seek STD services from safety net providers. Some of those reasons include:

~ General issues related to accessing health care services, such as financial constraints or lack of a primary care provider (PCP);

~ Confidentiality concerns;

~ A desire for same-day services and high-quality care; and

~ Efforts to avoid stigma from PCPs or peers who might identify them at other clinics.

Safety net STD providers are also needed because:

~ Some PCPs might be uncomfortable offering STD services;

~ Research suggests that STD services from health departments might be of higher quality than those at private clinics, especially in areas like education and counseling; and

~ Facilities dedicated to diagnosing and treating STDs have the level of expertise and other capabilities necessary to handle the complexity of such conditions.

Effects of Medicaid Expansion Decision on STD Prevention

The researchers wrote that the Supreme Court's 2012 decision in NFIB v. Sebelius, which made states' expansion of Medicaid optional, meant that 31 million U.S. residents would remain uninsured by 2016, compared with an estimate of 21 million before the ruling, according to Congressional Budget Office projections.

Not all states are expected to expand Medicaid, which will pose significant challenges to STD prevention efforts, Cramer and colleagues continued, noting that "nonpregnant adults with dependent children" and childless adults will not be eligible for Medicaid in many non-expansion states. "In a state that does not expand its Medicaid program, the need for providers of safety net STD services will likely continue because some populations will be ineligible for both Medicaid and private insurance subsidies," the researchers wrote.

In addition, while some USPSTF-recommended STD services are covered without cost-sharing under the ACA, "some private insurance plans and state Medicaid plans do not cover some STD screening and treatment services," the researchers explained. As a result, expansions in insurance coverage alone might not mean that individuals are "receiving care at lower costs than before the ACA," they added.

Conclusion

In summary, Cramer and colleagues noted that while the ACA will improve access to STD services, "many vulnerable populations are expected to remain uninsured" and "certain populations may continue to rely on safety net providers for STD services" in states that do not expand Medicaid.

Therefore, "careful consideration of access to safety net services would be useful for STD prevention," they wrote. Safety net providers are also an important source "of confidential, high-quality, same-day STD services," they concluded.

Study Finds Disparities in Fertility Preservation Counseling for Cancer Patients

Thu, 10/30/2014 - 22:24

A woman's likelihood of receiving fertility preservation counseling after a cancer diagnosis varies by race, age, marital status and cancer type, according to a Northwestern University study. The researchers examined the fertility preservation counseling histories of 353 adult women with breast, gynecologic and hematologic cancers, finding that such counseling was more common among certain groups -- such as younger women and Hispanics -- than others, including divorced women and blacks.

Study Finds Disparities in Fertility Preservation Counseling for Cancer Patients

October 30, 2014 —"Disparities in Counseling Female Cancer Patients for Fertility Preservation: Adding Insult to Injury?" Lawson et al., Fertility and Sterility, September 2014.

Researchers from Northwestern University's Department of Obstetrics and Gynecology developed a study to explore disparities in fertility preservation counseling among women with various types of cancer.

Methods

The researchers conducted a retrospective analysis of 353 adult female cancer patients for whom chemotherapeutic treatment data were available through electronic medical records. The women, ages 19 through 42, were diagnosed at an academic medical center from 2009 through 2013 with breast cancer, gynecologic cancers or hematologic cancers such as leukemia or lymphoma.

Results

Overall, 262 of the 353 women (74%) were treated with a gonadotoxic chemotherapeutic agent. Of those:

~ 161 (62%) "had documented counseling for fertility preservation";

~ 77 (29%) received no counseling; and

~ 24 (9%) had no documentation related to counseling in their charts.

The researchers also found that younger women were more likely to be counseled than those in other age groups, while "[d]ivorced women were less likely to be counseled than women of any other marital status." Counseling was more common among women who had gynecological or hematological cancer or whose cancer was at a lower stage, compared with those with breast cancer and women whose cancer was at a higher stage.

Counseling also varied by race, with 86% of Hispanic women, 65% of Asian women, 62% of white women and 53% of black women receiving documented counseling.

Conclusion

"[D]emographic and diagnostic disparities were evident in the counseling of cancer patients for fertility preservation," the researchers wrote. They noted that previous research has shown that cancer patients who are not offered fertility preservation before treatment "experience significant regret and poorer quality of life."

Further, disparities in fertility preservation counseling make it more difficult for some women to realize their "reproductive desires," the researchers wrote, concluding, "Equality in the counseling of female cancer patients for fertility preservation is imperative in order to reduce the risk of emotional harm and future infertility."

Paper Outlines Framework for Improving Maternal, Newborn Health Through Midwifery

Thu, 10/30/2014 - 22:23

Writing in The Lancet, reproductive health experts assess the power of midwifery care to improve maternal and newborn health and outline a policy framework for bolstering midwifery to improve reproductive health outcomes. Midwifery contributes to "high-quality maternal and newborn care" that "should be at the heart of all subnational, national, regional, and global efforts to improve women's and children's health and wellbeing," they write.

Paper Outlines Framework for Improving Maternal, Newborn Health Through Midwifery

October 30, 2014 —Summary of "Improvement of Material and Newborn Health Through Midwifery," Petra ten Hoope-Bender et al., The Lancet, Sept. 27, 2014.

In the last of a series of papers examining "the contribution of midwifery to the survival, health, and wellbeing of childbearing women and newborn infants," Petra ten Hoope-Bender of the Instituto de Cooperación Social Integrare and colleagues focus on policy implications, "the potential effect of life-saving interventions that fall within the scope of practice of midwives" and how health systems changes in countries that have embraced midwifery have contributed to reductions in maternal mortality.

In the paper, the authors briefly summarize three previous papers published in the series; highlight research priorities "to generate better evidence and suggest practical steps for all countries to move towards people-centred and woman-centred care"; and discuss "how achievement of universal, effective coverage of high-quality maternal and newborn care is of central importance to primary health care and the broader agenda for global health."

Previous Papers

The three prior papers in the series examined the "evidence base that distinguishes between what care is needed, how it is provided, and who should provide it," ten Hoope-Bender and colleagues write. They write in summary of the papers:

~ One found that "when systems are consistently strengthened over a long period of time, investment in midwives is a realistic and effective strategy to reduce maternal mortality";

~ One identified "key aspects of quality maternal and newborn care" and proposed an "evidence-based framework for quality maternal and newborn care, which expands the notion of quality of care from the conventional technical dimensions of what is done, to include how, where, and by whom this care is provided"; and

~ One found that "scaling up midwifery could help reduce adverse health outcomes ... and could be implemented with successful outcomes at any stage of a country's transition to lower maternal and newborn mortality rates."

Developing Effective Maternal and Newborn Health Care

The authors write that the "varied competencies and expertise" of different health care providers "should be brought together into an interprofessional practice-ready team" to "ensure continuity and quality of care." Well-educated midwives, when provided with adequate support, "possess the competencies across the reproductive, maternal and newborn health continuum and are both a connector across and a driving force behind that continuum," they add.

However, they note several potential obstacles for "implement[ing] the framework for quality maternal and newborn care" in middle- and low-income countries. They argue, "Investment in education alone will not suffice and will have to be combined with investment in regulation, effective human resource management, and the service delivery environment in which future midwives will work, so that they will not only be able to cope with the increased workload, but will also ensure quality clinical and psychological care."

Further, the authors note that "[m]ore evidence is needed to inform effective ways of scaling up the midwifery workforce," such as education, regulation and in-service training, among others. To this end, they propose "three priority research areas." Those areas include:

~ Better evidence on labor mobility, including "the recruitment, posting, and transfer of staff to remote and underserved areas; how to measure and improve staff deployment and retention; and how to ensure that the net increase in the number of midwives matches increases in demand in rural and urban areas";

~ A better understanding "of the productivity of the midwifery workforce, maternity units, and the models of practice, such as midwifery led care," as well as a "set of effective implementation strategies"; and

~ "The development of adequate strategies to manage the increasing commercialisation [of childbirth] ... that will mitigate the adverse effects of commercialisation and tackle the resulting inequalities."

Improving the Quality of Maternal and Newborn Care

The authors note that while primary care services have "fully recognised the importance of people-centred care," maternal and newborn health care has remained focused "on life-saving interventions and increases in coverage."

They continue, "To deliver high-quality care, health professionals and policy makers need to create an environment in which the 72 effective midwifery interventions identified in this Series can be implemented consistently with the woman-centred values and philosophy outlined in the framework for maternal and newborn care." According to the authors, this environment would include education for health care professionals, "efficient regulation of practice" and "partnership and dialogue between care providers and with care users and communities."

How Midwifery Can Contribute to 'Effective Coverage and Women-Centred Agendas'

"Midwives, when working to the framework for quality maternal and newborn care and within an enabled environment, have the potential to bring care close to women and communities and tailor it to their social and cultural needs," the authors write.

Specifically, they note that effective midwifery can optimize "the normal processes of reproduction and the early years of life"; safely manage health complications "before they become life-threatening"; and help reduce maternal mortality, stillbirths and complications while boosting rates of breastfeeding, patient satisfaction and vaginal births.

Recognizing High-Quality Maternal and Newborn Care as a Global Priority

"People-centred care that recognises people's legitimate right to and expectations for equitable, high-quality, safe, and respectful care should be a global health priority and be put at the heart of the movement to improve maternal and newborn care," the authors write, adding that midwifery is a "vital solution" for providing such care for women and newborns "in all countries."

However, they note that "progress made in the midwifery workforce" has been insufficient "to enable the attainment of [Millennium Development Goal] 4 and MDG 5 in all countries by 2015." Citing studies about the efficacy of midwifery, the authors write that "investment in midwifery is an effective solution to attain MDG 4 and MDG 5 and the new global targets, provide a basis for primary health care and universal health coverage, achieve the grand convergence in global health by 2035, and deliver on women's rights to sexual and reproductive health."

Conclusion

"As shown by the estimates of lives saved through increases in coverage of the midwifery package of care and the experiences of a few exemplary low-income and middle-income countries that have invested in midwives, use of the framework for quality maternal and newborn care is a means to good health and improved social outcomes for women, men, and children," the authors write.

They add, "The high-quality maternal and newborn care described in this Series should be at the heart of all subnational, national, regional, and global efforts to improve women's and children's health and wellbeing, and it needs a core position within the post 2015 agenda."

Abortion Does Not Contribute To Couples' Relationship Dissolution, Study Finds

Thu, 10/30/2014 - 22:17

There is a lack of reliable research comparing how a man and woman's relationship is affected when the woman terminates an unwanted pregnancy versus when she seeks an abortion but ends up carrying to term because she is unable to obtain the procedure. To assess the issue, researchers studied interviews with more than 850 women who sought abortions, including many who were beyond a facility's gestational limit and went on to give birth. The study found "no evidence that having an abortion causes relationship dissolution," but rather that "having an abortion appears to allow relationship dissolution to continue at its own pace, while having the baby seems to postpone the end of the relationship."

Abortion Does Not Contribute To Couples' Relationship Dissolution, Study Finds

October 30, 2014 —"Effect of Abortion vs. Carrying to Term on a Woman's Relationship With the Man Involved in the Pregnancy," Mauldon et al., Perspectives on Sexual and Reproductive Health, Sept. 8, 2014.

While previous studies have found "no solid evidence" that an abortion disrupts a man and woman's relationship or that carrying an unwanted pregnancy to term extends such relationships, no research exists that compares "the trajectory of a relationship when an unwanted pregnancy results in a birth with its path when the pregnancy is terminated," according to Jane Mauldon of the University of California-Berkeley's Goldman School of Public Policy and colleagues Diana Greene Foster and Sarah Roberts of UC-San Francisco's Bixby Center for Global Reproductive Health.

The researchers developed a study that "addresses that gap" by examining the relationship trajectories of women in the Turnaway Study, a prospective study that involved longitudinal interviews with women recruited at 30 U.S. abortion facilities "to investigate and establish effects of abortion on various aspects of" their lives, including their "intimate relationships."

Methods

The Turnaway Study recruitment sites included facilities in areas that were representative of the nation's regional diversity and "had the highest gestational age limit for abortion of any facility within a 150-mile radius," the researchers wrote. Women in the study were the divided into three groups:

~ "[N]ear-limit abortion," which included women who presented for abortion care within two weeks of a facility's gestational limit and obtained an abortion;

~ "[T]urnaway," which consisted of women who were up to three weeks past a facility's gestational limit and did not obtain an abortion there; and

~ "[F]irst-trimester abortion," which included women who obtained the procedure in their first trimester.

The turnaway group was subdivided into two additional categories:

~ "Turnaway/birth," which included the three-fourths of turnaways who carried their pregnancies to term; and

~ "Turnaway/no birth," which consisted of women who either obtained an abortion at another facility or miscarried.

For their analysis, Mauldon and colleagues used data from Turnaway Study interviews conducted at eight days and six, 12, 18 and 24 months after participants presented to seek abortion care. In total, their data encompassed 862 women, including "405 in the near-limit abortion group, 156 in the turnaway/birth group, 48 in the turnaway/no birth group and 253 in the first-trimester abortion group."

The researchers assessed two measures -- relationship status and relationship quality -- and performed bivariate and multivariate analyses that incorporated several relevant variables.

Results

All participants "were in some type of relationship with the man involved in the pregnancy" when they conceived, and there were no significant differences in participants' relationship status across study groups. At the time of conception:

~ 80% of participants were in a romantic relationship with the man involved;

~ 71% were romantically involved but not married to the man; and

~ 9% were married to the man.

One week after they presented for abortion care, 90% of participants still had ongoing contact with the man involved in the pregnancy, but this proportion fell to 68% by the two-year mark.

However, women in the turnaway/birth group were significantly more likely to still be in contact with the man after two years (79%) than those in the near-limit abortion group (68%), according to the bivariate analysis. This tendency was confirmed in the multivariate analysis. By contrast, women's odds of being romantically involved with the man did not significantly differ among the groups at the first interview or at two years.

The higher rate of ongoing contact among women in the near-limit group compared with those in the turnaway/birth group "results, in part, from their temporarily higher likelihood of romantic involvement," which, at its maximum, was about 10 percentage points greater than that in the turnaway/birth group. However, by two years, the "ongoing contact was no longer primarily romantic," the researchers found.

Overall, the proportion of women in a romantic relationship with the man fell from 80% at the time of conception to 61% at the time of their first Turnaway Study interview (around eight days after presenting for abortion care) to 37% by the two-year interview. The study also found that "relationship quality was no better and no worse in the turnaway/birth group than in the near-limit abortion group."

Discussion, Recommendations for Policymakers

Two findings should be particularly encouraging to "[p]olicymakers seeking to foster parental involvement among children of unmarried parents," the researchers wrote.

First, turnaway/birth participants "were more likely than those in the near-limit abortion group to have some type of ongoing contact, even if nonromantic, with the man involved in the pregnancy," they noted. Second, the study shows that "childbirth put[s] a temporary brake on the rapid pace at which these couples' romantic relationships dissolved," the researchers wrote. They suggested that "parenting or support responsibilities" contributed to the greater level of contact between the men and women in the turnaway/birth group.

Two even "[m]ore noteworthy" findings are "the overall rapid rate of relationship dissolution" observed in the study and the proportion of participants who were not romantically involved with the father at the time of conception (20%). This suggests that policymakers should exercise "caution in trying to increase father involvement uniformly" when a birth results from an unwanted pregnancy, the researchers wrote. In some of these cases "women would have preferred to terminate because of serious problems in the relationship," like violence or drug abuse among men whose "engagement in children's lives may not benefit anybody," according to the researchers.

Conclusion

In summary, the study found "no evidence that having an abortion causes relationship dissolution" but showed that there is "a downward trajectory of romantic involvement among all the women who sought to terminate unwanted pregnancies," the researchers wrote, concluding, "Thus, having an abortion appears to allow relationship dissolution to continue at its own pace, while having the baby seems to postpone the end of the relationship."

Efforts To Promote LARC Methods Must Avoid Undermining 'Reproductive Autonomy,' Experts Argue

Thu, 10/30/2014 - 22:16

In a commentary, three reproductive health experts consider whether "unchecked enthusiasm" for and promotion of long-acting reversible contraceptive (LARC) methods "may deny some women reproductive control." They argue that such an outcome can be avoided by ensuring that programs promoting LARC methods "put the priorities, needs and preferences of individual women -- not the promotion of specific technologies -- first."

Efforts To Promote LARC Methods Must Avoid Undermining 'Reproductive Autonomy,' Experts Argue

October 30, 2014 —Summary of "Women or LARC First? Reproductive Autonomy and the Promotion of Long-Acting Reversible Contraceptive Methods," Manchikanti Gomez et al., Perspectives on Sexual and Reproductive Health, September 2014.

The "enthusiasm" surrounding long-acting reversible contraceptive (LARC) methods, such as intrauterine devices (IUDs) and implants, "has skyrocketed among U.S. reproductive health care providers" in recent years because of their "potential to budge the rate of unintended pregnancy," according to a commentary by Anu Manchikanti Gomez, assistant professor at the University of California-Berkeley's School of Social Welfare; Liza Fuentes, senior project manager at Ibis Reproductive Health; and Amy Allina, deputy director of the National Women's Health Network.

However, "unchecked enthusiasm for" LARC methods could "lead to the adoption of programs that, paradoxically, undermine women's reproductive autonomy," they argue.

When "efforts move beyond ensuring [LARC] access for all women to promoting use among 'high-risk' populations," the result "is that the most vulnerable women may have their options restricted," the authors write.

Putting Social, Reproductive Health Inequalities in Context

Given the "[c]lear disparities in levels of unintended pregnancy" rates among black, Latina and low-income women, providers and reproductive health researchers have developed intervention strategies to target these "high-risk" populations to increase the use of LARC methods, Manchikanti Gomez and colleagues write. However, such "targeted approaches to LARC promotion" can lead to "'statistical discrimination'" because a woman's risk is estimated not by her "unique history, preferences and priorities," but by "epidemiologic data or previous clinical experiences," according to the authors.

It is important to note that "settings that serve the most vulnerable women seeking contraceptive care do not operate in a neutral context," but rather in an environment of "[p]ersistant racial and socioeconomic inequality," the authors continue.

Thus, the family planning community "must take steps to make certain that use of [LARC] methods is driven by women's own expressed desires for them, and not by a programmatic attempt to reduce population-level unintended pregnancy rates by encouraging 'risky' women to use them," they argue.

Looking Beyond Effectiveness

LARC methods are often touted for their "forgettable" nature and high rates of effectiveness, but this "conceptualization implies that these methods offer women the most control over their reproduction -- an implication that may not be reflected in the experiences of women who are currently the least likely to use LARC methods," according to the authors.

In addition, the implication that a low failure rate represents "optimal control" for all women is misguided, as some women might prioritize control over stopping or starting a method without a health care provider's involvement or control over their menstrual cycle with a certain method, the authors contend.

Further, an emphasis on a method's effectiveness in the context of the public health goal of reducing unintended pregnancies overlooks "the historical legacy and ongoing reality of reproductive coercion" in the U.S. and detracts from the importance of ensuring that women have the "resources and knowledge to be able to effectively use a contraceptive method of their choice."

The authors write, "When a woman is provided counseling to steer her toward the most effective methods, even if that is not her priority, the public health imperative plays a more significant role than it does when counseling starts with the woman and her concerns."

Recommendations

The authors recommend an improved LARC promotion and delivery strategy that appeals to all women, rather than targeting certain populations.

Providers should develop family planning services that "suppor[t] each woman in identifying her family planning priorities and in adopting the method that best meets her current needs." In addition, training for providers "should go beyond a 'LARC-first' counseling approach," which would enable providers to better "respon[d] respectfully to a woman's concerns and ... her choice not to use a LARC method, as legitimate and even successful."

Overall, they write, "LARC promotion must expand -- not restrict -- contraceptive options for all women."

Conclusion

"We can increase women's ability to prevent and plan pregnancies by ensuring that as we devise solutions that eliminate barriers to LARC use for all women, we do not inadvertently diminish the reproductive autonomy of some women," the authors conclude.

MKB Management Corp. v. Burdick

Thu, 10/30/2014 - 22:08

State court challenge to a North Dakota law that would effectively ban all medication abortions in the state by requiring compliance with conditions for the provision of "abortion-inducing drugs" that are impossible to meet.

MKB Management Corp. v. Burdick

State court challenge to a North Dakota law that would effectively ban all medication abortions in the state by requiring compliance with conditions for the provision of “abortion-inducing drugs” that are impossible to meet. The law was temporarily blocked pending a hearing. In addition, in May 2013 the complaint was amended to also challenge SB 2305, a law requiring that any physician performing abortions obtain admitting privileges at a local hospital. In July 2013, the court issued a permanent injunction prohibiting enforcement of the 2011 law and left for determination only any new issues created by SB 2305. North Dakota appealed the permanent injunction of the 2011 law and the temporary injunction of the 2013 law to the North Dakota Supreme Court. The parties settled the portion of the case challenging the admitting privileges requirement in SB 2305 because the providers obtained privileges. Current Status: Three of the five judges on the North Dakota Supreme Court concluded that the medication abortion restrictions are unconstitutional. However, the North Dakota Constitution requires at least four judges to agree to declare a law unconstitutional. Because the four-judge threshold was not met, the law is in effect. (See the law here. See the February 2012 temporary injunction order here. See the permanent injunction here. See the North Dakota Supreme Court opinion here. Read more here.)

Burns v. Cline

Thu, 10/30/2014 - 21:59

State court challenge to an Oklahoma law that requires abortion providers to have admitting privileges at a hospital within thirty miles of where the procedure is performed.

Burns v. Cline

State court challenge to an Oklahoma law that requires abortion providers to have admitting privileges at a hospital within thirty miles of where the procedure is performed. Current Status: In October 2014, the state court denied Plaintiff’s request to temporarily enjoin the law. The plaintiff immediately filed an emergency appeal to the Oklahoma Supreme Court. (See the law here. See the complaint here. See the emergency appeal to the Oklahoma Supreme Court here. Read more about the case here.)

Oklahoma Coalition for Reproductive Justice v. Cline

Thu, 10/30/2014 - 21:57

State court challenge to an Oklahoma law that imposes restrictions on medication abortion, including forcing physicians to administer medication in an outdated manner, requiring several in-person visits with a provider, and limiting provision of medication abortion to no more than 49 days' gestation.

Oklahoma Coalition for Reproductive Justice v. Cline

State court challenge to an Oklahoma law that imposes restrictions on medication abortion, including forcing physicians to administer medication in an outdated manner, requiring several in-person visits with a provider, and limiting provision of medication abortion to no more than 49 days’ gestation. Current Status: The court allowed the law to take effect but issued a temporary injunction enjoining provisions of the law that would subject providers to liability. (See the law here. See the complaint here. Read more about the case here.)

Women's Emotions After Pre-Abortion Ultrasounds Provide 'Little Support' for Mandatory Viewing

Thu, 10/30/2014 - 20:20

Researchers at the University of California-San Francisco's Bixby Center for Global Reproductive Health examined women's emotional responses to viewing an ultrasound prior to an abortion. They concluded that "the impact of [ultrasound] viewing on women's emotions about their pregnancy is overestimated" and provides "little support for abortion rights opponents' hope that viewing will inspire bonding emotions with the fetus."

Women's Emotions After Pre-Abortion Ultrasounds Provide 'Little Support' for Mandatory Viewing

October 30, 2014 —Summary of "Beyond Political Claims: Women's Interest In and Emotional Response To Viewing Their Ultrasound Image in Abortion Care," Kimport et al., Perspectives on Sexual and Reproductive Health, Sept. 10, 2014.

Abortion-rights opponents' "belief in the power of viewing an ultrasound has inspired a spate of state-level antiabortion legislation regulating ultrasound provision for women seeking the procedure, with the explicit aim of dissuading them from having abortions," even though "there is no empirical support ... that ultrasound viewing will change women's minds about abortion," according to Katrina Kimport, Tracy Weitz and Diana Green Foster of the University of California-San Francisco's Bixby Center for Global Reproductive Health.

"Given the differing meanings that supporters and opponents of abortion rights have assigned to ultrasound viewing," the researchers conducted a study "to evaluate what affects women's decision to view their preprocedure ultrasound; whether those who choose to view actually do have a negative emotional response; and what characteristics of women or their pregnancies, if any, are associated with particular emotional responses."

Methods

The researchers used data from the Turnaway Study, which recruited women from 30 different U.S. abortion facilities from 2008 to 2010 to assess the effects of obtaining or being denied an abortion. Kimport and colleagues focused their research on participants who obtained abortions.

Participants in the Turnaway Study completed a phone interview about one week after their abortions. The interview included questions about whether women had been offered a chance to view an ultrasound image, whether they did so and, if they were not offered an ultrasound viewing, whether they had requested one. Participants who viewed their ultrasounds were also asked about how they felt about it and their subsequent abortion.

The researchers also categorized the abortion facilities by their ultrasound viewing policies. The study only included data from women whose fetuses appeared to be healthy.

Results

The final sample in the analysis included 702 women, with the majority (62%) ages 20 through 29. About 72% of the women "underwent an abortion at a facility with no ultrasound viewing policy, 7% were subject only to a facility policy and 21% were subject to a state-mandated policy" requiring facilities to offer the woman the opportunity to view the image if an ultrasound is performed.

The study also found that 54% of participants said it had been somewhat or very difficult to decide to have an abortion.

Offers to View Ultrasound Images

According to the study, 48% of women were asked whether they wanted to view their ultrasound image, including 54% of women who had not previously given birth and 45% of women who had previously given birth.

In bivariate analyses, the highest proportion (67%) of women who received offers to view their ultrasound images were between 13 weeks and 21 weeks pregnant, while the lowest rate (36%) was among women who were more than 21 weeks pregnant. Bivariate analyses also found that women who were "in the later first trimester" were more likely (52%) to be offered an ultrasound viewing than "women in the early first trimester" (45%). Rates of being offered the opportunity to view ultrasound images did not vary significantly by age, race or ethnicity, or difficulty deciding to have an abortion in bivariate analyses.

In multivariate analyses, blacks were more likely than whites to receive an offer to view their ultrasound images, as were women who had not given birth before, compared with women who had previous births. Overall, "[t]he multivariate findings were generally consistent with the bivariate ones, except that gestational age lost significance and race became significant," the researchers wrote.

Further, 33% of women who underwent abortions at facilities without ultrasound viewing policies reported that they were offered a viewing, compared with 75% of women at facilities with ultrasound viewing policies and 91% of women at facilities in states with ultrasound viewing laws.

There were "[n]o significant differences ... found by age, race or ethnicity, or difficulty in deciding to have an abortion," according to the study.

Decision to View Ultrasound Images

Thirty-one percent of the participants reported viewing their ultrasound images, representing about 65% of those who were asked if they would like to view their ultrasounds. Younger women were more likely (35% to 37%) to view their ultrasound images than older women (26%), while women who had not previously given birth were more likely (37%) to view their ultrasound than women who had given birth (27%). Blacks were more likely than whites to view their ultrasound images.

In addition, "[t]he viewing rate varied by gestational age," with women between eight and 13 weeks of pregnancy most likely to view the images (38%). Further, 44% of women at facilities subject to state ultrasound laws viewed the images, compared with 34% of women at facilities with policies to offer the opportunity to view the images and 27% of women at facilities without such policies.

Emotional Response to Viewing

According to the researchers, 212 of the respondents gave open-ended responses to the question of how they felt about viewing the ultrasound images, with some women describing multiple emotional responses. Overall, the study found:

~ 77 of the women described a neutral emotion, which was the most common emotional response;

~ 49 of the women described "feeling sad or depressed";

~ 30 of the women "reported that viewing made them second-guess or feel guilty about their decision to have an abortion";

~ 29 of the women said they felt "upset or bad";

~ 22 of the women said they felt "happy or excited";

~ 15 of the women said they "felt comforted";

~ 13 of the women "reported emotions ... categorized as 'other'," including shock and nervousness;

~ 11 of the women said they "felt good";

~ 10 of the women said they felt "both positive and negative emotions"; and

~ Six of the women said they "felt 'mixed' emotions, but did not elaborate." Women who had not previously given birth were more likely "to express an explicitly positive emotion" to their ultrasound viewing. Meanwhile, "Latinas were more likely than whites to report an explicitly negative emotion to viewing," the study found.

In addition, women at a facility with an ultrasound viewing policy were more likely to report feeling a negative emotion than those at facilities without ultrasound viewing policies, and "the association between being subject to a state law and reporting a negative emotion was marginally significant."

Discussion and Conclusion

"[W]omen's emotional responses to viewing their ultrasound found little support for abortion rights opponents' hope that viewing will inspire bonding emotions with the fetus," according to Kimport and colleagues. In addition, the researchers "found no support for the assumptions of many abortion care providers that viewing a more developed fetus ... is associated with more negative emotional responses, suggesting that practitioner and advocate concerns about viewing the more 'baby-like' fetus at later gestations may be misplaced."

However, the researchers wrote that "viewing an ultrasound did generate negative emotional reactions for some women," which "were associated with being subject to a clinic policy to offer viewing, and were marginally associated with being subject to a state law on viewing." These findings "suggest[ed] the possibility that viewing 'offers' are experienced more as 'recommendations' by patients, and hence women may not feel as free to decline as practitioners may intend," the researchers wrote. They added that providers "may want to pay careful attention to how the offer is made to ensure that patients do not feel pressured to view their ultrasound."

Kimport and colleagues continued that their "findings that some women experienced positive emotions, and that the most frequent reported emotions were neutral ones, stand in pointed contrast to the politicized nature of the debate over preabortion ultrasound viewing, highlighting how the politics of this debate ignore women's actual experience of care" and "pos[ing] a challenge to the presumption that viewing always creates an emotional response."

They concluded, "We believe that the conversation about women's experience -- emotional and otherwise -- of abortion care must go beyond making political claims about the impacts of their responses to a medical technology and incorporate their subjective understandings."

3-D Breast Cancer Screenings Cost-Effective for Some Women, Study Finds

Thu, 10/30/2014 - 17:33

A combination of a conventional digital mammogram and 3D screening might result in long-term cost savings for women with dense breasts, according to a recent study published in Radiology, Time reports.

3-D Breast Cancer Screenings Cost-Effective for Some Women, Study Finds

October 30, 2014 — A combination of a conventional digital mammogram and 3D screening might result in long-term cost savings for women with dense breasts, according to a recent study published in Radiology, Time reports.

According to Time, the volume of cells in the breast tissue of women with dense breasts places them at a moderate to high risk of developing breast cancer.

The 3-D screening, called tomosynthesis, is a relatively new technology that may help health care providers better detect early cancers, but it remains unclear whether such screenings are worth their higher cost, according to Time. A separate study earlier this year found that tomosynthesis aids detection of breast cancers while reducing false positives.

Study Details

For the new study, researchers created a model for patients with dense breasts to gauge the cost-effectiveness of a digital mammography performed every other year and digital mammography with 3-D screening performed every other year.

The researchers also used data from the National Cancer Institute's Breast Cancer Surveillance Consortium to calculate breast cancer and death rates for both screening methods.

Clinical Effectiveness

The researchers found that one additional death was avoided for every 2,000 women with dense tissue who were screened using digital mammography with 3-D screening, compared with digital mammography alone.

Lead researcher Christoph Lee of the University of Washington noted that the study predicted that using mammography with 3-D screening averted 810 false-positive results. "The savings represented by 810 fewer false positives are a huge savings in anxiety, diagnostic workup and resource utilization in the health care system," he said (Park, Time, 10/28).


Video Round Up: Voters Mull Antiabortion-Rights Ballot Measures, Pregnancy Discrimination Remains Widespread, More

Thu, 10/30/2014 - 17:23

In today's clips, Melissa Harris-Perry and a panel discuss the antiabortion-rights amendments on the ballots in Colorado, North Dakota and Tennessee. Meanwhile, HuffPost Live's Caroline Modarressy-Tehrani explains how an Ohio law could make Cincinnati the largest metropolitan area in the U.S. without an abortion clinic.

Video Round Up: Voters Mull Antiabortion-Rights Ballot Measures, Pregnancy Discrimination Remains Widespread, More

October 30, 2014 — In today's clips, Melissa Harris-Perry and a panel discuss the antiabortion-rights amendments on the ballots in Colorado, North Dakota and Tennessee. Meanwhile, HuffPost Live's Caroline Modarressy-Tehrani explains how an Ohio law could make Cincinnati the largest metropolitan area in the U.S. without an abortion clinic.



MSNBC's Melissa Harris-Perry, Irin Carmon and Joy Reid, along with Cafe.com columnist Carmen Rita Wong, discuss antiabortion-rights ballot measures facing voters next month in Colorado (Amendment 67), North Dakota (Measure 1) and Tennessee (Amendment 1). Harris-Perry explains that all three initiatives ask voters to make "a decision ... regarding a woman's right to maintain dominion over her own body" (Harris-Perry, "Melissa Harris-Perry," MSNBC, 10/18).




Harris-Perry talks about workplace pregnancy discrimination with a panel of commentators, including women's equality advocate Armanda Legros, who was pushed out of her job after giving her employer a doctor's note advising that she avoid heavy lifting during her pregnancy. The panel also reviews the findings of A Better Balance report that found women often face a "pregnancy penalty" that results in "lasting economic disadvantages." Many women, particularly those who are low-income "are put in this terrible situation where they are being asked to choose between their job and the health of their pregnancy, which is a decision nobody should have to make," says Emily Martin of the National Women's Law Center (Harris-Perry, "Melissa Harris-Perry," MSNBC, 10/25).




HuffPost Live host Caroline Modarressy-Tehrani and a panel discuss how an Ohio law that requires each clinic to obtain a transfer agreement with a local hospital could force the last abortion facility in Cincinnati to shut its doors, which would make the city the largest metropolitan area in the U.S. without an abortion clinic. Planned Parenthood Advocates of Ohio Communications Director Celeste Ribbins notes that because antiabortion-rights activists "haven't been successful in reversing Roe v. Wade, ... they're taking every possible opportunity they can to tick off each clinic one-by-one" (Modarressy-Tehrani, HuffPost Live, 10/27).




NBC News profiles a New Mexico teen who gave birth to her son while she was a senior at the state's Valencia High School. In an accompanying news story, NBC highlights a "first of its kind" 2013 New Mexico law that created "an abbreviated parental leave policy for high school students," which the young woman says "changed [her] life" and will allow her to "have a career and ... be a mother" (NBC News, 10/19).