CMS on Friday denied Indiana's appeal of a 2012 administrative ruling prohibiting the state from withholding Medicaid funding to Planned Parenthood of Indiana and other abortion providers, the AP/Huffington Post reports.

CMS Rejects Appeal of Indiana's Request To Block Planned Parenthood From Medicaid

June 3, 2013 — CMS on Friday denied Indiana's appeal of a 2012 administrative ruling prohibiting the state from withholding Medicaid funding to Planned Parenthood of Indiana and other abortion providers, the AP/Huffington Post reports.

The decision came just days after the Supreme Court last week refused to consider the state's appeal of a lower court's injunction against the same law.

The state had argued in both its administrative and legal appeals that Medicaid funds used by groups such as Planned Parenthood to provide general health services would indirectly subsidize abortions, even though federal law prohibits the use of federal funds for abortion.

According to the AP/Huffington Post, both decisions effectively nullify the state law (AP/Huffington Post, 5/31).

Background of CMS Request

CMS in June 2011 informed the state that the law was unacceptable. The state appealed, but CMS hearing officer Benjamin Cohen in July 2012 urged the agency to uphold its initial decision.

Cohen explained that the law violates the federal requirement that Medicaid beneficiaries be permitted to obtain care from any qualified provider, regardless of whether the state approves non-covered care (Women's Health Policy Report, 7/9/12).

Attorney General's Response

Indiana Attorney General Greg Zoeller (R) on Friday in a news release said the state is "monitoring other challenges to similar laws in other states that are working their way through other federal circuit appeals courts."

Zoeller added that the state is seeking an opportunity "to assert our legal position through amicus briefs to the Supreme Court that Medicaid dollars should not indirectly subsidize the payroll and overhead expenses of abortion providers" (Indianapolis Star, 5/31).

El Salvador's health minister on Thursday granted permission for doctors to perform a caesarean section on a woman with a life-threatening pregnancy whose fetus has a fatal disorder, the AP/U-T San Diego reports.

El Salvador Allows C-Section To Save Woman; Case 'Isn't Unique,' Letter to the Editor Says

May 31, 2013 — El Salvador's health minister on Thursday granted permission for doctors to perform a caesarean section on a woman with a life-threatening pregnancy whose fetus has a fatal disorder, the AP/U-T San Diego reports.

The move by Health Minister María Isabel Rodríguez comes a day after the Salvadoran Supreme Court denied a request for an abortion from the 22-year-old woman -- known as Beatriz -- who has lupus and kidney failure (Aleman, AP/U-T San Diego, 5/30). Additionally, ultrasound images show the fetus has a fatal condition called anencephaly, in which much of the brain fails to develop (Women's Health Policy Report, 5/30).

After the court's decision, the Inter-American Court of Human Rights called on the government to "immediately adopt the necessary measures to protect the life, personal integrity and health" of Beatriz (Zabludovsky, New York Times, 5/30).

Abortion-rights groups said Beatriz is 26 weeks pregnant, meaning that the nation's abortion laws no longer apply. As such, the health minister can decide what is medically appropriate for the woman versus the fetus, they said (AP/ U-T San Diego, 5/30).

Rodríguez's Announcement

On Thursday, Rodríguez gave doctors permission to perform a c-section at the first sign of danger, saying, "At this point, the interruption of the pregnancy is no longer an abortion, it is an induced birth."

She said an induction leading to a vaginal birth would also be acceptable, adding that "the important thing is saving Beatriz's life" (New York Times, 5/30).

Beatriz's Case 'Isn't Unique,' Center for Reproductive Rights' Northup Writes

"The Salvadoran court's refusal to allow [an abortion] that could save Beatriz's life is a disgraceful violation of her fundamental human rights," writes Nancy Northup, president and CEO of the Center for Reproductive Rights, in a New York Times letter to the editor.

"Unfortunately, Beatriz's story isn't unique," she adds. Northup explains that El Salvador's abortion ban has resulted in the denial of other medically necessary abortions, as well as "the wrongful imprisonment of far too many women who suffered miscarriages or obstetric complications."

She warns that if some U.S. lawmakers "get their way, American women could face equally dire circumstances as a result of extreme abortion bans" (Northup, New York Times, 5/30).

We've compiled some of the most thought-provoking commentaries from around the Web. Catch up on the conversation with bloggers from Slate, Jezebel and more.

Blogs Comment on Abortion Access, Court Cases on Contraceptive Coverage, EC, Abortion Bans

May 31, 2013 — We've compiled some of the most thought-provoking commentaries from around the Web. Catch up on the conversation with bloggers from Slate, Jezebel and more.

EMERGENCY CONTRACEPTION: "President Obama, Please Let Young Teens Have Access to Plan B," Susannah Baruch, Slate's "XX Factor": In a blog urging the Obama administration to drop efforts to enforce age limits for nonprescription access to emergency contraception, Baruch writes that restricting EC "to those 15 and over who show a government ID creates a real barrier, and not only for the younger teens." She points out that "fewer than half of 16 and 17 year olds have a driver's license and 25 to 30 percent of 18 and 19 year olds have no driver's license," which is "[n]ot to mention the lack of ID among immigrant women and the high number of African Americans and lower-income Americans who have no ID." Government "decision making ought to address the needs of the most vulnerable, particularly in areas of public health," such as the "prevention of teen pregnancy," she adds. Baruch asks, "Is it too much to hope the appeals court ... tells the Administration to put the delays and excuses aside and get [EC] out of the courts and on the store shelves?" (Baruch, "XX Blog," Slate, 5/28).

CONTRACEPTION: "Shh: NY Catholic Church Quietly Paying for Birth Control, Abortions," Tracie Egan Morrissey, Jezebel: Although the "New York Archdiocese is suing the federal government to stop the mandate that employer-paid insurance policies must cover birth control ... it turns out the Archdiocese of [New York] has been quietly paying for such coverage -- even abortions -- for over a decade," Morrissey writes. She adds, "[T]he way its health care is set up now, the church's funds are much more involved in providing contraception than if it just accepted the terms offered by Obamacare" (Egan Morrissey, Jezebel, 5/28).

What others are saying about contraception:

~ "Many Women Aren't Using the Best Birth Control Method for Them -- And it's Not Their Fault," Kyla Donnelly, RH Reality Check.

ADOLESCENT HEALTH: "Young Mamas Push Back Against the Candie's Foundation Teen Pregnancy Ads," Verónica Bayetti Flores, Feministing: A coalition of reproductive justice organizations and "some fierce young mamas" are pushing back against the Candie's Foundation's advertisements that denounce teen pregnancy by "shaming young parents," Flores writes. The coalition's efforts include a petition, a Twitter campaign with the hashtag #NoTeenShame and a demand for a meeting with the foundation's founder, Neil Cole (Bayetti Flores, Feministing, 5/29).

ABORTION ACCESS: "The Cost of Abortion Care," Blog for Choice, NARAL Pro-Choice American's "Blog for Choice": "Anti-choice activists sometimes use the argument that abortion should be illegal because 'irresponsible' women frequently use abortion care as birth control -- which is offensive," the blog states. A recent study shows that in addition to the roughly $500 cost of a first-trimester abortion, women must factor in the costs of taking time off of work, child care and travel. The blog notes, "The sad truth is, many women who seek abortion care are low-income and need financial assistance to cover the cost of abortion," adding, "Blocking access to abortion care doesn't actually change a woman's mind, but it can bar her from making the best, safest decision for herself and her family" ("Blog for Choice," NARAL Pro-Choice America, 5/30).

What others are saying about abortion access:

~ "Misoprostol is a Game-Changer for Safe Abortion and Maternal Health Care. Why Isn't it More Widely Available?" Francine Coeytaux/Elisa Wells, RH Reality Check.

~ "Ending Safe Abortion Access One City at a Time?" Robin Marty, RH Reality Check.

VIOLENCE AGAINST WOMEN: "Obama, Hagel Offer Lip Service on Military Sexual Assault," Adele Stan, RH Reality Check: Stan writes that despite reports of more sex crimes against women in the military, neither President Obama nor Secretary of Defense Chuck Hagel "has signed on to the one sure means of stemming the crisis: Take the reporting and adjudication of these crimes out of the chain of command." Hagel has claimed the change would "weaken the system," while Obama has failed to endorse a bill (S 967) by Sen. Kirsten Gillibrand (D-N.Y.) that would "take the prosecution of sexual crimes away from the commander of the accused," she adds. "The military's decades-long sexual assault epidemic ... suggests that the commanders have failed at the job of doing justice for those set upon by the sexual predators in their charge," Stan writes, concluding, "It's time they were relieved of command at that particular post" (Stan, RH Reality Check, 5/30).

What others are saying about violence against women:

~ "Campaign Against Gender-Based Hate Speech on Facebook -- Activists Win!" Rachel Walden, Our Bodies Ourselves' "Our Bodies, Our Blog."

~ "#FBrape Unleashes the Power of the Feminist Internet," Alexandra Brodsky, Feministing.

~ "Powell: Soldiers Shouldn't be Dishonorably Discharged After a Sexual Assault," Mindy Townsend, Care2.

~ "ACLU Seeks Accountability for Police Violation of the Rights of Domestic Violence Victims," Katie Haas, American Civil Liberties Union's "Blog of Rights."

~ "Rape-splaining: 10 Examples of Victim Blaming," Natasha Turner, Ms. Magazine blog.

~ "Could the Facebook Win Be Feminism's Tipping Point?" Jessica Valenti, The Nation.

ABORTION BANS: "ACLU Challenges Arizona's Race and Sex Selection Abortion Ban," Jessica Mason Pieklo, RH Reality Check: The American Civil Liberties Union of Arizona on Wednesday filed a lawsuit seeking to permanently block an Arizona law that bans abortions based on the race or sex of the fetus, Mason Pieklo writes, adding that suit argues that the measure "relies on harmful racial stereotypes to shame and discriminate against Black women and Asian and Pacific Islander (API) women who decide to end their pregnancies." Alexa Kolbi-Molinas -- attorney with the ACLU Reproductive Freedom Project and lead lawyer in the lawsuit -- said, "This law takes the personal and private health care decisions of women of color and exploits them for political gain," adding that the "Constitution flatly prohibits states from passing laws based on racist stereotypes." Mason Pieklo notes that "during the law's passage, supporters cited higher rates of abortion among Black women as evidence that Black women either were motivated by a discriminatory intent to prevent the birth of Black children, or were being duped into having abortions as part of a racist plot" (Mason Pieklo, RH Reality Check, 5/29).

What others are saying about abortion bans:

~ "Fetal Viability and 20-Week Bans: A Constitutional 'Bright Line' for Abortion Restrictions," Mason Pieklo, RH Reality Check.

SALVADORAN ABORTION CASE: "Will El Salvador's Anti-Choice Government Let a Pregnant Woman Die?" Katha Pollitt, The Nation: The case of a woman in El Salvador who has been denied a request to terminate a life-threatening pregnancy has "captured international attention," and reproductive rights advocates "need to keep the pressure on so that her life can be saved," Pollitt writes. She adds that since El Salvador enacted a complete abortion ban in 1998, "over 600 Salvadoran women have been imprisoned for having abortions, including miscarriages and stillbirths suspected of being the result of abortion," according to the Central American Women's Network. Pollit writes, "A word to the wise: when US abortion opponents insist they would never put women on trial for terminating a pregnancy, be skeptical" (Pollitt, The Nation, 5/30).

What others are saying about the Salvadoran abortion case:

~ "El Salvador Denies Woman a Life-Saving Abortion," Katie Halper, Feministing.

~ "Salvadoran Government Ordered To Provide Beatriz Access to Life-Saving Care," Kathy Bougher, RH Reality Check.

The California Assembly on Wednesday advanced a bill (AB 912) that would require insurers to cover procedures to preserve fertility for individuals with cancer or other serious diseases, the AP/U-T San Diego reports.

Calif. Bill Would Require Coverage of Fertility Treatments for Cancer Patients

May 31, 2013 — The California Assembly on Wednesday advanced a bill (AB 912) that would require insurers to cover procedures to preserve fertility for individuals with cancer or other serious diseases, the AP/U-T San Diego reports. The bill now heads to the state Senate for consideration.

The measure would require insurance plans to include coverage for egg extraction and sperm freezing before patients begin treatments that could harm their fertility. The fertility procedures can cost up to $15,000, according to the AP/U-T San Diego.

Assembly member Sharon Quirk-Silva (D), the bill's sponsor, called the measure "a sensible, humane and cost-effective solution to foreseeable harm for medically necessary treatment."

The state requires insurance companies to offer fertility treatment coverage, but it does not require that policies include such benefits. If the bill becomes law, California would be the first state to enact such a requirement (Olson, AP/U-T San Diego, 5/29).

The Wisconsin Assembly Health Committee on Wednesday heard from critics and supporters of a bill (AB 216) that would restrict health insurance coverage of abortion and contraception, the AP/Atlanta Journal-Constitution reports.

Wis. Bill Would Limit Abortion, Contraceptive Coverage

May 31, 2013 — The Wisconsin Assembly Health Committee on Wednesday heard from critics and supporters of a bill (AB 216) that would restrict health insurance coverage of abortion and contraception, the AP/Atlanta Journal-Constitution reports.

The bill -- sponsored by state Rep. Andre Jacque (R) -- would prohibit taxpayer funding from being used to pay for abortion coverage in public employees' health insurance plans. The bill also would exempt some religious organizations and employers from a state law that requires employers to include contraceptive coverage in health plans, unless they are self insured.

Key Testimony

During the hearing, Nicole Safar, public policy director for Planned Parenthood Advocates of Wisconsin, noted that more than 90% of women use contraceptives. The cost of contraception could be burdensome to low-income women, she said.

Supporters of the bill argued that self insurance is not a viable alternative for many businesses because the cost is too great, it would result in reduced coverage and lead to higher premiums for employees (Wang, AP/Atlanta Journal-Constitution, 5/29).

Planned Parenthood of Montana on Thursday filed suit in a state district court against two laws (LR 120, HB 391) that require minors to involve their parents in abortion decisions, the AP/Great Falls Tribune reports.

Mont. Parental Involvement Laws Draw Court Challenge

May 31, 2013 — Planned Parenthood of Montana on Thursday filed suit in a state district court against two laws (LR 120, HB 391) that require minors to involve their parents in abortion decisions, the AP/Great Falls Tribune reports (Haake, AP/Great Falls Tribune, 5/30).

LR 120, which was approved through a ballot measure in 2012, mandates that minors younger than age 16 notify their parents before obtaining an abortion. The law includes exceptions for medical emergencies and for minors who petition a Youth Court for a waiver (Women's Health Policy Report, 11/7/12).

The second measure requires minors under 18 to obtain parental consent before abortions. With the expectation that the law would be struck down in court, Gov. Steve Bullock (D) last month allowed the legislation to become law without his signature. The strategic move also simultaneously killed a companion referendum (HB 521) that would have otherwise gone before voters in 2014 (Women's Health Policy Report, 4/26).

According to the Montana Standard, HR 391 will supersede the 2012 parental notification law once it takes effect on July 1 (Dennison, Montana Standard, 5/31).

Arguments in PPMT Suit

PPMT argues that both laws should be struck down on the grounds that they violate women's constitutional right to privacy. The group is also seeking an injunction to block enforcement of HB 391 while the suit proceeds (AP/Great Falls Tribune, 5/30).

The suit notes that a Montana court in 1995 struck down a parental notification law for violating a minor's right to abortion. It argues that the current measures restrict minors' rights in a similar way.

Stacey Anderson -- director of public affairs for PPMT -- said the organization encourages discussion between adults and adolescents about sexuality, but "[t]he sad truth is that some teens live in dangerous homes and can't go to their parents." She added, "The intent of [these laws] is to make it extraordinarily difficult for girls from abusive families to get access to health care" (Montana Standard, 5/31).

Bill Sponsor, Attorney General's Office Respond

State Rep. Jerry Bennett (R), the sponsor of HB 521, said it would hold up in court because it includes a provision -- absent from the 1995 law -- that allows minors to ask a judge for a bypass from the consent requirement (AP/Great Falls Tribune, 5/30).

John Barnes -- a spokesperson for state Attorney General Tim Fox (R) -- said the state will "defend these laws vigorously at every stage of the process," adding that "voters and duly elected representatives have made it very clear they want the parental notification and consent laws on the books" (Montana Standard, 5/31).

"Shh: NY Catholic Church Quietly Paying for Birth Control, Abortions" (Egan Morrissey, Jezebel, 5/28); "ACLU Challenges Arizona's Race and Sex Selection Abortion Ban" (Mason Pieklo, RH Reality Check, 5/29).

May 31,2013

FEATURED BLOGS

  "Shh: NY Catholic Church Quietly Paying for Birth Control, Abortions," Tracie Egan Morrissey, Jezebel: Although the "New York Archdiocese is suing the federal government to stop the mandate that employer-paid insurance policies must cover birth control ... it turns out the Archdiocese of [New York] has been quietly paying for such coverage -- even abortions -- for over a decade," Morrissey writes. She adds, "[T]he way its health care is set up now, the church's funds are much more involved in providing contraception than if it just accepted the terms offered by Obamacare" (Egan Morrissey, Jezebel, 5/28).

What others are saying about contraception:

~ "Many Women Aren't Using the Best Birth Control Method for Them -- And it's Not Their Fault," Kyla Donnelly, RH Reality Check.

  "ACLU Challenges Arizona's Race and Sex Selection Abortion Ban," Jessica Mason Pieklo, RH Reality Check: The American Civil Liberties Union of Arizona on Wednesday filed a lawsuit seeking to permanently block an Arizona law that bans abortions based on the race or sex of the fetus, Mason Pieklo writes, adding that suit argues that the measure "relies on harmful racial stereotypes to shame and discriminate against Black women and Asian and Pacific Islander (API) women who decide to end their pregnancies." Alexa Kolbi-Molinas -- attorney with the ACLU Reproductive Freedom Project and lead lawyer in the lawsuit -- said, "This law takes the personal and private health care decisions of women of color and exploits them for political gain," adding that the "Constitution flatly prohibits states from passing laws based on racist stereotypes." Mason Pieklo notes that "during the law's passage, supporters cited higher rates of abortion among Black women as evidence that Black women either were motivated by a discriminatory intent to prevent the birth of Black children, or were being duped into having abortions as part of a racist plot" (Mason Pieklo, RH Reality Check, 5/29).

What others are saying about abortion bans:

~ "Fetal Viability and 20-Week Bans: A Constitutional 'Bright Line' for Abortion Restrictions," Mason Pieklo, RH Reality Check.

The California Assembly on Wednesday advanced a bill (AB 912) that would require insurers to cover procedures to preserve fertility for individuals with cancer or other serious diseases, the AP/U-T San Diego reports.

Calif. Bill Would Require Coverage of Fertility Treatments for Cancer Patients

May 31, 2013 — The California Assembly on Wednesday advanced a bill (AB 912) that would require insurers to cover procedures to preserve fertility for individuals with cancer or other serious diseases, the AP/U-T San Diego reports. The bill now heads to the state Senate for consideration.

The measure would require insurance plans to include coverage for egg extraction and sperm freezing before patients begin treatments that could harm their fertility. The fertility procedures can cost up to $15,000, according to the AP/U-T San Diego.

Assembly member Sharon Quirk-Silva (D), the bill's sponsor, called the measure "a sensible, humane and cost-effective solution to foreseeable harm for medically necessary treatment."

The state requires insurance companies to offer fertility treatment coverage, but it does not require that policies include such benefits. If the bill becomes law, California would be the first state to enact such a requirement (Olson, AP/U-T San Diego, 5/29).

The Wisconsin Assembly Health Committee on Wednesday heard from critics and supporters of a bill (AB 216) that would restrict health insurance coverage of abortion and contraception, the AP/Atlanta Journal-Constitution reports.

Wis. Bill Would Limit Abortion, Contraceptive Coverage

May 31, 2013 — The Wisconsin Assembly Health Committee on Wednesday heard from critics and supporters of a bill (AB 216) that would restrict health insurance coverage of abortion and contraception, the AP/Atlanta Journal-Constitution reports.

The bill -- sponsored by state Rep. Andre Jacque (R) -- would prohibit taxpayer funding from being used to pay for abortion coverage in public employees' health insurance plans. The bill also would exempt some religious organizations and employers from a state law that requires employers to include contraceptive coverage in health plans, unless they are self insured.

Key Testimony

During the hearing, Nicole Safar, public policy director for Planned Parenthood Advocates of Wisconsin, noted that more than 90% of women use contraceptives. The cost of contraception could be burdensome to low-income women, she said.

Supporters of the bill argued that self insurance is not a viable alternative for many businesses because the cost is too great, it would result in reduced coverage and lead to higher premiums for employees (Wang, AP/Atlanta Journal-Constitution, 5/29).

Planned Parenthood of Montana on Thursday filed suit in a state district court against two laws (LR 120, HB 391) that require minors to involve their parents in abortion decisions, the AP/Great Falls Tribune reports.

Mont. Parental Involvement Laws Draw Court Challenge

May 31, 2013 — Planned Parenthood of Montana on Thursday filed suit in a state district court against two laws (LR 120, HB 391) that require minors to involve their parents in abortion decisions, the AP/Great Falls Tribune reports (Haake, AP/Great Falls Tribune, 5/30).

LR 120, which was approved through a ballot measure in 2012, mandates that minors younger than age 16 notify their parents before obtaining an abortion. The law includes exceptions for medical emergencies and for minors who petition a Youth Court for a waiver (Women's Health Policy Report, 11/7/12).

The second measure requires minors under 18 to obtain parental consent before abortions. With the expectation that the law would be struck down in court, Gov. Steve Bullock (D) last month allowed the legislation to become law without his signature. The strategic move also simultaneously killed a companion referendum (HB 521) that would have otherwise gone before voters in 2014 (Women's Health Policy Report, 4/26).

According to the Montana Standard, HR 391 will supersede the 2012 parental notification law once it takes effect on July 1 (Dennison, Montana Standard, 5/31).

Arguments in PPMT Suit

PPMT argues that both laws should be struck down on the grounds that they violate women's constitutional right to privacy. The group is also seeking an injunction to block enforcement of HB 391 while the suit proceeds (AP/Great Falls Tribune, 5/30).

The suit notes that a Montana court in 1995 struck down a parental notification law for violating a minor's right to abortion. It argues that the current measures restrict minors' rights in a similar way.

Stacey Anderson -- director of public affairs for PPMT -- said the organization encourages discussion between adults and adolescents about sexuality, but "[t]he sad truth is that some teens live in dangerous homes and can't go to their parents." She added, "The intent of [these laws] is to make it extraordinarily difficult for girls from abusive families to get access to health care" (Montana Standard, 5/31).

Bill Sponsor, Attorney General's Office Respond

State Rep. Jerry Bennett (R), the sponsor of HB 521, said it would hold up in court because it includes a provision -- absent from the 1995 law -- that allows minors to ask a judge for a bypass from the consent requirement (AP/Great Falls Tribune, 5/30).

John Barnes -- a spokesperson for state Attorney General Tim Fox (R) -- said the state will "defend these laws vigorously at every stage of the process," adding that "voters and duly elected representatives have made it very clear they want the parental notification and consent laws on the books" (Montana Standard, 5/31).

We've compiled some of the most thought-provoking commentaries from around the Web. Catch up on the conversation with bloggers from Slate, Jezebel and more.

Blogs Comment on Abortion Access, Court Cases on Contraceptive Coverage, EC, Abortion Bans

May 31, 2013 — We've compiled some of the most thought-provoking commentaries from around the Web. Catch up on the conversation with bloggers from Slate, Jezebel and more.

EMERGENCY CONTRACEPTION: "President Obama, Please Let Young Teens Have Access to Plan B," Susannah Baruch, Slate's "XX Factor": In a blog urging the Obama administration to drop efforts to enforce age limits for nonprescription access to emergency contraception, Baruch writes that restricting EC "to those 15 and over who show a government ID creates a real barrier, and not only for the younger teens." She points out that "fewer than half of 16 and 17 year olds have a driver's license and 25 to 30 percent of 18 and 19 year olds have no driver's license," which is "[n]ot to mention the lack of ID among immigrant women and the high number of African Americans and lower-income Americans who have no ID." Government "decision making ought to address the needs of the most vulnerable, particularly in areas of public health," such as the "prevention of teen pregnancy," she adds. Baruch asks, "Is it too much to hope the appeals court ... tells the Administration to put the delays and excuses aside and get [EC] out of the courts and on the store shelves?" (Baruch, "XX Blog," Slate, 5/28).

CONTRACEPTION: "Shh: NY Catholic Church Quietly Paying for Birth Control, Abortions," Tracie Egan Morrissey, Jezebel: Although the "New York Archdiocese is suing the federal government to stop the mandate that employer-paid insurance policies must cover birth control ... it turns out the Archdiocese of [New York] has been quietly paying for such coverage -- even abortions -- for over a decade," Morrissey writes. She adds, "[T]he way its health care is set up now, the church's funds are much more involved in providing contraception than if it just accepted the terms offered by Obamacare" (Egan Morrissey, Jezebel, 5/28).

What others are saying about contraception:

~ "Many Women Aren't Using the Best Birth Control Method for Them -- And it's Not Their Fault," Kyla Donnelly, RH Reality Check.

ADOLESCENT HEALTH: "Young Mamas Push Back Against the Candie's Foundation Teen Pregnancy Ads," Verónica Bayetti Flores, Feministing: A coalition of reproductive justice organizations and "some fierce young mamas" are pushing back against the Candie's Foundation's advertisements that denounce teen pregnancy by "shaming young parents," Flores writes. The coalition's efforts include a petition, a Twitter campaign with the hashtag #NoTeenShame and a demand for a meeting with the foundation's founder, Neil Cole (Bayetti Flores, Feministing, 5/29).

ABORTION ACCESS: "The Cost of Abortion Care," Blog for Choice, NARAL Pro-Choice American's "Blog for Choice": "Anti-choice activists sometimes use the argument that abortion should be illegal because 'irresponsible' women frequently use abortion care as birth control -- which is offensive," the blog states. A recent study shows that in addition to the roughly $500 cost of a first-trimester abortion, women must factor in the costs of taking time off of work, child care and travel. The blog notes, "The sad truth is, many women who seek abortion care are low-income and need financial assistance to cover the cost of abortion," adding, "Blocking access to abortion care doesn't actually change a woman's mind, but it can bar her from making the best, safest decision for herself and her family" ("Blog for Choice," NARAL Pro-Choice America, 5/30).

What others are saying about abortion access:

~ "Misoprostol is a Game-Changer for Safe Abortion and Maternal Health Care. Why Isn't it More Widely Available?" Francine Coeytaux/Elisa Wells, RH Reality Check.

~ "Ending Safe Abortion Access One City at a Time?" Robin Marty, RH Reality Check.

VIOLENCE AGAINST WOMEN: "Obama, Hagel Offer Lip Service on Military Sexual Assault," Adele Stan, RH Reality Check: Stan writes that despite reports of more sex crimes against women in the military, neither President Obama nor Secretary of Defense Chuck Hagel "has signed on to the one sure means of stemming the crisis: Take the reporting and adjudication of these crimes out of the chain of command." Hagel has claimed the change would "weaken the system," while Obama has failed to endorse a bill (S 967) by Sen. Kirsten Gillibrand (D-N.Y.) that would "take the prosecution of sexual crimes away from the commander of the accused," she adds. "The military's decades-long sexual assault epidemic ... suggests that the commanders have failed at the job of doing justice for those set upon by the sexual predators in their charge," Stan writes, concluding, "It's time they were relieved of command at that particular post" (Stan, RH Reality Check, 5/30).

What others are saying about violence against women:

~ "Campaign Against Gender-Based Hate Speech on Facebook -- Activists Win!" Rachel Walden, Our Bodies Ourselves' "Our Bodies, Our Blog."

~ "#FBrape Unleashes the Power of the Feminist Internet," Alexandra Brodsky, Feministing.

~ "Powell: Soldiers Shouldn't be Dishonorably Discharged After a Sexual Assault," Mindy Townsend, Care2.

~ "ACLU Seeks Accountability for Police Violation of the Rights of Domestic Violence Victims," Katie Haas, American Civil Liberties Union's "Blog of Rights."

~ "Rape-splaining: 10 Examples of Victim Blaming," Natasha Turner, Ms. Magazine blog.

~ "Could the Facebook Win Be Feminism's Tipping Point?" Jessica Valenti, The Nation.

ABORTION BANS: "ACLU Challenges Arizona's Race and Sex Selection Abortion Ban," Jessica Mason Pieklo, RH Reality Check: The American Civil Liberties Union of Arizona on Wednesday filed a lawsuit seeking to permanently block an Arizona law that bans abortions based on the race or sex of the fetus, Mason Pieklo writes, adding that suit argues that the measure "relies on harmful racial stereotypes to shame and discriminate against Black women and Asian and Pacific Islander (API) women who decide to end their pregnancies." Alexa Kolbi-Molinas -- attorney with the ACLU Reproductive Freedom Project and lead lawyer in the lawsuit -- said, "This law takes the personal and private health care decisions of women of color and exploits them for political gain," adding that the "Constitution flatly prohibits states from passing laws based on racist stereotypes." Mason Pieklo notes that "during the law's passage, supporters cited higher rates of abortion among Black women as evidence that Black women either were motivated by a discriminatory intent to prevent the birth of Black children, or were being duped into having abortions as part of a racist plot" (Mason Pieklo, RH Reality Check, 5/29).

What others are saying about abortion bans:

~ "Fetal Viability and 20-Week Bans: A Constitutional 'Bright Line' for Abortion Restrictions," Mason Pieklo, RH Reality Check.

SALVADORAN ABORTION CASE: "Will El Salvador's Anti-Choice Government Let a Pregnant Woman Die?" Katha Pollitt, The Nation: The case of a woman in El Salvador who has been denied a request to terminate a life-threatening pregnancy has "captured international attention," and reproductive rights advocates "need to keep the pressure on so that her life can be saved," Pollitt writes. She adds that since El Salvador enacted a complete abortion ban in 1998, "over 600 Salvadoran women have been imprisoned for having abortions, including miscarriages and stillbirths suspected of being the result of abortion," according to the Central American Women's Network. Pollit writes, "A word to the wise: when US abortion opponents insist they would never put women on trial for terminating a pregnancy, be skeptical" (Pollitt, The Nation, 5/30).

What others are saying about the Salvadoran abortion case:

~ "El Salvador Denies Woman a Life-Saving Abortion," Katie Halper, Feministing.

~ "Salvadoran Government Ordered To Provide Beatriz Access to Life-Saving Care," Kathy Bougher, RH Reality Check.

Planned Parenthood of Montana on Thursday filed suit in a state district court against two laws (LR 120, HB 391) that require minors to involve their parents in abortion decisions, the AP/Great Falls Tribune reports.

Mont. Parental Involvement Laws Draw Court Challenge

May 31, 2013 — Planned Parenthood of Montana on Thursday filed suit in a state district court against two laws (LR 120, HB 391) that require minors to involve their parents in abortion decisions, the AP/Great Falls Tribune reports (Haake, AP/Great Falls Tribune, 5/30).

LR 120, which was approved through a ballot measure in 2012, mandates that minors younger than age 16 notify their parents before obtaining an abortion. The law includes exceptions for medical emergencies and for minors who petition a Youth Court for a waiver (Women's Health Policy Report, 11/7/12).

The second measure requires minors under 18 to obtain parental consent before abortions. With the expectation that the law would be struck down in court, Gov. Steve Bullock (D) last month allowed the legislation to become law without his signature. The strategic move also simultaneously killed a companion referendum (HB 521) that would have otherwise gone before voters in 2014 (Women's Health Policy Report, 4/26).

According to the Montana Standard, HR 391 will supersede the 2012 parental notification law once it takes effect on July 1 (Dennison, Montana Standard, 5/31).

Arguments in PPMT Suit

PPMT argues that both laws should be struck down on the grounds that they violate women's constitutional right to privacy. The group is also seeking an injunction to block enforcement of HB 391 while the suit proceeds (AP/Great Falls Tribune, 5/30).

The suit notes that a Montana court in 1995 struck down a parental notification law for violating a minor's right to abortion. It argues that the current measures restrict minors' rights in a similar way.

Stacey Anderson -- director of public affairs for PPMT -- said the organization encourages discussion between adults and adolescents about sexuality, but "[t]he sad truth is that some teens live in dangerous homes and can't go to their parents." She added, "The intent of [these laws] is to make it extraordinarily difficult for girls from abusive families to get access to health care" (Montana Standard, 5/31).

Bill Sponsor, Attorney General's Office Respond

State Rep. Jerry Bennett (R), the sponsor of HB 521, said it would hold up in court because it includes a provision -- absent from the 1995 law -- that allows minors to ask a judge for a bypass from the consent requirement (AP/Great Falls Tribune, 5/30).

John Barnes -- a spokesperson for state Attorney General Tim Fox (R) -- said the state will "defend these laws vigorously at every stage of the process," adding that "voters and duly elected representatives have made it very clear they want the parental notification and consent laws on the books" (Montana Standard, 5/31).

Our video roundup includes a unique assortment of Web videos hand-picked by our editors. In this edition, we feature a look back at the now-debunked "crack baby" claims from the 1980s, as well as a video from celebrities who are urging President Obama to protect reproductive rights.

Video Looks Back at 'Crack Baby' Myth, Celebs Push for 'Bill of Reproductive Rights'

May 31, 2013 — Our video roundup includes a unique assortment of Web videos hand-picked by our editors. In this edition, we feature a look back at the now-debunked "crack baby" claims from the 1980s, as well as a video from celebrities who are urging President Obama to protect reproductive rights.

The New York Times' "Retro Report" looks back at media reports from the 1980s warning of a generation of "crack babies" born to women who used the drug during pregnancy, supposedly putting their infants at risk of brain damage, birth defects, cerebral palsy and other problems. Fueled by a single study involving about two dozen cases, experts and politicians at the time warned of children who would grow up dependent on social programs, struggle in school and be plagued by health problems. Although other research showed the symptoms supposedly found in crack babies were consistent with those in other premature infants, by the late 1980s women who used drugs during pregnancy were being prosecuted as child abusers and murderers. "Retro Report" speaks with researchers involved in the original studies and checks in with adults who were allegedly exposed to crack in utero ("Retro Report," New York Times, 5/20).




The latest video from the Center for Reproductive Rights' Draw the Line campaign features actor Stanley Tucci, comedian Whitney Cummings and other celebrities who urge advocates to sign a Bill of Reproductive Rights to protect reproductive freedom and ensure affordable access to a full range of women's health services. The new video -- which specifically calls on President Obama to stand up against attacks on reproductive rights and women's health care -- follows similar campaigns last year involving Meryl Streep, Amy Poehler and others (Center for Reproductive Rights, 5/22).

El Salvador's health minister on Thursday granted permission for doctors to perform a caesarean section on a woman with a life-threatening pregnancy whose fetus has a fatal disorder, the AP/U-T San Diego reports.

El Salvador Allows C-Section To Save Woman; Case 'Isn't Unique,' Letter to the Editor Says

May 31, 2013 — El Salvador's health minister on Thursday granted permission for doctors to perform a caesarean section on a woman with a life-threatening pregnancy whose fetus has a fatal disorder, the AP/U-T San Diego reports.

The move by Health Minister María Isabel Rodríguez comes a day after the Salvadoran Supreme Court denied a request for an abortion from the 22-year-old woman -- known as Beatriz -- who has lupus and kidney failure (Aleman, AP/U-T San Diego, 5/30). Additionally, ultrasound images show the fetus has a fatal condition called anencephaly, in which much of the brain fails to develop (Women's Health Policy Report, 5/30).

After the court's decision, the Inter-American Court of Human Rights called on the government to "immediately adopt the necessary measures to protect the life, personal integrity and health" of Beatriz (Zabludovsky, New York Times, 5/30).

Abortion-rights groups said Beatriz is 26 weeks pregnant, meaning that the nation's abortion laws no longer apply. As such, the health minister can decide what is medically appropriate for the woman versus the fetus, they said (AP/ U-T San Diego, 5/30).

Rodríguez's Announcement

On Thursday, Rodríguez gave doctors permission to perform a c-section at the first sign of danger, saying, "At this point, the interruption of the pregnancy is no longer an abortion, it is an induced birth."

She said an induction leading to a vaginal birth would also be acceptable, adding that "the important thing is saving Beatriz's life" (New York Times, 5/30).

Beatriz's Case 'Isn't Unique,' Center for Reproductive Rights' Northup Writes

"The Salvadoran court's refusal to allow [an abortion] that could save Beatriz's life is a disgraceful violation of her fundamental human rights," writes Nancy Northup, president and CEO of the Center for Reproductive Rights, in a New York Times letter to the editor.

"Unfortunately, Beatriz's story isn't unique," she adds. Northup explains that El Salvador's abortion ban has resulted in the denial of other medically necessary abortions, as well as "the wrongful imprisonment of far too many women who suffered miscarriages or obstetric complications."

She warns that if some U.S. lawmakers "get their way, American women could face equally dire circumstances as a result of extreme abortion bans" (Northup, New York Times, 5/30).

The California Assembly on Wednesday advanced a bill (AB 912) that would require insurers to cover procedures to preserve fertility for individuals with cancer or other serious diseases, the AP/U-T San Diego reports.

Calif. Bill Would Require Coverage of Fertility Treatments for Cancer Patients

May 31, 2013 — The California Assembly on Wednesday advanced a bill (AB 912) that would require insurers to cover procedures to preserve fertility for individuals with cancer or other serious diseases, the AP/U-T San Diego reports. The bill now heads to the state Senate for consideration.

The measure would require insurance plans to include coverage for egg extraction and sperm freezing before patients begin treatments that could harm their fertility. The fertility procedures can cost up to $15,000, according to the AP/U-T San Diego.

Assembly member Sharon Quirk-Silva (D), the bill's sponsor, called the measure "a sensible, humane and cost-effective solution to foreseeable harm for medically necessary treatment."

The state requires insurance companies to offer fertility treatment coverage, but it does not require that policies include such benefits. If the bill becomes law, California would be the first state to enact such a requirement (Olson, AP/U-T San Diego, 5/29).

The Wisconsin Assembly Health Committee on Wednesday heard from critics and supporters of a bill (AB 216) that would restrict health insurance coverage of abortion and contraception, the AP/Atlanta Journal-Constitution reports.

Wis. Bill Would Limit Abortion, Contraceptive Coverage

May 31, 2013 — The Wisconsin Assembly Health Committee on Wednesday heard from critics and supporters of a bill (AB 216) that would restrict health insurance coverage of abortion and contraception, the AP/Atlanta Journal-Constitution reports.

The bill -- sponsored by state Rep. Andre Jacque (R) -- would prohibit taxpayer funding from being used to pay for abortion coverage in public employees' health insurance plans. The bill also would exempt some religious organizations and employers from a state law that requires employers to include contraceptive coverage in health plans, unless they are self insured.

Key Testimony

During the hearing, Nicole Safar, public policy director for Planned Parenthood Advocates of Wisconsin, noted that more than 90% of women use contraceptives. The cost of contraception could be burdensome to low-income women, she said.

Supporters of the bill argued that self insurance is not a viable alternative for many businesses because the cost is too great, it would result in reduced coverage and lead to higher premiums for employees (Wang, AP/Atlanta Journal-Constitution, 5/29).

In a commentary for The Lancet, Navanethem Pillay of the United Nations writes that maternal mortality and morbidity "continue to be a serious human rights concern," with an estimated 287,000 women dying of maternal causes in 2010. She outlines how a 2012 report released by her office can be used to "strengthen the bridges between [the] sectors" that need to work together to make progress on maternal health. The guidance "presents an opportunity to move from rhetoric to reality in implementing policies and programmes on the ground that explicitly work toward the realisation of women's human rights," she states.

United Nations Guidance Frames Maternal Mortality and Morbidity as 'Human Rights Imperative'

May 30, 2013 — Summary of "Maternal Mortality and Morbidity: A Humans Rights Imperative," Pillay, The Lancet, April 2013.

"Maternal mortality and morbidity continue to be a serious human rights concern -- it is estimated that 287,000 women died of maternal causes in 2010," according to a commentary by United Nations High Commissioner for Human Rights Navanethem Pillay. This human rights crisis "stems from discrimination against women," manifested as "violence against women, underprioritisation and underfunding of services and goods that only women require, and lack of accountability mechanisms to respond to maternal deaths and injuries," she writes.

Pillay discusses how a report published by her office can help "strengthen the bridges between sectors" that need to work together to make "human rights a reality on the ground."

The 2012 report -- titled "Technical guidance on the application of a human rights-based approach to the implementation of policies and programmes to reduce preventable maternal mortality and morbidity" -- is a tool that "translates human rights norms and standards into concrete policy action and aims to make human rights more accessible and practical for policy makers," she writes. Pillay notes that it has received the approval of the Humans Rights Council, which directed her to report back on how nations and other stakeholders are using the tool.

Guidance Summary

Pillay explains that the guidance is based on general human-rights principles that recognize "health in a broad sense and not only isolated pathologies; the need for attention to the social determinates of women's health; and special attention to women who are subject to multiple forms of discrimination and have increased rates of maternal mortality and morbidity as a result." The guidance also emphasizes the role of women as "active rights holders" who have the right to take part in matters related to their sexual and reproductive health.

Recognizing that a "national plan of action or strategy is an important first step in meeting human rights obligations," the guidance "details what issues should be covered in such a plan, ... with specific steps toward ensuring universal access and addressing disparities in access." The guidance calls for nations to allocate budgets "to devote the maximum available resources" toward human rights, Pillay writes.

The guidance also includes a "diagnostic exercise" that can be used to "reveal human rights concerns and gaps in accountability" and help policymakers design "responses that comply with human rights obligations," she continues. In addition, Pillay outlines several "accountability mechanisms" explained in the guidance, such as "[m]onitoring and data collection" and "effective remedies" -- including restitution and compensation.

Conclusion

Pillay writes that the guidance "is distinct in its holistic approach."

It "presents an opportunity to move from rhetoric to reality in implementing policies and programmes on the ground that explicitly work towards the realisation of women's human rights," she writes, concluding, "Everyone has a part to play in making this happen."

Deepali Godha, an independent consultant in India, and colleagues evaluated data from a survey of women in four South Asian countries with high rates of child marriage -- Bangladesh, India, Nepal and Pakistan -- to "assess the influence of child marriage on reproductive health outcomes and service use." They found that "child marriage is significantly associated with poor fertility outcomes, lower contraceptive use early in the marriage, and inadequate maternal health care use." They added, "Of particular concern is the limited scope for such girls and young women to achieve better reproductive and maternal health because of reduced educational and income-generating opportunities and restricted mobility, which makes them a hard-to-reach population for reproductive health programs."

Study Links Child Marriage in South Asia to Poor Reproductive Health Outcomes

May 30, 2013 — Summary of "Association Between Child Marriage and Reproductive Health Outcomes and Service Utilization: A Multi-Country Study From South Asia," Godha et al., Journal of Adolescent Health, May 2013.

"Despite the pervasiveness of child marriage and its potentially adverse consequences on reproductive health outcomes, there is relatively little empirical evidence available on this issue, which has hindered efforts to improve the targeting of adolescent health programs," Deepali Godha, an independent consultant in India, and colleagues wrote in the study.

They noted that child marriage remains "a pervasive problem in South Asia" and is significantly associated with poor health outcomes, including an increased risk of miscarriage or stillbirth, unwanted pregnancies, and rapid repeat childbirth. They added that while the legal age to marry is 18 in Bangladesh, India and Nepal, and 16 in Pakistan, the median age at first marriage in those countries ranges from 15 to 19.

Methods

The researchers analyzed data from a recent Demographic and Health Survey. They restricted their analyses to four countries -- Bangladesh, India, Nepal and Pakistan -- with high rates of child marriage, defined as marriage before age 18. The study included 2,129 women in Bangladesh; 14,628 in India; 1,658 in Nepal; and 1,546 in Pakistan who were currently 20 to 24 years old and married, divorced or widowed.

The researchers determined the women's ages at marriage and divided them into two categories: those married at ages 14 and younger and those married at ages 15 to 17. They conducted analyses to determine any association between age at marriage and various reproductive health-related outcomes, such as whether women gave birth within the first 12 months of marriage, women's current use of modern contraceptives and the number of unintended pregnancies.

Results

The proportion of women who reported being married at ages 17 or younger ranged from 50% in Pakistan to 77% in Bangladesh. The proportion of women married at ages 14 or younger ranged from 12% in Nepal to 38% in Bangladesh.

Compared with women married as adults, women married before age 18 were "significantly more likely not to have used contraception before first childbirth, to have had a pregnancy termination, and to have had an unintended pregnancy," the study found.

The proportion of women who participated in antenatal care visits at least four times during their pregnancies ranged from about 16% to 27% among those married at age 14 or earlier and from about 22% to 35% among those married at ages 15 to 17. However, women who were married as children were not more likely than other women to have given birth within their first year of marriage or to have had rapid repeat births.

In India and Nepal, women married as children were more likely than women who were married as adults to report having been sterilized. The researchers did not assess sterilization rates in Bangladesh and Pakistan because of low levels of female sterilization in those countries.

The results suggested that age at marriage is significantly associated with current modern contraceptive use in all four countries. However, when the number of living sons was included in the model, the association remained only for women in India and women married at ages 14 or younger.

Regarding antenatal care, the study found that there was no significant association between age at marriage and the expected number of antenatal visits in India or Pakistan. However, the expected number of antenatal visits was lower among women married at ages 14 or younger in Bangladesh and those married at ages 15 to 17 in Nepal, compared with women married as adults.

In addition, compared with women married as adults, the likelihood that a woman's most recent delivery was assisted by a skilled health worker was significantly lower among women married at ages 15 to 17 in Bangladesh, Nepal and Pakistan, as well as those married at ages 14 or younger in Bangladesh.

Discussion

"The study results suggest that in the South Asian context, child marriage is significantly associated with poor fertility outcomes, lower contraceptive use early in the marriage, and inadequate maternal health care use," the researchers wrote.

The relationships between child marriage, fertility control and fertility could be the result of a number of factors, including "limited knowledge about temporary modern contraceptives, social norms for childbearing, longer duration of marriage, and women's limited decision-making power and access to resources," the researchers noted. However, "[i]nterestingly," the study found no significant association between early fertility and child marriage, they added.

In all the studied countries, higher wealth and education levels "were important positive predictors for maternal health care use," while "higher birth order and residing in rural areas were frequently negative predictors of health care use," according to the study. The researchers noted that age at marriage remained associated with maternal health care use even after controlling for other factors, which "may result from the limited empowerment of women who were married as children and a corresponding lack of decision-making power and access to resources."

The researchers wrote that "strict reinforcement of laws is required to curb" child marriage. They noted that "[o]f particular concern is the limited scope for such girls and young women to achieve better reproductive and maternal health because of reduced educational and income-generating opportunities and restricted mobility, which makes them a hard-to-reach population for reproductive health programs." They added that while most programs focus on preventing child marriage, strategies also should be "targeting women who were married at early ages, and their families."

In a Fertility and Sterility editorial, Jacques Donnez of the Infertility Research Unit summarizes seven articles in the May 2013 issue that discuss fertility preservation (FP), including methods for women with cancer. Donnez writes that medicine has moved beyond the need to simply cure patients' cancer to incorporating quality of life after treatment and fertility preservation. "Currently, embryo and mature oocyte cryopreservation are the only techniques endorsed" by the American Society for Reproductive Medicine for fertility preservation, but Donnez concludes that "the evidence is strong enough to also consider ovarian tissue freezing and reimplantation as a feasible method of FP to be applied in clinical practices and endorsed by the ASRM."

Editorial Reviews Latest Research on Fertility Preservation for Cancer Patients

May 30, 2013 — Summary of "Fertility Preservation, From Cancer to Benign Disease to Social Reasons: The Challenge of the Present Decade," Donnez, Fertility and Sterility, May 2013.

Fertility preservation (FP) "in female cancer and non-cancer patients is extensively discussed" in the May issue of Fertility and Sterility, Jacques Donnez of the Brussels-based Infertility Research Unit writes in an editorial summarizing the various findings.

The goal of cancer care is no longer only to cure the disease, Donnez writes, adding that patients' quality of life after cancer and fertility preservation are also important considerations.

Summary of Articles

The first review evaluates "accurate assessment of the ovarian reserve and its relationship with anti-müllerian hormone (AMH)," as well as discusses the "impact of cancer therapy ... on the female reproductive tract," Donnez writes. He adds, "Low AMH levels are not predictive of reduced fertility in healthy young women and may be of limited value in childhood cancer survivors."

The second review examines "time constraints, potential complications, and limited opportunity for ... ovarian stimulation in women with cancer" and stresses the "need to maximize the number of oocytes and embryos" because the patient typically "has a single cycle opportunity." This review also discusses "[p]revention of ovarian hyperstimulation syndrome in cancer patients," and "use of gonadotropin-releasing hormone (GnRH) agonist is proposed to trigger final oocyte maturation in women at risk of OHSS," Donnez adds. However, he notes that because most cancer patients have never undergone embryo transfer, "there are not enough data to evaluate pregnancy rates with these new protocols."

Donnez reports that a third review on oocyte vitrification indicates that "vitrification is effective," finding that "[v]itrified oocytes retain their normal developmental potential, with survival rates around 90% and pregnancy rates ranging from 60% to 75%." He adds, "Many major scientific societies have changed their position in this regard and no longer consider oocyte vitrification as an experimental tool."

Donnez notes that "current evidence on the outcome of oocyte vitrification for FP in female cancer patients is very limited" but adds that "experience available from egg donation programs and infertile patients" could be used to improve counseling services.

In addition, a fourth review on embryo cryopreservation -- which Donnez describes as "an established and very successful method of FP when there is sufficient time to perform ovarian stimulation" -- analyzes "special considerations on ovarian stimulation for FP purposes." He notes that "ovarian stimulation protocols using GnRH antagonists" and "trigger of final oocyte maturation by GnRH agonist" should be the "preferred" methods in cancer patients in order to reduce the risk of OHSS.

The review also examines various "indications for embryo cryopreservation in case of malignant and benign diseases," Donnez writes, adding that the evidence suggests that "embryo cryopreservation is a safe and effective option in women at risk of premature ovarian failure," when sufficient time is available.

Meanwhile, a review on restoration of ovarian activity and pregnancies after cryopreserved ovarian tissue was transplanted showed ovarian activity was restored in 93% of the 60 cases included in the study, leading to 11 pregnancies that have already resulted in several births. However, Donnez notes that egg quality in "IVF after transplantation is not optimal and there is no doubt that dysfunctional folliculogenesis occurs."

Another review involving malignant cell presence in ovarian tissue analyzed "different 'at risk' pathologies," including leukemia. In more than 50% of cases, ovarian tissue from leukemia patients is positive for malignant cells, but malignant cells in leukemia patients who are in complete remission do not appear to be viable, Donnez writes. "Nevertheless, even if the risk [of malignant cells] is low in patients in complete remission, it cannot be excluded," he writes.

Donnez writes that the final review describes the challenges of developing culture systems to grow oocytes "through to maturity for IVF purposes could represent an exciting and challenging alternative in case of risk of malignant cell reimplantation." He notes, "As underlined in the review, the multistep approach needs to support the changing requirements of developing oocytes and surrounding somatic (granulosa) cells, as well as maintaining oocyte-somatic cell interactions."

Conclusions

"The time when the only goal was to cure [cancer] is long gone," Donnez writes, adding, "Now, curing the disease, quality of life after cancer, and fertility preservation are all important considerations."

Although "embryo and mature oocyte cryopreservation are the only techniques endorsed by the ASRM," the "evidence is strong enough to also consider ovarian tissue freezing and reimplantation as a feasible method of FP to be applied in clinical practices and endorsed by the ASRM," Donnez concludes.

Clinical management related to preterm births tends to focus on prevention, rather than care of the new mother and her family. In a review of health care practices after preterm births, Ira Kantrowitz-Gordon -- a midwife and senior lecturer at the University of Washington School of Nursing -- discusses postpartum care after a preterm birth and offers "effective strategies for midwives and other obstetric clinicians to leverage the high level of trust gained during pregnancy in order to assist mothers and their families" during this period. In addition to maintaining a therapeutic relationship with the mother, obstetric providers can help implement "specific, evidence-based interventions" -- such as kangaroo care and planning for future pregnancies -- to help families after preterm births, she writes.

Review Evaluates Challenges, Effective Strategies in Care for Families After Preterm Birth

May 30, 2013 — Summary of "Expanded Care for Women and Families After Preterm Birth," Kantrowitz-Gordon, Journal of Midwifery & Women's Health, April 17.

"Preterm birth remains one of the most common and significant complications of pregnancy," Ira Kantrowitz-Gordon writes in a review of health care practices and support for women who experience preterm birth and their families.

Kantrowitz-Gordon, a senior lecturer at the University of Washington School of Nursing and a midwife with the Providence Medical Group, notes that the U.S. ranks sixth in the world for the number of preterm births. "[T]he experience of premature birth can have a profound impact on a woman's transition to motherhood and a family's well-being," yet clinical management has largely focused on preventing preterm birth, "with less attention to the care of the new mother and her family after a preterm birth," she writes.

The review aims to evaluate "what is known about the experience of preterm motherhood and presen[t] effective strategies for midwives and other obstetric clinicians to leverage the high level of trust gained during pregnancy in order to assist mothers and their families in the postpartum period."

Impact of Preterm Birth on Maternal-Newborn Attachment

"Physical closeness is an important strategy toward facilitating maternal-newborn attachment in the NICU," Kantrowitz-Gordon writes. Proximity, reciprocity and commitment are the most important elements of that attachment, but the NICU environment can disrupt the bonding process.

Nurses can care for the "mother-newborn dyad rather than just the newborn" by including mothers in care, sharing information with mothers and encouraging their participation, she writes, adding that nurses might inhibit attachment by attempting to control mothers' behaviors and dismissing their concerns or desires.

Impact on Breastfeeding

Women who have a preterm birth "may experience more stress about breastfeeding in order to meet the expectation for being a good mother," Kantrowitz-Gordon writes.

"Unfortunately, there are many barriers to feeding a preterm newborn exclusively at the breast," she continues. For instance, premature infants can have immature neuromuscular development, which impairs their sucking patterns and motor strength, or be completely unable to feed at the breast. In this case, mothers would need to express milk by hand or a pump, which can in turn lead to discomfort or logistical challenges in delivering the milk to the NICU.

Impact on Maternal Mental Health

"There are many sources of stress for mothers in the NICU, including worries about the health of the [newborn], exhaustion, and competing obligations at home," Kantrowitz-Gordon writes.

She notes that a review of 26 studies found that rates of postpartum depression among women who experienced preterm birth were as high as 40%. Symptoms of post-traumatic stress and anxiety also are more prevalent when women have preterm births.

Impact on Families

The challenges of preterm births extend beyond the mother to her partner, other children and other family members, Kantrowitz-Gordon continues. In a large national survey, divorce and separation rates were twice as high among parents of very low birth weight infants than among other parents in the two years after birth, she reports.

Although little is known about the long-term impact of prematurity on siblings, one study of adults with extremely low birth weight siblings found that they remained "deeply affected by the birth story of the preterm sibling," according to Kantrowitz-Gordon.

Recommended Care After a Preterm Birth

"The trusting relationship that usually develops between a prenatal care provider and a pregnant woman is the ideal foundation for provision of continued support and guidance during a frightening experience," Kantrowitz-Gordon writes, adding that it is "especially important" for these providers to address the need of the woman and her family while other medical personnel attend to the newborn.

She also recommends "specific, evidence-based interventions" that have been shown to help families after preterm births. One such intervention is kangaroo care, or skin-to-skin contact between the mother or another family member and the infant, who is dressed only in a cap and diaper. Studies have shown kangaroo care is associated with improved breastfeeding rates, stable newborn temperatures, decreased hospital stays and improved neurological development.

Other evidence-based interventions shown to help families include successful lactation, postpartum mental health screening, family-directed care and guidance on planning future pregnancies, according to Kantrowitz-Gordon.

Conclusion

Midwives and other obstetric providers are in "a unique position to support the woman and family" after a preterm birth because of the trust that was established between them during the pregnancy, Kantrowitz-Gordon writes.

These providers are able to offer anticipatory guidance for caring for an infant in the NICU, provide methods for establishing and continuing adequate breast milk supply, and assess and intervene in response to distressing symptoms, including depression.

Kantrowitz-Gordon concludes by calling on providers to "advocate for systemic change in the health care system" to "improve the care of families experiencing the stress of preterm birth."