Daily Women's Health Policy Report

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Daily Women's Health Policy Report by the National Partnership for Women & Families
Updated: 1 hour 48 min ago

S.C. Senate Overrides Procedural Block, Set To Consider 20-Week Abortion Ban

Fri, 05/01/2015 - 15:41

South Carolina lawmakers voted to override a block barring a 20-week abortion ban bill (H 3114) from reaching the state Senate, meaning the full chamber is scheduled to take up the measure, the Columbia Free Times reports.

S.C. Senate Overrides Procedural Block, Set To Consider 20-Week Abortion Ban

May 1, 2015 — South Carolina lawmakers voted to override a block barring a 20-week abortion ban bill (H 3114) from reaching the state Senate, meaning the full chamber is scheduled to take up the measure, the Columbia Free Times reports.

The state House already approved the original version of the bill. State lawmakers have a deadline of May 1 to approve a measure in either the state House or Senate for it to be considered by the other legislative chamber (Moore, Columbia Free Times, 4/29).

Background

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

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

The bill, sponsored by state Rep. Wendy Nanney (R), would permit abortion after 20 weeks to save a woman's life. If an abortion is needed to save a woman's life, a physician would be required to remove the fetus using a method that would give the fetus the best chance of survival. In addition, physicians would be required in such cases to report certain data to the state, including the method of abortion used and the age of the woman.

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

Earlier this month, a state Senate committee amended the bill to include exceptions for victims of rape, incest and in instances where "severe fetal anomalies" would prevent fetal survival (Women's Health Policy Report, 4/20).

Procedural Block Removed

State senators voted to override a procedural block -- known as a minority report -- on the measure that prevented the chamber from debating the bill (Columbia Free Times, 4/29).

State Sens. Brad Hutto (D) and Joel Lourie (D) placed the minority report because they believed the bill would impede women's reproductive rights. The minority report required two-thirds of the full state Senate to vote to remove the block in order to send it to the full chamber for consideration (Women's Health Policy Report, 4/20).

According to the Free Times, other state senators voted to send the bill to the full chamber for "special order." The measure now is one of the top three priority bills on the chamber's legislative calendar.

Meanwhile, Lourie and other state lawmakers have expressed concern that debate over the 20-week ban could stall consideration of other major priorities before the May 1 deadline, the Free Times reports. Specifically, Lourie said it would be a "terrible mistake" for the state Senate to take up the 20-week ban before acting on other priorities, including a road improvement bill (Columbia Free Times, 4/29).


Video Round Up: Texas Rep. Decries Hypocrisy of Abortion Restrictions, Comedian Satirizes Antiabortion-Rights Lawmakers

Fri, 05/01/2015 - 15:39

In today's clips, Texas Rep. Jessica Farrar (D) points out the hypocrisy of antiabortion-rights lawmakers opposing legislation to support breastfeeding women and families. Elsewhere, SNL's Cecily Strong calls out antiabortion-rights lawmakers at the White House Correspondents' Dinner.

Video Round Up: Texas Rep. Decries Hypocrisy of Abortion Restrictions, Comedian Satirizes Antiabortion-Rights Lawmakers, More

May 1, 2015 — In today's clips, Texas Rep. Jessica Farrar (D) points out the hypocrisy of antiabortion-rights lawmakers opposing legislation to support breastfeeding women and families. Elsewhere, SNL's Cecily Strong calls out antiabortion-rights lawmakers at the White House Correspondents' Dinner.



Texas Rep. Jessica Farrar (D) speaks out against state lawmakers who added an antiabortion-rights amendment to an unrelated bill (HB 2510), which would alter the state's law (HB 2) banning abortion after 20 weeks of pregnancy to remove exceptions in instances of fetal anomalies. HB 2510 was later sent back to committee for revision.

Farrar notes that state lawmakers who are opposed to abortion rights have also refused to back legislation to help assist breastfeeding women and families, adding that "the hypocrisy must stop" (NARAL Pro-Choice Texas, 4/24).




Cecily Strong, a cast member with NBC's "Saturday Night Live," satirizes antiabortion-rights lawmakers imposing abortion restrictions during the White House Correspondents' Dinner, which is attended by politicians and members of the press. In her comments, she pinpoints the hypocrisy of politicians legislating women's bodies (Huff Post/AOL News, 4/26).




MSNBC's Jose Diaz-Balart talks with NBC's Frank Thorp about the compromise reached by Senate lawmakers on antiabortion-rights language in a human trafficking bill (S 178) that was later passed by the chamber. Thorp notes that while the agreement prevents an expansion of existing restrictions on abortion funding by not permanently applying the Hyde Amendment to a survivors' compensation fund, it also still subjects funds for health care services for survivors to the restrictions.

The agreement also cleared the way for the Senate to confirm now-U.S. attorney general Loretta Lynch, who had been nominated for more than five months (Diaz-Balart, "The Rundown," MSNBC, 4/21).


Op-Ed: Texas Bills Would Help 'Protect the Patient-Provider Relationship'

Fri, 05/01/2015 - 15:38

Two measures introduced in Texas "would protect the patient-provider relationship from inappropriate political interference in personal decisions that should be [made] by women and their trained health care providers," family physician Bich-May Nguyen writes in a Houston Chronicle opinion piece.

Op-Ed: Texas Bills Would Help 'Protect the Patient-Provider Relationship'

May 1, 2015 — Two measures introduced in Texas "would protect the patient-provider relationship from inappropriate political interference in personal decisions that should be [made] by women and their trained health care providers," family physician Bich-May Nguyen writes in a Houston Chronicle opinion piece.

Nguyen explains that lawmakers increasingly are "trying to dictate how my fellow physicians and I care for our patients, using ideology to trump evidence, medical ethics, and the best interests of women." However, she writes that two proposed bills -- the "'You Can't Force a Doctor to Lie'" Act (HB 1210) and Marlise's Law (HB 3183) -- would help fix such interference and ensure that patients can "trust that their care is high-quality and based on their circumstances and preferences, not politics."

HB 1210 Would Protect Providers, Patients

Nguyen writes that HB 1210 could help protect providers and patients by addressing certain state restrictions on abortion.

Specifically, she notes that although abortion "has a 99 percent safety record," it "is singled out for medically unnecessary restrictions." For example, a woman seeking medication abortion is required to make four trips to her physician. According to Nguyen, the patient goes first to receive "state-mandated 'counseling' that includes information that is patently false, and a state-mandated ultrasound," then "return[s] for second and third visits to receive the medication she needs, even though research shows, and the American College of Obstetricians and Gynecologists recommends, that it be taken at home." The fourth visit is for follow-up, Nguyen adds.

Nguyen expresses concern that "poor women in rural Texas ... have to travel hundreds of miles -- sometimes without a car or money for gas or bus fares -- and take time off work to make these unnecessary trips."

She contends that by adopting HB 1210, Texas would set patients by "a standard that says Texas will not force health care providers to choose between their medical training and ethical obligations versus politically motivated laws."

Marlise's Law Would Protect Pregnant Women

Meanwhile, Nguyen also discusses the "tragic" case of Marlise Muñoz, who was kept on mechanical support at a Texas hospital against her family's wishes "simply because she was 14 weeks pregnant." She adds, "No family should have to endure the trauma of losing a loved one so cruelly compounded by state interference in a personal health care decision."

She explains that Marlise's Law would "remov[e] the pregnancy exception to end-of-life directives and allow pregnant women and their family the right to make end-of-life decisions."

According to Nguyen, HB 1210 and HB 3183 both would help rebut the trend of "the Texas Legislature insert[ing] politics into the exam room" and allow "providers ... to be able to use their professional judgment and give the best possible care without running afoul of the law" (Nguyen, Houston Chronicle, 4/29).


House Votes To Block D.C. Reproductive Health Non-Discrimination Law

Fri, 05/01/2015 - 15:31

The House on Thursday voted 228-192 on a measure (HJR 43) to block a reproductive health non-discrimination law (Act 20-593) passed by the Washington, D.C., Council, the AP/New York Times reports.

House Votes To Block D.C. Reproductive Health Non-Discrimination Law

May 1, 2015 — The House on Thursday voted 228-192 on a measure (HJR 43) to block a reproductive health non-discrimination law (Act 20-593) passed by the Washington, D.C., Council, the AP/New York Times reports (AP/New York Times, 4/30).

The vote marked the first time since 1991 that either the House or Senate has passed a bill to block a D.C. law from taking effect, according to The Hill (Marcos, The Hill, 4/30).

Background on Reproductive Health Non-Discrimination Law

The Reproductive Health Non-Discrimination Amendment Act of 2014 was passed by the D.C. Council in December. It amends the District's Human Rights Act of 1977 to include language prohibiting employers from discriminating against employees based on their reproductive health decisions (Women's Health Policy Report, 2/9).

Vote 'Largely Symbolic'

According to the AP/Times, the vote was "largely symbolic," as Congress is unlikely to meet a Saturday deadline to block the law before it takes effect. The Senate likely will not take up the measure by that date. In addition, the White House has issued a veto threat of the measure if it were to pass both chambers of Congress.

The White House wrote that the House bill, by blocking the D.C. law, would "give employers cover to fire employees for the personal decisions they make about birth control and their reproductive health" (AP/New York Times, 4/30).


Ala. House Panel Hears Testimony on Antiabortion-Rights Bills

Fri, 05/01/2015 - 14:49

An Alabama House committee on Wednesday heard testimony on three measures that would restrict access to abortion in the state, the Alabama News Network reports.

Ala. House Panel Hears Testimony on Antiabortion-Rights Bills

May 1, 2015 — An Alabama House committee on Wednesday heard testimony on three measures that would restrict access to abortion in the state, the Alabama News Network reports.

The committee plans to vote on the measures next week (Alabama News Network, 4/29).

Bill Details

One bill (HB 527), filed by state Rep. Ed Henry (R), would prohibit the state Department of Public Health from issuing or renewing health center licenses to abortion or reproductive health clinics located within 2,000 feet of a public school's campus or property. The measure would force most of the state's clinics to close, including the Huntsville Women's Clinic, which is the sole abortion facility in Northern Alabama (Women's Health Policy Report, 4/24).

The state House Health Committee also heard testimony on HB 405, which could prohibit abortion as early as six weeks' gestation (Perallon, AP/WHNT News, 4/29). Specifically, the bill would require physicians to check for a fetal heartbeat before performing an abortion and make it illegal to perform an abortion if a heartbeat can be detected. Currently, the state permits abortion until 20 weeks of pregnancy.

The state House passed a similar ban last year, but it did not advance in the state Senate (Women's Health Policy Report, 4/6).

According to Montgomery Advertiser, the panel also heard testimony on a bill (HB 491) that would allow most health care providers to refuse to perform medical services to which they have personal objections (Lyman, Montgomery Advertiser, 4/29).

Testimony Details

During the hearing, Jayme Calhoun, a spokesperson for Alabama Reproductive Rights Advocates, said previous restrictions (HB 57) enacted in the state already had forced the Huntsville Women's Clinic to move from its original location to its current location. "Now that we've found a clinic that suits all of our needs, they're using their next excuse to try to shut us down," she said (AP/WHNT News, 4/29).

Meanwhile, supporters of the zoning bill said it was designed to ensure children's safety around schools (Montgomery Advertiser, 4/29).

Calhoun noted, "We make a very strong point not to protest here. We simply escort women in and out and keep them free from harassment on our property." She added that "[i]t would make a lot more sense for (the protesters) to stop (protesting) ... than make a legitimate business close" (AP/WHNT News, 4/29).

Separately, Eric Johnston, of the Alabama Pro-Life Coalition, said the fetal heartbeat bill aimed "to limit the number of abortions" in the state (Montgomery Advertiser, 4/29).

Susan Watson, executive director of the American Civil Liberties Union of Alabama, said the measure "would ban abortions from essentially six weeks on." She said, "As I've said before abortions are [a] constitutionally protected right for women," adding that similar measures "ha[ve] already been rendered unconstitutional in other states" (Alabama News Network, 4/29).


Video Round Up: Texas Rep. Decries Hypocrisy of Abortion Restrictions, Comedian Satirizes Antiabortion-Rights Lawmakers

Thu, 04/30/2015 - 18:08

In today's clips, Texas Rep. Jessica Farrar (D) points out the hypocrisy of antiabortion-rights lawmakers opposing legislation to support breastfeeding women and families. Elsewhere, SNL's Cecily Strong calls out antiabortion-rights lawmakers at the White House Correspondents' Dinner.

Video Round Up: Texas Rep. Decries Hypocrisy of Abortion Restrictions, Comedian Satirizes Antiabortion-Rights Lawmakers, More

April 30, 2015 — In today's clips, Texas Rep. Jessica Farrar (D) points out the hypocrisy of antiabortion-rights lawmakers opposing legislation to support breastfeeding women and families. Elsewhere, SNL's Cecily Strong calls out antiabortion-rights lawmakers at the White House Correspondents' Dinner.



Texas Rep. Jessica Farrar (D) speaks out against state lawmakers who added an antiabortion-rights amendment to an unrelated bill (HB 2510), which would alter the state's law (HB 2) banning abortion after 20 weeks of pregnancy to remove exceptions in instances of fetal anomalies. HB 2510 was later sent back to committee for revision.

Farrar notes that state lawmakers who are opposed to abortion rights have also refused to back legislation to help assist breastfeeding women and families, adding that "the hypocrisy must stop" (NARAL Pro-Choice Texas, 4/24).




Cecily Strong, a cast member with NBC's "Saturday Night Live," satirizes antiabortion-rights lawmakers imposing abortion restrictions during the White House Correspondents' Dinner, which is attended by politicians and members of the press. In her comments, she pinpoints the hypocrisy of politicians legislating women's bodies (Huff Post/AOL News, 4/26).




MSNBC's Jose Diaz-Balart talks with NBC's Frank Thorp about the compromise reached by Senate lawmakers on antiabortion-rights language in a human trafficking bill (S 178) that was later passed by the chamber. Thorp notes that while the agreement prevents an expansion of existing restrictions on abortion funding by not permanently applying the Hyde Amendment to a survivors' compensation fund, it also still subjects funds for health care services for survivors to the restrictions.

The agreement also cleared the way for the Senate to confirm now-U.S. attorney general Loretta Lynch, who had been nominated for more than five months (Diaz-Balart, "The Rundown," MSNBC, 4/21).


Editorial Lambasts 'Dishonest' Bill Targeting Ala. Abortion Clinics

Thu, 04/30/2015 - 17:52

The Alabama Legislature should let state Rep. Ed Henry's (R) "ill-conceived, dishonest" antiabortion-rights bill (HB 527) "die," a Decatur Daily editorial states.

Editorial Lambasts 'Dishonest' Bill Targeting Ala. Abortion Clinics

April 30, 2015 — The Alabama Legislature should let state Rep. Ed Henry's (R) "ill-conceived, dishonest" antiabortion-rights bill (HB 527) "die," a Decatur Daily editorial states.

According to the editorial, the measure would ban abortion clinics from operating within 2,000 feet of a school, "supposedly" to "protect[t]" school students from seeing protests.

The editorial contends the measure is another effort by conservative state lawmakers to "chi[p] away" at Roe v. Wade by "taking whatever circuitous route they think they can to limit women's access to abortion in the state." For example, the editorial states that a new state law (HB 57) imposing building restrictions on abortion clinics is "cloaked in the disguise of health and safety," with supporters claiming that the legislation "will improve patient safety," even as they "freely admit they're happy with any law that limits abortions."

The editorial notes that Henry, the sponsor of the latest bill, "said he had no idea" that the measure "would threaten closure" for abortion clinics, though the statement "seems hard to believe" given recent "roundabout" abortion restrictions. Moreover, according to the editorial, if "Henry isn't being disingenuous," it is "arguably worse" that he "is introducing bills without so much as a clue as to their impact."

The editorial adds, "One thing Henry admits to knowing, however, is his bill will invite inevitable legal challenge, racking up yet more bills in the service of defending yet more constitutionally suspect legislation" (Decatur Daily, 4/28).


Va.-Based City Council Passes Ordinance Requiring Special Use Permits for Abortion Clinics

Thu, 04/30/2015 - 17:52

The City Council in Manassas, Va., on Monday voted to approve an ordinance (O-2015-15) that will require abortion clinics and certain other medical care facilities to receive a special use permit from the Council before they may open in any of the city's commercial districts, Potomac Local News reports.

Va.-Based City Council Passes Ordinance Requiring Special Use Permits for Abortion Clinics

April 30, 2015 — The City Council in Manassas, Va., on Monday voted to approve an ordinance (O-2015-15) that will require abortion clinics and certain other medical care facilities to receive a special use permit from the Council before they may open in any of the city's commercial districts, Potomac Local News reports.

According to the Potomac Local News, the requirements will apply to any non-hospital medical care facility that provides services in addition to being a doctor's office -- these additional services include pharmacies, laboratories and physical therapy centers.

Comments

Katherine Greenier of the American Civil Liberties Union of Virginia's Reproductive Health Project said the measure aims to restrict women's health care access. She stated, "City zoning laws should not make it disproportionally difficult to access this kind of care."

Other advocates warned that the changes would have political consequences and promised to vote against any of the councilmembers who voted to approve the measure.

Meanwhile, Manassas Planning/Zoning Services Manager Matt Arcieri said the change was one of many updates to various laws mandated by the city council for the first time in almost 70 years (Kiser, Potomac Local News, 4/28).


Tenn. Abortion Providers Say Antiabortion-Rights Bills Would Burden Women, Clinics

Thu, 04/30/2015 - 17:51

Tennessee abortion providers say that two antiabortion-rights measures before Gov. Bill Haslam (R) could create additional burdens for women and the clinics, including added costs and logistical challenges, the Tennessean reports.

Tenn. Abortion Providers Say Antiabortion-Rights Bills Would Burden Women, Clinics

April 30, 2015 — Tennessee abortion providers say that two antiabortion-rights measures before Gov. Bill Haslam (R) could create additional burdens for women and the clinics, including added costs and logistical challenges, the Tennessean reports.

Background on Bills

The state Legislature last week passed a measure (SB 1280) that would require the six abortion clinics in Tennessee that provide surgical abortions to be licensed as ambulatory surgical centers. Specifically, the bill would require all facilities or physician offices that perform more than 50 surgical abortions annually to be licensed as ambulatory surgical centers.

Four providers in the state currently meet ambulatory surgical center standards, while a fifth provider, in Knoxville, only provides medication abortion and is therefore not subject to the requirement. The two remaining clinics that provide surgical abortions and are not licensed as ambulatory surgical centers are the Bristol Regional Women's Center and the Women's Center in Nashville (Wadhwani, Tennessean, 4/27).

Meanwhile, the state Legislature also passed a bill (SB 1222) that would impose a 48-hour mandatory delay before a woman could obtain an abortion. The measure also would require that women receive in-person counseling from a physician prior to the procedure. In the case of a medical emergency, the counseling requirement is waived.

The bill also includes a "spring-back" provision that would reduce the delay to 24 hours if the measure is stayed or struck down by a court. In addition, the remainder of the bill would stay in effect if any portion of the measure is found invalid (Women's Health Policy Report, 4/22).

According to the Tennessean, both bills have been submitted to Haslam, who has indicated he will sign them.

Clinic Concerns

Corinne Rovetti, co-director of the Knoxville Center for Reproductive Health, said the mandatory delay and in-person counseling measure would be a "logistical nightmare" for the clinic, which sees about 1,800 patients a year and has a single part-time physician. She said the measure would increase costs for the clinic, noting that while clinic staff tries "as best as we can to have affordable, quality services ... we may have to pass those costs on" to patients.

In addition, Rovetti said the mandatory delay would require women to make two trips to the clinic. She said it would be particularly difficult for women who are employed and have children, as they could have to take two days off work, forgo pay, buy gas and arrange for the care of their children, among other challenges.

Similarly, Rebecca Terrell -- director of Choices, the Memphis Center for Reproductive Health -- said that while providers are trying to reduce costs for women, the new rules are "going to cost women money, many of whom can't afford it." She said the rules likely would increase the average cost of medical services associated with abortion care by $100, even though the clinic is already regulated as an outpatient surgical center.

Terrell noted that some patients travel as much as five hours to obtain abortion care at her clinic and that abortion providers in the state are discussing ways to assist women, including creating a transportation system or a state abortion fund to help pay for the cost of hotels and travel.

Meanwhile, Ashley Coffield, president and CEO at Planned Parenthood Greater Memphis Region, said her clinic might have to extend weekday hours, add weekend service days or raise costs as a result of the regulations. In addition, she said the new rules would both raise demand for doctors and make it harder to recruit physicians amid a "culture and climate" in the state Legislature that lawmakers are "out to get physicians who are abortion providers" (Tennessean, 4/27).


Review Assesses Effect of Intimate Partner Violence on Women's Contraceptive Use

Thu, 04/30/2015 - 17:23

In this review, researchers investigated the effect of intimate partner violence (IPV) on women's use of contraception and found an association between IPV and a decline in women's contraceptive use. The authors also noted that women who experience IPV are less likely to report condom use with male partners, suggesting that HIV prevention programs should "consider women's experiences of IPV."

Review Assesses Effect of Intimate Partner Violence on Women's Contraceptive Use

April 30, 2015 —Summary of "Estimating the Effect of Intimate Partner Violence on Women's Use of Contraception: A Systematic Review and Meta-Analysis," Maxwell et al., PLOS One, Feb. 18, 2015.

Introduction

"Understanding how IPV modifies women's ability to adopt contraception is central to designing [family planning] interventions that allow women who experience IPV to manage their fertility," as well as "to inform HIV prevention interventions," according to Lauren Maxwell of McGill University and colleagues.

The researchers aimed to "estimate the causal effect of IPV on contraceptive use" by conducting a systematic review to "buil[d] on" studies that that show "an association between IPV and different sexual health outcomes."

Methods

The researchers searched 11 biomedical databases "to identify research studies on IPV and women's [reproductive health] outcomes" conducted between Jan. 1, 1980 and Dec. 3, 2013.

The researchers first searched for "studies of women and girls of any age that evaluated the association between respondents' exposure to IPV ... and an outcome related to women's [reproductive health]." They "included all types of IPV," including "physical, sexual, psychological, or economic." Following the initial search, the researchers restricted their inclusion criteria to studies "with an outcome related to women's use of contraception."

Results

The researchers limited their analysis to 10 studies.

According to the researchers, the "[s]tudies varied in their description of IPV and in the time period over which they assessed IPV." The researchers noted that the studies "generally classif[ied] IPV into four separate categories: emotional, physical, sexual, and economic," but that all the studies "included physical violence in their exposure definition."

The researchers noted that five of the 10 studies "limited their estimate of the effect of IPV on women's contraceptive use to one or two methods, including oral contraceptives, condoms and diaphragms, and condoms." Of those studies, three also "considered withdrawal and the rhythm method as contraceptive methods," while two "limited their definition to modern methods."

Every study "adjusted for basic demographic confounders" and some "adjusted for factors thought to mediate the relationship between IPV and contraceptive use." Four studies looked at "additional [reproductive health] outcomes," such as use of hidden methods of contraception, use of emergency contraception, reports of several partners, "shortened interpartum intervals" and unprotected anal sex.

Meta-analysis

For the meta-analysis, the researchers excluded three studies that "were classified as having a high probability of bias." However, they noted that "[b]oth the studies classified as having a high probability of bias and studies classified as subject to low or moderate levels of bias indicated that IPV was associated with a decrease in women's odds of using contraception."

The researchers also found that the three studies that included both modern and "less effective" types of contraceptives "were more likely to find a non-significant association between IPV and women's use of contraception" compared with "the four studies that estimated the effect of IPV on women's use of modern contraceptive methods." Meanwhile, the three studies that looked at women's reports of their male partner's condom use found that women exposed to IPV "were significantly less likely to report that their partners used condoms than women who did not experience IPV."

The researchers wrote that the meta-analysis of all 10 studies "indicated that women who experience IPV have a lower odds of adopting contraception than women who do not experience IPV," although the "results were subject to a high level of heterogeneity." When assessing only the seven studies with low to moderate levels of bias, the researchers found that women exposed to IPV were 53% less likely to report contraceptive use than women who were not exposed to IPV.

The researchers noted that some studies classified violence based on severity while others looked at violence frequency. Among the three studies that measured IPV duration, according to the researchers, "the magnitude of the effect of IPV on women's use (or non-use) of contraception is greatest for women who experience persistent IPV."

Discussion

The researchers wrote that the meta-analysis findings "suggest that IPV affects women's use of contraception," with some evidence suggesting that there is a "relationship between duration of IPV exposure and women's contraceptive use." According to the researchers, "IPV is associated with a decrease in women's use of partner dependent methods," although the association "is likely modified by contextual factors."

The researchers identified several areas for future research, including research that:

~ Orders the timing of "of exposure and outcome [to] allow for a better understanding of the causal effect of IPV on women's use of contraception";

~ Uses a "more complete definition of IPV to better estimate the total impact of IPV on women's use of contraception";

~ Assesses "the impact of harm reduction strategies on the ability of women who experience IPV to use condoms with their male partners";

~ Examines whether women who experience IPV would "prefer to adopt long-acting reversible and permanent contraceptive methods that are less likely to require their partner's involvement";

~ Limits its assessment on the effect of IPV "to modern methods of contraception" and "differentiate[s] between methods that do and do not require ongoing negotiations between a woman and her male partner"; and

~ Examines the "importance of IPV duration in predicting women's use of contraception."

The researchers added that "HIV prevention interventions should consider addressing IPV," given that their review found that woman who reported IPV also indicated they were less likely to use condoms.


Study Evaluates Research on Developing New Longer-Acting Injectable Contraceptives

Thu, 04/30/2015 - 17:23

In this study, researchers examine past and present initiatives to develop longer-acting injectable contraceptives and recommend which methods would be most likely to create a LAI that gains regulatory approval and reaches the market. They recommend that developers create a 6-month LAI with acceptable side-effects that can be self-administered or easily administered by non-physician medical professionals.

Study Evaluates Research on Developing New Longer-Acting Injectable Contraceptives

April 30, 2015 —Summary of "Towards the Development of a Longer-Acting Injectable Contraceptive: Past Research and Current Trends," Halpern et al., Contraception, Feb. 25, 2015.

"New reversible products with durations between the current 3-month injectable contraceptives and contraceptive implants and intrauterine devices would fill an important gap in the existing contraceptive method mix and would increase choices for women," according to Vera Halpern and colleagues at FHI 360.

The researchers note that while long-acting reversible contraceptives (LARCs) have played an "unequivocal role" in reducing global rates of unintended pregnancy, LARCs remain unaffordable or unsuitable for some "women's needs or preferences." The researchers write that a "longer-acting injectable (LAI) … that lasts for 6 months would be a valuable addition to the method mix and ideal for women who are interested in spacing births and/or uncertain about their future reproductive plans," while also helping to "reduce the patient load burden on clinical facilities and community-based programs."

In this study, the authors "review[ed] past applications of drug delivery technologies to injectable contraceptives and review[ed] advancements in sustained drug delivery technologies that hold promise for the development of a new LAI contraceptive product."

Background

According to the study, two methods historically have been used to "extend duration of efficacy following the single" dose of contraceptive medications -- those using:

~ Active pharmaceutical ingredients (APIs); and

~ Delivery systems.

The researchers note that the API approach identifies "new chemical entities" that have longer efficacy durations by using higher doses or by altering administration methods. For example, the World Health Organization Special Programme of Research in Human Reproduction in 1975 launched a large-scale effort to develop new compounds for use in three- and six-month LAIs, but only one of the new compounds they created, levonorgestrel butanoate (LNG-B), "advanced to the dose-finding stage of clinical testing."

Meanwhile, the researchers note that the "delivery system approach uses innovative technologies to control the rate of drug release to achieve a longer period of efficacy." Some of "these systems have demonstrated the potential to extend the release of contraceptive hormones ... to achieve a longer duration of action from a single injection without increasing the dose of API."

Review of Past Research

The researchers explain how a drug delivery technology called microspheres can be manipulated to help "[c]ontro[l] the rate and duration of release of API." They note that "[o]ver the past three decades, a number of microsphere formulations using various biodegradable materials were evaluated for controlled delivery of contraceptive hormones."

For example, the researchers wrote that a biodegradable implant called Capronor was developed via one microsphere formulation to provide "up to 1 year of ovulation suppression," although "its further development was impeded by difficult removal" and other factors. However, the authors noted that another set of microsphere formulations -- currently "the most common polymers" -- has since been used in health care products that have been successful, including treatments for prostate cancer and fibroids. These polymers also "have shown promise for the controlled release of" levonorgestrel (LNG), the researchers write.

The researchers add that another sustained drug delivery technology, called in situ forming biodegradable systems, has "also been shown to be effective for ... contraceptive hormones." Specifically, they note that these systems have been used successfully in products that palliatively treat advanced prostate cancer, fibroids and endometriosis, and that they have been "investigated [for] the potential ... for sustained delivery of contraceptive steroids in animals."

Review of Current Trends

The researchers note that most "large-scale funding and coordinated efforts to develop a LAI contraceptive" using "biodegradable polymers have been suspended or stopped altogether for various reasons, including technical and funding challenges." In addition, the introduction of contraceptive implants that last from three to five years in the mid- to late-1990s "temporarily diminished donor interest" in developing LAIs. However, limited access to health care in low-income areas "has recently reignited" donor and researcher interest because such options would be "easy to administer and do not require removal." According to the researchers, interest in LAI development has also been stoked by positive developments in the global "political and financial climate in the family planning arena," as well as "the increased popularity and success of injectable contraceptives."

According to the researchers, developing new LAIs could "be achieved by capitalizing on new developments in controlled release drug delivery" currently used in other medical treatments "as well as [by] developing alternative lower-dose formulations to the currently approved" LAIs. For example, FHI 360 in 2011 launched a project that aims "to bring to market a safe and effective [LAI] that would provide 7 months of contraceptive protection (6 months plus a 1-month window for reinjection) to women in the developing world."

The researchers write that existing polymers and new materials -- such as novel polymers and "[a]n alternative material to polymers" called porous silicon -- look promising for new LAI development. "In addition to new materials, advancements in the manufacturing process of microspheres may benefit the development of a LAI contraceptive," the researchers write, adding that one such process, which narrows microsphere particle size distribution, could "allow greater control over" how and when APIs are released.

Further Development

The researchers cite several factors that should be considered in "[t]he design of any new" LAI.

For example, they note that for future LAIs, "a shorter duration of contraceptive protection [might be better than] longer-term duration (i.e., 6 months versus 12 or 18 months)" because the "irreversibility" of the methods could cause concern. Specifically, they note that "[i]f women using such a product develop serious side effects, such as hormonally responsive cancers or other conditions in which hormonal therapies would be contraindicated, the method could not be discontinued immediately."

The researchers write that developers should also consider how biodegradable drug delivery systems traditionally have had a long release tail -- "the period when blood levels of the API are still detectable but not sufficient enough to be effective" -- which can pose difficulties "for women who want to conceive." Further, novel LAIs should be developed to withstand extreme temperatures and humidity to "allow for easy storage and distribution in low-resource settings."

According to the researchers, FHI 360 to this end has "developed a target product profile that will guide development of a 6-month contraceptive product." Specifically, the product should be effective "for 7 months (6-month duration with a 1-month grace period ... for reinjection), a predictable return of fertility (well defined 'tail') and acceptable side effects." Further, the product "should be easily suited for self-administration and/or administration by lower cadres of health care workers in developing settings to facilitate wide uptake."

The researchers suggest that the new LAI "utilize a well-established contraceptive hormone," such as LNG, or a polymer "that [has] been approved and used in existing marketed drug products." The researchers add that developers also should "monitor emerging evidence" on the possible association between HIV acquisition and hormonal contraceptives.

The researchers note that FHI 360 aims to "bring to market a 6-month injectable within 10-15 years," noting that such an injectable "would provide women with greater choice, offer an intermediate duration of efficacy between short- and long-acting reversible methods, improve continuation and compliance and ultimately help reduce rates of unintended pregnancy around the world."


Study Assesses Relationship Between Reproductive Coercion, Pregnancy Behaviors

Thu, 04/30/2015 - 17:23

In this study, researchers examined "women's experiences with pregnancy-promoting behaviors by male partners," particularly among low-income and African American women, who are disproportionately likely to experience unintended pregnancies. The researchers found that reproductive coercion could be a factor contributing to disparities in the rate of unintended pregnancy.

Study Assesses Relationship Between Reproductive Coercion, Pregnancy Behaviors

April 30, 2015 —Summary of "Race and Reproductive Coercion: A Qualitative Assessment," Nikolajski et al., Women's Health Issues, Dec. 9, 2014.

"Unintended pregnancy, which disproportionately affects low-income and African American (AA) women, is a substantial public health issue associated with numerous adverse health and social consequences," wrote Cara Nikolajski of the University of Pittsburgh's Center for Research on Health Care's Department of Medicine and colleagues.

The researchers noted that while such pregnancies can be prevented by "consistent and correct use of effective contraception," AA women are more likely than white women to "have higher rates of contraceptive nonuse, incorrect use, and discontinuation." According to the study, research has found that male partner reproductive coercion, among other factors, could "influence women's use of contraception and may impact AA women differentially."

The researchers defined reproductive coercion as occurring when an individual directly interferes with a woman's contraceptive use, pressures a female sexual partner to become pregnant when she does not desire pregnancy, or pressures or threatens a woman to either continue or end a pregnancy.

In this study, the researchers assessed "women's experiences with contraceptive sabotage and pregnancy-promoting behaviors by male partners and how ... these experiences [may] vary by race."

Methods

For the study, researchers interviewed low-income AA and white women ages 18 through 45 between June 2010 and January 2013 who were recruited via flyers posted in reproductive health clinics in Western Pennsylvania. Overall, 36 AA women and 30 white women participated in the study.

According to the study, the interviews included questions about the contextual factors that affected women's contraceptive behaviors. The first 20 interviews did not include questions on reproductive coercion, but the issue spontaneously emerged in many of the initial interviews, leading researchers to add additional questions to the interview guide in order to fully explore the topic.

Findings

Of the 66 women interviewed, 25 women (38%) reported instances of reproductive coercion. Of those women, 21 reported having at least one personal experience with reproductive coercion, while four of the women described reproductive coercion that occurred to "other women in their social networks."

According to the study, reproductive coercion occurred more frequently and with greater severity among AA women than white women, with 19 of the 36 AA participants (53%) and six of the 30 white participants (20%) reporting instances of reproductive coercion. In addition, a larger portion of AA women than white women noted that their current or past pregnancies resulted from reproductive coercion.

Birth Control Sabotage and Pregnancy Pressure

The researchers noted that study participants "described male partners' behaviors around contraceptive control across a spectrum, from condom refusal or purposeful misuse/deception ... to overt sabotage of women's contraceptive efforts."

Specifically, women described instances in which their male partners refused to use condoms, or deceived women about condom use, either as part of male partners' "general refusal to use a barrier method (most commonly to enhance sexual pleasure)" or because the male partner wanted the woman to become pregnant. Others said their male partners were upset when asked to use condoms because they felt the request showed a lack of trust "or that the women did not consider their relationship as serious enough to forgo condom use."

Meanwhile, some women -- particularly AA women -- "described verbal and emotional pressure by a male partner to get pregnant."

Control of Pregnancy Outcomes

Some respondents also reported instances of male partners' attempts to ensure a pregnancy either was continued or terminated, in contrast to women's desired pregnancy outcomes. For example, women described situations in which they felt coerced to discontinue a pregnancy "because of their male partner's consistent pressure or threatening behavior." However, both AA and white women said pressure from their male partners to continue a pregnancy did not indicate that the partner "would remain present in the life of his partner or his child."

Potential Reasons for Reproductive Coercion

Researchers also "explored women's perceptions about reasons that men might want their female partners to get pregnant." However, the researchers noted that only AA women described "specific social and structural factors that might motivate men's pregnancy-promoting behaviors."

Specifically, AA women noted that "incarceration, lack of social support, and structural barriers to stable housing and employment seemed to motivate men to secure connections with their female partner via pregnancy." Meanwhile, white women largely linked male partners' reproductive coercion with "love or maintenance of the relationship."

Discussion

The researchers noted that their findings "add to the growing body of evidence that reproductive coercion may be commonly experienced by women and may contribute to the high rate of unintended pregnancy in this country." Further, they wrote that as "[s]ignificantly more AA participants also attributed pregnancy to reproductive coercion, suggesting that reproductive coercion may play a role in observed racial disparities in unintended pregnancy."

The researchers urged further research "of the prevalence and impact of reproductive coercion on disparities in unintended pregnancy in large, population-based samples," because such research "will have implications for pregnancy prevention programs which do not typically address male-pregnancy promoting behavior."

Further, the researchers wrote that their "study also sheds light on contextual and structural factors that might shape fertility behaviors, including the role of disproportionate incarceration of men and social instability in low-income, AA communities." The study urged more research to better understand the effect of a high incarceration rate "on unintended pregnancy and family formation," which could find that intervention strategies require "a more focused effort to incorporate structural interventions as well as pregnancy prevention efforts that target men in these communities."

According to the researchers, their findings are "clinically relevant" because "they highlight the fact that male partner reproductive coercion may be one explanation for contraceptive nonadherence." They noted that health care providers should question women about their male partners' reproductive goals "and consider the possibility of coercive behaviors," particularly "when women's stated pregnancy intentions are incongruent with her contraceptive behavior, when she expresses ambivalence, or for women who make frequent visits for pregnancy testing or emergency contraception." Clinicians can then use such differences in pregnancy intentions to help women identify ways to reduce their risk of unintended pregnancy while also respecting their relationship choices.

Study Compares Effects of Emergency Contraception Access via Call Center, Office Visit

Thu, 04/30/2015 - 17:23

In this study, researchers compare reproductive health outcomes of women who accessed emergency contraception via a call center with those of women who accessed EC via an office visit. They found that there is an "increased risk for unintended pregnancy and sexually transmitted infections in the subsequent 6-12 months among" both groups, indicating that "[i]nterventions to increase the initiation of effective, ongoing contraception" for such women "are needed."

Study Compares Effects of Emergency Contraception Access via Call Center, Office Visit

April 30, 2015 —Summary of "Reproductive Health Outcomes of Insured Adolescent and Adult Women Who Access Oral Levonorgestrel Emergency Contraception," Raine-Bennett et al., Obstetrics & Gynecology, April, 2015.

Introduction

"Increasing timely access to emergency contraception is important because it can prevent pregnancy after unprotected intercourse and it is more effective the sooner it is administered," according to Tina Raine-Bennett of Kaiser Permanente Northern California's Division of Research and colleagues.

Though EC is available over-the-counter, the researchers write that "many adolescents and women still obtain oral [EC] through a clinician to obtain medical advice, to avoid out-of-pocket costs, or both." In turn, "health care providers have created more convenient access routes such as on-call services to allow patients to obtain a prescription without an in-person visit with a clinician."

Overall, "[l]ittle is known" about women who seek EC and their reproductive health outcomes, or whether a woman who accessed EC through the "more convenient access routes, in which a full range of services is not available" had outcomes similar to those of women who had office visits. The researchers write that their study aims to "gain an understanding of the level of risk for adolescents and women who seek [EC] through various clinical routes and assess opportunities for improved care provision."

Methodology

For the study, researchers used electronic health record data on women and adolescents insured via Kaiser Permanente Northern California [KPNC]. KPNC members can access EC without an in-person visit by contacting nurses through "the regional appointment and advice call centers."

Specifically, the researchers used data on women ages 15 to 44 who had one or more prescriptions for oral levonorgestrel EC between Jan. 1, 2010 and Dec. 31, 2011. The data were sorted into two groups: One group consisted of data on individuals who had an in-person visit, while the other consisted of data on individuals who used the call center.

The researchers' "primary outcome of interest" was "initiation of very effective contraception (intrauterine contraceptive, implant, or sterilization ... )" on the day EC was prescribed "or in the subsequent 12 months." Secondary outcomes were "new short-acting contraception dispensed, chlamydia and gonorrhea tests, and pregnancies."

Results

The researchers found that of 21,421 "index prescriptions," or initial EC prescriptions an individual received during the study period, 14,531 (67.8%) prescriptions were obtained via the call center. According to the study, 92.4% of the EC prescribed via the call center was dispensed, compared with 79.3% of the EC prescribed via an office visit.

The researchers also found that 92.6% of women and adolescents "had not had [EC] dispensed" within the 12 months prior to accessing EC, while 40.7% had obtained "any prior short-acting contraceptive." According to the study, individuals who accessed EC via the call centers were more likely to have previously obtained short-acting contraception (45.9%) compared with those who accessed EC via an office visit (29.8%).

In addition, the study found that most individuals who accessed EC had visited with an obstetrician-gynecologist or primary care provider within 12 months beforehand (89.9%). The researchers noted that 7.8% of study participants who underwent chlamydia or gonorrhea testing at least 12 months before accessing EC were found to have at least one of the sexually transmitted infections. Similarly, 9.4% of individuals age 25 or younger who were tested for those STIs at least a year before accessing EC also were found to have at least one of the infections.

Meanwhile, the researchers found that 47.6% of the individuals who accessed EC did so at least once more within 12 months after their initial prescription. Further, 47% of those who had not taken short-acting contraception within 12 months prior to the EC consultation "had a new short-acting contraceptive method dispensed either on the day or in the subsequent 12 months after [EC] was accessed." Overall, individuals who accessed EC via an office visit were more likely to have EC dispensed within 12 months after accessing it (54.4%) than those who accessed EC via the call centers (37.7%).

According to the study, 10.6% of women and adolescents began using a "very effective" contraceptive -- such as an IUD, implant or sterilization -- within 12 months of accessing EC, with those who accessed EC via the call centers being similarly likely as those who accessed it via an office visit to do so.

The researchers also found that the majority of individuals visited either an ob-gyn (67.2%) or primary or pediatric care provider (90.6%) within 12 months of accessing EC. They added that 9.5% of individuals age 25 and younger and 7.9% of all study participants who had a chlamydia or gonorrhea test within 12 months of accessing EC tested positive.

Overall, the study found that 9.6% of individuals became pregnant within six months of accessing EC. According to the researchers, 64.9% of pregnancies that occurred within three months "were reported as [unintended] at the time of conception." Individuals who obtained EC via a call center and who experienced a pregnancy within three months were somewhat less likely to have an abortion (1.9%) than those who obtained EC via an office visit (3.2%).

Meanwhile, 4.4% of individuals became pregnant within four-to-six months after accessing EC, with individuals who accessed EC via the call center being more likely to become pregnant in that timeframe (5%) than those who accessed EC via an office visit (3.3%). Of those pregnancies, 57.8% were reported as unintended at the time of conception.

Overall, the researchers found that women in the call center group were less likely to become pregnant within three months of accessing EC, but more likely to become pregnant within four-to-six months, than women in the office visit group.

Discussion

The authors wrote that the data "revealed increased risk for unintended pregnancy and sexually transmitted infections in the subsequent 6-12 months among [those] who accessed [EC] through the call center or an office visit." They added that "protocols to routinely address unmet needs for contraception at all" call centers and office visits "should be investigated" because a "considerable proportion" of study participants visited an ob-gyn or primary care provider "before and after accessing [EC]."

Meanwhile, the researchers noted that individuals who accessed EC via a call center or office visit "were equally as likely to initiate very effective contraception in the subsequent 12 months," but that the "overall proportion of adolescents and women who initiated intrauterine contraception and implants (9.6%) is modest" compared with national averages.

However, they noted that individuals who accessed EC via office visits were "more likely to have a new short-acting contraception dispensed in the subsequent 12 months with the largest difference being on the day [EC] was accessed." The researchers found that people who obtained EC via office visits were more likely to have a short-acting contraception dispensed, perhaps because those who had an office visit "may have been seeking" such contraception or because providers "may have been more likely to offer it" in person than via phone. The researchers suggested that call centers "incorporate counseling and immediate access to prescriptions for an ongoing contraceptive method."

Meanwhile, the researchers noted that "[t]he proportion of pregnancies … reported as [unintended] at the time of conception" during the four-to-six months after accessing EC via a call center or an office visit "is indicative of an overall ongoing unmet need for contraception among these adolescents and women."

The authors also addressed the rate of gonorrhea and chlamydia, noting that the positive rate among women who were tested within 12 months before or after accessing EC was twice KPNC's overall rate. Further, the researchers write that the "findings add to other studies that suggest that adolescents and women who use [EC] are more likely to be from demographic groups [who] are higher risk," suggesting that chlamydia and gonorrhea testing "should be offered routinely to adolescents and women seeking [EC]."


Study: Providing No-Cost Contraceptive Implants Post-Abortion Reduces Future Abortion, Pregnancy Rates for at Least Two Years

Thu, 04/30/2015 - 17:22

In this study, researchers examined the effect of a long-acting levonorgestrel implant on pregnancy and abortion rates in New Zealand after the method became available at no-cost in the country in August 2010. The researchers found that receiving the LNG implant immediately after an abortion reduced pregnancy rates for a minimum of two years.

Study: Providing No-Cost Contraceptive Implants Post-Abortion Reduces Future Abortion, Pregnancy Rates for at Least Two Years

April 30, 2015 —Summary of "Immediate Postabortion Initiation of Levonorgestrel Implants Reduces the Incidence of Births and Abortions at 2 Years and Beyond," Rose et al., Contraception, March 26, 2015.

Using long-acting reversible contraception (LARC) immediately after an abortion or after childbirth "is the most promising strategy to reduce rates of unintended pregnancy," but the availability and cost of such methods have been major barriers to their use, according to Sally Rose of the University of Otago's Department of Primary Health Care and General Practice and colleagues.

However, the researchers noted that New Zealand in August 2010 began to fully subsidize "the progesterone-only sub-dermal implant Jadelle," also known as the LNG implant, which "now incurs only consultation and insertion-related costs." Meanwhile, the multiload copper-bearing intrauterine device (CuIUD) was already a fully subsidized LARC method, while the "etonogestrel sub-dermal implant" (Implanon) and the "levonorgestrel-releasing intrauterine system" (LNG-IUS) were also available at the time of the study, although they both had device costs. According to the study, there are also several shorter-acting contraceptive methods that are partially or fully subsidized in New Zealand, including condoms, oral contraceptives and "depot medroxyprogesterone acetate/DMPA."

The researchers devised the study "to compare immediate postabortion uptake of the recently subsidized (no-cost) LNG-implant with already available intrauterine methods and with all other shorter-acting methods, and to describe the incidence of subsequent pregnancies within 2-years."

Methods

The researchers analyzed contraceptive, clinical and demographic data for individuals discharged from a public hospital abortion clinic between Aug. 1, 2010, when the LNG implant became fully subsidized, and July 31, 2012. The researchers linked records to determine subsequent abortions until July 2014 and subsequent births until December 2013.

According to the study, the clinic offered surgical abortion patients three LARC methods for immediate post-abortion insertion, including CuIUD, LNG-IUS and LNG-implants. Medication abortion patients who wanted a LARC method could opt for a surgical abortion.

Results

The study involved 4,698 women who initiated or selected a contraceptive method at the time of abortion. According to the researchers, 19.9% of the woman received a LNG implant, 19.6% received a CuIUD, 6.4% received a LNG-IUS and 54% selected "other shorter-acting methods."

Likelihood of Selecting LARC Method

The researchers found that younger women were significantly more likely to select the no-cost LNG implant or CuIUD LARC methods than shorter-acting contraceptive methods. In addition, women who had had more deliveries or more abortions were more likely to select LNG implants over shorter-acting methods. Researchers also said that an increasing number of past abortions or past deliveries was associated "to a lesser extent" with being more likely to select LNG implants or CuIUDs over more short-acting methods.

The researchers also found that ethnicity was significantly associated with women's contraceptive choice, with Maori women, relative to European women, being the most likely to select an LNG implant over a CuIUD. Meanwhile, Pacific women were the most likely to select an LNG implant over a shorter-acting method, while Asian women, compared with European women, were about 50% as likely to select an LNG implant instead of a shorter-acting method.

According to the study, low-income status was not significantly associated with women's contraceptive choices.

Subsequent Abortions

Rose and colleagues found that women who selected LNG implants or the LNG-IUS method were the least likely to have had a subsequent abortion at 12 or 24 months post-abortion. Specifically, they found that after adjusting for previous pregnancy, age and ethnicity, women who selected an LNG implant were about four times less likely to have an abortion than women who selected shorter-acting methods.

The researchers also found that women who selected LNG implants or LNG-IUS methods were the least likely to have a subsequent abortion at 24 months and 48 months. According to the study, the incidence of a subsequent abortion at 24 months was:

~ 3.0% for women who selected the LNG-IUS method;

~ 3.8% for women who selected a LNG implant;

~ 5.6% for women who selected a CuIUD; and

~ 11.6% for women who selected other shorter-acting contraceptive methods.

Meanwhile, women who opted for a LNG implant or for the LNG-IUS method also had the lowest rate of subsequent abortion at 48 months, at 6.6% and 8.2%, respectively.

Subsequent Pregnancies

The researchers found that "contraceptive method, age and previous births were significantly associated with subsequent continued pregnancy." Specifically, they found that "LARC methods were associated with at least a sixty-percent reduction in subsequent continued pregnancy, compared to shorter-acting methods."

According to the study, women who selected LNG implants or LNG-IUS methods were the least likely to have a continued pregnancy at 24 months or 34 months. The researchers found that the incidence of a continued pregnancy at 24 months was:

~ 6.0% for women who selected the LNG-IUS method;

~ 6.3% for women who selected a LNG implant;

~ 6.4% for women who selected a CuIUD; and

~ 15.7% for women who selected shorter-acting contraceptive methods.

Meanwhile, the researchers found that women who opted for a LNG implant or for the LNG-IUS method had the lowest rate of continued pregnancy by 34 months, at 7.2% and 8.3% respectively.

Discussion

Rose and colleagues wrote that the "[i]mmediate postabortion initiation of an implant significantly reduced the incidence of subsequent abortion and continued pregnancy within 24-months (and beyond) when compared with choice of other shorter-acting methods."

The researchers wrote that "[o]verall LARC uptake was 45% ... with similar proportions of women choosing implants and copper-IUDs." Specifically, they noted that 20% of the study cohort selected a LNG implant, including about 25% of women under age 20, "a group not historically accessing or [being] offered long-acting methods." According to the study, women under age 20 "had the highest uptake of implants in this study."

The researchers noted that the cost of the LNG-IUS in New Zealand is "significant" and "prohibitive to many women wishing to use it for contraceptive purposes," as reflected by the study results. However, the method was associated with women being less likely to have an abortion at follow-up. The researchers wrote, "Extending government funding in New Zealand to include the LNG-IUS would therefore have both personal and public health benefit[s]."

Rose and colleagues concluded, "This study demonstrates that receipt of no-cost contraceptive implants immediately postabortion reduces subsequent pregnancy rates for at least 2-years. Women wishing to prevent or delay pregnancy following an abortion should have access to, and be counselled to consider use of long-acting methods."




Study Examines Effect of N.C. Mandatory Delay, Biased Counseling Law on State Providers

Thu, 04/30/2015 - 17:22

In this study, researchers examined how providers were affected by a 2011 North Carolina law (SL 2011-405) that requires women to undergo mandatory counseling at least 24 hours prior to receiving abortion care. They noted that, while proponents of the law said it aimed to bolster patient safety and knowledge, providers thought "its actual purpose was to discourage women from obtaining abortion by restricting access or providing misleading information."

Study Examines Effect of N.C. Mandatory Delay, Biased Counseling Law on State Providers

April 30, 2015 —Summary of "The Experiences and Adaptations of Abortion Providers Practicing Under a New TRAP Law: a Qualitative Study," Mercier et al., Contraception, March 6, 2015.

Targeted regulations of abortion providers (TRAP laws) impose "unique challenges" on abortion providers, potentially "impact[ing] the number of abortion providers within a state or region and ... contribut[ing] to a stigmatizing and threatening atmosphere," according to Rebecca Mercier of the Sidney Kimmel Medical College of Thomas Jefferson University's Department of Obstetrics and Gynecology and colleagues.

The researchers examined one such law, North Carolina's "Women's Right to Know" (WRTK) Act (SL 2011-405), which went into effect in October 2011. The law, similar to those in 37 other states, imposes a 24-hour delay after health care providers tell women state-mandated information, with "no provisions for providers to use discretion in consideration of specific patient circumstances," according to the researchers. The researchers noted that a provision in the law requiring an ultrasound and a description of the image "was enjoined and later overturned."

Mercier and colleagues "performed a qualitative study of abortion providers in North Carolina to investigate how providers perceived the [WRTK] law and how compliance affected their abortion practice."

Methods

For the study, the researchers conducted interviews with providers who "worked under the WRTK law and had prior experience practicing in a less restrictive environment."

The researchers then analyzed the interview responses to determine themes about the experiences of providers.

Results

The researchers interviewed 31 providers, including 17 physicians, nine nurses, three clinic administrators, one physician assistant and one counselor. In total, the providers represented 11 different clinical practices and eight of North Carolina's 100 counties.

According to the researchers, "[p]roviders adapted their practice not only to comply with the law but also to ameliorate its effects on patients," meaning that "providers' overall experience was defined both by the requirements of the law itself and by effects of the adaptations they made on the institutional and individual level to protect their patients' interests."

Provider Objections, Challenges

According to the researchers, all of the respondents "had negative opinions of the WRTK law," with five major themes emerging during the interviews, including:

~ Ethical and professional objections to the law;

~ The law's negative effect on providers;

~ The law's negative effect on providers' relationships with patients; and

~ The law's negative effect on the patient.

Specifically, the researchers found that providers thought the law was "an unreasonable intrusion into the practice of medicine" that "targeted [abortion] above and beyond other areas of medicine." In addition, the providers said they "resented the regulation of medical practice by politicians with little medical knowledge." They also said they believed that the "actual purpose" of the law, while "purportedly intended to improve patient knowledge and safety ... was to discourage women from obtaining abortions by restricting access or providing misleading information."

Further, most providers said that the law "created a substantial institutional burden" to comply with the measure. According to the study, providers cited the increased costs associated with implementing the mandatory counseling requirement and added emotional and physical stress stemming from complying with a law that they did not believe "matter[ed] for the provision of safe abortion care."

Respondents also said the law could negatively affect the patient-provider relationship and the patient herself, including by:

~ Creating further barriers to abortion access;

~ Making women feel as if providers were attempting to deny care or impose barriers to treatment; and

~ Making patients feel as if providers were questioning the woman's decision or not supporting her decision.

Further, the providers noted that some patients experienced "emotional distress" from the counseling and that the standardized mandatory counseling information was "inappropriate, irrelevant or harmful," particularly for women seeking abortions in cases of rape, health or fetal anomalies.

According to the study, "[n]o provider recalled a case where a patient seemed to change her mind about having an abortion as a result of the law."

Providers Adapting to the Measure

Mercier and colleagues noted several ways that providers changed their practices to adapt to the law. For example, on an institutional level:

~ Most providers had to switch from offering abortion care within one office visit to either offering abortion care in two visits or by "perform[ing] the required counseling by phone prior to the abortion visit," which "required staffing and bureaucratic changes;"

~ Facilities where fellows and residents provided counseling had to divert time "from other clinical and academic duties to perform" the mandatory counseling by phone; and

~ Providers had to seek other revenue sources to compensate for cost increases so they would not be passed on to patients.

In addition, on an individual level, many respondents said they employed strategies to reduce the potentially negative effects of the mandatory counseling on women, including "prefac[ing] the counseling with statements which distanced themselves from the content or apologiz[ing] for what they were about to say." According to the study, some providers "shared their own contrary opinions regarding" the state-mandated content and some "expressed agreement with patients' negative statements regarding the counseling."

Meanwhile, providers also said "the ultrasound provision of WRTK would have been extremely burdensome to both patients and providers."

Discussion

Mercier and colleagues wrote, "Providers viewed the law as intrusive and politically motivated," with their negative reactions in the study "stemm[ing] from ... ethical and professional objections to the law, challenges faced in compliance and concern about potential impacts on patients."

The researchers added that "[t]he individual adaptations providers employed to distance themselves from the law and align themselves with patients' interests might help to preserve the [patient-provider] relationship in the face of" the challenges presented by the law.

Further, they wrote "the finding that the patient-provider relationship is in fact compromised in certain situations" by the law "may give insight" into a potential legal argument against such measures based on the concept of compelled speech being unconstitutional.

Mercier and colleagues concluded, "While less likely to lead to clinic closures and access barriers" than TRAP laws in some other states, "WRTK still has [a] significant" negative effect "on providers and patients." 


Reports: Some Insurers Not Complying With ACA Coverage Requirements for Women's Health Benefits

Thu, 04/30/2015 - 17:03

Not all insurers are meeting the Affordable Care Act's (PL 111-148) requirement that plans provide a range of preventive services at no cost, with some insurers not covering or requiring cost-sharing for several women's health benefits, according to new studies from the National Women's Law Center, Kaiser Health News reports.

Reports: Some Insurers Not Complying With ACA Coverage Requirements for Women's Health Benefits

April 30, 2015 — Not all insurers are meeting the Affordable Care Act's (PL 111-148) requirement that plans provide a range of preventive services at no cost, with some insurers not covering or requiring cost-sharing for several women's health benefits, according to new studies from the National Women's Law Center, Kaiser Health News reports (Rovner, Kaiser Health News, 4/30).

Background

The ACA's preventive services provision, which took effect in 2012, requires insurers to cover a range of services, including comprehensive coverage of breastfeeding equipment and support, without copayments or deductibles (Women's Health Policy Report, 3/9).

Meanwhile, federal guidance on the contraceptive coverage rules under the ACA states that insurers must cover the full range of FDA-approved contraceptive methods without cost sharing. However, insurers are permitted to use "reasonable medical management techniques" to curb costs, such as only covering the generic version of an approved contraceptive (Women's Health Policy Report, 4/17).

Details of Studies

According to KHN, one study specifically addressed contraceptive coverage, while a second study analyzed coverage for several women's health benefits, such as breastfeeding support and maternity care.

For the studies, researchers analyzed publicly available insurance documents for more than 100 plans in 15 states, including states operating their own marketplace and those using the federal marketplace. They looked at policies from plan years 2014 and 2015 (Kaiser Health News, 4/30).

In addition, the study on contraception also included information from NWLC's communication with insurers and with women calling into NWLC's CoverHer hotline, which assists women who are not receiving contraceptive coverage as required by the ACA (NWLC release, 4/29).

Key Findings: Contraceptive Coverage

In the contraceptive coverage study, NWLC found that several plans either did not provide certain FDA-approved contraceptives to some or all women or required cost-sharing for the products. For example, several plans did not cover contraceptives for women ages 50 and above, and some plans did not cover follow-up visits or other costs associated with contraceptives (Kaiser Health News, 4/30).

Researchers said insurers most often violated ACA requirements by not adequately covering intrauterine devices, hormonal patches or vaginal rings. According to NWLC, some insurers "suggest[ed] that a woman switch methods if she [did] not want any out-of-pocket costs" (Ferris, The Hill, 4/29).

For example, NWLC found that some insurers were not covering the copper IUD, which does not have a generic equivalent (Radnofsky, Wall Street Journal, 4/29). In addition, some insurers covered generic versions of certain contraceptives without also covering the brand-name versions.

Further, some insurers said they did not provide coverage for the ring or the patch because they already covered oral contraceptives, which deliver the same hormones (Pear, New York Times, 4/29). However, HHS officials have previously said that because oral contraceptives are different types of methods than the ring or the patch, they all must be covered (Women's Health Policy Report, 4/17).

Key Findings: Other Women's Health Benefits

In the second study, researchers found that more than 50% of the plan documents analyzed appeared to be in violation of ACA requirements (Kaiser Health News, 4/30).

For example, NWLC found that some health plans did not cover maternity care for dependents (Johnson, AP/Sacramento Bee, 4/29). In addition, some plans did not provide certain breastfeeding supplies (Wall Street Journal, 4/29).

The study cited several other examples, such as a Wisconsin plan that in 2014 provided only limited coverage for prenatal vitamins for women younger than age 42 (Kaiser Health News, 4/30). Meanwhile, an Alabama plan would cover only six annual prenatal visits for women, and plans in Colorado and South Dakota limited ultrasounds for pregnant women.

NWLC Recommendations, Comments

NWLC urged regulators to increase oversight of health plans and called on insurers to comply with the ACA. In addition, researchers called for increased public access to insurers' coverage documents, particularly to help individuals who want to compare plans.

Gretchen Borchelt, NWLC's vice president for health and reproductive rights, said "The health care law has done so much for women. We now need to make sure it reaches every woman and every woman gets the full range of benefits required by the law" (AP/Sacramento Bee, 4/29).

Reaction

Rep. Rosa DeLauro (D-Conn.) said, "The rules prohibiting cost-sharing on preventive care, including contraception, are clear, and insurers who are not following them are in violation of the law. Insurance companies need to come into compliance immediately. [HHS] and state regulators need to crack down on those who do not."

Similarly, Sen. Patty Murray (D-Wash.) said she is "extremely disappointed" by the findings, and she urged HHS Secretary Sylvia Mathews Burwell to address the issue (New York Times, 4/29).

Meanwhile, HHS spokesperson Katie Hill said the Obama administration takes allegations of insurers not complying with the ACA "very seriously." She said, "HHS continues to work with the states, which play a key role in ensuring that insurance plans follow the law." Hill added that HHS "will continue to provide guidance to help ensure that women have access to recommended preventive benefits and will explore whether additional measures are necessary" (Wall Street Journal, 4/29).

According to Burwell, the administration intends to clarify its guidance for states' insurance regulators (New York Times, 4/29).

Meanwhile, some insurers said that they had made changes to their policies after recognizing coverage problems or that they would rework the language in their plans' coverage certificates to clarify what services are covered (Wall Street Journal, 4/29).

Karen Ignagni, America's Health Insurance Plans' president and CEO, said the "report presents a distorted picture of reality." She noted that insurers "provide access to care for millions of women each day and receive high marks in customer satisfaction surveys" (Kaiser Health News, 4/30).

Sen. Murray Urges Wash. Plans To Comply With ACA

In related news, Murray on Tuesday sent a letter to the eight Washington state insurers who offer marketplace coverage in the state expressing concern that they are not complying with the ACA's contraceptive coverage rules, The Hill reports.

Murray sent the letter in response to a report by NARAL Pro-Choice Washington and Northwest Health Law Advocates on the eight health plans. According to the report, the insurers sometimes gave beneficiaries erroneous information about having to pay for contraceptives.

In the letter, Murray said the insurers' lack of transparency about their coverage "is unacceptable." She added, "A benefit that's hidden from consumers is the same as having no benefit at all. Insurers must do their part to provide accurate information to all Washingtonians."

According to The Hill, the Washington insurance commissioner said this month that the insurers cited in the report have agreed to rework their benefit information. Murray indicated in her letter that she would monitor their work to ensure compliance (Sullivan, The Hill, 4/28).


Blogs Comment on Human Trafficking Bill, Advocating Contraception To Commemorate Earth Day, More

Thu, 04/30/2015 - 16:59

Read the week's best commentaries from bloggers from RH Reality Check, Care2 and more.

Blogs Comment on Human Trafficking Bill, Advocating Contraception To Commemorate Earth Day, More

April 24, 2015 — Read the week's best commentaries from bloggers from RH Reality Check, Care2 and more.

ABORTION RESTRICTIONS: "Human Trafficking Senate Compromise Will Deny Abortion Funding to Survivors," Emily Crockett, RH Reality Check: "Senators announced a compromise Tuesday [to] move two long-stalled legislative items: a human trafficking bill [S 178] that has been embroiled in a fight over abortion restrictions, and the confirmation of Loretta Lynch to be the nation's first Black female attorney general," Crockett writes. However, Crockett notes that the "compromise on the trafficking bill was a limited victory for pro-choice advocates" because while "[i]t stopped Republican efforts to expand the reach of the anti-choice Hyde Amendment," it also will "restric[t] abortion services for ... victims of sex trafficking." She explains that the deal created two separate funding pools to help survivors, one of which is funded by "fine[s] collected from convicted sex traffickers" and which "would no longer pay for any health-care services, instead going to things like law enforcement and legal aid for survivors." Meanwhile, the second pool will pay for survivors' health care needs via "community health center funds, which recently passed as part of a Medicare reform bill [HR 2] and are already prevented by Hyde from covering abortion services" (Crockett, RH Reality Check, 4/21).

What others are saying about abortion restrictions:

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

CONTRACEPTION: "Have (Safe) Sex This Earth Day," Jeffrey Hollender, Care2: Hollender, founder and CEO of Sustain Condoms, commemorates this year's Earth Day by discussing how "safe sex and climate change ... are two extremely important interconnected issues that most people don't put together." Hollender explains that a recent report from the Intergovernmental Panel on Climate Change found "that population was one of the most important drivers behind global climate change." He notes that "we [have] had such a hard time connecting the dots" between overpopulation and climate change, however, Hollender explains, "most of the pregnancies in the world are unintended, unplanned or even unwanted." He writes, "Let’s educate and empower women to take control of their sexual and reproductive health so they can have better planned families," which his group believes "is a critical component to addressing the most pressing issues our world is facing" (Hollender, Care2, 4/22).

What others are saying about contraception:

~ "The Fighting Irish Shouldn’t Pick a Fight With Women’s Equality," Brigitte Amiri, American Civil Liberties Union's "Speak Freely."

'FETAL HOMICIDE' MEASURES: "Colorado Pro-Choice Advocates: Giving Legal Rights to Fetuses Doesn’t Protect Pregnant Wom[e]n," Jason Salzman, RH Reality Check: "Colorado pro-choice activists on Wednesday decried a bill (SB 15-268) introduced ... in response to a grotesque crime against a pregnant woman that would give 'personhood' rights to fetuses," Salzman writes. He notes that during a news conference before a hearing on the measure, "pro-choice advocates urged lawmakers to focus on measures to protect women from violence instead of giving fetuses legal rights that could be used to arrest pregnant women." For example, Salzman notes that Lynn Paltrow, executive director of National Advocates for Pregnant Women, asked, '"Why are we having a conversation about how many years is long enough (to incarcerate someone for destroying a fetus), rather than asking whether these laws do anything to deter violence against pregnant women, to protect pregnancies, embryos, and fetuses?"' Meanwhile, Salzman notes that other abortion-rights supporters said the state's current law against such crimes -- which "does not give legal rights to fetuses" -- already imposes "severe penalties" on individuals who illegally terminate pregnancies while simultaneously protecting pregnant women and medical professionals from prosecution (Salzman, RH Reality Check, 4/23).

D.C. ANTIDISCRIMINATION MEASURE: "A 'New Low'? GOP Tries To Block D.C.'s New Reproductive Health Law," Emily Crockett, RH Reality Check: The House Oversight and Government Reform Committee on Tuesday voted 20-16 to advance a measure that aims "to overturn a new law [Act 20-593] that would protect women in Washington, D.C., from being fired due to their reproductive health-care choices," Crockett writes. Supporters of the law, D.C.'s Reproductive Health Non-Discrimination Act, cite "cases of non-Catholic women who become pregnant out of wedlock being fired from Catholic schools as an example of why the law is needed," Crockett notes, explaining that "[l]aws against gender discrimination or pregnancy discrimination don't always cover cases in which a woman's reproductive health choices run afoul of her employer's ideology." Meanwhile, the law's opponents, "which include the U.S. Conference of Catholic Bishops," have "claim[ed] that it would restrict religious freedom," Crockett writes. She notes that because the effort to halt the law is "unlikely to succeed," opponents have "urged House budget leaders to stop the new law by blocking funds to implement it" (Crockett, RH Reality Check, 4/22).

What others are saying about the D.C. antidiscrimination measure:

~ "It Won't Surprise You, But the House Wants To Allow Bosses To Fire Women for Their Personal Reproductive Health Decisions," Leila Abolfazli, National Women's Law Center's "Womenstake."

SEXUALITY EDUCATION: "It's Not Enough To Just Mention Condoms -- Sex Education Should Be Sex-Positive," Marcotte, RH Reality Check: "It's time to start advocating not just for contraception-inclusive or vaguely termed 'comprehensive' sex education, but to call it sex positive-education -- and to call the shaming, religion-based programs what they are, which is sex-negative," Amanda Marcotte writes. She notes that before the Obama administration decided to stop restricting federal sexuality education to only abstinence education, arguments against such programs "convinced the public that 'abstinence-only' doesn't work" to prevent sex, pregnancy or sexually transmitted diseases, but "elide[d] the greater issue of whether or not abstinence-only should work." Marcotte contends that as a result, "conservatives just tweaked [abstinence-only programs] a little so that it's not technically abstinence-only and were able to keep the flame alive." She writes, "Maybe it's time" for abstinence-only opponents "to change strategies and stop playing defense," adding, "We want our young people to grow up looking forward to a future of fun, fulfilling sex, not to teach them that it’s a thing that they will probably do but should feel bad about" (Marcotte, RH Reality Check, 4/22).

What others are saying about sexuality education:

~ "One Woman Live-Tweeted Her Son’s Abstinence-Focused Sex Ed Class. Now Things Might Change," Tara Culp-Ressler, Center for American Progress' "ThinkProgress."

~ "We've Been Here Before: Congress Quietly Increases Funding for Abstinence-Only Programs," Nicole Cushman et al., RH Reality Check.


Editorial: Maine Lawmakers Should Drop Antiabortion-Rights Bill, Support 'Proactive' Women's Health Bill

Thu, 04/30/2015 - 16:58

Maine lawmakers should drop a disputed abortion clinic regulations bill (LD 1312) and instead pursue a "proactive measur[e] [LD 319] to protect women's health," according to a Kennebec Journal/Morning Sentinel editorial.

Editorial: Maine Lawmakers Should Drop Antiabortion-Rights Bill, Support 'Proactive' Women's Health Bill

April 29, 2015 — Maine lawmakers should drop a disputed abortion clinic regulations bill (LD 1312) and instead pursue a "proactive measur[e] [LD 319] to protect women's health," according to a Kennebec Journal/Morning Sentinel editorial.

The editorial explains that state lawmakers currently are debating a bill that "would give the state Department of Health and Human Services enhanced authority to write rules for abortion clinics that could interfere with their operation." While the measure does not include any "specific regulations," requirements "created by the [state] DHHS could prevent women, especially low-income women," from accessing abortion services, the editorial states.

According to the editorial, state Rep. Deb Sanderson (R), the bill's sponsor, claims the measure aims "to protect women's health" and should therefore be considered by the state Committee on Health and Human Services. Meanwhile, "[t]he bill's opponents ... say that since the proposal has the potential to reduce access to abortion, it raises constitutional issues and should be considered" by the state Judiciary Committee. The measure "will die between chambers" if the state "House and Senate cannot agree" where it should be heard, the editorial states, adding that such a result "would be the best outcome."

The editorial contends that the measure "looks like a way to sneak abortion restrictions into the law under the guise of routine regulation" and "is too close to the approach used by anti-abortion lawmakers in other states to be taken at face value." The editorial urges state senators to "let this bill die" and instead support LD 319, which "would provide access to a variety of women's health services -- including high-quality birth control to low-income women" (Kennebec Journal/Morning Sentinel, 4/28).


Tenn. Abortion Providers Say Antiabortion-Rights Bills Would Burden Women, Clinics

Thu, 04/30/2015 - 16:57

Tennessee abortion providers say that two antiabortion-rights measures before Gov. Bill Haslam (R) could create additional burdens for women and the clinics, including added costs and logistical challenges, the Tennessean reports.

Tenn. Abortion Providers Say Antiabortion-Rights Bills Would Burden Women, Clinics

April 30, 2015 — Tennessee abortion providers say that two antiabortion-rights measures before Gov. Bill Haslam (R) could create additional burdens for women and the clinics, including added costs and logistical challenges, the Tennessean reports.

Background on Bills

The state Legislature last week passed a measure (SB 1280) that would require the six abortion clinics in Tennessee that provide surgical abortions to be licensed as ambulatory surgical centers. Specifically, the bill would require all facilities or physician offices that perform more than 50 surgical abortions annually to be licensed as ambulatory surgical centers.

Four providers in the state currently meet ambulatory surgical center standards, while a fifth provider, in Knoxville, only provides medication abortion and is therefore not subject to the requirement. The two remaining clinics that provide surgical abortions and are not licensed as ambulatory surgical centers are the Bristol Regional Women's Center and the Women's Center in Nashville (Wadhwani, Tennessean, 4/27).

Meanwhile, the state Legislature also passed a bill (SB 1222) that would impose a 48-hour mandatory delay before a woman could obtain an abortion. The measure also would require that women receive in-person counseling from a physician prior to the procedure. In the case of a medical emergency, the counseling requirement is waived.

The bill also includes a "spring-back" provision that would reduce the delay to 24 hours if the measure is stayed or struck down by a court. In addition, the remainder of the bill would stay in effect if any portion of the measure is found invalid (Women's Health Policy Report, 4/22).

According to the Tennessean, both bills have been submitted to Haslam, who has indicated he will sign them.

Clinic Concerns

Corinne Rovetti, co-director of the Knoxville Center for Reproductive Health, said the mandatory delay and in-person counseling measure would be a "logistical nightmare" for the clinic, which sees about 1,800 patients a year and has a single part-time physician. She said the measure would increase costs for the clinic, noting that while clinic staff tries "as best as we can to have affordable, quality services ... we may have to pass those costs on" to patients.

In addition, Rovetti said the mandatory delay would require women to make two trips to the clinic. She said it would be particularly difficult for women who are employed and have children, as they could have to take two days off work, forgo pay, buy gas and arrange for the care of their children, among other challenges.

Similarly, Rebecca Terrell -- director of Choices, the Memphis Center for Reproductive Health -- said that while providers are trying to reduce costs for women, the new rules are "going to cost women money, many of whom can't afford it." She said the rules likely would increase the average cost of medical services associated with abortion care by $100, even though the clinic is already regulated as an outpatient surgical center.

Terrell noted that some patients travel as much as five hours to obtain abortion care at her clinic and that abortion providers in the state are discussing ways to assist women, including creating a transportation system or a state abortion fund to help pay for the cost of hotels and travel.

Meanwhile, Ashley Coffield, president and CEO at Planned Parenthood Greater Memphis Region, said her clinic might have to extend weekday hours, add weekend service days or raise costs as a result of the regulations. In addition, she said the new rules would both raise demand for doctors and make it harder to recruit physicians amid a "culture and climate" in the state Legislature that lawmakers are "out to get physicians who are abortion providers" (Tennessean, 4/27).


Editorial: N.C. Gov. Can't Use Women's Safety 'Spin' on Abortion Delay Bill

Thu, 04/30/2015 - 16:57

If North Carolina Gov. Pat McCrory (R) breaks his campaign pledge and signs a bill (HB 465) imposing a 72-hour mandatory delay before abortions, he will not be able to rationalize his actions by claiming the measure improves women's safety, a Charlotte Observer editorial states.

Editorial: N.C. Gov. Can't Use Women's Safety 'Spin' on Abortion Delay Bill

April 28, 2015 — If North Carolina Gov. Pat McCrory (R) breaks his campaign pledge and signs a bill (HB 465) imposing a 72-hour mandatory delay before abortions, he will not be able to rationalize his actions by claiming the measure improves women's safety, a Charlotte Observer editorial states.

According to the editorial, McCrory already "turned his back on that [campaign] promise ... when he signed into law legislation [SL 2013-366] that made it harder and more costly for abortions to be performed." However, the editorial notes that while McCrory rationalized "that non-veto" by claiming that "he wanted to 'ensure women's safety,'" the "latest abortion bill ... doesn't offer him that opportunity for spin."

The editorial explains that the proposed measure -- which has passed the state House and now heads to the Senate -- "serves no demonstrable purpose other than to create emotional and financial hardships for women." Specifically, the editorial notes that the bill "doesn't protect women's health" because it "could cause women to delay the decision until later in pregnancy," which " goes against the advice of medical professionals, who say longer waiting periods for abortions could unnecessarily jeopardize women's safety."

Further, the measure "presupposes that women are unable to make up their own minds without further government intervention," the editorial states. The editorial adds, "That [is] not just what we believe," but "[t]hose are the words of another governor, Missouri's Jay Nixon [D]," who "had the political courage to veto" a mandatory delay measure (HR 1307) "even though he knew the legislature would override his decision."

According to the editorial, what happened to Nixon "could happen to McCrory," as the North Carolina House passed the bill "by a 74-45 margin, a couple of votes more than necessary to override a veto." Nonetheless, the vote should not prevent McCrory from "acknowledging the obvious -- that making women wait 72 hours after first consulting with a doctor or clinic ... doesn't protect women's health" and "could result in child-care complications and time spent away from work" or "could unnecessarily jeopardize women's safety" (Charlotte Observer, 4/24).