Daily Women's Health Policy Report

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Daily Women's Health Policy Report by the National Partnership for Women & Families
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W. Va. Gov. Tomblin Vetoes 20-Week Abortion Ban

Mon, 03/31/2014 - 14:23

West Virginia Gov. Earl Ray Tomblin (D) on Friday vetoed a bill (HB 4588) that would have banned most abortions after 20 weeks of pregnancy, saying that the bill likely is unconstitutional and would restrict pregnant women's health care, the Charleston Gazette reports.

W. Va. Gov. Tomblin Vetoes 20-Week Abortion Ban

March 31, 2014 — West Virginia Gov. Earl Ray Tomblin (D) on Friday vetoed a bill (HB 4588) that would have banned most abortions after 20 weeks of pregnancy, saying that the bill likely is unconstitutional and would restrict pregnant women's health care, the Charleston Gazette reports (White, Charleston Gazette, 3/28).

The state House approved the bill earlier this month after the state Senate amended it to allow exceptions if a pregnancy is not viable. The changes also reduced the penalty for physicians who violate the ban from a felony to a misdemeanor (Women's Health Policy Report, 3/11).

Tomblin said he vetoed the bill because his legislative attorneys and his legal team advised that it "is unconstitutional as shown by actions of the Supreme Court of the United States" (Charleston Gazette, 3/28). The high court previously rejected a request to consider a similar law in Arizona that a lower court had struck down, according to AP/Sacramento Bee.

Tomblin also said he vetoed the bill because the medical community believes that the measure's legal penalties would impose on the patient-doctor relationship (AP/Sacramento Bee, 3/28).

"All patients, particularly expectant mothers, require the best, most unfettered medical judgment and advice from their physicians regarding treatment options," Tomblin said, adding, "The medical community has made it clear to me [that] the legal penalties this bill imposes will impede that advice, and those options, to the detriment of the health and safety of expectant mothers" (Charleston Gazette, 3/28).


Rape Culture Should Be Part of Discourse on Sexual Assault, Op-Ed Argues

Mon, 03/31/2014 - 14:20

The widespread presence of rape culture in the U.S. "is why it's so disappointing that the country's largest anti-sexual-violence organization, RAINN, recently advised a White House task force that efforts to curb rape on college campuses should move away from the 'unfortunate trend towards blaming "rape culture,"'" feminist author Jessica Valenti writes in a Washington Post opinion piece.

Rape Culture Should Be Part of Discourse on Sexual Assault, Op-Ed Argues

March 31, 2014 — The widespread presence of rape culture in the U.S. "is why it's so disappointing that the country's largest anti-sexual-violence organization, RAINN, recently advised a White House task force that efforts to curb rape on college campuses should move away from the 'unfortunate trend towards blaming "rape culture,"'" feminist author Jessica Valenti writes in a Washington Post opinion piece.

According to Valenti, "RAINN -- which works with Congress on policy and sets political agendas" -- issued the recommendations in a memo to the White House Task Force to Protect Students from Sexual Assault that stated that "'rape is caused not by cultural factors but by the conscious decisions, of a small percentage of the community, to commit a violent crime.'" Valenti adds that the organization also argued that a "focus on rape culture is misguided because most young adults know rape is wrong, thanks to 'repeated messages from parents, religious leaders, teachers, coaches, the media, and, yes, the culture at large.'"

Valenti writes that RAINN President Scott Berkowitz -- despite acknowledging "systematic issues" in the criminal justice system for rape survivors -- told her that the term rape culture "'muddies' the conversation about how to help survivors and risks alienating allies." Berkowitz said, "Many people interpret [the term rape culture] -- men in particular -- as accusatory," adding, "We need to encourage their good instincts rather than pointing a finger."

Valenti argues, "Talking about rape culture isn't meant to shift focus away from rapists but to paint a fuller picture of how rapists operate and the best ways to stop them." She writes that RAINN "should know this," adding that if the organization is "worried about alienating allies, it shouldn't dismiss the efforts of feminist activists" who embrace the term.

"[I]gnoring the culture in which rapists commit and get away with crimes won't stop rape," Valenti writes, concluding, "And it will hurt victims" (Valenti, Washington Post, 3/28).


Planned Parenthood To Complete Texas Abortion Clinic Before Restrictions Take Effect

Mon, 03/31/2014 - 14:17

Planned Parenthood is planning to open a $5 million facility in San Antonio, Texas, that will comply with abortion regulations that are scheduled to take effect in September under a state law (HB 2), Reuters reports.

Planned Parenthood To Complete Texas Abortion Clinic Before Restrictions Take Effect

March 31, 2014 — Planned Parenthood is planning to open a $5 million facility in San Antonio, Texas, that will comply with abortion regulations that are scheduled to take effect in September under a state law (HB 2), Reuters reports.

The group expects to complete the facility, which will offer surgical abortions, before the restrictions take effect (Garza, Reuters, 3/27).

Many abortion clinics in the state are unable to meet the law's requirement that they have on-site ambulatory surgical centers. In addition, many Texas clinics have stopped offering abortions or closed because they are not able to comply with a provision that requires abortion providers to have admitting privileges at nearby hospitals (Women's Health Policy Report, 3/7).

According to Planned Parenthood, only about six abortion clinics are expected to be able to comply with the ambulatory surgical center requirements.

Planned Parenthood South Texas spokesperson Mara Posada said, "Women may have the right to legal abortion in theory, but in practice, this right is vanishing for many women in Texas" (Reuters, 3/27).


Funding for Expiring Maternal Home Visit Program Included in 'Doc Fix' Bill

Mon, 03/31/2014 - 14:13

The Senate is preparing to vote on a bill (HR 4302) on Medicare physician reimbursements that would also fund an expiring maternal and child home visiting program for six months, CQ HealthBeat reports.

Funding for Expiring Maternal Home Visit Program Included in 'Doc Fix' Bill

March 31, 2014 — The Senate is preparing to vote on a bill (HR 4302) on Medicare physician reimbursements that would also fund an expiring maternal and child home visiting program for six months, CQ HealthBeat reports (Reichard, CQ HealthBeat, 3/28).

The Senate is expected to vote on the bill Monday afternoon after three hours of debate, during which amendments will not be allowed. The House passed the bill on Thursday, and the Senate likely will approve the legislation (Goedert, Health Data Management, 3/28).

Program Details

The Maternal, Infant and Early Childhood Home Visiting Program was established in 2010 under the Affordable Care Act (PL 111-148) and authorized for funding through Sept. 30, 2014. The program provides grants to states to support voluntary home visit programs designed to provide parenting help to teenage parents, low-income households and other high-risk families. Program volunteers also help connect families with counseling services for domestic violence or substance misuse, medical services, shelters and other resources.

Maternal and child health advocates urged Congress to extend funding for the MIECHV Program by attaching a five-year reauthorization to legislation to change Medicare's physician reimbursement policies, known as the "doc fix."

Supporters of the home visiting program targeted the SGR efforts because it is considered to be one of the few health-related measures that lawmakers need to pass this year. Advocates have argued that waiting for other legislation -- such as the fiscal year 2015 continuing resolution, likely to be debated in August -- would lead states to start winding down their MIECHV programs either by rejecting new applicants or curtailing services to current participants (Women's Health Policy Report, 3/26).


Colo. GOP Candidate Attempts To Soften Antiabortion-Rights Stance in Senate Race

Mon, 03/31/2014 - 13:54

Rep. Cory Gardner (R-Colo.) appears to be strategically softening his hardline conservative positions on abortion rights and other social issues as he pursues a Colorado seat in the U.S. Senate, Politico reports.

Colo. GOP Candidate Attempts To Soften Antiabortion-Rights Stance in Senate Race

March 31, 2014 — Rep. Cory Gardner (R-Colo.) appears to be strategically softening his hardline conservative positions on abortion rights and other social issues as he pursues a Colorado seat in the U.S. Senate, Politico reports.

Gardner last month persuaded other Republican primary candidates to drop out of the race, ensuring that he could run unopposed and effectively "thrusting Colorado to the fore of his party's efforts to capture the Senate for the final two years of [President Obama's] presidency," according to Politico. Gardner is "one of a handful of candidates" in Democratic-leaning or politically divided states who hope to bolster the GOP's chances of winning the six Senate seats needed to take control of the chamber, Politico reports.

Race With Udall

Gardner faces incumbent Sen. Mark Udall (D-Colo.). According to Politico, Udall is focusing on abortion rights and immigration to motivate voters, particularly women, and working to paint Gardner as an "ideological extremist."

Udall said in a recent interview, "The more that the voters of Colorado understand that Cory Gardner's [voting] record is out of the mainstream, the more they're going to be strongly supportive of rehiring me."

Gardner previously sponsored legislation in the House that would only permit abortion when a woman's life is in danger. However, he is now emphasizing times he supported antiabortion-rights legislation that would permit exceptions for rape and incest.

Although Gardner in 2010 supported a "personhood" amendment to endow rights beginning at fertilization -- which was rejected by 70% of Colorado voters -- he now says he opposes similar legislation because of concerns that it would block access to contraception.

According to Politico, Gardner essentially has to convince voters in the state that his conservative record on issues like abortion and immigration do not disqualify him "to lead one of the country's perennial bellwether states" (Raju, Politico, 3/27).


Study Examines STI Prevalence, Risk Among Sexually Minority Women

Fri, 03/28/2014 - 21:08

Researchers examined gonorrhea and chlamydia diagnoses at walk-in clinics to assess the prevalence of the sexually transmitted infections (STIs) among women who reported having sex with women. They also assessed sexual risk behaviors, including substance use, finding that sexual minority women were much more likely than heterosexual women to report recent substance use. All of the women diagnosed with gonorrhea and chlamydia had recently had sex with men, including those who identified as lesbian, suggesting that all women who have sex with men should be screened for STIs regardless of sexual identity.

Study Examines STI Prevalence, Risk Among Sexually Minority Women

March 28, 2014 — Summary of "Differences in Sexual Health, Risk Behaviors, and Substance Use Among Women by Sexual Identity: Chicago, 2009-2011," Estrich et al., Sexually Transmitted Diseases, March 2014.

Little literature exists regarding sexual behavior and the risk of sexually transmitted infections (STIs) among women who identify as bisexual or lesbian or have sex with woman, also known as sexual minority women (SMW), even though STIs can be transmitted between female sex partners, according to a study by Cameron Estrich of the American Dental Association and colleagues. STIs among SMW are often undetected because of a lower perceived STI risk in this population, lower use of reproductive health care compared with heterosexual women and primary care providers' "lack of knowledge ... about appropriate screening," the researchers noted.

Despite the lack of detection in many cases, several studies have found higher rates of STIs among SMW than women who only have sex with men. Some research also has indicated an association between "substance use, particularly before or during sex[,] ... and STI diagnosis," suggesting that "elevated rates of substance use may impact sexual behavior and STI outcomes among SMW," according to Estrich and colleagues.

In an attempt to better estimate STI prevalence among SMW and associated risks, the researchers examined "both sexual identity and partner sex to distinguish between risks associated with identification as a sexual minority and the sex of partners."

Methods

The researchers conducted a cross-sectional examination of data on 669 women who received reproductive health care services at the Howard Brown Health Center walk-in STI clinic, which "primarily serves lesbian, gay, bisexual, and transgender (LGBT people)." The study included female patients who reported a sexual identity during their first visits to the clinic between January 2009 and December 2011.

The study looked at reports of urogenital gonorrhea (GC) and chlamydia (CT), which are included in the clinic's standard screening protocols. The diagnosis reports were obtained from patients' electronic medical records.

Women's sexual behaviors were measured using risk assessments employed during routine STI screenings. The screenings collected patents' race/ethnicity, age, sexual orientation, STI history, number and sexes of sexual partners for the 90 days prior to the visit, whether sex partners were anonymous, whether they met sex partners on the Internet, and how often they used protective sexual barriers like condoms. The screenings also assessed patients' alcohol and drug use within the past 12 months.

In addition, patients reported their partners' sex; partnership type, such as main or casual; partners' race/ethnicity; relationship type, such as nonmonogamous or monogamous; and whether they participated in unprotected sex of any kind with that partner. Patients also reported whether they or their partners had used alcohol or drugs the last time they had sex.

To analyze the data, the researchers "compared sexual behavior, substance use, and STI diagnoses by sexual identity."

Results

Out of the 669 women in the study, 9.3% identified themselves as lesbian, 15.3% said they were bisexual and 75.4% said they were heterosexual. The study found no significant differences in sexual identity across racial/ethnic groups.

According to the study, bisexual woman were much more likely (68%) to report having more than one recent sexual partner, compared with heterosexual (43%) or lesbian women (42%).

The researchers noted a "discordance between sexual identity and reported sex partner sex," with "32.8% of lesbians report[ing] male partners in the last 90 days, and 2.5% of heterosexuals report[ing] female partners." They also found that bisexual women were about twice as likely as heterosexual women to have an anonymous partner and that bisexual women were less likely than both heterosexual and lesbian women to report that their most recent sexual partner was their main or monogamous partner.

In examining substance use, the researchers found that SMW were two times more likely than heterosexual women to have used drugs in the past 12 months. Bisexual women were most likely to have used drugs overall, and their sex partners were "significantly more" likely to have used substances at their last instance of sex, the researchers wrote. Meanwhile, reported alcohol use within the past 12 months was high among all groups, although self and partner alcohol use at the last instance of sex was significantly higher among bisexual and heterosexual women than it was among lesbian women.

Almost all of the women in the study reported having oral, anal or vaginal sex within the 90 days prior to the visit, with no notable differences by sexual identity. Both bisexual and lesbian women were statistically similar in their reports of vaginal sex and were both less likely to have reported having vaginal sex than heterosexual women. According to the study, reports of consistent condom use during vaginal sex were "low and did not vary by sexual identity." Bisexual women were more likely to report having anal sex than lesbian or heterosexual women, and they also had the highest rate of condom use among those who reported having anal sex.

On STI prevalence, the study found 1.5% of women had laboratory-confirmed GC and 5.2% had lab-confirmed CT. GC and CT rates were significantly higher among women ages 25 or younger compared with women older than age 25. Neither GC nor CT rates varied by sexual identity, but all women with GC or CT diagnoses had reported recent male sex partners.

According to the study, only partner sex and age were significantly associated with STI diagnosis. In addition, the study found variances in self-reported STI history, with 43.4% of bisexuals and 42.6% of heterosexuals reporting having been previously diagnosed with an STI, while 18.3% of lesbians had reported a previous diagnosis. The study also showed that lesbian women were significantly less likely to be diagnosed with an STI compared with both heterosexual and bisexual women.

Discussion and Conclusions

Because "sexual identity was not as powerful a predictor of STI risk as sex of partners," it is important to collect "patient information on both sexual identity and sex partners ... to fully understand risks," the researchers wrote, although they noted that "eliciting accurate disclosure can be difficult, as SMW may anticipate heterosexist or homophobic treatment from providers."

To address this issue, the researchers suggested that providers receive diversity training. They added, "Knowledge of patients' sexual identity is helpful not only in providing culturally competent care but also in correctly identifying risks associated with social prejudice and stress, such as substance use and mental health outcomes."

They also highlighted the "significant differences in behaviors and STI diagnoses between lesbian and bisexual women, suggesting that combining SMW into a single category may mask important differences in behavior and disease prevalence." Further, the "discordance between sexual orientation and sex of partners suggests that" all women who have sex with men should be screened for STIs, the researchers wrote.

Labor Interventions Associated With Lower Chance of Late Preterm Birth, Study Finds

Fri, 03/28/2014 - 21:07

To test speculation that obstetrical interventions, such as cesarean sections and induced labor, are driving the increase in late preterm (LP) births, researchers studied a cohort of nearly one million women who gave birth in Ontario hospitals. They found that interventions were associated with a lower likelihood of preterm birth relative to term birth when risk factors were the same, suggesting "that obstetrical care providers may be preferentially avoiding interventions to bring about LP birth in the setting of equivalent maternal and obstetrical risk." The study also identified "potentially modifiable risk factors," such as maternal smoking, that were independently associated with LP birth.

Labor Interventions Associated With Lower Chance of Late Preterm Birth, Study Finds

March 28, 2014 — Summary of "The Association Between Obstetrical Interventions and Late Preterm Birth," Bassil et al., American Journal of Obstetrics and Gynecology, Feb. 28. 2014.

Preterm birth is the No. 1 cause of infant morbidity and mortality, according to Kate Bassil of the Maternal-Infant Care Research Institute at Mount Sinai Hospital and colleagues. They noted that late preterm (LP) births -- those between 34 and 36 weeks of gestation -- account for the majority of preterm births and put infants at greater risk for adverse outcomes relative to term births.

"There is concern that obstetrical interventions may be driving the increase in LP birth in recent years and are responsible for a substantial proportion of LP births," the researchers wrote. They developed a study to assess associations between obstetrical interventions and LP births.

Methods

The researchers conducted a population-based cohort study of women who gave birth in hospitals in Ontario, Canada, from April 2005 through March 2012. They used an Internet-based surveillance system in the province to extract maternal, fetal and obstetrical data on women who gave birth from 34 weeks to 40 weeks and six days of pregnancy during the study period.

The researchers defined late preterm (LP) births as those occurring between 34 weeks and 36 weeks and six days of gestation, while term births were those occurring between 37 weeks and 40 weeks and six days.

The primary exposure variable was "any obstetrical intervention," including pre-labor cesarean sections or induced deliveries. The secondary exposure variables were pre-labor c-section and induced delivery, considered separately. The researchers defined pre-labor c-section as any c-section delivery performed before labor had been induced or started naturally. Induced delivery was defined as any medical or surgical intervention to initiate contractions before labor began on its own, including induced deliveries that ended in c-sections.

The researchers also assessed various factors known or thought to be associated with preterm birth, including maternal characteristics, such as age, socioeconomic status and smoking; maternal health problems, such as diabetes; and obstetrical complications, such as preeclampsia and breech positioning of the fetus.

To analyze the data, the researchers randomly assigned births into one of two roughly equally sized cohorts: a derivation cohort and a validation cohort, which "was used to test the associations identified through the derivation cohort." For both cohorts, they conducted a primary analysis that tested the association between obstetrical interventions and LP birth, adjusted for the factors associated with preterm birth. They then conducted a secondary analysis that repeated the first analysis but assessed pre-labor c-section and induced delivery separately.

Results

After excluding births that were less than 500 grams and those with incomplete data capture, 917,013 live births were included in the study, including 49,157 that were LP. The researchers split the births into the derivation and validation cohorts, finding that in both groups, 38% of births involved "any obstetrical intervention," 21% were induced and 17% were pre-labor c-sections.

In the primary analysis, after adjusting for factors associated with preterm birth, the study found that "any obstetrical intervention" was negatively associated with LP birth relative to term birth in the derivation cohort. In the secondary analysis, which assessed pre-labor c-section and induction separately, both interventions also were negatively associated with LP birth relative to term birth.

The study also found that risk factors known or thought to be linked with preterm birth were independently associated with LP birth, including "several potentially modifiable risk factors," such as smoking during pregnancy, previous c-section, and material and social deprivation.

Discussion and Conclusions

"[I]nduction and pre-labour cesarean section were associated with a lower likelihood of LP birth relative to term birth for pregnancies with similar maternal and fetal risk," the researchers wrote, noting that "this trend persisted through each LP gestational week up to 37 weeks."

"There has been concern that the escalation in LP birth over the past 20 years may be related to obstetrical interventions and iatrogenic preterm birth," the researchers noted, adding that a recent multicountry analysis found that c-sections and induction of labor "together accounted for approximately 20% of the change in LP birth between 1989 and 2004."

They continued, "However, maternal and fetal health problems are also increasing and expedited delivery through obstetrical intervention in the setting of maternal or fetal compromise is generally accepted practice to avoid potentially disastrous maternal or neonatal outcomes."

The findings in the study suggest "that obstetrical care providers may be preferentially avoiding interventions to bring about LP birth in the setting of equivalent maternal and obstetrical risk" and "that increased awareness among obstetrical care providers about the harms of unnecessary LP birth may be a contributing factor," according to the researchers. They speculated that elective c-sections and inductions, "which obstetrical care providers may be more liberal with in the term than in the late period," might also be a factor.

The researchers also noted that "potentially modifiable factors" that "were independently associated with LP birth" -- such as smoking during pregnancy, unnecessary c-sections, and "material and social deprivation" -- could "be useful targets for interventions to reduce LP birth."

Reproductive Justice Approach Also Applies to LARC, Commentary Argues

Fri, 03/28/2014 - 21:06

In a commentary, Jenny Higgins of the University of Wisconsin highlights the "promise and potential" of long-acting reversible contraception (LARC), as well as its potential "drawbacks." She urges advocates and providers to "integrate a reproductive justice approach into our reproductive health toolkit" by not only improving the affordability and accessibility of LARC but by "respect[ing] women's decisions not to use LARC, their ability to have LARC removed when they wish and their ability to have the children they want to have."

Reproductive Justice Approach Also Applies to LARC, Commentary Argues

March 28, 2014 — Summary of "Celebration Meets Caution: LARC's Boons, Potential Busts, and the Benefits of a Reproductive Justice Approach," Higgins, Contraception, Feb. 12, 2014.

Noting the "attention" and "palpable enthusiasm" devoted to long-acting reversible contraception (LARC) in the reproductive field in recent decades, Jenny Higgins of the University of Wisconsin's Department of Gender and Women's Studies highlights the "compelling advantages of LARC," its "possible drawbacks" and how a "reproductive justice approach" can be integrated into the "LARC promotion toolkit."

She notes that for the purposes of her commentary, "LARC refers to intrauterine contraception (IUC), implants and other in-development methods that prevent pregnancy for extended time periods without user action."

LARC's Benefits

"The reproductive health field's excitement about LARC is certainly understandable, especially along lines of efficacy," Higgins writes, noting that IUC and implants are unparalleled in their ability to prevent pregnancy. Further, more widespread use of LARC could lower the unintended pregnancy rate and "thus reduce both the social and financial consequences of unintended pregnancies," she writes.

According to Higgins, one of the "less frequently" noted benefits is that "many LARC users enjoy not having to think about or attend to their device after insertion." LARC also "has the potential to improve some women's sexual enjoyment," including by allowing more sexual spontaneity, she adds.

"Given LARC's efficacy, acceptability, and both documented and potential benefits," it is understandable why one of the reproductive field's "primary charters is to simply increase access to LARC," she states, adding, "Increasing access to LARC is a vital aspect of a broader reproductive rights agenda in which women can avail themselves of basic preventive health care."

LARC's Potential 'Drawbacks'

There are "at least three aspects of LARC to which we should devote care and consideration," in order to "avoid repeating prior reproductive rights abuses, from eugenicist promotion of birth control in the early 20th century, to use of population 'targets' in developing country settings, to U.S. sterilization laws affecting the disabled and poor women of color," Higgins argues.

Higgins cautions against treating LARC as "a potential magic bullet, without larger consideration of the cultural and structural factors that may contribute to unintended pregnancies in the first place." Such "reasoning suggests that lack of access to effective contraceptives is the primary driver behind this health disparity -- and that unintended pregnancies are a cause rather than a consequence of social inequality," she adds.

Reproductive health advocates also should be aware of "how we consider recommending contraceptive methods to clients," Higgins continues, adding that heath care professionals should be careful about "equating pregnancy prevention with other types of health prevention such as heart disease, cancer and other illnesses." Higgins "celebrate[s]" the fact that "we do have an array of methods to recommend to women and their partners," but notes that while LARC is "a terrific option for many women ... no one method will be perfect for all couples."

Higgins continues, "A third and final consideration to keep in mind is the ways in which our socially disadvantaged clients, particularly women of color, have endured legacies of social injustice that will affect the way they experience LARC promotion." She argues, "Directly acknowledging such racist and eugenicist legacies," such as compulsory sterilization programs, does not necessarily discourage LARC use, but it could aid in addressing clients' "suspicions of reproductive injustice" and "facilitate more possible openness to long-acting contraceptive services."

Integrating a Reproductive Justice Approach

Higgins calls for "integrat[ing] a reproductive justice approach into our reproductive health toolkit." She explains, "Reproductive justice recognizes that the main reproductive challenge facing poor women of color is not unintended pregnancy by itself, but rather socioeconomic and cultural inequalities that provide some people with easier access to self-determination and bodily autonomy than others."

She stresses that the "ultimate reproductive justice endgame is to enhance the heath, social well-being and bodily integrity of all our contraceptive clients." As such, "let us continue our efforts to make LARC affordable and easy to access, but let us also respect women's decisions not to use LARC, their ability to have LARC removed when they wish and their ability to have the children they want to have," she writes.

Ob-Gyn Groups Issue Recommendations on Screening for Age-Related Fertility Decline

Fri, 03/28/2014 - 18:09

In a committee opinion, the American College of Obstetricians and Gynecologists and the American Society for Reproductive Medicine offer recommendations for education, screening and treatment related to age-related fertility decline. Specifically, women older than age 35 should be evaluated and treated if they have failed to conceive after six months, while "immediate evaluation and treatment are warranted" in women over age 40, the opinion says. It also urges practitioners to educate patients about age-related fertility decline.

Ob-Gyn Groups Issue Recommendations on Screening for Age-Related Fertility Decline

March 28, 2014 — Summary of "Female Age-Related Fertility Decline," American College of Obstetricians and Gynecologists Committee on Gynecologic Practice/Practice Committee of the American Society for Reproductive Medicine, Obstetrics & Gynecology, March 2014.

A woman's fertility "decreases gradually but significantly beginning approximately at age 32 years and decreases more rapidly after age 37 years," according to a committee opinion by the American College of Obstetricians and Gynecologists Committee on Gynecologic Practice and the Practice Committee of the American Society for Reproductive Medicine.

Biological Bases for Age-Related Fertility Decline

The number of oocytes in a woman's ovaries "naturally and progressively" decreases as the ovaries age, the opinion explains. The number of oocytes that exist in a woman's body begins at approximately six million to seven million at 20 weeks of gestation in the female fetus and declines to about 1,000 by age 51, which is the average age women begin menopause in the U.S.

The decrease in fertility in a woman's 30s primarily represents lower egg quality associated with "a gradual increase in the circulating level of follicle-stimulating hormone and decreases in circulating antimullerian hormone and inhibin B concentrations," according to the opinion. It notes that while "it is difficult to separate out the effects of sexual behavior from age," given that sexual activity also tends to decrease with age, research involving insemination and in vitro fertilization suggests that younger women -- and younger eggs, in donor situations -- are more likely to produce live births.

The committees note that other factors can contribute to early fertility decline, including "prior ovarian surgery, chemotherapy, radiation therapy, severe endometriosis, smoking, pelvic infection, or a strong family history of early menopause."

In addition, age-related fertility decline is "accompanied by significant increases in the rates of aneuploidy and spontaneous abortion," the opinion states.

Recommendations

"[G]iven the anticipated age-related decline in fertility, the increased incidence of disorders that impair fertility, and an increased risk of pregnancy loss, women older than 35 years should receive an expedited evaluation and undergo treatment after 6 months of failed attempts to conceive or earlier, if clinically indicated," the opinion recommends.

In women older than age 40, "immediate evaluation and treatment are warranted," according to the committees.

In addition, the opinion stresses that "[e]ducation and enhanced awareness of the effect of age on fertility is essential in counseling the patient who desires pregnancy."

Most Abortion Clients Support Over-the-Counter Access to Oral Contraceptives

Fri, 03/28/2014 - 18:08

While research suggests many U.S. women are interested in over-the-counter access to oral contraceptives, no studies have examined such interest among abortion patients, a group that is at high risk of unintended pregnancies. In this study, Kate Grindlay of Ibis Reproductive Health and colleagues surveyed abortion clients' interest in OTC access, finding that the vast majority supported it. Interest in OTC access and likelihood of using it was especially highest among uninsured women and those older than age 19. The researchers suggested that OTC access to birth control pills could help reduce unintended pregnancies among women seeking abortions.

Most Abortion Clients Support Over-the-Counter Access to Oral Contraceptives

March 28, 2014 — Summary of "Attitudes Toward Over-the-Counter Access to Oral Contraceptives Among a Sample of Abortion Clients in the United States," Grindlay et al., Perspectives on Sexual and Reproductive Health, June 2014.

Over-the-counter "access to oral contraceptives has been proposed as a way to improve the availability of this effective [birth control] method, and may be particularly attractive to those who have faced barriers to obtaining prescription birth control, including some women seeking abortion," according to Kate Grindlay, senior project manager at Ibis Reproductive Health, and colleagues.

While a "growing body of research" suggests that women in the U.S. are interested in over-the-counter (OTC) access to oral contraceptives, "no research has been conducted among women seeking abortion, a population at particularly high risk of unintended pregnancy," Grindlay and colleagues wrote. For this study, the researchers aimed to "assess support for and use of [OTC] access to oral contraceptives among this population."

Methods

Between May 2011 and July 2011, the researchers recruited "women who were seeking an abortion or a follow-up appointment after an abortion, and who could read and write in English or Spanish ... in the waiting rooms of six large, urban clinics that provide abortion services at a range of gestational ages in the first and second trimesters." The researchers noted that the clinics -- located in Arkansas, California, Georgia, Illinois, New Jersey and Texas -- "were selected to represent geographic and demographic diversity."

The study's data were "collected as part of a larger survey that included questions on women's attitudes toward new contraceptive methods, empowerment and abortion care," the researchers wrote. The participants also provided demographic information, such as their age, race and ethnicity, and marital status.

Among other questions, the researchers asked study participants about their contraceptive use in the three months prior to their pregnancy, including whether they had ever used the pill, tried to obtain a prescription for birth control or had difficulty in obtaining birth control. Women who said that they had experienced difficulty were asked to describe the problems, and all the women were asked about the contraceptive methods, if any, they intended to use after their abortion.

Study participants also were asked about their opinions on OTC access to birth control, including their reasons for supporting or opposing it. In addition, women were surveyed about the likelihood of using OTC or pharmacy access to oral contraceptives, and again asked to detail their reasons.

The researchers also asked women about their willingness to use a progestin-only pill -- because it likely would be the first type made available OTC in the U.S. -- and to explain the reason for their responses. Lastly, women were asked how much they would be willing to pay for a month's supply of oral contraceptives if the pills were available OTC, and whether they would be willing to pay an additional amount to consult with a pharmacist about any contraceptive-related questions.

Results

Grindlay and colleagues determined that 81% of the 651 respondents in the final sample said that they were in favor of OTC access to oral contraceptives, with higher support among whites (91%), Hispanics (86%), women with higher education levels (84%-87%), and women who had used oral contraceptives before, intended to use them or had difficulty obtaining a refill (87%-90%).

However, there was no difference among women who had difficulty obtaining a prescription and those who did not. Support was lower among black women compared with white women and among women without a high school degree compared with women with at least a college degree.

The 514 women who supported OTC access to oral contraceptives cited several reasons, including convenience (76%) and beliefs that such access would reduce teenage pregnancy (58%), result in fewer unintended pregnancies (55%), be less expensive (39%) and not require an appointment with a health care provider (16%).

Meanwhile, the 118 women who did not support OTC access cited concerns about needing to meet with a provider beforehand to discuss pill use (44%), contributing to earlier and increased sexual behavior among teenagers (27%), incorrectly using the pill (25%), choosing the wrong pill (16%), forgoing other well-women visits (11%) and raising the cost of the pills (9%).

Likelihood of Use

According to the study, 61% of respondents said that they would likely use oral contraceptives if they were available OTC, with white women (73%) and Hispanic women (66%) being more likely than women of other races and ethnicities (52%-55%) to say they would take advantage of OTC access. In addition, uninsured women (68%) were more likely than insured women (55%-61%) to say they would use OTC access.

The study also found that women who intended to use the pill post-abortion (86%) were more likely than those who planned to use an alternative method (33%-52%) to say that they would use OTC access. Women who previously had difficulty obtaining prescriptions (81%) also were more likely than women who did not report difficulty (57%) to say that they would obtain pills OTC.

The 391 women who said they would use OTC access cited several reasons for their responses, including saving time (63%), convenience of location and hours (54%), and financial savings from not having to visit a clinic (47%). Meanwhile, among the 41 women who said they would support prescription-only access, the most commonly cited reasons included wanting to meet with a provider to discuss the pill (54%), privacy (42%), wanting to ask questions about proper pill use (42%), wanting a physical or pelvic exam (29%), and wanting provider supervision (24%).

Other Findings

The study found that 62% of respondents said that they would likely use pharmacy access to obtain oral contraceptives, with the likelihood increasing among women who were intended to use the pill post-abortion and among women who had difficulty obtaining a prescription.

Meanwhile, 46% of respondents said that they would likely use an OTC progestin-only pill.

The researchers also found that the 394 women who said they would be likely to use OTC oral contraceptives said that they would be willing to pay, on average, $21 per month for such access. By comparison, the study found that the average additional amount that a women would be willing to pay for a pharmacist consultation would be $5, with 72% saying that they would not pay anything for such consultation services.

Discussion

"These results indicate a high level of interest in [OTC] access to oral contraceptives among this sample of women seeking abortion -- higher than among women in the general U.S. population," the researchers wrote, adding that such interest might reflect how "this population has had more difficulties accessing contraceptives in the past or that they are more interested in oral contraceptives generally."

The researchers noted that one-third of women who were not planning to use contraceptives post-abortion, as well as nearly 40% of those who intended to only use condoms, said they would likely use oral contraceptives if they were available OTC, "suggesting that such access has the potential to increase the use of effective methods in this population."

Grindlay and colleagues added that while there were some women who said they would use OTC access to oral contraceptives instead of IUDs or implants, this "reduction in use of more effective methods would likely be dwarfed by the number of new pill users who would otherwise be using no method or a less effective one."

Conclusion

"Support for and interest in [OTC] access to oral contraceptives were high in this sample of abortion clients," the researchers wrote, adding, "Initiation and continuation of oral contraceptive use among women at high risk of unintended pregnancy may increase if oral contraceptives are made available without a prescription."

Addressing Neonatal Mortality Also Requires Focus on Adolescent Pregnancy, Editorial States

Fri, 03/28/2014 - 18:05

Citing a report from Save the Children that outlines eight interventions to end preventable neonatal deaths worldwide, an editorial in The Lancet argues that a ninth area "deserves more attention": adolescent pregnancy. The editorial argues that investing in girls -- including through education and prevention of child marriage -- will produce "not only an acceleration of progress towards ending maternal, neonatal, and child mortality, but also a better educated future generation of women who will contribute to the skilled workforce and so the economic development of their countries."

Addressing Neonatal Mortality Also Requires Focus on Adolescent Pregnancy, Editorial States

March 28, 2014 — Summary of "Every Newborn, Every Mother, Every Adolescent Girl," The Lancet, March 1, 2014.

When it comes to reducing neonatal mortality rates, "the 'N' in the reproductive, maternal, neonatal, and child health (RMNCH) agenda needs to be more than just a letter," according to an editorial in The Lancet, which adds that it is also "time to add the letter 'A'" -- for adolescents, who account for millions of pregnancies worldwide each year.

Citing a Save the Children report -- part of the organization's No Child Born to Die Campaign -- as a "powerful reminder of the reasons for neonatal deaths," the editorial calls for "concerted and integrated action plans, political will, and dedicated funding" to implement the recommendations. In addition to the eight areas of interventions outlined in the report, the editorial notes that pregnancy among adolescent girls "deserves more attention" in efforts to improve neonatal outcomes.

Neonatal Mortality Causes and Prevalence

The editorial notes that deaths among children younger than age five are almost 50% lower than in 1990, but "progress in the reduction of neonatal deaths has been much slower than that of children older than 4 weeks."

Currently, 44% of deaths among children younger than five are neonatal deaths, compared with 38% in 2005. About 2.9 million newborns died within 28 days of birth in 2012, and an additional 1.2 million stillbirths occurred just before or during labor. The editorial notes that the most common causes of infant mortality include prematurity-related complications (34%); intrapartum-related complications (24%); sepsis, meningitis or pneumonia (22%); and inherited abnormalities (9%).

Suggested Interventions

The Save the Children report suggests eight areas of intervention, which were developed from The Lancet's 2005 Neonatal Survival Series and the Every Newborn Bottleneck Analysis Tool.

The eight interventions include "skilled care at birth and emergency obstetric care"; "management of preterm births"; "basic neonatal care," such as immediate breastfeeding and general hygiene practices; "neonatal resuscitation"; "kangaroo mother care"; prompt identification and antibiotic treatment of serious infections; "inpatient care for small and sick newborns"; and "prevention of mother-to-child transmission of HIV," according to the editorial.

Focus on Adolescent Girls

In addition, the editorial urges "dedicated and targeted intervention" to address births among adolescents girls, an area that is only "mentioned in passing" in the report.

Pregnant adolescents are "in fact children bearing children," the editorial states. Adolescent girls have a "higher risk of adverse maternal and birth outcomes, including stillbirths, neonatal deaths, preterm births, small-for-gestational-age babies, and complications during birth" than women who give birth at ages 19 or older, the editorial adds.

The "prevention of child marriage and unwanted births, comprehensive access to sexual and reproductive education (including contraception), keeping girls in secondary education and therefore delaying age at the birth of the first child, and empowerment to make the right choices for health and wellbeing" should all be included in interventions aimed at reducing pregnancies and births among adolescent girls, the editorial states.

The editorial argues that investing in girls will produce "not only an acceleration of progress towards ending maternal, neonatal, and child mortality, but also a better educated future generation of women who will contribute to the skilled workforce and so the economic development of their countries." It adds, "The continuum of care needs to become a lifecycle of care."

"Prevention of stillbirths and neonatal mortality and morbidity must include greater attention to adolescent girls in particular" the editorial continues, concluding, "It is time to add the letter 'A' to RMNCH."

Featured Blogs

Fri, 03/28/2014 - 17:19

"Kansas Moves To Defund Planned Parenthood and Force Doctors To Report Every Miscarriage," (Marcotte, "XX Factor," Slate, 3/26); "Two Anti-Choice Candidates in Colorado Rescind Support for 'Personhood,' (Salzman, RH Reality Check, 3/26).

March 28, 2013

FEATURED BLOG

 "Kansas Moves To Defund Planned Parenthood and Force Doctors To Report Every Miscarriage," Amanda Marcotte, Slate 's "XX Factor": While "conservative attacks on insurance coverage of contraception have been garnering a lot of attention," Marcotte notes that "it's important to remember that this is just one small part of a larger push from the right to do as much damage as possible to women's reproductive rights." She explains, "A couple of stories out of Kansas demonstrate this [push] quite well." For example, she cites a recent federal appeals court's decision to allow "lawmakers to deprive low-income women of access to contraception and other reproductive health services by allowing Kansas to immediately start defunding" Planned Parenthood of Kansas and Mid-Missouri. Marcotte also points to a "bill [HB 2613] winding its way through the state's legislature," with an amendment that "would require doctors to report all miscarriages to the state health department, no matter how early they occur in a pregnancy" (Marcotte, "XX Factor," Slate, 3/26).

What others are saying about abortion restrictions:

~ "Federal Court Extends Order Temporarily Blocking Alabama Admitting Privileges Law," Jessica Mason Pieklo, RH Reality Check.

~ "Fact-Checking a Texas Republican's Claims on Women's Health 'Advances,'" Andrea Grimes, RH Reality Check.

~ "Federal Appeals Court Refuses To Overturn Texas' Stringent New Abortion Law," Tara Culp-Ressler, Center for American Progress' "ThinkProgress."

FEATURED BLOG

"Two Anti-Choice Candidates in Colorado Rescind Support for 'Personhood,'" Jason Salzman, RH Reality Check: Two Republicans from Colorado -- U.S. Reps. Cory Gardner and Mike Coffman -- who are running for the state's "most hotly contested congressional seats have withdrawn their support for a 'personhood' amendment," Salzman writes. Gardner is trying to unseat U.S. Sen. Mark Udall (D), while Coffman is running for re-election against Democrat Andrew Romanoff. In the blog post, Salzman explains the amendment "would ban all abortion and give legal rights to fertilized human eggs, also called zygotes." According to Salzman, a Coffman spokesperson has said that "this year's [ballot] measure, which would redefine the definition of 'child' in the Colorado criminal code, isn't as broad as previous personhood measures, depending on how it would be interpreted by the courts." Meanwhile, Salzman notes, Gardner "has yet to clarify what his new abortion stance is" and whether "he supports an abortion ban, Roe v. Wade, or another policy" (Salzman, RH Reality Check, 3/26).

What others are saying about politics and elections:

~ "In Unprecedented Assault, Koch Brothers Aim for Anti-Choice Senate in 2014," Adele Stan, RH Reality Check.

~ "We Need an Act of Congress to Get More Women in Congress," Crystal Shepeard, Care2.

Planned Parenthood To Develop N.C. Abortion Clinic in Compliance With Potential Regulations

Fri, 03/28/2014 - 17:11

Raleigh, N.C.-based Planned Parenthood Health Systems announced it will open a new abortion clinic that will comply with a new state law (SB 353) that authorizes making ambulatory surgery center rules applicable to clinics, the Carolina Public Press reports.

Planned Parenthood To Develop N.C. Abortion Clinic in Compliance With Potential Regulations

March 28, 2014 — Raleigh, N.C.-based Planned Parenthood Health Systems announced it will open a new abortion clinic that will comply with a new state law (SB 353) that authorizes making ambulatory surgery center rules applicable to clinics, the Carolina Public Press reports. The move comes despite a recent state report suggesting there will be a delay in releasing the rules designed to enforce that law (Elliston, Carolina Public Press, 3/27).

An expansive antiabortion-rights measure, signed by North Carolina Gov. Pat McCrory (R) in July, allows the state Department of Health and Human Services to "apply any requirement" for ambulatory surgical centers to abortion clinics, so long as the regulations do not impede access to abortion.

DHHS was required to provide an update on its progress in developing the rules by Jan. 1, but there is no deadline to create the rules for abortion clinics (Women's Health Policy Report, 12/17/13).

DHHS Interim Report

In an interim report submitted to the state Legislature in December 2013, DHHS said that it would work to develop permanent rules, rather than spend time creating and implementing temporary regulations. The report also outlined the numerous steps required to finalize the permanent rules, suggesting that it could be some time before the final regulations are released.

Specifically, DHHS will first create a set of draft rules, which will then be submitted for approval to the state Office of Administrative Hearings and the Office of State Management and Budget. DHHS would then review the rules again, resubmit them to OAH for approval and then publish them in the North Carolina Register for public consideration.

DHHS at that time will invite stakeholders to comment on the regulations via the register notice, a public hearing and a public comment process. Once cleared, the rules would be formally adopted by the agency and submitted to the state's Rules Review Commission for final approval before being implemented.

The report did not specify how long the entire process would take.

Ashville Clinic Plans

PPHS said it would open a new abortion clinic in Ashville to replace Femcare, a clinic also based in Ashville that is the only abortion provider of the state's 15 clinics that would currently be able to meet the ambulatory surgical center standards. Femcare is scheduled to close.

PPHS Vice President of Communications Melissa Reed said, "It's certainly what we felt we needed to do in anticipation of what may come, so that was why we decided to build to that [ambulatory surgical center] standard." She said the new clinic is scheduled to open by summer.

Comments

NARAL Pro-Choice North Carolina Executive Director Suzanne Buckley said that while it is unknown when the final rules will be published, "The rule-making process is certainly a long one, and there are a lot of turning points along the way where things could change. But our hope is that folks let the process play out as it is designed to, to take into account sound science and medicine and make rules based on that and the practical implications of these laws, and let politics stay out of it."

Reed said, "We're anxious to see what" DHHS proposes, adding, "They did include a group of people that included experts on women's health care that are providers, and we felt that that showed a good faith effort." She continued, "They indicated that their primary concern was patient safety and not putting unnecessary building requirements on providers. We're hoping that that continues to be the focus, and that that's what we'll see when they reveal the draft regulations" (Carolina Public Press, 3/27).


Ala. Could Consider Bill Extending Mandatory Delay Period for Abortion Next Week

Fri, 03/28/2014 - 17:09

While there is less than a week before the Alabama Legislature's 2014 session ends, lawmakers still could vote on a bill (HB 489) that would extend the state's mandatory delay period before an abortion from 24 to 48 hours, WHNT News reports.

Ala. Could Consider Bill Extending Mandatory Delay Period for Abortion Next Week

March 28, 2014 — While there is less than a week before the Alabama Legislature's 2014 session ends, lawmakers still could vote on a bill (HB 489) that would extend the state's mandatory delay period before an abortion from 24 to 48 hours, WHNT News reports.

The bill has passed the state House and was approved by a state Senate committee earlier this month.

According to sponsor state Rep. Ed Henry (R), the bill would give a woman time "to think about what she's fixing to do, for some type of intervention, for somebody to come in her life and maybe speak a word to her that encourages her not to end the life of that child" (Banaszak, WHNT News, 3/26).


Appeals Court Upholds Texas Admitting Privileges, Medication Abortion Law

Fri, 03/28/2014 - 17:08

The 5th U.S. Circuit Court of Appeals on Thursday upheld two contested provisions in a Texas antiabortion-rights law (HB 2), ruling that the restrictions do not unduly burden women, the New York Times reports.

Appeals Court Upholds Texas Admitting Privileges, Medication Abortion Law

March 28, 2014 — The 5th U.S. Circuit Court of Appeals on Thursday upheld two contested provisions in a Texas antiabortion-rights law (HB 2), ruling that the restrictions do not unduly burden women, the New York Times reports (Eckholm, New York Times, 3/27).

In October, the appeals court ruled that a provision in the law requiring abortion providers to have admitting privileges at a nearby hospital, as well as a second provision that would require a physician to be present when administering medication abortion, could take effect while the case was appealed. The next month, the Supreme Court declined an emergency application filed by women's health care providers to block the law (Women's Health Policy Report, 1/7).

Thursday's Ruling

A three-judge panel issued a unanimous decision in favor of the state, finding that the rules are constitutional because the state's objective was to protect abortion patients' health and the plaintiffs did not adequately demonstrate that the rules excessively burdened women.

The judges wrote that the state's "articulation of rational legislative objectives, which was backed by evidence placed before the state legislature, easily supplied a connection between the admitting-privileges rule and the desirable protection of abortion patients' health" (Aaronson, Texas Tribune, 3/27).

The judges added that the admitting privileges rule "would also promote the continuity of care in all cases, reducing the risk of injury caused by miscommunication and misdiagnosis when a patient is transferred from one health care provider to another."

However, the judges did decide to allow clinics that have applied for admitting privileges but not yet received confirmation to continue offering abortion care (Herskovitz, Reuters, 3/27).

The ruling in favor of the state was not surprising because the 5th Circuit is a conservative court and previously signaled it likely would uphold the law, the Times reports (New York Times, 3/27).

Clinic Closures

According to the Texas Tribune, there were 40 licensed abortion providers in the state in August, before the rules took effect. There are now 28 licensed abortion providers, but just 24 still offer abortion care.

The law also includes other provisions that have not been challenged in court, including a 20-week abortion ban and requirements that all abortion facilities meet ambulatory surgical center requirements.

The number of operational abortion clinics in the state likely will drop to six when those provisions take effect in September, according to the Tribune.

Reaction

Texas Gov. Rick Perry (R) said in a statement, "Today's court decision is good news for Texas women and the unborn, and we will continue to fight for the protection of life and women's health in Texas."

Planned Parenthood Federation of America President Cecile Richards pledged to continue fighting the legislation, stating, "We will combat these laws in the courts, and our separate political arm will mobilize voters to replace lawmakers who champion these dangerous laws in the first place."

Brigitte Amiri, a senior staff attorney at the American Civil Liberties Union's Reproductive Freedom Project, said the law is having a "devastating impact" on Texas women. "Texas women deserve better than to have extremist politicians endanger their health and safety by preventing them from accessing safe and legal abortion," she added (Texas Tribune, 3/27).

Meanwhile, Center for Reproductive Rights President Nancy Northup said admitting privileges, in Texas or other states, "is an issue that is hurtling its way toward the Supreme Court" (New York Times, 3/27).


Blogs Comment on Family Planning Funding, Supreme Court Gun Ruling, More

Fri, 03/28/2014 - 16:29

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

Blogs Comment on Family Planning Funding, Supreme Court Gun Ruling, More

March 28, 2014 — We've compiled some of the most thought-provoking commentaries from around the Web. Catch up on the conversation with bloggers from Slate, RH Reality Check and more.

ABORTION RESTRICTIONS: "Kansas Moves To Defund Planned Parenthood and Force Doctors To Report Every Miscarriage," Amanda Marcotte, Slate's "XX Factor": While "conservative attacks on insurance coverage of contraception have been garnering a lot of attention," Marcotte notes that "it's important to remember that this is just one small part of a larger push from the right to do as much damage as possible to women's reproductive rights." She explains, "A couple of stories out of Kansas demonstrate this [push] quite well." For example, she cites a recent federal appeals court's decision to allow "lawmakers to deprive low-income women of access to contraception and other reproductive health services by allowing Kansas to immediately start defunding" Planned Parenthood of Kansas and Mid-Missouri. Marcotte also points to a "bill [HB 2613] winding its way through the state's legislature," with an amendment that "would require doctors to report all miscarriages to the state health department, no matter how early they occur in a pregnancy" (Marcotte, "XX Factor," Slate, 3/26).

What others are saying about abortion restrictions:

~ "Federal Court Extends Order Temporarily Blocking Alabama Admitting Privileges Law," Jessica Mason Pieklo, RH Reality Check.

~ "Fact-Checking a Texas Republican's Claims on Women's Health 'Advances,'" Andrea Grimes, RH Reality Check.

~ "Federal Appeals Court Refuses To Overturn Texas' Stringent New Abortion Law," Tara Culp-Ressler, Center for American Progress' "ThinkProgress."

RELIGION: "Jimmy Carter Says Pope Francis Promised 'Women Should Have a Greater Role,'" Michelle Boorstein, Washington Post's "Post Local": Recapping President Carter's recent visit to the Post, Boorstein writes that "it wasn't surprising ... to hear" that the former president "typed out and mailed a letter to Pope Francis challenging the pontiff on the status of women in the Catholic church," given that Carter is known for being outspoken. Carter said Francis had promised him that "he thought women should have a greater role" in the Catholic Church. Carter also discussed "the intersection of religion and gender in a wide range of contexts, including prostitution, scripture and abortion," Boorstein adds (Boorstein, "Post Local," Washington Post, 3/26).

POLITICS AND ELECTIONS: "Two Anti-Choice Candidates in Colorado Rescind Support for 'Personhood,'" Jason Salzman, RH Reality Check: Two Republicans from Colorado -- U.S. Reps. Cory Gardner and Mike Coffman -- who are running for the state's "most hotly contested congressional seats have withdrawn their support for a 'personhood' amendment," Salzman writes. Gardner is trying to unseat U.S. Sen. Mark Udall (D), while Coffman is running for re-election against Democrat Andrew Romanoff. In the blog post, Salzman explains the amendment "would ban all abortion and give legal rights to fertilized human eggs, also called zygotes." According to Salzman, a Coffman spokesperson has said that "this year's [ballot] measure, which would redefine the definition of 'child' in the Colorado criminal code, isn't as broad as previous personhood measures, depending on how it would be interpreted by the courts." Meanwhile, Salzman notes, Gardner "has yet to clarify what his new abortion stance is" and whether "he supports an abortion ban, Roe v. Wade, or another policy" (Salzman, RH Reality Check, 3/26).

What others are saying about politics and elections:

~ "In Unprecedented Assault, Koch Brothers Aim for Anti-Choice Senate in 2014," Adele Stan, RH Reality Check.

~ "We Need an Act of Congress to Get More Women in Congress," Crystal Shepeard, Care2.

VIOLENCE AGAINST WOMEN: "Man Convicted of Domestic Violence Can't Possess a Gun, Supreme Court Rules," Nicole Flatow, Center for American Progress' "ThinkProgress": The Supreme Court in a unanimous ruling on Wednesday said that people who have been convicted of domestic violence, "even pushing or grabbing," are subject to a federal ban on possessing a gun, Flatow writes. "The ruling could have significant implications in interpreting which state domestic violence laws bar gun possession," she writes, noting that "domestic violence is one of the biggest risks associated with gun ownership." Flatow explains, "Because of this relationship ... federal law bars those convicted of a misdemeanor domestic violence offense from possessing a gun. But state crimes dubbed 'domestic violence' come with different definitions in different states." She also notes that "several bills introduced in Congress aim to fill ... gaps" in the current federal law, which only covers misdemeanors and "omits several other types of domestic violence offenses, including temporary protective orders and stalking offenses" (Flatow, "ThinkProgress," Center for American Progress, 3/26).

What others are saying about violence against women:

~ "A Year After VAWA, Still More Work To Be Done," Mark Kirschenbaum, Huffington Post blogs.

~ "From Dee to Patti: Transgender Women Fighting Back Against Sexual Assault in Detention," Chase Strangio, American Civil Liberties Union's "Blog of Rights."

~ "Feminists Take to Twitter To Explain That Rape Culture is Alive and Well," Culp-Ressler, Center for American Progress' "ThinkProgress."

~ "Survivors of Domestic Violence Now Have Better Access to Obamacare Benefits," Culp-Ressler, Center for American Progress' "ThinkProgress."

NEED FOR SAFE ABORTION: "Unsafe Abortions Have Killed 1 Million and Injured 100 Million in the Last Two Decades," Maya Dusenbery, Feministing: "[L]awmakers and public health leaders from over 30 countries have released a new declaration calling for the world's nations to repeal all criminal abortion laws and 'make safe, legal abortion universally available and accessible to all women regardless of age, income, or where they live,'" Dusenbery writes. The declaration represents a substantial update from the 1994 International Conference on Population and Development, where global leaders said that "abortion should be made 'safe where legal,'" she notes. Dusenberry adds, "As everyone -- except, of course, anti-choicers with their heads in the sand -- knows, outlawing the procedure does not stop people from getting abortions -- it just makes them less safe." She notes that 21 million women undergo unsafe abortions every year, adding that since 1994, more than one million have died from the procedures and 100 million more have sustained "often life-long" injuries (Dusenbery, Feministing, 3/27).

What others are saying about the need for safe abortion:

~ "UMich Exhibit Celebrates 4000 Years of Reproductive Choice," Callie Beusman, Jezebel.


Appeals Court Upholds Texas Admitting Privileges, Medication Abortion Law

Fri, 03/28/2014 - 15:14

The 5th U.S. Circuit Court of Appeals on Thursday upheld two contested provisions in a Texas antiabortion-rights law (HB 2), ruling that the restrictions do not unduly burden women, the New York Times reports.

Appeals Court Upholds Texas Admitting Privileges, Medication Abortion Law

March 28, 2014 — The 5th U.S. Circuit Court of Appeals on Thursday upheld two contested provisions in a Texas antiabortion-rights law (HB 2), ruling that the restrictions do not unduly burden women, the New York Times reports (Eckholm, New York Times, 3/27).

In October, the appeals court ruled that a provision in the law requiring abortion providers to have admitting privileges at a nearby hospital, as well as a second provision that would require a physician to be present when administering medication abortion, could take effect while the case was appealed. The next month, the Supreme Court declined an emergency application filed by women's health care providers to block the law (Women's Health Policy Report, 1/7).

Thursday's Ruling

A three-judge panel issued a unanimous decision in favor of the state, finding that the rules are constitutional because the state's objective was to protect abortion patients' health and the plaintiffs did not adequately demonstrate that the rules excessively burdened women.

The judges wrote that the state's "articulation of rational legislative objectives, which was backed by evidence placed before the state legislature, easily supplied a connection between the admitting-privileges rule and the desirable protection of abortion patients' health" (Aaronson, Texas Tribune, 3/27).

The judges added that the admitting privileges rule "would also promote the continuity of care in all cases, reducing the risk of injury caused by miscommunication and misdiagnosis when a patient is transferred from one health care provider to another."

However, the judges did decide to allow clinics that have applied for admitting privileges but not yet received confirmation to continue offering abortion care (Herskovitz, Reuters, 3/27).

The ruling in favor of the state was not surprising because the 5th Circuit is a conservative court and previously signaled it likely would uphold the law, the Times reports (New York Times, 3/27).

Clinic Closures

According to the Texas Tribune, there were 40 licensed abortion providers in the state in August, before the rules took effect. There are now 28 licensed abortion providers, but just 24 still offer abortion care.

The law also includes other provisions that have not been challenged in court, including a 20-week abortion ban and requirements that all abortion facilities meet ambulatory surgical center requirements.

The number of operational abortion clinics in the state likely will drop to six when those provisions take effect in September, according to the Tribune.

Reaction

Texas Gov. Rick Perry (R) said in a statement, "Today's court decision is good news for Texas women and the unborn, and we will continue to fight for the protection of life and women's health in Texas."

Planned Parenthood Federation of America President Cecile Richards pledged to continue fighting the legislation, stating, "We will combat these laws in the courts, and our separate political arm will mobilize voters to replace lawmakers who champion these dangerous laws in the first place."

Brigitte Amiri, a senior staff attorney at the American Civil Liberties Union's Reproductive Freedom Project, said the law is having a "devastating impact" on Texas women. "Texas women deserve better than to have extremist politicians endanger their health and safety by preventing them from accessing safe and legal abortion," she added (Texas Tribune, 3/27).

Meanwhile, Center for Reproductive Rights President Nancy Northup said admitting privileges, in Texas or other states, "is an issue that is hurtling its way toward the Supreme Court" (New York Times, 3/27).


President Obama, Vatican Leaders Touch on Contraception, Religious Freedom in Talks

Fri, 03/28/2014 - 14:43

President Obama on Thursday briefly touched on contraception and religious freedom rights during a visit to the Vatican, but he said his conversations with Pope Francis and Cardinal Pietro Parolin -- the Vatican's secretary of state -- focused primarily on global conflicts and economic opportunity, Politico reports.

President Obama, Vatican Leaders Touch on Contraception, Religious Freedom in Talks

March 28, 2014 — President Obama on Thursday briefly touched on contraception and religious freedom rights during a visit to the Vatican, but he said his conversations with Pope Francis and Cardinal Pietro Parolin -- the Vatican's secretary of state -- focused primarily on global conflicts and economic opportunity, Politico reports (Budoff Brown/Epstein, Politico, 3/27).

Obama said his 52-minute meeting with the Pope was a "wide-ranging session" that focused mostly on the "challenges of conflict and how elusive peace is around the world." Obama said that the conversation did not include "a whole lot about social schisms," adding, "I think His Holiness and the Vatican have been clear about their position on a range of issues, some of them I differ with, most I heartily agree with."

Contraception, Religious Freedom Discussed

However, Obama said his conversation with Cardinal Parolin delved more deeply into the subjects of contraception and religious freedom. Obama said he told the cardinal he would "continue to dialogue with the U.S. Conference of [Catholic] Bishops to make sure we can strike the right balance, making sure that not only everybody had health care but families, and women in particular, are able to enjoy the kind of health care coverage that the (health care law) offers, but that religious freedom is still observed" (Clark, Miami Herald, 3/27).

Meanwhile, the Vatican issued a short statement on Obama's visit, saying that the talks were "cordial" and touched on "rights to religious freedom, life and conscientious objection," which was a reference to the federal contraceptive coverage rules, according to the AP/U-T San Diego (Winfield, AP/U-T San Diego, 3/27).


Federal Judge Sides With Ga. Catholic Groups in Contraceptive Coverage Case

Fri, 03/28/2014 - 14:39

A federal judge in Georgia on Wednesday ruled that certain not-for-profit groups in the state do not have to comply with the federal contraceptive coverage rules, the AP/Augusta Chronicle reports.

Federal Judge Sides With Ga. Catholic Groups in Contraceptive Coverage Case

March 28, 2014 — A federal judge in Georgia on Wednesday ruled that certain not-for-profit groups in the state do not have to comply with the federal contraceptive coverage rules, the AP/Augusta Chronicle reports (Brumback, AP/Augusta Chronicle, 3/27).

The contraceptive coverage rules, which are being implemented under the Affordable Care Act (PL 111-148), require most health plans to offer contraceptive coverage in their employer-sponsored health plans. Houses of worship are exempt from the requirement, and religiously affiliated not-for-profits are eligible for an accommodation that ensures they do not have to pay for or directly provide the coverage to their employees.

The U.S. Supreme Court on Tuesday heard oral arguments in separate cases challenging the rules that were brought by two private companies whose owners object to providing contraceptive coverage because of their religious beliefs (Women's Health Policy Report, 3/26).

Georgia Case Details

The case was filed in October 2013 by two independent not-for-profits -- Catholic Education of North Georgia and Catholic Charities of the Archdiocese of Atlanta -- that are affiliated with the Catholic Church. CENG implements the archdiocese's educational agenda in five independent Catholic schools, according to court filings. CCAD provides social services to the community.

The groups argued that requiring them to fill out a form to avoid providing contraceptive coverage directly makes them complicit in providing the coverage (AP/Augusta Chronicle, 3/27).

Religiously affiliated not-for-profits that object to contraceptive coverage must complete a form that states their objection. Doing so requires the organizations' insurers or a third-party administrator to organize and pay for the birth control coverage options for the organizations' employees (Women's Health Policy Report, 3/13). "Catholic groups have argued signing such a form makes them complicit in providing contraception coverage," which they oppose on religious grounds, according to the AP/Chronicle.

Ruling

U.S. District Judge William Duffey permanently prohibited the federal government from enforcing the contraceptive coverage rules on the plaintiffs on the grounds that the requirements violate the Religious Freedom Restoration Act of 1993 (PL 103-141). RFRA prohibits the government from implementing rules that substantially burden a person's religious practice.

Duffey ruled that because the archdioceses are "entirely exempt" from the rules, the groups and schools that they manage also are exempt.

According to the AP/Chronicle, a lawyer for the U.S. Department of Justice did not respond to after-hours requests for comment (AP/Augusta Chronicle, 3/27).


Ala. Could Consider Bill Extending Mandatory Delay Period for Abortion Next Week

Fri, 03/28/2014 - 14:35

While there is less than a week before the Alabama Legislature's 2014 session ends, lawmakers still could vote on a bill (HB 489) that would extend the state's mandatory delay period before an abortion from 24 to 48 hours, WHNT News reports.

Ala. Could Consider Bill Extending Mandatory Delay Period for Abortion Next Week

March 28, 2014 — While there is less than a week before the Alabama Legislature's 2014 session ends, lawmakers still could vote on a bill (HB 489) that would extend the state's mandatory delay period before an abortion from 24 to 48 hours, WHNT News reports.

The bill has passed the state House and was approved by a state Senate committee earlier this month.

According to sponsor state Rep. Ed Henry (R), the bill would give a woman time "to think about what she's fixing to do, for some type of intervention, for somebody to come in her life and maybe speak a word to her that encourages her not to end the life of that child" (Banaszak, WHNT News, 3/26).