Repro Health Hub

On Thursday, March 5^th, President Obama held the White House Summit on Health Care Reform, which brought together members of Congress, health care experts and advocates in the field of health to discuss how our current health care system need to be revamped. The Summit follows the recent news that health care will be a major aspect of the budget plan, with a first ever down payment made towards ensuring health care access for all.  President Obama asked Congress to set aside $634 billion over the course of ten years, much of the money coming from savings made from restructuring government spending on current public health programs.

Thankfully, some women’s health advocates attended the Summit, including Cecile Richards, President of Planned Parenthood Federation of America, and Marcia Greenberger, President of the National Women’s Law Center. Although it will be weeks before President Obama outlines specific plans to reform health care, it is reassuring to know that health care is a top priority for this administration. Tell Congress that health care means a lot to you too.

Watch Cecile Richards speak at the Summit about how reproductive health care is an essential part of overall health care:

(Thanks to RH Reality Check for posting video.)

By Pooja Awatramani

The Chicago Tribune reports that 12 states are considering implementing bills that would require doctors to offer women seeking abortions the option of obtaining an ultrasound; some states would even make ultrasounds mandatory. The content of these bills varies from state to state and ranges from giving women the option to have an ultrasound to requiring women to have the ultrasound, hear “medical descriptions” of these ultrasound images, and even listen to the fetus’s heartbeat. (A complete list of each state’s proposed measures can be found here.)

Not only do mandated ultrasounds force women to undergo an unnecessary and costly test, but they are thinly veiled attempts to scare and shame women into carrying unwanted pregnancies to term. Unfortunately, they would not be the first of their kind. An article in USA Today points out that 16 states already have laws related to abortion ultrasounds on the books.

US News & World Report contributing editor Bonnie Erbe sums up the shaming and guilt-inducing intentions behind these proposals well:

No woman seeking an abortion does so unthinkingly. Few, if any, women use abortion as birth control, although the religious right would have us believe otherwise. And women seeking abortions do not need moralistic lectures about the horrors they are about to commit. To require them to have an ultrasound prior to an abortion is the most invasive type of moralistic lecture imaginable.

By Allison Farer

A new report released by the Guttmacher Institute today provides ample evidence that publicly funded family planning services are much-needed and extremely cost-effective.

According to the report, publicly funded family planning services prevent 1.94 million unintended pregnancies each year. Not only are these services improving quality of life, they are also saving taxpayer dollars. For every dollar put into family planning programs, $4.02 is saved in Medicaid funds that would otherwise be spent on pregnancy-related care. Even with these great strides, many women still do not have access to services due to lack of resources. Unintended pregnancies among low-income women have started to rise at the same time that they are decreasing in other groups.

The majority of family planning programs are publicly funded, with over 9 million clients receiving publicly funded contraceptive services in 2006. Increasing Medicaid family planning coverage and updating Title X policies is a necessary step for more women to have access to these services.

The report calls for a national floor of family planning coverage to fill in the gaps in state programs. The effect would be an additional 800,000 prevented unintended pregnancies, overall saving $2.6 billion in Medicaid costs.

Recognizing the savings associated with the program, 21 states have chosen to expand eligibility for family planning for low-income women who otherwise would not qualify for Medicaid. However, in order to do so, states must first go through a time-consuming process to get a federal waiver, and a proposal to eliminate this cumbersome red tape was unfortunately dropped from the economic stimulus package last month after adamant Republican opposition.

While highlighting the effectiveness of the program, the authors point to a number of policy changes that could help further increase its value. In addition to eliminating the waiver requirement, they recommend lifting a ban on family planning coverage for legal immigrants in their first five years in the United States and increasing funding for the Title X program, the main federal family planning program.

A proposal to increase—perhaps even double—Title X funding is already pending in Congress. Hopefully, armed with this evidence from Guttmacher, advocates for women’s health will have no trouble pushing through such a cost-effective proposal. As one of the report’s authors notes, “Family planning should be noncontroversial.”

Download the full report here.

By Monika Grzeniewski and Maya Dusenbery

Today, after weeks of often tense negotiations, President Obama signs the economic stimulus package into law. The final version of the stimulus package will contain many stipulations for basic health care, but will notably not contain a provision that would have allowed states to more easily extend Medicaid coverage for family planning services.

House Republicans demanded that the provision be dropped amid a mainstream media debate marked by its misinformation and dismissive innuendo.

Early in the process, Rep. John Boehner claimed the stimulus package included a $200 million budget request for contraception. But the proposal simply eliminated a long application process before states can expand Medicaid family planning services and over 5 years would have helped an estimated 2.3 million low-income women prevent unintended pregnancies.

The $200 million figure Rep. Boehner mistakenly referenced was the estimated amount the provision would have saved the government within 5 years, according to the Congressional Budget Office (CBO). After 10 years, projected savings would reach $700 million.

From the tone and quality of the media debate that ensued, however, you’d never have guessed the provision was so benign.

Representatives tittered through a House Caucus meeting on the subject. Chris Matthews, in all apparent seriousness, compared expanding access to contraception to China’s one-child policy. Fox New’s Neal Cavuto, asked with a wink, “How is this, no pun intended, ’stimulative’ of the economy?”

Had he really wanted to know, plenty of people could have answered that question. Many, including House Majority Leader Nancy Pelosi, tried without much success to explain how making it easier to provide basic reproductive health care to low-income women would provide much-needed relief to women affected by the economic crisis and save the government money by reducing unintended pregnancies.

On The Huffington Post, Julie Menin of the DNC’s Women’s Leadership Forum explained that in a stimulus bill designed to offer relief, reform, and reconstruction, the contraception provision would fall into the “relief” category:

The family planning aid fails under the rubric of “relief” for those who are struggling in this dire economy. Close to 50 million Americans lack health care coverage and 40 percent of all Americans have medical debts. Just as the New Deal created jobs and built new infrastructure and provided relief in the form of aid to those who needed it most, our economic stimulus bill must provide relief on the vital issue of basic health care.

On the New York Times Economix Blog, Nancy Folbre, an economics professor at the University of Massachusetts, Amherst, discussed the often over-looked effects of family planning spending on the economy, writing, “Increased spending on family planning (including contraceptives) would generate about as many direct and indirect jobs as any other health expenditures, and probably more than an equivalent tax cut.” The Brookings Institution also offered an analysis of the beneficial impact of the policy.

President of the National Family Planning & Reproductive Health Association, Mary Jane Gallagher, perhaps summarized the benefits of the contraception provision best on RH Reality Check:

The vehement opposition to a provision that would enable states to provide quality, essential health care to millions of women, all the while creating jobs AND saving the government precious tax dollars is beyond the limits of reason…until you realize that reason has nothing to do with it.

The American public similarly understands the benefits of expanding access to affordable contraception. A new survey by the YWCA and National Women’s Law Center found that nearly three-quarters of 1,000 self-identified Republicans and Independents favor legislation that would make it easier for people at all income levels to obtain contraception.

President Obama has assured women’s health advocates that the proposal, or a similar one, though stripped from the stimulus package, will be reintroduced on its own or added onto another piece of legislation in the near future. Hopefully, the next time around, the discussion—in both Congress and the media—will focus more on the merits of the provision and less on how many times one can make a pun with the word “stimulate.”

By Maya Dusenbery

The Director of the National Institute’s Low Income Access Program, Myra Batchelder has an article on RH Reality Check about the possible cost barriers to over-the-counter contraception.

A number of pilot projects in England have begun offering hormonal birth control pills over-the-counter at pharmacies. Although the benefits of being able to obtain birth control pills without having to see a doctor or get a prescription are clear, Batchelder warns that before we move to an over-the-counter model, we must ensure that costs remain affordable for all women:

We must ensure that public and private health insurance programs will provide coverage for over-the-counter oral contraceptives so that all women will be able to obtain the product - not just those who can afford to pay a high price.

Batchelder points to the lessons learned when emergency contraception (EC) became available over-the-counter. Most state Medicaid programs still require women to obtain a prescription in order for EC to be covered. As a result, the cost of over-the-counter EC remains prohibitively high for many low income women.

In the end, we must be aware of the cost and insurance barriers across the entire spectrum of reproductive health care, Batchelder says:

Ensuring access to reproductive health care, including contraception and abortion, is about more than just the legal ability to obtain these services. As advocates we need to work to ensure that all women have access to needed contraception and abortion services, regardless of their socioeconomic status or the health care program in which they participate. We will not have true reproductive rights until all women have the ability to access quality reproductive health care.

The long-term goal is to establish a universal health care system that will provide everyone with access to all needed medical services, including abortion and over-the-counter contraception. The important steps along the way include providing Medicaid and other public and private insurance coverage for over-the-counter EC and other forms of birth control without a prescription, as well as for abortion.

Together, we can work to achieve this. As advocates we must always recognize the cost and insurance pieces of any reproductive health care service and work to ensure that all women have access; cost must never be a barrier to accessing these services.

By Maya Dusenbery

Feministing reports that the Family Violence Prevention Fund (FVPF) has launched a new initiative, the kNOw More Initiative, which connects the dots between sexual violence and unintended pregnancies.

On the topic of reproductive coercion, FVPF President Esta Soler says,

The intersection of sexual violence and reproductive health is largely unexplored…With this initiative, we are overcoming stigma and raising awareness about the many women who, while dating or in relationships are forced into choices not their own through rape, sexual coercion or because partners prevent them from using protection. These women are at risk for sexually transmitted infection, unintended pregnancy, HIV, and more. Some suffer miscarriages when they want to carry pregnancies to term. Others become mothers before they are ready. Still others lose their fertility. We are creating a space for women to share stories, and raising awareness among those who may be at risk as well as their friends, policy makers and others.

Get the facts on reproductive coercion and read the chilling firsthand stories that the kNOw More Initiative has collected.

By Tara Sweeney

In many prisons and jails throughout the country pregnant women are routinely shackled during labor and delivery. Surprisingly, California, Illinois, and Vermont are the only states to have passed anti-shackling legislation.

Prison and jail protocols require ankle shackles and, until recently, stomach restraints. Access to Reproductive Health Care in New York State Jails, a New York Civil Liberties Union (NYCLU) report released last March, argues that shackling violates the Eighth Amendment’s prohibition of cruel and unusual punishment. Shackling seems especially ridiculous when we consider that the majority of women are in custody for non-violent crimes.

A few months ago the Bureau of Prisons (BOP) finally decided to prohibit “face-down four-point restraints and restraint belts that directly constrict the area of the pregnancy.” Further amendments to the shackling policy are in the works. Policies in state jails vary extremely. According to the NYCLU report, only three New York jails have written procedures concerning the shackling of pregnant women; of those three, only two forbid it.

The Second Chance Act of 2007 (HR 1593) was recently passed into law and requires the Attorney General to submit a detailed report to Congress on correctional facility policies regarding the restraint of pregnant women. Facilities must also report on “the reasons for the use of the physical restraints, the length of time that the physical restraints were used, and the security concerns that justified the use of the physical restraints.” The bill should become effective by next spring.

In the past thirty years, the number of incarcerated women has increased by 800%–and women of color are the fastest growing prison population in the US. Groups like the Rebecca Project and the Prison Doula Project are fighting to ensure that pregnant women are never shackled and even to provide for a positive labor experience. We need to respond responsibly with additional anti-shackling legislation and appropriate health care for the safety of these women and their newborn babies.

By Samantha Hurley

While 3.5 million pregnancies are among women ages 19–29 and one-third of all HIV diagnoses are made among young adults, many people in this age group are uninsured and lack regular health care.

According to a new report from the Commonwealth Fund, 13.7 million young adults, ages 19–29 were uninsured in 2006, an increase from 13.3 million in 2005. What’s even worse is that low-income young adults, especially young adults of color, are disproportionately uninsured. 53 percent of Hispanics and 36 of African Americans in this age group lack insurance, compared to 23 percent of whites.

Many young adults go without coverage because they lose it as soon as they graduate from college. In the year following their undergraduate graduation, 34 percent are uninsured at least part of the time. Those who do not wish to further their education after high school are also cut from their health care policies. 60 percent of young adults who do not enroll in college full-time lose coverage under a parent’s policy around the age of 18. To avoid becoming uninsured, some graduates resort to creative methods. According to a Wall Street Journal article, one college grad enrolled in an online university simply so he could stay on his parent’s insurance plan as a student.

What’s most upsetting about this data is that young adults, and particularly young women, are left without coverage to receive regular preventative and reproductive health care. Having no insurance, young adults are either burdened with the costs of health care or forced to go without. More than 60 percent of uninsured young adults opted out of getting health care they needed in the past year due to high costs. This includes failing to fill prescriptions, skipping treatments, and avoiding the doctor all together. Presumed to be a strong, vital source of life, young adults are becoming a larger demographic within the uninsured, overlooked as a group of people that both need and deserve good health care.

By Samantha Hurley

You’re probably familiar with the anecdotal evidence of select pharmacists across the country refusing to fill prescriptions for birth control. But an article in today’s issue of The Washington Post discusses how some pharmacies are taking this troubling trend one step further by refusing to carry contraceptives at all.

One strand of the argument in support of pharmacies’ “right” to refuse certain medications is that stores should be able to exclude any products they choose, and pharmacists should not have to do anything that violates their personal points of view.

But we have come to expect that pharmacists, as health care professionals, place the health and well-being of their clients above their own political ideology. And what about women’s right to receive adequate, and equal care? As Marcia Greenberg from the National Women’s Law Center told the Post, “Contraception is essential for women’s health. A pharmacy like this is walling off an essential part of health care. That could endanger women’s health.”

Another strand of the argument against the widespread availability of contraception says that consumers can simply go elsewhere to have their birth control prescriptions filled. That may well be the case in cities and large towns with a plethora of pharmacies. But what about women who live in areas with fewer pharmacies from which to choose? The Post quotes R. Alta Charo, a University of Wisconsin bioethicist who says,

We may find ourselves with whole regions of the country where virtually every pharmacy follows these limiting, discriminatory policies and women are unable to access legal, physician-prescribed medications. …We’re talking about creating a separate universe of pharmacies that puts women at a disadvantage.

And even if women are able to fill their prescriptions at another local pharmacy, what about the women who are so humiliated at being turned away from a pharmacy that they are afraid to even try their luck at other pharmacies? And what about women seeking the morning-after pill, who could lose vital hours in searching for a drugstore that provides this most basic service of filling a prescription?

While some states have laws that allow pharmacists to refuse to fill certain prescriptions (one wonders whether other medications, like Viagra, ever meet pharmacists’ refusal), California, New Jersey, Illinois, and Washington have passed legislation requiring pharmacists to either fill prescriptions or help women fill them elsewhere.

I doubt these anti-choice pharmacies would provide any such service. Even so, it could be too little, too late.

By Tara Sweeney

Another pat on the back for the Guttmacher Institute! Earlier this year, the research center published some enlightening information about the recent trends in abortion rates within the U.S. and have now released their most recent research is a study on sexual behavior of American teens.

According to the study led by Laura Lindberg, the Institute analyzed information about teens between the ages of 15-19 taken from the 2002 National Survey of Family growth, with findings that demystify the myth that teens perform oral sex as a way of both being sexually active and remaining virgins.

The findings were as follows

• 55 percent of teenagers have engaged in heterosexual oral sex
• 50 percent have engaged in vaginal sex; and 11 percent have had anal sex.
• Both oral and anal sex are much more common among teens who have already engaged in vaginal intercourse than among those who haven’t, suggesting that teens initiate a range of sexual activities around the same time, rather than substitute one for another, Lindberg says.

“Our research shows that this supposed substitution of oral sex for vaginal sex is largely a myth,” Lindberg said in a statement. “There is no good evidence that teens who have not had intercourse engage in oral sex with a series of partners.”

The study will be published in the July issue of the Journal of Adolescent Health.

Studies like these are imperative to understanding teenage sexuality, how to best prepare those who are sexually active to act safely and be aware of possible risks, and how to shape policy that effectively support these findings.

“The study has clear policy implications,” said Lindberg. “While oral and anal sex carry no risk of pregnancy, engaging in these behaviors can nevertheless put teens at risk of sexually transmitted infections (STIs). Counseling and education should take into account total STI risk by addressing the full range of behaviors that teens engage in, including oral and anal sex. It is crucial that teens receive evidence-based education and counseling about STI risks and protective behaviors for all types of sexual activity. The federal government’s exclusive emphasis on abstinence-only-until-marriage programs does not give teens the skills and information they need to be safe.”

We couldn’t agree more.