Nineteen House members sent a letter to House Speaker Nancy Pelosi stating that they will not vote for health care reform legislation “unless it explicitly excludes abortion funding from the scope of any government-defined or subsidized health insurance plan.”

Right-o. Because nothing says “crafting broad support” than cutting off health services to half of the population.

The letter continues:

We believe that a government-defined or subsidized health insurance plan, should not be used to fund abortion.

Furthermore, we want to ensure that the Health Benefits Advisory Committee cannot recommend abortion services be included under covered benefits or as part of a benefits package. Without an explicit exclusion, abortion could be included in a government subsidized health care plan under general health care. The health care reform package produced by Congress will be landmark, and with legislation as important as this, abortion must be addressed clearly in the bill text.

Dan Gilgoff at U.S. News & World Report notes that this move made the conservative Family Research Council very happy.

These are the signers: Dan Boren (Okla.), Bobby Bright (Ala.), Travis Childers (Miss.), Jerry Costello (Ill.), Kathy Dahlkemper (Penn.), Lincoln Davis (Tenn.), Steve Driehaus (Ohio), Tim Holden (Penn.), Paul Kanjorski (Penn.), Marcy Kaptur (Ohio), Mike McIntyre (N.C.), Charlie Melancon (La.), John Murtha (Penn.), Jim Oberstar (Minn.), Solomon Ortiz (Texas), Collin Peterson (Minn.), Heath Shuler (N.C.), Bart Stupak (Mich.), and Gene Taylor (Miss).

Plus: Raising Women’s Voices sent an email alert regarding the Senate Finance Committee’s consideration of health care coverage for abortion services:

The Senate Finance Committee has been writing a health care reform bill and struggling to create legislation that will have bipartisan support. Chairman Max Baucus considered several compromises to win Republican support, so they can claim it is bipartisan legislation. One of these potential compromises comes in the form of an abortion exclusion, which would prevent abortion services from being covered by some or all insurance plans in the Health Insurance Exchange. We fear that members of the Senate Finance Committee are considering such a compromise.

Contact the Senate Finance Committee and let them know that women do not support health care reform that happens at the expense of our access to comprehensive care!! Our health care decisions should not be made by politicians and we refuse to allow politically motivated restrictions to undermine reform efforts. We want health care that covers the services we need, and does not compromise on critical women’s health needs.

To contact the members on Subcommittee on Health Care within Senate Finance Committee click here. For the full list of committee members click here.

Please cc info@raisingwomensvoices.net so that we know how many of you have raised your voices to speak out for women’s health and challenge the notion that health care can happen on the backs of women and our needs!

Read more at Raising Women’s Voices blog.

We’ve mentioned in previous posts that comparative effectiveness research (research that directly compares the effectiveness of different treatments for the same illness) received funding in the stimulus bill, and that the Institute of Medicine was gathering public input in order to inform a report providing specific recommendations to Congress for prioritizing the expenditure of the funds. On Tuesday, the IOM released that report, “Initial National Priorities for Comparative Effectiveness Research“, which includes a list of 100 top topics (out of 1,268 unique suggestions) that the authoring committee believes should be prioritized for funding.

The committee writes that the list of priorities was determined not just by which conditions affect the largest number of people, but with balance in mind. The full report notes that rare diseases and conditions that disproportionately affect specific segments of the population were also considered. They also explain that while comparative effectiveness research often focuses on comparing drug A to drug B, the committee felt it was important to include a diversity of interventions and different types of therapies, and they also considered where the gaps are in existing research.

The priority list includes several childbirth related topics, including this: “Compare the effectiveness of birthing care in freestanding birth centers and usual care of childbearing women at low and moderate risk.” The report doesn’t specify what “usual care” is, so we can only assume that it means birth in a hospital with an ob/gyn. The list also doesn’t include details on how the effectiveness of birthing care will be judged, but we’ll certainly keep an eye out for more information!

Several other topics that are at least partially specific to women’s health made it into the top 25 priorities (the list of 100 was further broken down into quartiles). They include:

• Genetic and biomarker testing and usual care in preventing and treating breast, colorectal, prostate, lung, and ovarian cancer, and possibly other clinical conditions for which promising biomarkers exist.
• Interventions to reduce health disparities in cardiovascular disease, diabetes, cancer, musculoskeletal diseases, and birth outcomes.
• Clinical interventions (e.g., prenatal care, nutritional counseling, smoking cessation, substance abuse treatment, and combinations of these interventions) to reduce incidences of infant mortality, pre-term births, and low birth rates, especially among African American women.
• Innovative strategies for preventing unintended pregnancies (e.g., over-the-counter access to oral contraceptives or other hormonal methods, expanding access to long-acting methods for young women, providing contraceptive methods at public clinics, pharmacies, or other locations).

Other relevant topics include comparison of weight-bearing exercises and bisphosophonates for preventing fractures in older women with osteoporosis, film screen or digital mammography and mammography plus MRI for breast cancer screening in high risk women, outcomes with and without the use of obstetric ultrasound in normal pregnancies, and “strategies for promoting breastfeeding among low-income African American women.”

This Week’s Super Fun Health Reform Graphic: The Kaiser Family Foundation’s side-by-side comparison of healthcare reform proposals now includes details about the House Tri-Committee proposal (discussed here last week). Check it –

We also direct your attention to the Center for Policy Analysis, a resource for information on progressive health reform. The real treasure is its EQUAL Health listserv (Equitable, Quality, Universal, Affordable Health). Sign up and take part in conversations about women’s health, national health reform and how to advocate for policies that would benefit us all.

The Center also provides guidance on reaching out to members of Congress: This chart shows which caucus committee members belong to — which is a good indication of which plan they’re supporting. Use it to contact your representative, because times are tough …

Perilous Roadblocks: “Four divisive issues could dash President Barack Obama’s hopes of overhauling health care: cost, creating a government-run plan, taxing workers’ benefits and penalizing employers that don’t offer coverage,” writes the AP’s Ricardo Alonso-Zaldivar. “Even if lawmakers come back from their July Fourth recess charged up to tackle health care, these issues are going to keep simmering for months. A big blowup over any single one could threaten the entire legislation.”

We Got Nothing: Republicans are doing their part to wage fear over a government-supported health insurance program (the public option), while also acknowledging that none of the existing Democratic plans will gather bipartisan support.

“Asked how many Senate Republicans could sign on to developing Democratic plans, Senator Richard M. Burr of North Carolina, author of a Republican alternative, said: ‘I think right now, none. Zero,’” reports The New York Times, which later on notes, “Republicans, however, have yet to put forward their own concrete plans that would broadly expand health coverage while also holding down costs.”

Over at Talking Points Memo, Zachary Roth points out that arguments against the public option on the grounds that it will destroy free-market competition miss the mark:

Sen. Richard Shelby (R-AL), speaking earlier this month on Fox News, called President Obama’s plan the “first step in destroying the best health care system the world has ever known.” A public option, Shelby added, would “destroy the marketplace for health care.”

But the notion that most American consumers enjoy anything like a competitive marketplace for health care is flatly false. And a study issued last month by a pro-reform group makes that strikingly clear.

The report, released by Health Care for America Now (HCAN), uses data compiled by the American Medical Association to show that 94 percent of the country’s insurance markets are defined as “highly concentrated,” according to Justice Department guidelines. Predictably, that’s led to skyrocketing costs for patients, and monster profits for the big health insurers.

The full HCAN report and executive summary are available here.

Marking Progress (or Lack Thereof): Obama adviser David Axelrod isn’t ruling out the possibility of a tax on health insurance benefits:

Speaking on ABC’s “This Week,” David Axelrod declined to repeat Obama’s “firm pledge” during the campaign that families making under $250,000 would not see “any form of tax increase, not your income tax, not your payroll tax, not your capital gains taxes, not any of your taxes.”

Instead, Axelrod said the president has no interest in “drawing lines in the sand” on the issue of how to pay for the costly health reform plan making its way through Congress.

Nor is he holding all that tight to the public option. Again with the sand, this time on NBC’s “Meet the Press”:

Axelrod said he is “confident that we’re going to get a health care reform bill”: “I think a public choice will be part of it. I think the public wants to have that option, and wants to see that kind of competition, and I think we will have that.”

Moderator David Gregory followed up: “When it comes to a public plan, though, no ultimatums from the president?”

“Well, the president believes strongly in a public choice, and he has made that very, very clear,” Axelrod replied. “He has made that clear privately. He has made that clear publicly, and we’re going to continue to do so. … Look, we have gotten a long way down the road by not drawing bright lines in the sand — other than on the major points, which is that we can’t add to the deficit with this health care reform, so it has to be paid for, it has to reduce costs, and we want to make sure that all Americans have quality, affordable health care.

Single-Payer Advocates Not Only Ones Feeling Left Out: Emily Pierce at Roll Call writes:

Sens. Ron Wyden (D-Ore.) and Bob Bennett (R-Utah) have 11 other co-sponsors already — six Democrats, one Independent and four Republicans — on their bill, which is aimed at creating more competition in the insurance market and lowering costs by eliminating employer-provided health care coverage. Instead, consumers would get pay raises equal to their current health benefits and buy insurance on the open market.

Bennett said he believes the bill has lacked traction with Senate leaders because neither he nor Wyden is in a position to place it at the center of the debate.

“Hell has no fury like a committee chairman whose jurisdiction has been challenged. And neither Sen. Wyden nor I is a committee chairman,” Bennett said. “I think that’s part of it.”

Insured but Unprotected: Just a reminder of how poorly our current system protects those with insurance: The New York Times reports that “an estimated three-quarters of people who are pushed into personal bankruptcy by medical problems actually had insurance when they got sick or were injured,” and patient advocates are calling for federal rules “to correct the current state-by-state regulatory patchwork that allows some insurance companies to sell relatively worthless policies.”

“Underinsurance is the great hidden risk of the American health care system,” said Elizabeth Warren, a Harvard law professor who has analyzed medical bankruptcies. “People do not realize they are one diagnosis away from financial collapse.”

Plus: Elizabeth Warren earlier this year appeared on PBS’s NOW with Maria Hinojosa. Read or listen to the interview.

Health Reform That Benefits Women: From Women’s eNews: As Congress debates at least 10 health care proposals, prominent women’s advocates say work and wage issues make the single-payer model the best deal for women — but it’s not picking up much legislative support . Molly M. Ginty talked to a number of women’s health advocates, including our own Judy Norsigian. OBOS has formally endorsed the single-payer model. Amnesty International also urged action on single-payer this week.

Though single-payer legislation is not being considered in the Senate, the House is weighing it in the form of the U.S. National Health Care Act (HR 676), which was introduced January 26 by Michigan Rep. John Conyers, Jr.

Prominent advocates for women’s health say the lagging single-payer model would serve women best. The National Women’s Health Network, for instance, has endorsed this model since 1978.

“Most of the leading health care proposals on the table would tie insurance coverage to employment in a way that is problematic for women,” said Judy Norsigian, executive director of the Boston-based Our Bodies, Ourselves.

The story notes that California Rep. Barbara Lee plans to reintroduce another single-payer plan — the U.S. Universal Health Service Act (HR 3000). It was in fact reintroduced last week.

Single-Payer Testimony: Single-payer advocates Quentin Young and Steffie Woolhandler, both with Physicians for a National Health Program, last week testified before the House Ways and Means and the Energy and Commerce committees, respectively.

Dr. Young’s testimony reads in part:

I wish to make two points to the Members of this Committee. The first is that the best health policy science, literature, and experience indicate that the Tri-Committee proposal will fail miserably in its purported goal of providing comprehensive, sustainable health coverage to all Americans. And it will fail whether or not it includes a so-called “public option” health plan.

The second point I wish to make is that single-payer national health insurance is not just the only path to universal coverage, it is the most politically feasible path to health care for all, because it pays for itself, requiring no new sources of revenue.

Wendell Potter, a former health insurance executive who had a change of heart, also testified. Potter is now senior fellow on health care for the Center for Media and Democracy in Madison.

Take Action
National Women’s Law Center: Join NWLC on July 6 for a national health care reform call-in day, and tell your members of Congress that health care reform can’t wait. More info.

Are you on Twitter? NWLC is running a Twitter stream on healthcare reform. Finish the sentence, “Women need health care reform this year because … ” and add the hashtag #healthcare09 to your tweet.

Stay tuned for Political Diagnosis II, the rest of the week in Washington …

Despite ADA regulations regarding accessibility of public buildings, people with disabilities often face barriers to accessing healthcare that are not addressed by the law, including a lack of appropriate staff training and accessible equipment. A report in Friday’s Boston Globe indicates that two nationally known, Harvard-affiliated area hospitals - Massachusetts General Hospital and Brigham and Women’s Hospital - will be spending millions of dollars over the next several years to make their services more accessible to people with disabilities.

Disability activists worked with Greater Boston Legal Services and the Boston Center for Independent Living to inform hospital leadership of the barriers patients were facing in accessing care. These included patients who could not be weighed (because there were no scales that could accommodate a wheelchair), making  it difficult for their chemotherapy or other drugs to be properly dosed; patients who were unable to receive needed mammograms; and patients who were asked by hospital staff if they were “sure” they couldn’t walk or who were branded as uncooperative because of their disabilities.

Under a new agreement between the hospitals and the advocacy groups, the hospitals will survey and remove physical/architectural barriers to care, purchase accessible medical devices and equipment (including mammography equipment), review and modify hospital policies, provide appropriate training to staff.  The hospitals must regularly report to patients and their advocates on the progress they are making. According to the Globe, advocates hope that the changes to be made at these facilities will serve as an example for hospitals across the country.

For more on the topic of disabilities and access to care, check out some of the following resources (and feel free to leave links to more in the comments):

• Breast Health Access for Women with Disabilities
• Disability Rights Education and Defense Fund: Access to Care
• Center for Research on Women with Disabilities
• Agency for Healthcare Research and Quality: Disability Research Findings

Woman Shackled During Labor Sues State: A former inmate at the Washington Corrections Center for Women who was shackled while in labor is suing the state of Washington for violating her constitutional rights. Read the full complaint here (pdf).

The Seattle-based women’s rights organization Legal Voice filed the federal lawsuit last week on behalf of Casandra Brawley. According to the complaint, Brawley, who was serving a 14-month sentence for shoplifting, was shackled by a metal chain around her belly during transportation to the hospital. At the hospital, she was shackled to her hospital bed during several hours of labor. A physician demanded the leg iron be removed while he performed an emergency c-section. The shackles were replaced after the baby was born.

“It defies common sense – and the Constitution – to risk any pregnant woman’s health, safety, and dignity by shackling her while she is in the process of giving birth,” Sara Ainsworth, senior counsel at Legal Voice and co-counsel for Brawley, said in a release.

“Like Ms. Brawley, the majority of women incarcerated in Washington State are serving sentences for non-violent crimes. And the idea that labor presents an escape opportunity is absurd. There is simply no justification that outweighs the medical risks of this inhumane, demeaning practice.”

Extra Sentence for Pregnant, HIV-Positive Woman: Rachel Mehlsak, a legal intern at the National Women’s Law Center, wrote a good summary of a court case involving a 28-year-old pregnant woman from Cameroon. A judge in Maine had sentenced the woman — who pleaded guilty to possessing false immigration documents — to a prison term longer than the maximum suggested under federal sentencing guidlines to ensure she would deliver her baby in prison. Why? Because she is HIV-positive, and the judge rationalized that she would receive better care behind bars, thus reducing the risk of HIV transmission. No joke.

The woman was recently released while her appeal to the 1st U.S. Circuit Court of Appeals is pending in Boston. Margo Kaplan of the Center for HIV Law and Policy has more.

New Push for Fetal Homicide Law: Another example of an ill-conceived attempt to protect the fetus comes by way of New Mexico, where the murder of a 22-year-old pregnant woman has led to talk of a fetal homicide law.

“Most crimes of this nature are prosecuted under state law, and according to the National Conference of State Legislatures, at least 36 states have fetal homicide laws (variously known as the Fetal Protection Act, the Preborn Victims of Violence Act and the Unborn Victim of Violence Act). Some laws apply to the killing of a fetus at any time after conception, while others only apply to a fetus that is capable of surviving outside the womb,” writes Gwyneth Doland of the New Mexico Independent.

There are, of course, hefty consequences:

“What we’ve discovered is that the minute one of these laws passes, the first people who are prosecuted are not batterers, but pregnant women themselves,” says Lynn Paltrow of National Advocates for Pregnant Women, a women’s rights organization that has fought against fetal homicide laws.

“These cases are always presented as a response to violence against women. But not a single state has ever looked at whether these laws have done anything to decrease the epidemic of violence against women. And no state should pass another law like this until that research is done,” Paltrow says.

Paltrow says that similar laws in other states are used to prosecute pregnant women who suffer from substance abuse problems.

In particular, she points to South Carolina, where a fetal homicide law has been used to prosecute dozens of pregnant women struggling with substance abuse. In one case, a 22-year-old homeless woman whose pregnancy resulted in a stillbirth was convicted of murder and sentenced to 12 years in prison, even though health experts said there was no evidence her drug problem caused the stillbirth.

A Model Program: I recently learned about the work of Women’s Equity in Access to Care and Treatment (WE-ACTx), which began working in Rwanda in early 2004 to help genocide rape survivors, many of whom had contracted HIV from their attackers. Today, WE-ACTx focuses on increasing women’s and children’s access to comprehensive HIV/AIDS care and services, education and training.

Earlier this month, WE-ACTx held its 4th annual celebration of Day of the African Child (commemoration of the 1976 child uprising in Soweto against apartheid) with more than 400 children with HIV and their families.

In addition to running several medical clinics, the organization educates people affected by HIV/AIDS  about their legal rights, and empowers them to take action to resolve legal problems they may face. Here’s the English version of the WE-ACTx Community Handbook on Health-Care Rights and Other Laws (pdf). If you’re looking for an organization to support, take a look at WE-ACTx.

Resources on HIV Testing: National HIV Testing Day was June 27, and the Kaiser Family Foundation has released new and updated materials on attitudes toward HIV testing. First, take a look at the 2009 Survey of Americans on HIV/AIDS, the Foundation’s seventh major survey of the American public’s attitudes, knowledge and experiences related to HIV/AIDS.

Two new survey briefs were prepared as a follow-up: The first, on views and experiences with HIV Testing, looks at the U.S. public’s attitudes about experiences with HIV testing, including which groups are most likely to report being tested for HIV, reasons for being tested/not being tested, communication with doctors and partners about HIV/AIDS and more. The second brief examines more closely African American’s views and experiences with HIV testing.

Fem 2.0 is hosting a blog carnival on caregiving. Here’s the notice we received via email with encouragement to share:

Women take care of children, spouses, parents, family members, friends. We dominate the caregiving professions, like nursing or social work. Ask anyone receiving care of any kind and he or she will most likely tell you that the primary caregiver is a woman.

Caregiving is a huge part of women’s lives, and so often it’s a job for which we usually don’t get or expect monetary compensation. How can caregiving be made easier to make our lives easier?

Over the next couple of weeks, Fem2.0 is partnering with the National Family Caregivers Association, the Christopher and Dana Reeve Foundation, and the American College of Nurse-Midwives to start a fresh discussion about caregiving and women.

What is caregiving in all its shapes and forms?
What role does it play in women’s lives?
What can be done, or what changes need to happen, to facilitate caregiving?

We are looking for insights, comments, and expertise. We are looking for personal stories to illustrate the human experience of caregiving and to build a sense of solidarity among all caregivers.

Here’s how you can get involved:

1. Blog about it at your own site by July 13, and send Fem2.0 the link, so they can add your post to the blog carnival on Fem2.0. Alternatively you can write a piece for the Fem2.0 blog and send it to info@fem2pt0.com.

2. Participate in the Women and Caregiving Twittercast Monday, July 13, at 10 p.m. (EST) — hashtag #fem2. Find out how to join a Twittercast here.

In November 2008, The American Journal of Obstetrics & Gynecology published a review, Evidence-based labor and delivery management [PDF], that looked at the quality of the evidence used to support labor and birth practices. In response to the review, nurse-midwife and epidemiologist Judith Rooks and OBOS Executive Director Judy Norsigian wrote a letter to the editor that was published in the May 22, 2009 issue of AJOG, which we’ve posted at the OBOS site.

In it, Norsigian and Rooks note that while the review “makes an important contribution to the care of healthy women having normal labors,” it is problematic because “Berghella’s ‘D’ grade (’fair evidence that harms outweigh benefits’) for home-like births in hospitals was skewed by their decision not to review the evidence on many frequently used obstetric interventions, some of which (eg, induction) can cause harm when they are overused.”

If you have access to AJOG, the authors have responded to “agree that midwife-led models of care for labor and delivery should be encouraged, based on the recent Cochrane metaanalysis” and that they “support future randomized trials to compare” the options of home vs. hospital births.

Over at the Huffington Post, Marcia Yerman examines arguments surrounding the safety of breast implants, as presented in the documentary film “Absolutely Safe” — and efforts underway to require doctors to provide accurate information about breast implants.

Our Bodies Ourselves has teamed up with “Absolutely Safe” director Carol Ciancutti-Leyva and the film company Amaranth Productions to advocate for legislation that will require plastic surgeons to provide prospective patients with a  booklet outlining the risks, complications and unknowns, along with alternatives to reconstructive breast implant surgery.

As Yerman notes, such legislation is not without precedent:

[The] model for legislation is a New York State Law (State of New York - Article 24-E, Section 2499w New York State law) that required the state’s Department of Health to publish a booklet that must be received by every woman considering a hysterectomy. It succinctly outlines risks, complications, alternative treatments, and recuperation expectations. Presently, the FDA has a guide on breast implants, but it is not legally mandated that prospective patients receive it. The “FDA Breast Implant Consumer Handbook” was published in 2004. Ciancutti-Leyva told me that the information reads as “a cautionary tale.” [...]

The need for informed consent was addressed as far back as 2000, in an editorial appearing in the Fall issue of The Journal of the American Medical Women’s Association. Written by Nancy Neveloff Dubler, LLB and Anna Schissel, JD, it was entitled “Women, Breasts, and the Failure of Informed Consent.” The authors examined whether “informed consent for breast augmentation is too fragile a reed to withstand the storm of commerce.”

You better believe opposition will be strong. Last year I discussed a marketing campaign by breast implant manufacturer Allergan that recasts augmentation surgery as a feminist act — a choice women can make for themselves. Allergan actually says its “empowering” women with information about size and shape options. The company has one goal in mind: to increase the number of breast implant procedures from 400,000 per year to more than 1 million.

If you really want to do something empowering, get involved with the informed consent campaign. Leave a comment on Marcia Yerman’s story (a good way to help promote the piece at Huffington Post). Visit the “Absolutely Safe” website for more information about what informed consent means, and check out the film’s trailer below.

You might also want to bookmark Ciancutti-Leyva’s blog for the latest news about breast implant safety. Finally, the Politics of Women’s Health section of “Our Bodies, Ourselves” contains a good amount of information on breast implants, including articles and online resources.

Maternal mortality and morbidity is a large problem worldwide, and one we’ve written about here in various contexts in the past. According to the World Health Organization, 1,500 women die from pregnancy- or childbirth-related complications every day, mostly in developing countries, and most of these deaths are avoidable.

In an attempt to focus international attention on this problem, The United Nations Human Rights Council included in its recent session a resolution on maternal mortality and morbidity.  According to the agency’s press release the resolution calls for the following:

• a study on preventable maternal mortality and morbidity, including identification of human rights aspect
• an overview of initiatives and activities within the United Nations system to address all causes of preventable maternal mortality and morbidity
• identification of how the Human Rights Council can add to existing efforts by providing human rights analysis, including efforts to achieve the Millennium Development Goal on improving maternal health
• recommended options for better addressing the human rights dimension of preventable maternal mortality and morbidity throughout the United Nations system.

In a joint release responding to the resolution, the Center for Reproductive Rights notes that “This is a groundbreaking step towards ensuring every woman’s basic human right to a safe and healthy pregnancy and childbirth. Governments should heed the call of the Human Rights Council and take urgent action to prevent women from dying needlessly in pregnancy and childbirth.”

A representative of Action Canada for Population and Development quoted for the release described the importance of the resolution thusly: “By supporting this resolution, governments have affirmed the right of women and girls to receive care before, during, and after pregnancy and childbirth, and to survive these experiences without illness or disability.”

When you think of prenatal care, you might think of things like ultrasounds, nutrition, dealing with chronic conditions, and other checking and rechecking of vital signs and changes throughout a pregnancy. I recently read, however, about a program in rural Kentucky that incorporates dental care into a CenteringPregnancy approach to prenatal care.

The CenteringPregnancy model of prenatal care typically involves participants with similar due dates, who meet in group sessions for physical examination, education, and group discussion and support on pregnancy and childbirth.

In a recent issue of the Journal of Health Care for the Poor and Underserved, one article describes the implementation of such a program with an added oral health component, led by a nurse midwife at a women’s health clinic in Kentucky. The authors explain:

…oral health information and treatment was incorporated into eight of the 10 group sessions. Topics included the oral systemic health link, myths and realities, plaque and how it causes disease, plaque removal techniques, dentition development, oral anatomy, caries and prevention, periodontal disease and prevention, and care for baby’s teeth. Second, a dental operatory was established within the CWH, so that every pregnant mother enrolled in CPS™ [CenteringPregnancySmiles] was given a dental examination approximately 14 weeks into their pregnancy, followed by therapeutic intervention to provide control of oral infections.

The authors report that at the first dental examination (around 13-16 weeks), nearly 70% of the women (primarily rural Medicaid recipients) had active caries (cavities), and many had tooth pain, infections, abscesses, gum inflammation and other dental concerns. By 34-38 weeks, however, the oral health of participants had improved considerably. For example, the percent of participants with bleeding points around the gums fell from more than 60% to 35%, and more than half of the oral infections were completely resolved.

The authors also noted lower rates of preterm birth and low birth weight among participants compared to the general population - although this is a preliminary finding requiring further investigation, the authors explain that “previous studies on the effect of oral infections on PTB and LBW pregnancy outcomes have estimated that up to 20% of these adverse birthing outcomes could be related to oral infections.”

I thought this was a neat approach to providing needed care that might have otherwise been unavailable or inaccessible to these women.

This Week’s Super Fun Health Reform Graphic: The award goes to The New York Times for the multi-tab Key Challenges in the Healthcare Debate. Below is the view from the section on “Getting Through Congress.”

Cuts to Medicare Drug Costs: The AARP has endorsed an offer by drug manufacturers to discount the price of some Medicare prescriptions by $80 billion over the next decade. The announcement was made today at the White House; a transcript of President Obama’s remarks is available here.

“The unusual offer by the Pharmaceutical Research and Manufacturers of America (PhRMA) is part of its effort to convince skeptical lawmakers that it backs major health-care legislation,” writes Ceci Connolly of the Washington Post. “Though the agreement represents a fraction of the total cost of health-care reform, it has been managed for maximum public relations exposure.”

Connolly explains how the deal would work:

When the Medicare prescription drug benefit approved by Congress went into effect in 2006, it left a coverage gap that charges seniors the full cost of medications once a patient has received $2,700 worth of drugs, until the total reaches about $6,100. At that point, “catastrophic” coverage kicks in and covers nearly all drug expenses.

“The existence of this gap in coverage has been a continuing injustice that has placed a great burden on many seniors,” Obama said over the weekend.

Under the proposal, seniors who fall into the coverage gap known as the “doughnut hole,” would pay half price for all brand-name medicines. The discounts could save 3.5 million retirees up to $1,700 a year, according to AARP. In addition, the full price of the drug would count toward a person’s out-of-pocket total, thus maximizing the insurance benefit.

Connolly also wrote a good Sunday Outlook piece on Obama’s strategic approach to health reform, and this morning she participated in an online discussion about the article.

Study Time: It’s a busy week for Congress, as three House committees — Ways and Means, Energy and Commerce and Education and Labor — take up health-reform legislation. Here’s the draft bill released Friday by House Democrats.

Kaiser Health News’ Mary Agnes Carey discusses the highlights of the bill, which includes an individual mandate for coverage, with some exclusions, and an employer mandate – called “pay or play.” As for how it will be paid for:

They stressed that everything is on the table. They have some ideas. They want major Medicare and Medicaid system reform such as ‘accountable care’ organizations that really try to coordinate medical care to make sure it’s the best possible care for the patient and reducing hospital re-admissions.

But of course, they’re always talking about taxes as well. And these are some of the ideas that will be discussed in the coming weeks: a tax on the benefits that an employer provides, a payroll tax, a tax on sugary drinks, taxes on alcohol, value added taxes (also called VAT) on some goods and services.

Igor Volsky at The Wonk Room notes that the Tri-Committee proposal “seems to contain a fairly robust public insurance option.” The Times published a poll Sunday showing overwhelming support for a government-funded public option that would compete with private insurance plans.

“On the whole,” adds Volsky, “the bill’s affordability measures are impressive.” His post includes a comparison of the HELP bill, the Senate Finance Committee draft and the Tri-Committee bill.

Raising Women’s Voices notes that the new House bill includes a statement on meeting women’s health care needs. Two points in particular stand out:

• Include coverage of maternity services as a benefit category in the new basic benefit package. All plans in the Exchange would be required to maternity services and over time plans outside the Exchange would be required to do so as well.
• Prohibit plans in the Exchange from charging women more than men by banning gender rating. This protection will extend to all health plans outside the Exchange over time as well.

Pus: The Senate debate kicked off Wednesday, and it was a rocky start. Jeffrey Young at The Hill has more.

Here are six senators to watch for their involvement in crafting a bipartisan health-care bill, via The Fix. Three former Senate majority leaders — Democrat Tom Daschle, and Republicans Bob Dole and Howard Baker — have reemerged with their own plan. They must be missing the excitement.

Dan Balz writes that Obama is soon going to have to “make clear what he’ll accept and what he won’t” when it comes to “cost and coverage, revenue and savings, a public option or not, and the cost vs. the desirability of bipartisan agreement.”

Cost and coverage suddenly became a more central issue after the Congressional Budget Office issued new estimates last week. The goal of reform advocates long has been a plan that moves the country to universal coverage. Earlier assumptions put the price tag in the neighborhood of $1 trillion over 10 years. The CBO shattered those assumptions, though their numbers were based on incomplete plans.

A preliminary estimate of the Senate Finance Committee’s draft bill put the price tag of universal coverage at $1.6 trillion over 10 years. That was considerably more than anyone anticipated and forced the committee to delay work on the bill. The cost of the incomplete plan drafted by the Senate Health, Education, Labor and Pensions Committee was pegged at about $1 trillion over 10 years, but the CBO said that would still leave 30 million (rather than the current 46 million) people without coverage.

Talking Points: Media Matters notes that during a Sunday morning interview with members of the Obama administration’s health care team, Good Morning America’s Diane Sawyer didn’t include any questions that reflected the concerns or positions of progressives.

Meanwhile, single-payer advocates continue to make news. The Boston Globe has a Q&A with Dr. Steffie Woolhandler, a Cambridge Health Alliance internist and Harvard Medical School professor who co-founded Physicians for a National Health Program. And MinnPost.com interviews PNHP’s president, Dr. Oliver Fein, who notes how popular single payer has become, despite its unpopularity:

What I think is really interesting is that although Sen. [Max] Baucus says that single payer is off the table, at the minimum, we’re the elephant under the table. Everybody is referring to us.

So, you have someone like [Health and Human Services Secretary Kathleen] Sebelius now saying we’ll create a public option that will not go to single payer. You have Republicans saying that the thing they fear is single payer; you have a whole variety of discussion that’s going on that keeps referring to this thing called single payer. Probably one of the real problems is there’s not enough of a definition for the public to make an assessment about what that really is.

Plus: Here’s Sebelius’s no-single-payer interview with NPR.

In other political news …

So About That All-Important Sounding Council …: Linda Lowen, About.com Guide to Women’s Issues, is waiting to hear what the White House Council on Women and Girls is doing. And she doesn’t like waiting. Via Feminist Peace Network (she doesn’t like waiting, either).

Did You Hear the One About the Republican Senator Who Wouldn’t Condemn Clinic Violence?: Sadly, it’s true. Jodi Jacobson reports at RH Reality Check that an anonymous Republican senator used his (it’s presumed, with good reason, that the Republican in question is male) power “to put a ‘hold’ on a Senate Resolution originally introduced by U.S. Senators Jeanne Shaheen (D-NH), Barbara Boxer (D-CA), and Amy Klobuchar (D-MN) condemning violence against women’s health providers, thereby blocking any vote on the resolution.”

Bush Bioethics Panel No More: The New York Times reports: “Members of the President’s Council on Bioethics were told by the White House last week that their services were no longer needed and were asked to cancel a planned meeting, a council staff member said Wednesday.”

Reid Cherlin, a White House press officer, told the NYT the panel was designed to a “a philosophically leaning advisory group” that was more about discussion than consensus-building.  that favored discussion over developing a shared consensus. Obama will appoint a new panel charged with offering “practical policy options,” said Cherlin.

The FDA’s Full Plate: FDA Commissioner Margaret Hamburg told USA TOday there’s no truth to the rumors that the FDA will split in two, with one half overseeing food safety and tobacco and the other responsible for oversight of medical products.

Drug safety, tobacco regulation and direct-to-consumer advertising top Hamburg’s agenda. On the subject of advertising, Hamburg said, “There certainly have been concerns about the quality and authenticity of some of the messages … We have a dedicated staff working on the issue.”

On Tuesday, June 23 (tomorrow!), the National Women’s Law Center is sponsoring a webinar, “Planning for the Future: What Women Need to Know About Social Security.” It’s scheduled to start at 1 p.m. EST. It’s free, but registration is required.

Here’s the write-up:

As women think about retirement, they may take stock of their savings and realize they don’t have enough saved ─ and they don’t know what to do with the savings they do have. They may not know what benefits they can get from Social Security, and how their decisions about when to claim benefits (and their husband’s, if they are married) can affect the benefits they receive.

Don’t panic! The National Women’s Law Center is hosting a two-part series of free webinars to help women prepare for retirement, for service providers, advocates, and individuals. The first webinar is about women and Social Security; the second is about pensions and savings.

Featured speakers will include:

* Joan Entmacher, National Women’s Law Center
* Maria Freese, National Committee to Preserve Social Security and Medicare

If you have an hour free tomorrow, go register.

Kaiser Family Foundation has released an important package of resources that shines a spotlight on health disparities between white women and women of color in all 50 states and Washington, D.C.,

The report (pdf), “Putting Women’s Health Care Disparities On The Map: Examining Racial and Ethnic Disparities at the State Level,” takes into account 25 indicators, including rates of diseases such as diabetes, heart disease, AIDS and cancer, and access to health insurance and health screenings.

The states with the largest rate of disparities were Arkansas, Indiana, Louisiana, Mississippi, Montana and South Dakota. States such as Virginia, Maryland, Georgia and Hawaii showed relatively smaller disparities between women of color and white women on health outcomes and health care access.

The reports also notes that white women and minority women were doing similarly well in Maine — and similarly poorly in Kentucky and West Virginia.

This introductory page includes links to the full report and numerous documents that look closely at health status, access to health care, social determinants and workforce statistics.

Among the key findings:

Disparities existed in every state on most measures. Women of color fared worse than White women across a broad range of measures in almost every state, and in some states these disparities were quite stark. Some of the largest disparities were in the rates of new AIDS cases, late or no prenatal care, no insurance coverage, and lack of a high school diploma.

In states where disparities appeared to be smaller, this difference was often due to the fact that both White women and women of color were doing poorly. It is important to also recognize that in many states (e.g. West Virginia and Kentucky) all women, including White women, faced significant challenges and may need assistance.

Few states had consistently high or low disparities across all three dimensions. Virginia, Maryland, Georgia, and Hawaii all scored better than average on all three dimensions. At the other end of the spectrum, Montana, South Dakota, Indiana, and several states in the South Central region of the country (Arkansas, Louisiana, and Mississippi) were far below average on all dimensions.

States with small disparities in access to care were not necessarily the same states with small disparities in health status or social determinants. While access to care and social factors are critical components of health status, our report indicates that they are not the only critical components. For example, in the District of Columbia disparities in access to care were better than average, but the District had the highest disparity scores for many indicators of health and social determinants.

Each racial and ethnic group faced its own particular set of health and health care challenges.
The enormous health and socioeconomic challenges that many American Indian and Alaska Native women faced was striking. American Indian and Alaska Native women had higher rates of health and access challenges than women in other racial and ethnic groups on several indicators, often twice as high as White women. Even on indicators that had relatively low levels of disparity for all groups, such as number of days that women reported their health was “not good,” the rate was markedly higher among American Indian and Alaska Native women.

Plus: Kaiser also put together a video companion to the report. Filmed at the Arlington (Va.) Free Clinic, the video looks at the challenges that uninsured women face.

It started with a bomb threat.

We were at the National Network of Abortion Funds Organizing Summit, held at a Chicago hotel last weekend. The Network consists of grassroots groups who raise money to directly help women and girls with the cost of abortion, and ever year it bring members together for training and meetings. This was my eighth year attending, and I was looking forward to the first night’s social hour, a time to reconnect with old friends and meet new ones. It’s always been one of my favorite moments.

So there we were, in the hotel bar, when the staff informed us of the threat. An uneasy silence was quickly replaced with loud chatter that reflected our anger. The police told us that the threat was non-specific, but you have to admit it was horrible timing. We were already grieving the murder of Dr. George Tiller, and the threat of additional violence, directly related to us or not, was almost too much. But true to the work that we do, we kept to the schedule. If there’s one thing abortion rights activist have in common, it’s a ridiculous amount of determination.

During the Friday morning plenary, I noticed a large number of participants under age 35. In fact, I would easily estimate more than half of the 140 attendees were young women, which left me feeling a bit giddy for the future of the movement. (The majority of Funds are all volunteer run, so those who believe young women aren’t activists should take note.)

As member Funds introduced themselves and gave their yearly reports, it became evident that abortion funding is evolving as an international movement. Not only did 55 out of the 100 U.S. member Funds attend, but Funds from England/Ireland, Canada and Mexico were also present. There’s also one Fund that operates solely online. I was thrilled to learn more about the global work to ensure access to abortion care.

I was contemplating access to rights when we learned that Gretchen Dyer, executive director of the Texas Equal Access Fund, had died unexpectedly of heart failure in a Dallas hospital. She was a tireless supporter of women’s rights, especially dedicated to bringing young women and women of color into the movement. She also loved art and film and found a way to combine her passions by writing and producing “1 in 3,” a play about abortion. Our small community faced yet another devastating loss. Once again, under the weight of grief, our determination kept us going.

Over the next couple of days, I attended a variety of workshops on fundraising and organizing, including programs on repealing the Hyde Amendment and even how to avoid activist burn out. At the Saturday evening banquet, we mourned our losses and celebrated our victories. We honored one of the original Network founders, Tom Moss, founder of the Iowa Medical Aid Fund (Tom joked that he was still one of the only men in the room, which was true).

Many other Funds were honored, including the Roe Fund in Tulsa, Okla., (part of the Religious Coalition for Reproductive Choice), which was recognized for 30 years of service, and the Eastern Massachusetts Abortion Fund, of which I am a board member. We received props for volunteer involvement and as a model for movement building.

When the formalities were over, we moved on to the talent show. Fund members performed songs, spoken word, cheerleading (yes, cheerleading), and, of course, comedy. Though many performances emphasized the intersection between the work we do and our personal lives, it was a chance to present our whole selves and not just our roles as abortion rights activists. I was in the last group to perform, along with friends from North Dakota and Virginia. When we finished our comedy/singing act, we held up a sign that read, “Abortion Funds Rock.” Everyone stood in unison, clapping, cheering and pounding on tables in agreement.

On Sunday, the Network presented Rep. Jane Schakowsky (D-Illinois) with an award for her work around women’s rights, health care reform and social justice. Schakowsky discussed the ongoing battle for health care reform, including reproductive rights. It was a fitting end to an intense four days.

As the Summit concluded, I was exhausted, sad and ready for my own bed. I was also inspired and rejuvenated, armed with new tools and ready to take on another year of fighting the good fight. I am determined to change minds, and laws, to ensure women and girls always have access to abortion care. And after last weekend, I am reminded that I am not alone.

Wendy Brovold is the communications and marketing manager at Our Bodies Ourselves, and a board member of the Eastern Massachusetts Abortion Fund. For more information about the National Network of Abortion Funds, including how to start a Fund in your area, please visit www.nnaf.org.

A recent piece at Salon by Kate Harding (also of Shapely Prose) asks, Is there a next generation of abortion providers? Harding explains that while fear of violence and growing up after Roe may play a role in medical students’ decisions not to learn to perform abortions, “another factor keeping young doctors away from providing abortions is lack of comprehensive family planning training in medical schools.”

Harding points out that “fewer than 50 institutions in the U.S., out of 130 accredited medical schools, offer abortion training as part of their residency programs.” Harding also profiles one ob/gyn who explains that the one hour of lecture material on abortion she received in her first two years of med school was delivered by an anti-choice professor who misrepresented both state law and the medical evidence on abortion.

Harding also interviewed Susan Wicklund, author of This Common Secret: My Journey as an Abortion Doctor, and Dr. Mitchell Crenin of the Society for Family Planning. Each notes that anti-choice pressure on medical school administration has reduced access to training, as schools seek to avoid controversy by avoiding the topic of abortion.

A few organizations are working to increase access to (accurate) abortion-related training. Medical Students for Choice (MSFC, mentioned in the Salon piece) does student organizing and advocacy to influence medical school curricula, workshops (including the “papaya” workshops mentioned in this Double Dose) and lectures on abortion techniques. The organization also helps to link medical students and residents with family planning externships. They also maintain a list of ob/gyn residencies that provide abortion training. MSFC began in 1992, after two incidents occurred back to back:  medical students across the U.S. received anti-choice mailers at home, and abortion provider Dr. David Gunn was murdered.

The Ryan Program (which I learned about via this reader and doula/midwife-turned-med student) has as its mission “to increase and strengthen training opportunities in abortion and contraception for residents in obstetrics and gynecology and to encourage and support residents’ exposure to evidence-based clinical care and research in the field of family planning.” Based at UC San Francisco, the program provides funding, technical expertise, curriculum, workshops, and other resources to support training opportunities in abortion and contraception for ob/gyn residents.

Physicians for Reproductive Choice and Health works with American Medical Student Association members to provide “project in a box” materials for medical students wanting to assess and influence their schools’ curricula on sexual and reproductive health.

For more on this topic, see the Salon piece as well as the organizational websites linked above.