Archive for the ‘Birth Control & Family Planning’ Category

March 2, 2012

Los Intentos de los Republicanos por Frenar la Cobertura para Anticonceptivos Falla, pero ahora Viene la Pregunta: ¿Qué si habrían 83 Senadoras?

Escrito por Christine C. Traducido del orginial en inglés March 1, 2012.

OBOS has received funding to make blog entries available in Spanish. We hope to expand outreach efforts in the coming year.

Con una votación muy cerrada, 51 a 48 votos, hoy el Senado frenó una medida que permite a los empleadores y compañías de seguro médico negar cobertura para anticonceptivos y otros servicios médicos por cualquier objeción religiosa o moral.

El voto fue una de las enmiendas propuestas por el senador Republicano Roy Blunt de Missouri, quien buscó agregar la cuña política más grande entre un individuo y su doctor.  La enmienda hubiera permitido que los empleadores y compañías de seguro nieguen cobertura de “puntos o servicios específicos” si la cobertura fuera “contraria a ciertas creencias religiosas y convicciones morales del patrocinador, emisor, u otra entidad que ofrece el plan.”  Así es como se pudo desarrollar la propuesta, y como ésta pudo haber afectado a la comunidad LGBT.

La enmienda se escribió en respuesta al debate sobre el plan del presidente de exigir cobertura, sin copago, por servicios médicos que el Instituto de Medicina categoriza como “preventivos”—incluyendo los anticonceptivos.

Los republicanos obstaculizaron el acuerdo que el Presidente Obama presentó el mes pasado en un esfuerzo por responder a las preocupaciones generadas por la Conferencia de Obispos Católicos de los Estados Unidos.  Según ellos, las organizaciones sin fines de lucro afiliadas a la iglesia, como hospitales y universidades, no deberían ser obligadas a proveer cobertura de control de la natalidad a sus empleados—aunque esas organizaciones reciben fondos públicos y emplean personas de todas las religiones.  (Iglesias y otras organizaciones explícitamente religiosas ya son eximidas).  Al evadir el problema, las compañías de seguro proveerían directamente cobertura de anticonceptivos, lo cual por supuesto,  no gustó a los críticos.

De acuerdo a la encuesta de seguimiento hecha pública hoy por la Fundación de la Familia Kaiser, 6 de 10 americanos, incluyendo católicos, apoyan el requisito de que los planes de seguro médico provean servicios anticonceptivos gratuitos como beneficios preventivos para las mujeres.

El debate de hoy fue acalorado; muchos demócratas mostraban frustración, porque a su parecer, el país parece estar atascado en un debate de ya medio siglo sobre el control de la natalidad.  El Senador Bernie Sanders de Vermont resumió la cuestión muy bien:

“Este ataque es terriblemente injusto, y espero que los hombres se unan a las mujeres en la lucha para proteger este derecho básico.  Déjenme añadir mi fuerte opinión que si el Senado de los Estados Unidos tuviera 83 mujeres y 17 hombres en vez de 83 hombres y 17 mujeres, una propuesta de ley como ésta nunca hubiera llegado al piso.”

Además, algunos Republicanos parecían sorprendidos (¡sorprendidos!) al percatarse que la anticoncepción es considerada parte de los servicios de salud preventiva.  Para examinar en profundidad sobre este asunto, lea este artículo escrito por Adam Sonfield que fue publicado en la edición de primavera del 2010 en el Guttmacher Policy Review.  Incluimos aquí una sección del mismo:

[...] Healthy People (Gente Saludable) 2010, explica la importancia de la planificación familiar, como servicio preventivo, para controlar los costos sociales, económicos y médicos de los embarazos no planificados.  En este contexto, los costo médicos son más notables: “Medicamente, los embarazos no planeados son graves por cuanto se pierde la oportunidad de preparación para un embarazo óptimo; aumenta la posibilidad de enfermedades en el bebé y en la madre, y hay la posibilidad de aborto.  Es menos probable que la madre busque cuidado prenatal en el primer trimestre y es más probable que no busque cuidado prenatal en absoluto.  Es menos probable que ella amamante a su bebe y es más probable que ella exponga a su bebe a drogas peligrosas, como el tabaco o el alcohol.  El niño de este embarazo tiene mayor riesgo de un bajo peso neonatal, de morir en el primer año, de sufrir de abuso, y de no recibir suficientes recursos para un desarrollo saludable.

Los Centros para el Control y la Prevención de Enfermedades mencionan razones parecidas en su trabajo para prevenir los embarazos no planeados y para designar a la planificación familiar como uno de los 10 mejores éxitos del siglo 20.  Y por supuesto, hay clara evidencia de que la anticoncepción es un cuidado preventivo efectivo.  Así por ejemplo, solo los servicios anticonceptivos y provisiones con fondos públicos ayudan a las mujeres de los Estados Unidos a evitar casi dos millones de embarazos no planeados por año.  Sin estos servicios (que se pueden recibir en centros de planificación familiar o de doctores que trabajan con pacientes que reciben ayuda pública “Medicaid”), el nivel de embarazos no planeados, abortos y partos no planeados en los Estados Unidos sería aproximadamente dos-tercios más alto en las mujeres en general, y casi el doble en las mujeres pobres.  La evidencia es igualmente clara a nivel internacional: en el 2008, el uso de anticonceptivos modernos ayudó a las mujeres a prevenir 188 millones de embarazos no planeados y, por eso, prevenir 1.2 millones de muertes de bebes recién nacidos, y salvó decenas de millones de años de vida productiva (artículo relacionado, página 12).

Por tanto, no es sorpresa que la panificación familiar es una de las cinco áreas de prioridad enumeradas bajo “servicios preventivos de salud” en el primer número de Healthy People (Gente Saludable) del 1979 y ha sido una de las áreas de enfoque en cada edición siguiente.

Este enlace dirige también a otro excelente artículo, “Planificación Familiar y Maternidad Segura: Dólares y Sentido,” que provee una visión general más global.  Para un resumen breve de los importantes beneficios globales, vea el testimonio de la Secretaria del Estado Hillary Clinton de esta semana sobre fondos de los EEUU para la panificación familiar internacional.

Estos son los aspectos sobresalientes del articulo de Clinton: “Los cálculos globales indican que al ayudar a las mujeres a separar sus partos y evitar embarazos no planeados, la  planificación familiar tiene el potencial de prevenir el 25% de muertes de madres y bebés en los países en vías de desarrollo.  La planificación familiar es la mejor manera que tenemos para prevenir embarazos no planeados y abortos.”

Para más información en español sobre el tema:


March 2, 2012

Friday Women’s Health Hero: Sandra Fluke

Just when we think Rush Limbaugh couldn’t possibly sink lower, he takes on Georgetown University Law student Sandra Fluke for testifying about the importance of insurance coverage for contraceptives. During his radio show this week, Limbaugh used the most offensive language he can get away with on-air: He called Fluke a slut.

The good news is at least two advertisers so far (Sleep Train and Sleep Number) have pulled their commercials off Limbaugh’s show (a petition is underway to get ProFlowers to do the same). Faculty, administrators and students from Georgetown and other law schools released a statement applauding Fluke’s “strength and grace” in the face of the attacks (really: Fluke is unflappable in every TV appearance, consistently taking the high road). President Obama called Fluke to thank her for speaking out on behalf of women — adding that her parents should be proud.

And we had the pleasure of reading Jen Doll’s take on Limbaugh, published at The Atlantic Wire:

If Rush Limbaugh slut-shames you, you’re doing something right, because he is pulling out what he imagines to be his most hurtful, vicious, full-barreled defense strategy against a woman. If you call a woman a “slut,” you see, she will cower in a corner and hide because that is akin to calling her ugly, or worthless. At least that’s what small-thinking men (and sometimes women) assume; women would rather die than be dubbed such a thing! Slut-shaming is a tool of cowards who want to make women feel bad because, truthfully, they’re afraid of what those women might do given a platform like, say, the floor of Congress. And this means Limbaugh is not just a bully, but also an über-troll, exploiting his own drummed-up outrage and the Internet’s eagerness to amplify it. Which only makes Sandra Fluke, and all of the thoughtful people out there fighting for women’s contraceptive rights — who, for the record, aren’t resorting to name-calling or troll tractics — look even better.


February 23, 2012

The True Costs of Birth Control

With the recent furor over contraceptive coverage, many of us have heard some version of, “But isn’t birth control really cheap and easy to get anyway?”

The reality is much less straightforward. When the Institute of Medicine looked at this issue while deciding whether to recommend that birth control be included among preventive services to be provided at no cost, it noted that while contraceptive coverage has expanded for many with private or federal coverage, many women still do not have insurance coverage or, if they do, their copays for prescriptions may have increased in recent years.

The Institute also cited evidence that even small increases like cost-sharing (requiring patients to pay more) create a barrier to preventive services like birth control. When out-of-pocket costs are reduced or eliminated, however, women are more likely to choose more effective methods of contraception. Testimony from the Guttmacher Institute (pdf) supported the preventive benefits of contraception and described the financial barriers to use.

While women with insurance may have coverage for birth control on paper, the actual costs may still pose a barrier to actually getting it — and probably contributes to half of pregnancies in the United States being unintended.

Jessica Arons of the Center for American Progress has a great piece at RH Reality Check, “The High Costs of Birth Control: A Major Barrier to Access.” Arons presents a number of facts and resources on contraceptive costs and use, explaining that “High costs have forced many women to stop or delay using their preferred method, while others have chosen to depend on less effective methods that are the most affordable.”

And Michelle Andrews at Kaiser Health News writes: “With prices ranging from about $1 for a condom to more than $800 for an intrauterine device (IUD), some of these women, maybe a lot of them, might switch methods if they could afford to.” She continues:

That’s exactly what many women’s health advocates hope. Long-acting methods such as the IUD and the hormonal implant are nearly 100 percent effective, require no effort after insertion and protect against pregnancy for up to 10 years. (In contrast, birth control pills are about 92 percent effective, and many other common methods are even less reliable in everyday use.)

For an estimate of how much a woman could expect to spend on birth control depending on her age, method, and insurance coverage, check out this calculator at Mother Jones.

Plus: Sandra Fluke, the law student at Georgetown University who was blocked from testifying at last week’s hearing on insurance coverage for contraception while five clergymen weighed in, testified today at a hearing the Democrats put together on women’s health. Yet in another move to silence debate, Republicans prevented C-SPAN from televising the hearing.


February 22, 2012

Birth Control, Santorum and the Media: Battle Over Women’s Health Hits Feverish Pitch

You know when you’re feverish and you overhear bits and pieces from the news and it all swirls together in headache-fueled song? That’s how I spent a good part of February. I’m still coming to terms with the fact that covering prenatal testing has been called into question, or that Virginia legislators thought it would be cool to mandate transvaginal ultrasounds for women seeking abortions — at least until Gov. Robert McDonnell saw his VP hopes sink lower every time the word “transvaginal” was mentioned (the Virginia House passed an amended bill today requiring external ultrasounds instead).

At one point I assumed Komen must be behind all of this — a PR maneuver to distract from the Planned Parenthood blowback — but that, too, was the fever talking. Reality was far harsher: Republicans had set the cultural clocks back to 1950.

Consider this bit of political history, courtesy of Ann Gerhart:

“We need to take sensationalism out of this topic so that it can no longer be used by militants who have no real knowledge of the voluntary nature of the program but, rather, are using it as a political stepping stone,” said George H.W. Bush. “If family planning is anything, it is a public health matter.”

Title X, the law he sponsored that still funds family planning for the poor, passed the House by a vote of 298 to 32. It passed the Senate unanimously. A Republican president, Richard Nixon, enthusiastically signed it.

That was 1970.

Cable news channels played into the time warp, inviting almost twice as many men as women onto news programs to discuss women’s access to contraception — a huge topic thanks to a very small group, the U.S. Conference of Bishops. Jennifer Pozner, executive director of Women in Media and News, gives those media figures some depressing context:

The twitterverse seemed shocked to learn that female experts were sought out as commentators only 38 percent of the time on a story about women’s health. As a media critic, I was surprised, too—because that’s actually a higher percentage of women’s voices than typically heard across all news categories, not just in stories involving women’s bodies.

To understand institutional sexism within the media, look no further than the systematic sidelining of women’s perspectives in corporate news and public affairs programming. Women are a paltry 14 percent of all guests on influential, agenda-setting Sunday morning news shows on ABC, NBC, CBS, FOX and CNN—more than half of whose episodes feature no female guests at all (White House Project). The disparity is just as stark in nightly news, where women are 19 and 27 percent of cable and network news sources, respectively (Pew Project for Excellence in Journalism).

A new report from the Women’s Media Center paints a similarly bleak picture.

I’ve been frustrated, too, by the lack of useful information. Often (mostly) male anchors and guests ruminate over the politics of women’s health without bothering to fact-check the pompous statements and accusations, letting misinformation sit uncontested.

But there are signs of relief. While print/online publications and public radio are doing a better job than television at presenting the facts (see Erika Christakis’s smart column in Time magazine on the birth control debate and the rise of unintended pregnancies, and Irin Carmon’s longer analysis in Salon), TV news has shown some improvement.

In the wake of GOP candidate Rick Santorum’s harmful claims, I was grateful to see Marjorie Greenfield, a professor of obstetrics and gynecology at University Hospitals Medical Group and a longtime contributor to “Our Bodies, Ourselves,” address the importance of insurance coverage for prenatal testing Tuesday on MSNBC. She explained the difference between routine screening tests, such as ultrasounds, and more specific diagnostic tests, such as amniocentesis, which can determine whether a fetus has certain genetic conditions. Most women who are offered amniocentesis are carrying healthy fetuses, she said, so in the vast majority of cases, testing provides reassurance.

Greenfield noted that when she discusses amniocentesis to her patients, some are certain they would terminate a pregnancy if the fetus has a genetic anomaly such as Down Syndrome; others are sure they would not. In the middle are women who don’t have a clear position but who want more information so they can decide, with their families and physicians, the best course of action. Families may turn to support groups or specialists to learn how to prepare for a child with particular health challenges, or, if the genetic anomaly is fatal, arrange for hospice care.

Amniocentesis is expensive, often costing several thousand dollars. If it were not covered by insurance, many women would be unable to obtain the facts they need to make informed decisions.

That brings us to class issues that are rarely discussed, even though the intersections of race, class and gender are unavoidable in most any discussion about women’s health. So let’s cheer for Melissa Harris-Perry, a gifted debater, who is now hosting her own two-hour news program Saturday and Sunday mornings on MSNBC. Harris-Perry made her public intellectual name as frequently the only pundit to complicate solely political horse-race debates by providing a broader social context.

Additionally, Pozner notes that Harris-Perry is “the first black progressive woman to ever solo-host her own news and politics show on a major corporate TV news outlet.” And she isn’t giving up her day job — the Tulane professor is also “the first scholar to teach a full course-load during the week, and grill politicians and pundits on live TV over the weekends.”

This past weekend featured a discussion of gender roles and positions of power in religion and in Congress. Harris-Perry started with a wonderfully nerdy look at how schema affects our attitudes and expectations of who gets to be a leader — and the importance of changing the picture. And it might be good to start with our House — and Senate. Consider: Women comprise only 17 percent of the U.S. Senate and 16.8 percent of the House membership.

Harris-Perry also took on Virginia’s anti-women push — three bills that deal women a losing hand, including the aforementioned transvaginal probes for women seeking to have an abortion; Medicaid restrictions that would force poor women to carry pregnancies to term when the fetus has an incapacitating deformity or mental deficiency; and personhood legislation that could criminalize contraception and outlaw abortion.

There is quite a good amount of organizing going on against these and other attacks on women’s rights and health — including a silent protest this week at the Virginia state capitol and this-just-in news about a march on Washington on April 28.

A number of women’s health groups have formed the Coalition to Protect Women’s Healthcare. It’s new, and it will be interesting to see where it goes. Member groups are organizing visibility events this week at the district offices of members of Congress — especially those who have been promoting religious employer exemptions. You can visit the site for facts about contraception and sign a pledge calling for insurance coverage of birth control, no matter where women work.

Visit Pinterest much? Check out The War on Women page, started by Hello Ladies, for a running catalog of stories and images (love the description: “Ladies, we are under attack. Stay informed. Stay vocal. Run for office.”).

And there’s much needed humor, and not just from the typically awesome Jon Stewart and Stephen Colbert. See The Second City’s Network take on contraception hearings below.

Laughter really is the best medicine.


February 17, 2012

Keeping Up With the War on Choice and Contraception

This past week has been an absolute whirlwind of “What the….?!?” with ongoing attempts by Republicans to push back against women’s access to contraception and choice. If you’re catching up now, here’s some good reading:

At ThinkProgress, Democratic Women Boycott House Contraception Hearing After Republicans Prevent Women From Testifying. Right, who needs women at a hearing about women’s health and access to medications?

The Democrats wanted to have one woman testify about the effects on women of lacking access to contraceptive coverage, but Oversight Committee Chair Darrell Issa refused to let her. You can view the intended testimony online.

Pelosi got it right when she asked in frustration: “Five men are testifying on women’s health. Where are the women? Imagine having a panel on women’s health and they don’t have any women on the panel. Duh?”

Santorum supporter Foster Friess told Andrea Mitchell that “back in (his) day,” women put an aspirin between their knees and that worked pretty well for contraception — the implication being that women could just keep their legs together (or feign a headache?). He’s since tried to say it was just a bad joke, but I think we know where that sentiment comes from — the insistence that women should not have sex if they don’t want to get pregnant (which also completely ignores the non-contraceptive uses for hormonal birth control).

At Slate, Virginia’s Proposed Ultrasound Law Is an Abomination. That state’s legislature passed a law requiring that women seeking an abortion undergo ultrasound imaging showing the fetal heartbeat and gestational age prior to the abortion. There is no medical purpose — just a shaming one. And since most abortions are done within the first trimester, the information required would necessitate a transvaginal ultrasound in which a condom-covered probe is inserted in the vagina. Thus, Virginia has mandated that women seeking abortions must be forced to have an object inserted in their vaginas for no medical reason.

RH Reality Check also covered this Virginia law, in State-Sanctioned Rape: Trans-Vaginal Ultrasound Laws in Virginia, Texas, and Iowa. I would just change this to “State-Mandated,” because I think it lets the legislature off too easy with “sanctioned” — they are explicitly demanding it. The story has a useful illustration of what it really means to get a transvaginal ultrasound.

Have other links we should read? Leave ‘em in the comments.


February 15, 2012

Rachel Maddow on Republican-Led State Efforts to Interfere with Birth Control, Abortion

Last night, Rachel Maddow took on Republican anti-birth control, anti-abortion efforts around the states, including really egregious legislation in Virginia that would force women to undergo transvaginal ultrasounds if they want an abortion. This would be the state mandating that women have an object placed in their vaginas, for no medical purpose, with no opportunity to refuse consent if they wanted an abortion, and no opportunity for their healthcare provider to decide if the imaging was necessary.

Just check out the clip:

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A transcript is available on the website.


February 10, 2012

From the White House: Women at Religious Institutions Will have Contraception Covered

Today, the White House released a document addressing recent controversy over one preventive service covered under the Affordable Care Act – birth control. Under the Act, insurance plans are required to provide coverage for contraception without charging a co-pay, co-insurance or a deductible. U.S. Catholic bishops objected to the coverage, claiming it was a violation of their religious beliefs.

The statement indicates:

The policy also ensures that if a woman works for a religious employer with objections to providing contraceptive services as part of its health plan, the religious employer will not be required to provide, pay for or refer for contraception coverage, but her insurance company will be required to directly offer her contraceptive care free of charge.

In other words, Catholic or other religiously affiliated organizations get to say they selected health insurance plans for their employees that do not cover contraception, while those employees can still receive no-cost contraception directly via the insurance providers. Whether these costs will be covered by the insurance companies directly, or perhaps reimbursed to those companies via Medicaid, is not clear, and we’ll need to watch the implementation to make sure this ends up working for women.

The provision already had exemptions for religiously-focused organizations like churches. At issue were the religiously affiliated organizations such as Catholic hospitals and universities, which typically employee people from a variety of (or no) faith traditions. Many such organizations already offer contraception coverage to employees, and a number of states require employer-based plans to provide this coverage.

According to one recent survey, the majority of Catholic Americans (52%) say religiously affiliated colleges and hospitals should have to provide coverage that includes contraception. A 2011 Guttmacher report indicated that, “Among all women who have had sex, 99% have ever used a contraceptive method other than natural family planning. This figure is virtually the same, 98%, among sexually experienced Catholic women.”

Here’s Rachel Maddow talking about the issue on Wednesday, placing it in the context of the current elections:

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February 7, 2012

The War on Women’s Health Care: Judy Norsigian Joins Discussion on Influence of Conservative Groups

On Monday night, OBOS Executive Director Judy Norsigian discussed the politicization of women’s health on Al Jazeera with Hadley Heath, a senior policy analyst with the Independent Women’s Forum, and Tara McGuinness, senior vice president for communications at the Center for American Progress.

“Inside Story” host Shihab Rattansi was well prepared for what turned into a very interesting discussion. The questions on the table included: Is women’s health being damaged by politics in the U.S.? Has the controversy over funding to Planned Parenthood for breast cancer screening underlined the extent to which conservative groups now influence women’s health access?

On the subject of Komen backpedaling on its controversial decision to stop making grants to Planned Parenthood, Nosigian said: “What we see here is a conservatizing trend in this country that I think has emboldened many … I saw the reversal of the decision simply as damage control. I do not think there has been a profound change in perspective at all.”

McGuinness made this valuable point: “This was an effort to politicize what is not a political thing … I think when it comes to women’s health, there aren’t two sides to this issue.”

Even though Komen executive Karen Handel, who drove the decision to cut off funding to Planned Parenthood, resigned this morning, the controversy is far from being closed.

Watch the discussion below.


February 3, 2012

Now, About Planned Parenthood and the Bishops …

by Ellen Shaffer and Judy Norsigian

This week, we all learned a lot about Susan G. Komen for the Cure, and Planned Parenthood, and breast cancer. Now that Komen has caved (sort of; Planned Parenthood’s response), we might start to learn what it will take to mobilize an outcry to really stop the attacks on women’s health.

As Komen was committing a huge PR failure, it became clear via Facebook, Twitter and a new Tumblr site, Planned Parenthood Saved Me, that many women value and rely on Planned Parenthood for breast cancer exams and other preventive health services. A slam-dunk week for Planned Parenthood.

We need to make it a slam-dunk month. What Komen, and the evangelicals, and Republican Rep. Cliff Stearns, who launched the pointless political inquiry, and the U.S. Conference of Catholic Bishops are really mad at Planned Parenthood about is this:

Part of what they do is help people plan. Parenthood. You know. They support birth control. In some cases, they provide it. Like your corner drugstore, but better.

And this week, the bishops are howling about it because the Obama administration refused to grant a broad religious exemption to contraception coverage.

Never mind that virtually all Catholics use birth control, that the Church itself only began to oppose it in 1968, that the Pope recently conceded that condoms are useful, and approved condom use for stopping the transmission of AIDS.

Never mind that most Catholic-affiliated hospitals, schools and charities cover birth control in their health plans — health plans that come out of the wages employees earn themselves.

Never mind that undergraduate and graduate students are fighting for coverage — and are still being denied, even for medical reasons.

Close to every cent the Church has not spent settling lawsuits against priests who sexually molested children has gone into this week’s media campaign to rile up opposition to covering birth control.

So far they’re doing a pretty effective job of it. The Obama administration is standing firm, but Congress is still on the warpath.

You can send a message that you stand against attacks on birth control and with Planned Parenthood. The organization just launched a TV ad campaign in support of contraception coverage (watch below).

And learn more about the men behind the war on women. They’re not going away anytime soon.

Ellen Shaffer is co-director of the Trust Women/Silver Ribbon Campaign, a project of the Center for Policy Analysis. Judy Norsigian is co-founder and executive director of Our Bodies Ourselves.


January 26, 2012

El Departamento de Salud y Servicios Humanos (HHS) aprueba los anticonceptivos como servicio preventivo

Escrito por Rachel. Traducido del orginial en inglés Jan 20, 2012.

OBOS has received funding to make blog entries available in Spanish. We hope to expand outreach efforts in the coming year.

La secretaria del Departamento de Salud y Servicios Humanos (HHS), Kathleen Sebelius, publicó la declaración que establece el reglamento que requiere que los planes de seguro cubran el uso de anticonceptivos, sin la necesidad de un copago, un coaseguro, o un deducible.

Este servicio no siempre estuvo garantizado.  El pasado agosto, el HHS adoptó las recomendaciones del Instituto de Medicina para incluir los servicios de planificación familiar como uno de los aspectos del cuidado preventivo de la salud para las mujeres, a ser cubierto por los nuevos planes de salud, pero solo fue un reglamento provisional, sujeto a interpretaciones.

En noviembre hubo mucha preocupación sobre si la decisión de que los  anticonceptivos sean cubiertos como servicio preventivo por la Ley del Cuidado de Salud a Bajo Precio iba a sobrevivir. El Presidente Obama se reunió con obispos Católico Romanos, y uno de ellos salió de la reunión diciendo, “Salí sintiéndome un poco más en paz sobre el tema que cuando entré.”

Como se puede entender, muchas personas expresaron la preocupación de que la administración iba a abandonar los requisitos de cobertura para el control de la natalidad y a su vez ampliar el reglamento que permita el rechazo, para permitir que hospitales y universidades católicas nieguen cobertura de servicios de planificación familiar.  Pero la administración rechazó los pedidos que permitían a los empleadores optar por no cubrir anticonceptivos.  La declaración de Sebelius dice en parte:

Después de evaluar los comentarios, hemos decido añadir un elemento más al reglamento final. Los empleadores sin fines de lucro que basados en creencias religiosas no proveen cobertura para anticonceptivos en sus planes de seguro tendrán un año adicional, hasta el 1ro de agosto del 2013, para cumplir con la nueva ley.  Los empleadores que quieran aprovechar del año adicional necesitan probar que califican para la implementación retardada.  Este año adicional permitirá que estas organizaciones tengan más tiempo y flexibilidad para adaptarse a este nuevo reglamento.  Nosotros esperamos requerir que los empleadores que no ofrecen cobertura de servicio de anticonceptivos provean notificación a sus empleados, informándoles que los servicios de anticonceptivos están disponibles en lugares como centros comunitarios de salud, clínicas públicas y hospitales con ayuda basada en los ingresos.  Vamos a seguir trabajando estrechamente con grupos religiosos durante este periodo de transición para discutir sus preocupaciones.

Los científicos tienen mucha evidencia sobre los beneficios del control de la natalidad para la salud de mujeres y de sus familias.  Se ha documentado que reduce los costos de salud considerablemente, y es el medicamento tomado con más frecuencia en los Estados Unidos por jóvenes y mujeres de edad mediana. Este reglamento proveerá a las mujeres mayor acceso a los anticonceptivos por cuanto requiere la cobertura y prohíbe los costos compartidos.

Información adiciónale sobre el tema:

Solo los hechos:


January 20, 2012

HHS Affirms Contraception as Covered Preventive Service

Today, HHS Secretary Kathleen Sebelius issued a statement finalizing the rule that requires insurance plans to provide coverage for contraception without charging a co-pay, co-insurance or a deductibles.

It wasn’t always a sure deal. Back in August, HHS adopted the Institute of Medicine’s recommendation to include family-planning services as one of the preventive health care items for women that must be covered by newly issued health plans, but it was only an interim rule, subject to comments.

In November, there was a lot of worry about whether the decision that contraception should be a covered preventive service under the Affordable Care Act would survive. President Obama met with Roman Catholic bishops, and one of them came away saying, “I left there feeling a bit more at peace about this issue than when I entered.”

Understandably, many people expressed concerns that the administration was going to back away from birth control coverage requirements and broaden the refusal rule to allow Catholic hospitals and universities to refuse to cover family planning services. But the administration rejected calls allowing employers to opt out of covering contraception. The statement by Sebelius reads in part:

After evaluating comments, we have decided to add an additional element to the final rule. Nonprofit employers who, based on religious beliefs, do not currently provide contraceptive coverage in their insurance plan, will be provided an additional year, until August 1, 2013, to comply with the new law. Employers wishing to take advantage of the additional year must certify that they qualify for the delayed implementation. This additional year will allow these organizations more time and flexibility to adapt to this new rule. We intend to require employers that do not offer coverage of contraceptive services to provide notice to employees, which will also state that contraceptive services are available at sites such as community health centers, public clinics, and hospitals with income-based support. We will continue to work closely with religious groups during this transitional period to discuss their concerns.

Scientists have abundant evidence that birth control has significant health benefits for women and their families, it is documented to significantly reduce health costs, and is the most commonly taken drug in America by young and middle-aged women. This rule will provide women with greater access to contraception by requiring coverage and by prohibiting cost sharing.


December 8, 2011

Evidence Trampled By Politics: HHS Secretary Sebelius Overrides FDA Decision on OTC Emergency Contraception

Yesterday, Health and Human Services head Kathleen Sebelius interfered with the FDA’s decision that emergency contraception could safely be made available over the counter (OTC) without a prescription to women and girls of all ages.

The drug is already available without a prescription for women 17 and older, after years of political wrangling. Advocates have worked to ensure OTC access because emergency contraception is most effective when used as soon as possible, and time, distance, money, and privacy can be serious barriers to getting a prescription and obtaining the drug in time to prevent pregnancy.

The FDA’s Center for Drug Evaluation and Research (CDER) had completed a review of the issue and concluded that Plan B One-Step emergency contraception should be available OTC to younger women, which Commissioner Margaret Hamburg explains:

Based on the information submitted to the agency, CDER determined that the product was safe and effective in adolescent females, that adolescent females understood the product was not for routine use, and that the product would not protect them against sexually transmitted diseases. Additionally, the data supported a finding that adolescent females could use Plan B One-Step properly without the intervention of a healthcare provider…CDER experts, including obstetrician/gynecologists and pediatricians, reviewed the totality of the data and agreed that it met the regulatory standard for a nonprescription drug and that Plan B One-Step should be approved for all females of child-bearing potential.

That’s when Sebelius stepped in and blocked the findings of CDER from taking effect. In her letter [PDF] overruling the FDA’s findings, Sebelius objected that “The label comprehension and actual use studies submitted to the FDA do not include data on all ages for which the drug would be approved and available over-the-counter.”

That data is not available for the vast majority of over-the-counter drugs on sale to all age groups without a prescription. Many OTC drugs (like acetominophen and aspirin) can have serious, even fatal, effects if taken inappropriately because of deliberate misuse or misunderstanding the label and instructions. You will not find data on safety and label comprehension for every possible age group for these medicines, yet they are readily available OTC in adult doses to consumers of any age.

Former FDA official Susan Wood – who resigned after a previous round of political interference in emergency contraception – agrees:

“They don’t do this for pain medication, headache medication, cold medication,” she said. “That’s not part of how we assess products. Are we going to go and now do this with all products, or are contraceptives once again being singled out for this special treatment and this extra standard when we’re talking about a very safe and very effective product that can really help women?”

Change.org has a petition up urging Sebelius not to let politics trump science, and objecting to the HHS leader’s focus on very young girls who may access the drug:

The fact that the HHS and the Secretary are focusing on this extremely young age group is bizarre. Less than 1% of 11 year olds are sexually active, where over half of adolescents have had sex before their 17th birthday.

This decision is illogical and unfounded. Physicians around the country agree that Plan B is incredibly safe and effective for all ages, helping to decrease the number of unintended pregnancies.

Further reading:
This NPR coverage provides a succinct timeline and political explanation of the controversy over accessibility of emergency contraception.

Statement from Physicians for Reproductive Choice and Health stating that the Obama administration’s “put[ting] politics before science and responsible health policy…is appalling.”

Heather Corinna at Scarleteen urges young people to speak up in protest of this action.

Jodi Jacobson at RH Reality Check, who reminds us that the previous administration wasn’t the only one playing political games with reproductive rights:

…no amount of proof it seems can make up for the fact that, despite all the evidence, even President Obama and Secretary Sebelius appear to think young women are too stupid to make their own decisions or that they are just chum to be thrown to the religious right in an election year. As the saying goes, with friends like these, who needs the far right?


October 27, 2011

Judy Norsigian on “Our Bodies, Ourselves,” Past, Present and Future

NBC Nightly News, which broadcast a great report this week on the 40th anniversary of “Our Bodies, Ourselves,” has posted an exclusive web-only interview with Judy Norsigian, OBOS co-founder and executive director, that is well worth viewing and sharing. (Also see the equally impressive interview with Dr. Susan Love.)

Norsigian talks about how the earlier “Our Bodies, Ourselves” editions demystified health and medical care, helping women to feel entitled about their right to ask questions — and get answers — from a paternalistic medical system. The book “changed the basic discourse” around women’s bodies and health, while also offering explicit information about access to birth control and abortion.

One of the ongoing health challenges, she notes, is the rate of sexually transmitted infections; women around the globe still struggle to have sex that doesn’t put their health at risk.

The video includes footage of a recent book signing for the brand new 2011 edition of “Our Bodies, Ourselves” held at Porter Square Books in Cambridge, Mass., and references the work of women’s groups in other countries that have adapted “Our Bodies, Ourselves” for their own communities.

In under 3 minutes, this interview provides one of the best historical and forward-looking assessments of the impact of “Our Bodies, Ourselves” around the world.

Visit msnbc.com for breaking news, world news, and news about the economy


October 21, 2011

Memphis, TN Gives Family Planning Funds to Religious Organization That Plans to Deny Services

In Memphis, TN, Title X family planning funds have been awarded to Christ Community Health Services, a religious health provider that has indicated that it may refuse to provide information, referrals, and some kinds of health care to Shelby County’s women.

Title X funds have historically gone to Planned Parenthood in Memphis; the move to give the funds to an anti-choice organization is part of nationwide efforts to defund Planned Parenthood because PP provides abortions. Existing laws already clearly prohibit Title X or other federal funds from being used for abortion services – the money goes to provide necessary services like contraception and cancer screenings.

Reports indicate that Christ Community has no intention of providing referrals to women who choose to have abortions, whether that is for personal or medical reasons. From a report by a Memphis newspaper (emphasis added):

[Christ Community CEO] Waller initially said the clinic refers patients to abortion providers if they request it, but he and Dr. Rick Donlon, a founding physician at the clinic, later called the newspaper to change that statement.

“We really try to provide women with other options and make sure they have those possibilities. And if they at the end still want a pregnancy termination, we know they know where to go,” Donlon said.

“They know where to go.” That doesn’t exactly sound like a professional provider of medical services to me. The clinic leaders obviously made a point of contacting the newspaper to make sure it was clear that they would *not* provide referrals, demonstrating a clear intent to put religious belief ahead of the medical care of women who may consider or require abortions.

Christ Community has also said it will not provide emergency contraception, only doing so through a third party. No details are available about how this will happen in practice, and how much additional time, travel and cost women may be subjected to in order to access this legal, previously available, and non-abortifacent medical care. This change clearly creates an additional burden for women seeking emergency contraception, and the women of Memphis currently have no guarantees that the third party provision will happen in a timely way, while timely administration of emergency contraception drugs is absolutely crucial for them to work.

I have not seen this discussed elsewhere, but it is also not readily apparent to me whether Christ Community would or could ever decide that any other forms of birth control are off-limits because of purely theoretical possibilities of preventing fertilized egg implantation. If we’re already providing the Title X money to a provider who can pick and choose services because of religious beliefs, I don’t see that refusing other forms of contraception is completely out of the question.

The organization also is reportedly working to install “crisis pregnancy centers” at its locations; these centers are well known for providing false and misleading information about abortion and exist to convince women not to choose abortion. Title X rules require “nondirective” counseling about abortion, and Planned Parenthood and other reputable providers who do provide abortions (using other, non-federal money) have processes and counselors in place to check whether women are certain of their decisions without pushing them in either direction.

Given the interest in installing deliberately biased in-house counseling and the stated intention to refuse to refer women out to other providers for abortion, it seems unlikely that Christ Community will be able to or has any intention of meeting the rules requiring factual, nondirective counseling. Women who cannot afford to access family planning care elsewhere will be subjected to a provider who clearly wishes to influence women’s choices, rather than providers who are committed to medical accuracy and offer women a full range of choices, supporting their right to individual decision-making about their bodies.

One woman reports that “Christ Community provides high-quality medical services, but that they sometimes come with a ‘sermon.’” She says she was told by a Christ Community provider, “If only my relationships with people and God were right, I would have fewer health problems.”

In addition to these concerns, there may be other issues with Christ Community’s administration of the Title X funds. I’m not personally familiar with CCHS’s existing health clinics and services on the ground. A Memphis local informed me Christ Community does not take appointments – patients must show up first thing in the morning and wait to be seen, and may even have to come back the next day if too many people show up. This is obviously not a good model for providing family planning services, especially when emergency contraception or other urgent services are needed or when women must take time off from jobs, school, or childcare in order to wait around for care. Although the organization’s website does have an “appointment line,” it indicates that this is to find out which clinics provide which services; I’d like to hear from others about whether this matches their experience at Christ Community clinics.

Another serious concern is that Christ Community’s proposal to provide these services clearly indicated that they would provide less care to fewer women than would Planned Parenthood. Steve Ross, of Memphis and blogging at Vibinc, has an excellent series chronicling the whole debacle, from the Tennessee state government pressuring the Memphis health department to take the funds despite their lack of capacity for family planning through to the current funding of Christ Community (parts 1, 2, 3, and 4). In part 2, he lays out the numbers and apparent relative deficiencies of the Christ Community proposal, including their lower numbers for proposed services and inconsistencies in how the proposals from Christ Community and Planned Parenthood were scored by local officials.

In Part 3, Steve points to the questions asked by the potential providers – Christ Community, Planned Parenthood, and a third non-religious applicant. Although they are unattributed, we can only assume that the following questions were asked by Christ Community, the only applicant with an explicit religious mission and on the record about refusing services because of beliefs. I think these are very telling about the intentions of the leadership of the organization that asked these questions, and how they plan to approach women’s health:

In providing information about pregnancy termination, is it sufficient to have the referral information in writing? [My interpretation: In other words, do we even have to bother to actually have a conversation with women about this?]

If the information about pregnancy termination is provided, is the contractor allowed to indicate in wiriting (NOT coerce) – on a referral sheet or in the office that it does not provide that service because of its beliefs.

If a contraceptive method is not provided on site by a provider because of the provider’s ethical beliefs, can the provider refer the client to another Title X provider who offers this method? If so, does the referring provider have to pay for the service?

The answers to these questions explicitly state that emergency contraception must be provided, the organization cannot choose not to provide forms of contraception because of its beliefs, and they are not allowed to talk about refusing abortion and referrals because of beliefs. Yet everything we’ve heard – as mentioned above – indicates that Christ Community plans to do exactly that.

As Steve writes:

To be honest, these three questions left me flabbergasted. Certainly individuals and associations of people are allowed to hold their own beliefs. Certainly, different physicians and networks of physicians have different preferred treatment plans. There’s plenty of room for this diversity out there in the private sector. However, when you choose to enter the public sector by seeking a contract for public dollars, you are bound by the requirements those public dollars place on you. If those requirements are unpalatable to you, then perhaps you shouldn’t seek them.

Honestly, I’m sure this whole thing will end in lawsuits, and I wouldn’t be unhappy if HHS would intervene. In the meantime, poor women suffer.

I will leave you with this excellent rant from Sig at DowntownMemphisBlog:

Public policy needs to be based on reason and fact, not feelings and faith. Abortion is a legal medical procedure. Any organization that aspires to hold a government contract in the area of family planning needs to present all options and perform all medical procedures, not just the ones it agrees with or likes. Not just the ones that make them feel warm and fuzzy inside. Not just the ones that fit into the narrow world view defined by their archaic religious beliefs.

See also: Aunt B

[cross-posted from Women's Health News]


October 12, 2011

Women Deserve Answers: Depo Provera and HIV Risk

A recent study published in The Lancet Infectious Diseases drew attention and controversy this month because of its finding that women using injectable types of contraception (known by the brand name Depo Provera) had twice the risk of acquiring HIV from their infected partners.

Heterosexual couples in which one partner had HIV were studied in seven African countries. The participants were sexually active, not pregnant, and not on antiretroviral medicines. Women were HIV-tested quarterly and asked at those times about their contraceptive use.

The researchers found that unprotected sex and sex with other partners was more likely when women used a hormonal contraceptive, but even when they controlled for this, the risk of HIV infection was higher in women using injectable contraceptives compared to oral or no hormonal birth control. Risk of infection in uninfected men from their infected partners was also higher.

The study was limited in that it relied on women’s self-reporting of contraception use and methods. The way participants were selected could have biased the results, and condom use was also self-reported. The study did not randomize women to a birth control method, nor was it designed from the outset as a test of HIV risk and specific types of contraceptive use. It also could not clearly evaluate any risk associated with oral birth control, because there were not enough users of the pill in the study.

Despite these limitations, there is reason to be concerned about whether there is a link between Depo Provera or its generic forms and risk of HIV infection. There are several ideas about how the drugs could potentially increase risk, but the HIV question has been around since at least 1996. That year, researchers working with monkeys and implantable contraceptives published a study suggesting increased risk of a similar virus. Researchers involved with early work on this subject have responded:

How many years has it been that the non-human primate model, and other researchers, have been warning about this and being ignored? What, 15 years now? Shocking.
and
It’s not like we did our work and it was published in an obscure journal. There’s absolutely no excuse for people doing contraceptive work to not have known this, and not to have taken this forward in the late ’90s. We should have had this answered [in humans] ten years ago.

Global health programs often promote long-acting methods like Depo Provera for women in areas where access to regular medical care is difficult and maternal mortality is high. These same areas often have high rates of HIV. I find it unacceptable that the question of contraceptive use and HIV risk has been around for years, and we don’t appear to be much closer to a clear answer. As Charles Morrison wrote in an accompanying editorial:

The question of hormonal contraceptive use and risk of HIV acquisition remains unanswered after more than two decades. Active promotion of DMPA in areas with high HIV incidence could be contributing to the HIV epidemic in sub-Saharan Africa, which would be tragic. Conversely, limiting one of the most highly used effective methods of contraception in sub-Saharan Africa would probably contribute to increased maternal mortality and morbidity and more low birthweight babies and orphans—an equally tragic result. The time to provide a more definitive answer to this crucial public health question is now; the donor community should support a randomised trial of hormonal contraception and HIV acquisition.

Such a trial would require careful design in order to minimize any risk to participants and to stop as soon as any increased risk of one method is clear. It might be impossible to get funding for, but we owe it to women, who deserve clear and accurate information about the potential risks of injectable and all forms of contraception.