The Washington Post today features a page-one story on efforts to reduce — not ban — abortion.

The emphasis on reduction is in part a response to the political reality of an Obama administration that will not be appointing Supreme Court justices who favor overturning Roe v. Wade, and the fact that several key ballot measures restricting access to abortion were defeated.

It’s also a reflection of the ongoing efforts of the “common ground” movement, which has been bringing together abortion foes and women’s rights supporters around issues they can agree on, such as providing more medical and economic support for pregnant women. President-elect Barack Obama actively supported this approach during the campaign.

And yet, as Jacqueline L. Salmon explains, some abortion foes aren’t interested in anything other than moral certitude:

The new effort is causing a fissure in the antiabortion movement, with traditional groups viewing the activists as traitors to their cause. Leaders worry that the approach could gain traction with a more liberal Congress and president, although they do not expect it to weaken hard-core opposition.

“It’s a sellout, as far as we are concerned,” said Joe Scheidler, founder of the Pro-Life Action League. “We don’t think it’s really genuine. You don’t have to have a lot of social programs to cut down on abortions.”

The diverse group that has come together to try a different tack includes prominent pastors such as Joel Hunter; Samuel Rodriguez, president of the National Hispanic Christian Leadership Conference; Catholics in Alliance for the Common Good; Sojourners, a progressive evangelical organization; and RealAbortionSolutions.org, a coalition of Catholics and evangelical leaders.

Others include Catholics United, a progressive Catholic lay group; Richard Cizik, vice president for governmental affairs of the National Association of Evangelicals; the Rev. Thomas Reese of Georgetown University’s Woodstock Theological Center, a prominent Jesuit thinker; and Nicholas Cafardi, former dean of the Duquesne University School of Law and a Catholic canon lawyer.

Their actions have not come without consequences. Cafardi resigned from the board of Franciscan University of Steubenville in Ohio after writing a column supporting Obama and declaring the abortion battle lost. Kmiec has received hate e-mail, and a priest denied him Communion in April. And Denver Archbishop Charles J. Chaput has criticized Kmiec and several of the groups involved, saying they have “undermined the progress pro-lifers have made and provided an excuse for some Catholics to abandon the abortion issue.”

The Real Deal, the blog of the National Council for Research on Women (and a new addition to our blogroll!), last week asked leaders of women’s organizations to speculate how life might be different in an Obama era, that is: “more equitable, healthier, more secure — for women and girls.”

The answers were posted on the Real Deal, and excerpts appeared on The Huffington Post.

Among the responses — Women’s eNews founder and editor Rita Henley Jensen calls for the creation of an Office of Maternal Health; Marie Wilson, president and founder of The White House Project, calls for the nation’s first Presidential Commission on Women and Democracy; and Marcia D. Greenberger and Nancy Duff Campbell, co-presidents of the National Women’s Law Center, note that “the nation has no time to spare in providing guaranteed, affordable health care for all, passing essential legislation that provides basic fairness in the workplace, like the Lilly Ledbetter Fair Pay Act, and undoing some of the onerous restrictions on women’s access to reproductive health that were imposed by the Bush Administration.”

The NCRW is hoping readers of blogs like OBOB will add their suggestions to the comments sections at HuffPo. So have at it.

Speaking of the National Women’s Law Center, the organization has been very tuned into health care and is hosting monthly Reform Matters conference calls for women’s advocates who are focused on health reform at the state and federal level.

The next call takes place Thursday, Nov. 13, 2008 at 1 p.m. (EST), and the discussion will focus on what the election means for women and health care reform. Interested? Register for the call here.

These calls provide a collaborative forum to share experiences and questions that have come up in addressing various health reform proposals. So if you miss this one, keep NWLC in mind for future conversations. You might also check out the NWLC’s resources on comprehensive and affordable health care.

Finally, the International Women’s Health Coalition has made available remarks by IWHC President Adrienne Germain on the prioritization of women’s and young people’s health under a new administration. The  16-page agenda for the future can be read online here (PDF).

Sure we’ll be back to other health news soon, but first here’s a wrap on presidential politics and women’s health priorities. And, just to remind you that voting feels oh-so-good, Babeland’s voter discount continues through Nov. 11. Enjoy!

Yes We Can … End Eight Years of Failed Women’s Health Policies: Sign the RH Reality Check petition, which asks President-elect Barack Obama to:

• Defund failed abstinence only programs in favor of proven, effective comprehensive sex ed programs,
• Reinstate global family planning funds that save women’s health and lives and overturn the Global Gag Rule,
• Take action on ensuring availability of publicly funded contraception for low-income women and women in poverty,
• Immediately implement your HIV/AIDS domestic agenda,
• Pass FOCA (Freedom of Choice Act) that overturns dangerous anti-choice state legislation, and
• Protect Roe v. Wade.

Plus: Theresa Braine, writing at Women’s eNews, notes that women’s groups aren’t wasting any time organizing around priorities: “From fixing the domestic health-care system and the economy, to making child care more accessible to working mothers, to rescinding the so-called global gag rule that cuts off foreign aid to groups that provide abortion or counseling, or even lobby for changes in abortion laws, women’s groups started exercising the type of grassroots activism that political analysts say helped bring the Democrats to power on Tuesday.”

What’s On the Agenda (So Far): Here’s the new Obama-Biden administration’s agenda on issues addressing women. Health care is up there at the top.

And when it comes to the administration’s hiring policy, it’s nice to see that gender identity is included in the nondiscrimination clause. (via Feministing)

Health Care Ballot Initiatives: A wrap-up of several health care measures that passed on state ballots.

Why Prop 8 Won: “If exit polls are to be believed, some 70 percent of African-Americans voted Yes on 8, as did 52 percent of Latinos and 49 percent of Asians; each of these demographics went heavily for Obama, blacks by a 94-to-6 margin,” writes Richard Kim, associate editor of The Nation.

The easy, dangerous explanation for this gap, and one already tossed around by some white gay liberals in the bitter aftermath, is that people of color are not so secretly homophobic. But a more complicated reckoning — one that takes into account both the organizing successes of the Christian right and the failures of the gay movement — will have to take place if activists want a different result next time. First, there’s the matter of the Yes on 8 coalition’s staggering disinformation campaign.

Plus: I’m still reeling after reading Proposition Hate over at NoFo (via Gapers Block).

The Mom on the Bus: Jodi Kantor has a great piece up at the The Caucus blog about covering the presidential and raising her daughter, Talia, who is almost 3.

Sayonara, Sarah: Katha Pollitt bids good-bye to Alaska Gov. Sarah Palin, but not without first explaining how Palin was a gift to feminism –

[T]he first way Palin was good for feminism is that she helped us clarify what it isn’t: feminism doesn’t mean voting for “the woman” just because she’s female, and it doesn’t mean confusing self-injury with empowerment, like the Ellen Jamesians in The World According to Garp (I’ll vote for the forced-childbirth candidate, that’ll show Howard Dean!). It isn’t just feel-good “you go, girl” appreciation of female moxie, which I cheerfully acknowledge Palin has by the gallon. As I wrote when she was selected, if she were my neighbor I would probably like her — at least until she organized with her fellow Christians to ban abortion at the local hospital, as Palin did in the 1990s. [...]

Second, Palin’s presence on the Republican ticket forced family-values conservatives to give public support to working mothers, equal marriages, pregnant teens and their much-maligned parents. Talk-show frothers, Christian zealots and professional antifeminists — Rush Limbaugh and Phyllis Schlafly — insisted that a mother of five, including a “special-needs” newborn, could perfectly well manage governing a state (a really big state, as we were frequently reminded), while simultaneously running for veep and, who knows, field-dressing a moose. No one said she belonged at home. No one said she was neglecting her husband or failing to be appropriately submissive to him. No one blamed her for 17-year-old Bristol’s out-of-wedlock pregnancy or hard-partying high-school-dropout boyfriend. No one even wondered out loud why Bristol wasn’t getting married before the baby arrived. All these things have officially morphed from sins to “challenges,” just part of normal family life. No matter how strategic this newfound broadmindedness is, it will not be easy to row away from it.

Good morning, readers! By now you all know that Barack Obama is our President-Elect. However, a number of specific reproductive health issues were up for a vote in this election - RH Reality Check has great coverage of the fate of anti-choice ballot initiatives in this election (links below), and Feministing has a good summary.

The stand-out negative of the election? Prop 8 — the California ballot proposition to amend the state’s Constitution to eliminate any rights to same-sex marriage, officially designating marriage as “between a man and woman”  — has passed.  You can find out more here.

The Center for Reproductive Rights has issued a call on “President-Elect Barack Obama to champion women’s reproductive freedom and equality and restore America’s leadership on these issues.” In their letter [PDF], the Center asks for reproductive health policies guided by science, not ideology, judicial appointments that support established rights, and support of reproductive rights and health in foreign assistance programs.

The Center for Gender and Health Equity has released a policy paper on U.S. foreign assistance and its implications for women and reproductive rights, entitled, “Making U.S. Foreign Assistance Work: Sexual and Reproductive Health and Human Rights as Key to Global Development [PDF].”

The authors explain that “many NGOs are preparing to give input to Congress’s considerations for reforming the 1961 Foreign Assistance Act,” but that “overhauling the Foreign Assistance Act will achieve nothing unless policy makers embrace the principle of advancing human rights, specifically by prioritizing the wellbeing, rights, and empowerment of women.” In examining the Millennium Development Goals, they argue that goals of reducing child mortality and poverty, improving maternal health, improving access education, combating HIV/AIDS and other diseases, and other goals all depend on Goal 3, which specifically calls for gender equality and the empowerment of women.

The authors also note that other organizations such as Oxfam have made proposals with important recommendations for reform, but that these existing recommendations “fail to address sexual and reproductive health and rights and women’s equality, even though these have been identified as critical components to global development.”

Among the topics and U.S. activities discussed in the report as hindering the achievement of development goals are prohibitions against prostitution, the Global Gag Rule, the withholding of UNFPA funds, and the push for abstinence-based programs. CHANGE proposes 6 specific reforms, including:

“Eliminate restrictions (including the Mexico City Policy, Anti-Prostitution Loyalty Oath, and denial of funding for UNFPA) and unnecessary reporting requirements, and fund comprehensive sexual and reproductive health programs that integrate HIV prevention based on human rights and public health best practices, allowing communities to determine what interventions meet their needs.”

Other recommendations include the creation of cabinet-level posts on global development and women, aligning U.S. foreign assistance with ICPD Programme of Action and the Millennium Development Goals, greater transparency in U.S. foreign policy goals on sexual and reproductive health, affirming the sexual and reproductive rights of all people, and getting funding directly into the hands of grassroots groups and women.

A number of bloggers have written over the past month about a new requirement that immigrants seeking permanent legal status in the United States must receive the HPV vaccine. The requirement is troublesome for a number of reasons, including the lack of an opt-out provision (in contrast to requirements for U.S. citizens), the expense of the series, the lack of significant public health risk posed by omitting this vaccine, and the vulnerability of the affected population.

This requirement originates in the CDC’s vaccination recommendations, which become mandatory for those seeking legal residency. These vaccines are typically for readily infectious diseases such as meningitis, polio, hepatitis, and measles. When the CDC adopted the HPV vaccine (currently only the Gardasil brand shot is available) into its recommendations, that triggered their requirement for immigrants.

Recently, the Wall Street Journal ran a piece on the controversy generated by this requirement, and noted that the CDC claims it never really intended the effect on immigrant populations. According to the piece:

“A CDC spokesman said the experts on the immunization committee didn’t realize their decision would affect tens of thousands of immigrants. However, a government official said the cervical vaccine’s inclusion on the list might be reviewed.”

I would have expected that considerations about the meaning of vaccine recommendations - of what actually happens as a result - might have been part of the decision-making process. Perhaps the CDC will be more alert in the future as to the actual implementation effects of their recommendations. A U.S. Citizenship and Immigration Services spokesperson interviewed by WSJ explained that the mandate is “a statutory requirement. It’s based on CDC recommendations.”

Read additional perspectives on this topic via:

• RH Reality Check
• Feministe
• WoC PhD

It’s mid-October, but the warm weather here in Chicago has me thinking we’re approaching summer. My small garden thinks so, too. Lettuce, basil, kale, peppers and chives are coming up strong, undaunted by the brown, crinkly leaves falling from the trees above.

Living in the city, planting space is limited and the season is (eventually) finite; I can’t rely solely on what I grow. But along with trips to the Green City Market downtown, and smaller farmers’ markets nearby, we probably eat locally grown produce for over half the year.

Of course, we are fortunate to have easy access to an abundance of fresh food choices. Huge swaths of Chicago are considered “food deserts” — in these neighborhoods, corner convenience stores and fast food restaurants greatly outnumber supermarkets, and access to affordable, healthy produce is severely limited by distance and cost.

Not surprisingly, residents in Chicago’s food deserts, the majority of whom are African American, experience a higher rate of diet-related illnesses (as a recent report shows), including diabetes, certain kinds of cancer and cardiovascular disease.

Support for urban agriculture is growing, along with a push to increase the number of farmers markets located throughout the city — a new market opened in Englewood, an impoverished South Side neighborhood, earlier this year. Yet affordability remains an issue. As this story points out, equipment is not available to process food stamp debit cards at all farmers markets, and even at markets with the equipment, not all vendors accept the cards.

Meanwhile, as Rachel has mentioned, the federal Women, Infants and Children program (WIC) is adding a paltry $8 a month for use at farmers markets by mid-2009 (read the latest here).

Despite increased public interest in farmers markets and community-supported agriculture (CSAs) that offer consumers a stake in a local farm, the relationship between food, health and the environment, as well as the importance of affordable and sustainable agriculture, doesn’t exactly make for a crowd-rousing stump-speech.

In fact, we’ve heard almost nothing from the presidential candidates about federal food policy, even as food prices keep rising. Perhaps that will change in the final weeks, but I wouldn’t bet my kale on it.

The political aspect hasn’t escaped Michael Pollan, however. The author of, most recently, “In Defense of Food: An Eater’s Manifesto,” Pollan penned an open letter to the president-elect that was published in The New York Times Magazine. It is perhaps the smartest and most engaging piece you’ll read this year on what a McCain or Obama administration should do to overhaul the way we grow food and radically change our approach to healthy eating.

Pollan begins by explaining, in no uncertain terms, the urgency:

[W]ith a suddenness that has taken us all by surprise, the era of cheap and abundant food appears to be drawing to a close. What this means is that you, like so many other leaders through history, will find yourself confronting the fact — so easy to overlook these past few years — that the health of a nation’s food system is a critical issue of national security. Food is about to demand your attention.

Complicating matters is the fact that the price and abundance of food are not the only problems we face; if they were, you could simply follow Nixon’s example, appoint a latter-day Earl Butz as your secretary of agriculture and instruct him or her to do whatever it takes to boost production. But there are reasons to think that the old approach won’t work this time around; for one thing, it depends on cheap energy that we can no longer count on. For another, expanding production of industrial agriculture today would require you to sacrifice important values on which you did campaign.

Which brings me to the deeper reason you will need not simply to address food prices but to make the reform of the entire food system one of the highest priorities of your administration: unless you do, you will not be able to make significant progress on the health care crisis, energy independence or climate change. Unlike food, these are issues you did campaign on — but as you try to address them you will quickly discover that the way we currently grow, process and eat food in America goes to the heart of all three problems and will have to change if we hope to solve them.

Pollan takes readers on a detailed yet easy-to-follow journey of how the United States food system developed the way it did — and what it can count as its chief success: namely, we produce cheap calories in great abundance.

He then offers an agenda for a 21st-century food system with specific proposals under three main sections: resolarizing the American farm; reregionalizing the food system; and rebuilding America’s food culture. His plan plan for a decentralized food system includes such essentials as modifying the food stamp program and expanding WIC:

Food-stamp debit cards should double in value whenever swiped at a farmers’ markets — all of which, by the way, need to be equipped with the Electronic Benefit Transfer card readers that supermarkets already have. We should expand the WIC program that gives farmers’-market vouchers to low-income women with children; such programs help attract farmers’ markets to urban neighborhoods where access to fresh produce is often nonexistent. (We should also offer tax incentives to grocery chains willing to build supermarkets in underserved neighborhoods.)

Federal food assistance for the elderly should build on a successful program pioneered by the state of Maine that buys low-income seniors a membership in a community-supported farm. All these initiatives have the virtue of advancing two objectives at once: supporting the health of at-risk Americans and the revival of local food economies.

The adventurous agenda includes suggestions for changing our relationship with food. For children, that means starting early: Plant gardens at every primary school, overhaul school menus and increase “school-lunch spending per pupil by $1 a day — the minimum amount food-service experts believe it will take to underwrite a shift from fast food in the cafeteria to real food freshly prepared.”

We also need to cease negotiating health messages with the food industry. Pollan calls for the surgeon general to take over the job of communicating with Americans about their diet. Currently it falls to the Department of Agriculture, which you might say has a conflict of interest.

But why not start at the top? In addition to encouraging the White House to go meatless one day a week, Pollan calls for the ultimate suburban sacrifice: tear out a portion of the White House lawn and plant an organic fruit and vegetable garden.

OK, insert your favorite arugula-loving-liberal joke here. But at another crucial point in history, White House support was influential:

When Eleanor Roosevelt did something similar in 1943, she helped start a Victory Garden movement that ended up making a substantial contribution to feeding the nation in wartime. (Less well known is the fact that Roosevelt planted this garden over the objections of the U.S.D.A., which feared home gardening would hurt the American food industry.) By the end of the war, more than 20 million home gardens were supplying 40 percent of the produce consumed in America. The president should throw his support behind a new Victory Garden movement, this one seeking “victory” over three critical challenges we face today: high food prices, poor diets and a sedentary population.

Eating from this, the shortest food chain of all, offers anyone with a patch of land a way to reduce their fossil-fuel consumption and help fight climate change. (We should offer grants to cities to build allotment gardens for people without access to land.) Just as important, Victory Gardens offer a way to enlist Americans, in body as well as mind, in the work of feeding themselves and changing the food system — something more ennobling, surely, than merely asking them to shop a little differently.

Read the whole piece (it’s well worth it!). Readers have posed interesting questions and suggestions in the comments, and the Times breaks out Pollan’s responses. Finally, here’s more good stuff from the “food issue.”

*Photo of scenes from Chicago Green City Market by schopie1, reprinted under a Creative Commons license.

With three months left to his presidency, George W. Bush just can’t seem to stop meddling with women’s reproductive health. And when this administration meddles, the results are usually tragic.

In the latest instance, the U.S. Agency for International Development has told six African governments that they must stop giving U.S.-donated contraceptives — including condoms, birth control pills and intrauterine devices — to Marie Stopes International, a UK-based reproductive family planning organization that distributes contraceptives and operates health clinics in needy communities.

The reason? MSI works with the U.N. Population Fund in China, and the United States in 2002 cut all financing for the population fund because the administration claims, without basis, that the fund supports coercive abortion in China.

Here’s some background on Bush’s grudge with the UNPF, and the distorted influence the Population Research Institute, a small, right-wing group in Virginia, had on Bush’s decision to cut funding.

The countries affected by the administration’s most recent move include Ghana, Malawi, Sierra Leone, Tanzania, Uganda and Zimbabwe. The New York Times’ Nicholas Kristof, in an excellent column published today, explains how the false accusation and the administration’s twisted logic will harm women:

It’s true that China’s one-child policy sometimes includes forced abortion, and when traveling in rural China, I still come across peasants whose homes have been knocked down as punishment for an unauthorized child. But the U.N. fund has been the most powerful force in moderating China’s policy, and a State Department team itself found no evidence of any U.N. involvement in the coercion.

Mr. Bush’s defunding of the U.N. Population Fund — backed by Senator McCain — has persisted since 2002. What is new is the extension of that policy to a leading private family-planning organization like Marie Stopes International.

“The irony and hypocrisy of it is that this is a bone to the self-described ‘pro-life’ movement, but it will result in deaths to women who just want to space their births,” said Dana Hovig, the chief executive of Marie Stopes International. The organization estimates that the result will be at least 157,000 additional unwanted pregnancies per year, leading to 62,000 additional abortions and 660 women dying in childbirth.

That may overstate the impact. Kent Hill, an official of the U.S. aid agency, insists that there will be no increase in pregnancies because the American contraceptives will simply be routed to other aid groups in Africa.

That will work to some degree in big cities. But it’s a fantasy in rural Africa. Over the years, I’ve dropped in on a half-dozen Marie Stopes clinics, and in rural areas there’s typically nothing else for many miles around. Women in the villages simply have no other source of family planning.

“This nearsighted maneuver will have direct and dire consequences,” a group of prominent public health experts in America declared in an open letter, adding that the action “will translate almost immediately into increased maternal death and disability.”

Plus: This is a good time to think about throwing some support to 34 Million Friends of UNFPA, which was founded to help make up for the loss of funds for women’s health services worldwide.

Prisoners of a Hard Life: Women and Their Children

PM Press has recently published “The Real Cost of Prisons Comix,” three comic books produced by the Real Cost of Prison Projects in one volume. The book includes:

“Prison Town: Paying the Price” tells the story of how the financing and site locations of prisons affects the people of rural communities in which prison are built as well as urban communities from where the majority of incarcerated people come from. Illustrated by Kevin Pyle; written by Craig Gilmore and Kevin Pyle.

“Prisoners of the War on Drugs” includes the history of the war on drugs, mandatory minimums, how racism creates harsher sentences for people of color, stories on how the war on drugs works against women, three strikes laws, obstacles to coming home after incarceration, and how mass incarceration destabilizes neighborhoods. Illustrated by Sabrina Jones; written by Ellen Miller-Mack, Sabrina Jones and Lois Ahrens.

“Prisoners of a Hard Life: Women and Their Children” includes stories about women trapped by mandatory sentencing and the “costs” of incarceration for women and their families. Illustrated by Susan Willmarth; written by Ellen Miller-Mack, Susan Willmarth and Lois Ahrens.

The book also features more than 30 responses from activists, teachers, health practitioners, prisoners and others about how they have used the comic books in their organizing.

The number of incarcerated women has risen at a rate nearly double that of men in recent decades, in large part due to mandatory sentencing and draconian drug laws. There is now believed to be about 200,000 incarcerated women in U.S. prisons, jails and immigration detention centers. 

In an article published at Our Bodies Ourselves, Ellen Miller-Mack, a co-author of two of the comics, describes the work of numerous anti-prison activists addressing problems faced by women prisoners, especially around issues of family preservation and reproductive rights. For instance, in 2000, the Illinois legislature prohibited the shackling of women prisoners while in labor — something that The Advocacy Project had been working on for years.

Shackling a woman who is giving birth sounds so ridiculous, like something from a different era done with no understanding or respect for a woman’s health, or the health of her infant.

Except that it’s still happening today. In fact, California and Illinois are the only states with laws on the books regulating the use of restraints on pregnant women.

Just this past July, Rachel wrote about an immigrant woman in Tennessee who was pulled over by police as she was leaving a prenatal clinic with her three children. Juana Villegas DeLaPaz did not have a current driver’s license and was subsequently jailed. She was taken to a local hospital when she went into labor that night, but the prison guard disconnected the phone so DeLaPaz couldn’t make outgoing calls and she didn’t see her husband. She was ankle-cuffed to the bed at all times except for a bathroom break. (Read an update of her case here.)

According to a report from Amnesty International, “Abuse of Women in Custody: Sexual Misconduct and Shackling of Pregnant Women,” 23 states and the U.S. Bureau of Prisons specifically permit shackling women in labor. And Louisiana and the U.S. Bureau of prisons have no restrictions on restraints other than specifying that pregnant women should not be restrained face-down in four-point restraints.

I’ll pause while you digest that sentence.

Sexual abuse is also a widespread concern. Last year Nicole Summer, writing at RH Reality Check, looked at how the prison system addresses sexual abuse against incarcerated women — most of which is perpetuated by prison guards — and prisoners’ access to contraception and abortion.

“Surviving a sexual assault and then navigating the health care system to receive adequate counseling and reproductive medical attention is daunting enough for those who walk freely on the outside. For women in prison, these hurdles can seem insurmountable,” writes Summer.

Miller-Mack’s article identifies a number of organizations working to address these and other issues, as well as resources for learning more about the conditions and realities of women in prison.

Plus: Miriam at Feministing recently live-blogged the Critical Resistance 10 conference. Check out her entries, particularly this one on prisons as a tool of reproductive oppression.

The American Association of Birth Centers has issued an appeal to supporters to contact Congress concerning a payment crisis that threatens insurance support for birth centers around the country.

After more than 20 years of providing funding, the Centers for Medicare and Medicaid Services (CMS) — the federal agency that runs Medicare/Medicaid — is now refusing to pay the federal percentage of Medicaid payments that states might make to birth centers.

“This is not a Medicaid crisis but a payment crisis for birth centers,” according to the AABC. “Historically all payers follow the lead of Medicaid.  If Medicaid stops paying the birth center facility fee so will other insurers.”

The AABC explains the background:

Over the past few years, CMS has begun disallowing federal matching funds for state Medicaid payments for freestanding birth center services. Birth centers have been recognized by CMS (and earlier, by HCFA) as a Medicaid provider type in State Medicaid Plans since 1987.

Recently, however, CMS has disallowed such payment by several state Medicaid Agencies, including Alaska, South Carolina, Texas, and Washington State, claiming that it lacks clear statutory authority and direction to do so. CMS has directed its regional offices to stop federal payments to any state for birth center services.

This action by CMS puts pregnant women at risk of losing access to safe, high quality maternity care.

Visit AABC for more information on how to contact your member of Congress and urge legislation to direct CMS to pay birth center facility fees. It would be great if midwives, women who have used birth centers and anyone who believes in the right to choose her own birth site got involved.

Here are some facts about birth centers:

• Birth Centers are part of a vital safety net for Medicaid mothers across the U.S.
• Birth centers fill the void left in many areas when hospitals — rural, urban or suburban — close their obstetrical services
• Many rural and urban birth centers serve a disproportionately high percentage of Medicaid recipients. Texas provides two examples – at least 95% of patients in an inner city Houston birth center, over 85% for a center in Weslaco, Texas in the Rio Grande Valley
• Birth centers have a proven history of reducing low birth weight and preterm birth, the main causes of neonatal death in the U.S.
• Birth centers provide innovative approaches to maternity care that reduce disparities for low-income and minority women, lower cesarean section rates, and reduce health care costs

Here’s a look at some health care news coming out of the Democratic National Convention and other interesting stories on politics and health care …

From Campaign for America’s Future (these events can be streamed at OurFuture.org):

- On Tuesday at 2pm MT, Campaign for America’s Future co-director Roger Hickey will talk about the principles of the new Health Care for America Now! Coalition to the thousands of activists and bloggers attending in person and online during the “Take Back America” event at the convention’s “Big Tent,” outside the Pepsi Center.  Rep. Jan Schakowsky, one of the progressive health care champions in the Congress, will talk about the need for health care change, sign HCAN’s statement, join HCAN in urging Members of Congress and candidates to publicly declare their position on the health care choice that confronts the new Congress:  Are you with us for a guarantee of quality affordable health care for all? OR Are you for leaving us on our own to buy private health insurance?

- On Wednesday at 2:30 pm MT, the Healthcare for America Now! Coalition and SEIU will host a rally featuring DeVotchka, Death Cab for Cutie, Chuck D and Jim Hightower at Sunken Gardens Park.

On “Fresh Air” today, Terri Gross talks with political scientist Jonathan Oberlander, who offers an in-depth comparison of the Obama and McCain health proposals. Oberland compared the candidates in his report, “The Partisan Divide — The McCain and Obama Plans for U.S. Health Care Reform,” which was published Aug. 21, 2008 in the New England Journal of Medicine. Audio will be available this afternoon. Here’s more background on the two plans.

Harry and Louise are back again, in a new ad with an interesting mix of backers. Trudy Lieberman writes at Columbia Journalism Review: “The significance of the current Harry and Louise redux is not that groups with wildly different agendas can now play nicely together — although arguably that’s the message the sponsors want to send. It’s that the range of acceptable solutions to the health care crisis hasn’t advanced much since 2000. Or since 1994, for that matter.

Is health care no longer a primary ailment? “It was once the ‘it’ topic of public policy that helped propel the Clintons into office, sparked open warfare among special interests, and then toppled a Democratic Congress,” writes Jill Zuckerman at the Chicago Tribune.

For a while, health care was that which was not spoken about following the 1994 legislative debacle. For Sen. Hillary Clinton, it was something that taught her great lessons. And in the drawn- out Democratic primary fight between her and Obama, the cost and availability of health care were daily fodder in the debate over which candidate would do a better job as president.

And now, there is … not much.

The continual tussle between the two presumptive presidential nominees — Obama and McCain — has largely centered recently on national security and the high price of gasoline. Public opinion polls have shown that among the top issues of concern to Americans, health care is languishing far behind the economy, the war and the price of gas. One CBS poll from July put voter interest in health care at just 3 percent. In August, it was at 8 percent.

But a number of political experts quoted say health care costs are still a concern, even though it doesn’t get as much attention or publicity as high gas prices and energy costs.

“Beneath all that, when you probe, when you ask people what’s bothering you about the economy right now, in economic downturns — problems paying for health care and health insurance really loom large,” said Drew Altman, president of the Kaiser Family Foundation. “After people’s fixations paying for gas prices, problems paying for health care are right at the top with job issues.”

Not so much health-related, but Women’s eNews has coverage of a slew events taking place in Denver around women’s issues.

Here’s Nancy Keenan of NARAL, who spoke at the convention Monday afternoon:

Our Bodies Our Blog has invited the folks at Breast Cancer Action to write monthly guest posts on breast cancer and related issues.

by Brenda Salgado

Though billions of dollars have been spent on breast cancer research, the incidence of breast cancer is higher today than it was 20 years ago. Inequities in breast cancer mortality continue to increase, and we still can’t definitively figure out what’s causing this disease. Some gains have been made in treatment, but the results are simply not enough.

How can we ensure that research funds are used wisely and effectively? One model for how research should be done is the California Breast Cancer Research Program (CBCRP)

The CBCRP, which funds groundbreaking research, has changed how breast cancer is addressed around the world. Its research includes topics like psychosocial impacts, community-based participatory research, environmental exposures, and racial and ethnic disparities. It is also committed to disseminating research results.

You’d think a program like this would be reaping the rewards of funding, but no. In fact, the University of California Office of the President, CBCRP’s administrative home, wants to gut the program by eliminating the collaborative planning, evaluation and community outreach activities. This would impact the program’s ability to fund the best breast cancer research — and its ability to share these results with the community and health providers.

The CBCRP is funded by a state tobacco tax, donations from a voluntary tax check-off program, and individual contributions. It is the largest state-funded research program in the nation, and 95 percent of the money goes directly to funding research and education efforts.

The CBCRP was founded and is run by an unprecedented collaboration of women with breast cancer, advocates, activists, scientists, clinicians and researchers. Because of this collaboration, the program has a deep understanding of what breast cancer research has already been done, and what it needs to focus on next — such as environmental causes.

UCOP bureaucrats think they’re better suited to determine what research gets funded than the women and men working to end this disease. But UCOP can’t provide the insightful funding CBCRP has done for years. The CBCRP has funded important research that simply wouldn’t have seen the light of day otherwise.

UCOP and other research funders need to hear from women’s health advocates that we want effective and efficient use of our financial resources. Innovative health research programs like the CBCRP are about more than just breast cancer. They are models for how women and other affected communities can and must be included in deciding what research is funded and making sure that the results are shared with the public.

Want to help save this innovative and effective program? We’ve put together a letter you can email to U of C President Mark Yudof, asking him to stop this travesty. As we note in the letter, “We do not want or need more breast cancer research funding at the expense of smart breast cancer research funding.”

Brenda Salgado is the program manager at Breast Cancer Action. She manages BCA’s ongoing campaigns, oversees BCA’s legislative and policy work, and represents BCA on environmental and women’s health coalitions.

Yesterday, the Supreme Court of the State of Missouri reversed a lower court ruling in a 5-2 decision and upheld a 2007 law that would allow legal midwifery in the state. The law states that “any person who holds current ministerial or tocological certification by an organization accredited by the National Organization for Competency Assurance (NOCA) may provide services” - this would include both CNM/CMs certified by the American Midwifery Certification Board and CPMs certified by the North American Registry of Midwives.

After the bill, which dealt with numerous health issues as well as including the midwifery provision, was passed and signed into law by the Governor, the Missouri State Medical Association, The Missouri Association of Osteopathic Physicians and Surgeons, Missouri Academy of Family Physicians, and the St. Louis Metropolitan Medical Society filed suit to invalidate the section that would allow legal midwifery practice in the state. The lower court invalidated the statute, but an appeal was filed by the State of Missouri along with Friends of Missouri Midwives, the Missouri Midwives Association, and other parties.

The medical associations seeking to invalidate the law had claimed standing for the challenge by arguing that physicians may be subject to disciplinary actions if they cooperate with midwives, and that they should be allowed to challenge the law on behalf of patients as their representatives. The Court disagreed on both of these matters and indicated that the groups had no standing to challenge the Constitutionality of the law. They therefore reversed the lower court decision, allowing the law legalizing midwifery in Missouri to stand.

Organizations supporting midwifery in Missouri issued a press release in response to the ruling, stating that

“Today’s Missouri Supreme Court decision is a tremendous victory for Missouri families, who have been working for 25 years to gain legal access to professional midwives. The ruling increases access to maternity care in the state and allows women and families more birth options and affirms their ability to exercise their rights to choose how their babies are born.”

This ruling closely follows recent AMA/ACOG statements in which the organizations express intent to support legislation restricting or preventing both home birth and non-CNM midwifery. Susan Jenkins, legal counsel for the National Birth Policy Coalition and a consultant to the Missouri midwives, stated:

“This case confirms the message that’s been reverberating loud and clear in both the mainstream media and the blogosphere ever since the American Medical Association launched its attacks against midwives and home birth last week—physicians do not have the right to speak for patients when it comes to deciding who delivers their babies.”

Our Bodies Ourselves was among those who submitted an amicus curiae (friend of the court) brief in support of reversing an injunction against the law and thereby making midwifery legal in the state. Judy Norsigian, Executive Director of OBOS, also addresses the central choice issue:

Many women’s health advocates working on pregnancy and birth issues are deeply concerned about current trends in childbearing, especially the strange way in which “choice” is selectively used. More obstetricians now promote the acceptability of medically unindicated cesareans (”elective” cesareans), while at the same time fewer obstetricians are working to preserve the option of vaginal birth after cesareans (so-called “VBACs”), which are known to pose (overall) fewer serious risks to the mother than planned repeat cesarean sections. In fact, ACOG (the American College of Obstetricians and Gynecologists) has a position that calls for the 24/7 presence of an anesthesiologist if a hospital is to offer VBACs.

Ironically, organized medicine is now spending considerable energy to oppose the licensure and regulation of Certified Professional Midwives (CPMs, now officially recognized in 24 states), and in mid-June, the American Medical Association passed an anti-homebirth resolution (proposed by ACOG) that many believe is a step towards an attempt to make homebirth ultimately illegal. Despite the absence of evidence that planned homebirth with trained caregivers is any less safe overall than hospital birth, the AMA and ACOG apparently don’t apply the principle of reproductive choice when it comes to this arena of decision-making for a pregnant woman.

Similarly, in our recent post on the AMA/ACOG issue, we included a letter from Dr. Andrew Kotaska, who argued that “Modern ethics does not equivocate: maternal autonomy takes precedence over medical recommendations based on beneficience, whether such recommendations are founded on sound scienctific evidence or the pre-historic musings of dinosaurs.” Another obstetrician, Dr. Lauren Plante, has generously granted permission to publish her recent letter to ACOG on the same topic:

Dear Colleagues,

I was dismayed to read the recent ACOG statement opposing home birth and specifically disallowing any support for individuals that advocate or support home birth. While I understand ACOG’s concern for mothers and babies, any reasonable support for patient autonomy–which the College favors when it comes to cesarean upon maternal request–would have to include autonomy in choosing a birth place. Many of us would not agree that choosing to labor and deliver at home subordinates the goal of a healthy baby to the process. As you know, home birth remains a viable option in several developed nations where birth outcomes for both mother and baby are excellent. Many ACOG members have backed up home birth providers in the past, and a few have attended a home birth. I personally know of several ACOG members who themselves have chosen to deliver at home. The recent ACOG statement further marginalizes both our patients and our members.

Sincerely,
Lauren Plante, MD, MPH, FACOG
Associate Professor, Obstetrics & Gynecology
Thomas Jefferson University
Philadelphia PA

Our sincere appreciation goes to those physicians who are willing to openly share their dissent, and all those working to preserve choice for women.

Last month, Vermont directed health insurance companies to cap the out-of-pocket cost of a mammogram, setting the limit at $25.

“Studies suggest cost is a factor in whether women seek and receive mammography services,” Vermont Gov. James Douglas said. “This law is to encourage every woman to get regular mammograms.”

While Vermont’s new law is a step in the right direction, universal, affordable access is still a far-off goal .

OBOB recently looked at the risks and benefits of routine mammograms for premenopausal women in their 40s. Despite the controversy concerning mammograms for premenopausal women, the value of routine mammograms for postmenopausal women is widely accepted.

But not everyone has access to high quality mammograms and, if necessary, subsequent treatment. This month, we’re looking at the cost of mammograms, insurance co-pays and programs that provide low-income women with free mammography and breast exams.

While 80 percent of U.S. women over age 50 reported having a mammogram within the last two years (as of 2006), according to Kaiser’s State Health Facts, this map shows how the percentage varies by state, with Massachusetts at the high end (87.5 percent) and Mississippi (69.7 percent) at the bottom. The states are further broken down by race and ethnicity, though there’s not always enough information available for comparison.

The average cost of a mammogram is between $50 and $150; digital mammograms cost even more. Most states now require health insurance companies to pay all or most of the cost — although for some women, the remaining co-payment amount can stand in the way of making the appointment.

Mammography screening rates remained steady until about 2003 — at that point, the rates started to decline among women aged 50 and older. “I suspect patients’ fear, lack of knowledge of efficacy, physical discomfort during the procedure, denial, geographic barriers, lack of primary care doctor and inability to pay are all factors,” Dr. Alan Sager, professor of health policy and director of the health reform program at Boston University’s School of Public Health, told ABC News earlier this year.

The drop itself may not be a concern if women are making informed decisions about their personal health and are not avoiding mammograms because of cost, said Barbara Brenner, executive director of Breast Cancer Action.

“Falling mammography rates don’t necessarily mean that the sky is falling,” Brenner told OBOB. “After all, in Europe, women are screened less frequently and at older ages, with outcomes essentially the same as we have in the United States in terms of incidence and mortality. Mammography screening has lead to a lot of overtreatment, so the question is about which are the most underserved communities in this context, and conducting targeted screening outreach to them.”

Medicare, which serves people 65 and older and some people with disabilities, pays 80 percent of the cost of an annual screening mammogram for women age 40 and older, leaving most recipients with a co-pay of approximately $10 to $30. Researchers at Brown University in Providence, R.I., looked at 366,475 women covered by 174 different Medicare managed-care plans and found women who have co-payments of more than $10 are less likely to get regular mammograms than those with more generous insurance coverage, ABC News reported.

Here’s the study abstract — and more from ABC:

Mammogram screening rates were about 8 percent lower among women who had to pay more than $10 or 10 percent of a mammogram’s cost, researchers found.

Researchers then examined health plans that once fully covered the costs of mammograms but later switched to only partial coverage. From 2002 to 2004, mammography rates decreased by 5.5 percent in seven of these plans. However, in 14 other plans that continued to offer full coverage of mammograms, screening rates for breast cancer increased by 3.4 percent.

And the number of plans requiring women to make higher co-payments are on the rise. In 2004, one out of nine women was forced to pay for at least 10 percent of the cost of a mammogram out-of-pocket.

The worst impacts were seen among minorities and patients from communities with lower income and education levels, as these patients were mostly likely to enroll in cheaper health insurance plans that require co-payments for mammography.

What about women who don’t have health insurance? At the national level, the National Breast and Cervical Cancer Early Detection Program (NBCCEDP), a program of the Centers for Disease Control and Prevention, provides mammograms and clinical breast exams by a health professional to low-income, underinsured and underserved women. But the percentage of women reached is far from optimal.

One analysis of the 2002-2003 performance of the NBCCEDP found that:

Although the Program provided screening services to over a half-million low-income, uninsured women for mammography, it served a small percentage of those eligible. Given that in 2003 more than 2.3 million uninsured, low-income, women aged 40-64 did not receive recommended mammograms from either the Program or other sources, there remains a substantial need for services for this historically underserved population.

According to the NBCCEDP, between 8 and 11 percent of U.S. women of screening age (40 to 64) are eligible to receive services. (Women 65 and older are eligible for Medicare.) Federal guidelines establish an eligibility baseline to direct services to uninsured and underinsured women at or below 250 percent of federal poverty level. Contact information for programs in every state is available at the NBCCED website.

Some states provide subsequent funding for uninsured and underserved women to increase access to mammograms and comprehensive screening programs (including breast exams). Eligibility is determined by age and income requirements and varies by state, so it’s best to check with your state health department or your local representative’s office.

Here in Illinois, for instance, access to free mammograms and treatment, as well as clinical breast exams, pelvic exams and Pap tests, was recently extended to all women without health insurance between the ages of 35 and 64 under the Illinois Breast and Cervical Cancer Program.

“No one should have to forgo health screening because they can’t afford it. But screening is only one part of the puzzle,” said Brenner. “If a woman is diagnosed with breast cancer after a low-cost mammogram, how will she pay for her treatment? In California, a woman whose breast cancer is diagnosed after a mammogram administered through a state-run program will be treated at state expense. This isn’t the case in every state .”

Universal health care would solve the problem of women being able to afford breast cancer screening and treatment, adds Brenner.

“I’ve had breast cancer twice, missed in both cases by mammograms. I know how devastating this disease is. But the reality is that this isn’t just about mammography and breast cancer. We shouldn’t have to fight for health care and coverage disease by disease, body part by body part. Everyone should be able to get the care they need — whether it’s screening or treatment — regardless of the health concern.”

“In an overwhelmingly overweight nation that worships thinness, many describe prejudice against the obese as one of the last socially acceptable biases,” writes Lisa Anderson at the Chicago Tribune. “Advocates for the plus-sized, particularly activists in the ‘fat acceptance’ movement, want obesity to become a category legally protected against discrimination, like religion, race, age and sex. But not everyone agrees.”

“I think it would help mostly because it would send a message that fat people are equal citizens. It’s not in the litigation rates, but the rights consciousness that comes after legislation,” said Anna Kirkland, an assistant professor of women’s studies and political science at the University of Michigan who is author of the new book, “Fat Rights: Dilemmas of Difference and Personhood,” which examines the question of whether weight should be a protected category.

The story goes on to discuss a law to ban discrimination against weight and height pending in Massachusetts. Here’s the text of House bill 1844 (PDF), sponsored by Rep. Byron Rushing.

Rushing has offered similar bills six times in the last 12 years. He told the Trib that last month’s public hearing on the bill showed “there is a growing number of people who think this should happen and an even larger number of people who think we should at least be talking about it.”

Similar anti-discrimination legislation is already in place in Michigan and the District of Columbia, and cities such as San Francisco, Santa Cruz and Madison.

“It’s not really about litigation, but about taking a stand,” said Marilyn Wann, a fat-rights activist who testified at the Boston hearing and helped get San Francisco’s law passed in 2000. “I do think when a government says it’s not OK to dismiss someone as a person because of weight, that’s helpful.”

Plus: Read Fat People: Please Stop Existing at Big Fat Blog.