Archive for the ‘Public Policy’ Category

March 28, 2014

Why Contraception is a Health Issue for Everyone

Photo “ritual” by Monik Markus used under CC BY-2.0 from https://flic.kr/p/8YaubV

Some of the media coverage of Tuesday’s arguments before the Supreme Courton the contraception mandate tended to pit women’s rights activists against social conservatives, making contraception seem like a lifestyle choice that only benefits some women — you know, the ones who have sex.

What often gets lost in the debate is why contraception is considered a preventive health issue — and why treating it as such is beneficial for everyone.

During the healthcare debate, the Department of Health and Human Services charged the Institute of Medicine (IOM) with reviewing preventive services that are important to public health and well-being, and recommending which ones should be considered in the development of comprehensive guidelines.

IOM came up with this evidence-based list of preventive services for adults and children, all of which are now covered by insurers with no required co-payment. Take a look at the IOM report, which explains the selection process.

For women, this includes annual well-woman visits, testing for STIs and HIV, support for breastfeeding, and screening and counseling for domestic violence.

It also includes FDA-approved contraception methods, as well as patient education and counseling on contraception. What makes contraception a health issue? Well, with all due respect to Mike Huckabee, it’s not about women’s libidos.

Here’s the deal: When women use contraception, they can avoid unwanted pregnancies and space planned pregnancies to promote optimal birth outcomes.

When a pregnancy is planned, women can start prenatal care, including increasing their intake of folic acid; work with their healthcare providers to address relevant medical conditions, as well as substance abuse; and take other steps that lead to healthier outcomes for both the mother and the infant.

Pregnancies that are unplanned are more likely to be affected by delayed prenatal care, maternal depression, low birth weight, poorer childhood physical and mental health, and other complications. Breastfeeding rates are also lower after unintended pregnancies.

Social conservatives should also take note that 40 percent of unintended pregnancies end in abortion. And there is an economic cost: Two-thirds of unintended pregnancies are paid for by publicly funded insurance programs, usually Medicaid. For more information, Guttmacher Institute has a terrific fact sheet on unintended pregnancies that explains the incidence rate, demographics, outcomes and costs.

When you look at the facts, contraception is smart public health policy.

Of course, for some women, birth control is essential for other health reasons, including acne, fibroids, endometriosis and to reduce problems associated with irregular or very heavy periods.

Despite the proven health benefits — and the benefits to society as a whole — Hobby Lobby and Conestoga Wood claim that the requirement to provide health insurance that includes no-cost contraception violates their religious freedom.

Not surprisingly, the Court’s three female justices were most skeptical of their position. As Jeffrey Toobin writes in The New Yorker:

After Paul Clement, the lawyer for Hobby Lobby, began his argument, twenty-eight of the first thirty-two questions to him came from Ruth Bader Ginsburg (four questions), Sonia Sotomayor (eleven), and Elena Kagan (thirteen). The queries varied, of course, but they were all variations on a theme. The trio saw the case from the perspective of the women employees. They regarded the employer as the party in the case with the money and the power. Sotomayor asked, “Is your claim limited to sensitive materials like contraceptives, or does it include items like blood transfusion, vaccines? For some religions, products made of pork? Is any claim under your theory that has a religious basis, could an employer preclude the use of those items as well?” Clement hedged in response. When Clement asserted that Hobby Lobby’s owners, because of their Christian values, did care about making sure that their employees had health insurance, Kagan shot back:

“I’m sure they want to be good employers. But again, that’s a different thing than saying that their religious beliefs mandate them to provide health insurance, because here Congress has said that the health insurance that they’re providing is not adequate, it’s not the full package.”

At Talking Points Memo, Sahil Kapur wrote:

The most forceful was Justice Elena Kagan, who repeatedly asked aggressive questions throughout the 90-minute argument about the legal dangers of exempting certain entities from laws on the basis of religion.

“There are quite a number of medical treatments that religious groups object to,” she said, positing that a ruling against the Obama administration could empower business owners to seek exemptions from laws about sex discrimination, family leave and the minimum wage. “You’d see religious objectors come out of the woodwork,” Kagan warned, arguing that it’s problematic for judges to test the centrality of a belief to a religion or the sincerity of beliefs that are invoked in court.

Much of the argument also centers around whether companies really have religious freedom, or if that really only applies to people — whether corporations count as “people” has been a major issue before the Court in the recent past. In “The Hobby Lobby Case Represents The Worst Kind Of Anti-Choice Arrogance,” Sarah Erdreich writes:

But even if the owners do have a religious commitment, Hobby Lobby is not pretending that it is a religion. It is a business. That any business should have power over what can literally be the life-and-death health decisions of its employees, well, that’s another issue for another day. But as long as Hobby Lobby sells its supplies to saints and sinners alike, it has no business questioning what its employees do when they go to see the doctor.

Access to birth control is important for everyone — for preventing pregnancies, and to allow women and families to best time and plan healthy pregnancies. Hopefully the male members of the Supreme Court will see it that way, too.

To catch up on the issue, check out this coverage:


February 28, 2014

Stillbirths and Infant Health Risks Higher in California’s Artificially Conceived Infants

by Miriam Zoll

A new study published in the Journal of Perinatology online has found that in California from 2009-2011 there was a 24- to 27-fold increase in multiple births and significantly higher rates of preterm births, lower birth weights, fetal anomalies and stillbirth among infants born through assisted reproductive technologies (ART) or artificial insemination (AI) compared to babies conceived naturally.

The retrospective study was based on 2009-2011 data from the California Office of Statewide Health Planning and Development and conducted by researchers from the Loma Linda University School of Medicine.

The CDC’s Assisted Reproductive Technology Surveillance report for 2010 indicates that “ART-conceived births were highest in California, followed by Texas and New York,” and that nationwide that year, 46.4 percent of all ART births were multiples, compared to only three percent among naturally conceived infants.

While California has the most infertility clinics of any state in the country, the large increase in multiple births from ART/AI found in the study was higher than but not significantly different from those reported nationally. However, data from the Centers for Disease Control and Prevention (CDC) indicate that California’s rates of low- and very low-birth weight infants, as well as premature and very premature infants, exceed national averages.

According to the new Journal of Perinatology study, in 2009, 18,405 California women underwent ART cycles, which refers to procedures in which the egg and sperm are handled outside the body. Of the total number of women in California undergoing ART, only 3 percent of women underwent AI or intrauterine insemination.  A total of 15,953 embryos were transferred, resulting in 7,155 pregnancies and 5,710 live births. Roughly 1,718 of these births — or 30.1 percent — were multiple births consisting of twins, triplets or more.

The researchers found that when compared to naturally conceiving women, preterm labor and cesarean section were four times higher for women who underwent ART/AI, and their length of stay in hospital was twice as long. Compared to infants conceived naturally, among ART/AI pregnancies, there was a four- to five-fold increase in stillbirths, and a two to three-fold increase in fetal anomalies.

These findings align with those from another California study conducted by researchers at UCLA and published in 2013 in the Journal of Pediatric Surgery. Compared to naturally conceived babies, researchers found higher rates of congenital malformations among ART multiple babies — particularly of the eyes, neck, heart and urogenital tract.

In one case study highlighted in the Journal of Perinatology report, of 92 ART/AI infants born at Loma Linda Children’s Hospital over an 18-month period from 2012-2013, 10 very premature babies died on the first day. Seventeen were singleton births, with half requiring admission to the Neonatal Intensive Care Unit (NICU). Of the 27 pairs of ART/AI twins, one was stillborn, four deaths followed shortly after birth, and 22 sets were admitted to NICU. Three deaths occurred in two out of six sets of triplets and all surviving triplets required admission to the NICU. The average NICU hospitalization length of stay for these ART/AI babies averaged 38.4 days, with a range of anywhere from three to 138 days.

“We need to educate the public about these very serious risks,” Dr. Mitchell Goldstein of the Department of Pediatrics, Division of Neonatology, Loma Linda University School of Medicine,who co-authored the report, said in an interview. “If elective single embryo transfers became a higher priority among infertility specialists, we would likely see significant reductions in these severe health and stillbirth rates among ART/AI infants and reduced risks for mothers.”

Throughout the United States, the higher incidence of multiple and preterm births linked to ART/AI remains a significant public health concern, particularly for older women and their babies. A 2013 article in the New England Journal of Medicine estimated that 36 percent of twin births and 77 percent of triplet and higher-order multiple births in the U.S. were attributable to medically assisted conceptions.

The American Society for Assisted Reproductive Medicine recommends that reproductive endocrinologists transfer single embryos for most women, yet many doctors continue to transfer multiple embryos with the hope of procuring at least one live birth.

“Once a patient becomes pregnant through ART/AI,” explained Goldstein, “many reproductive endocrinologists lose touch with them and are then completely disconnected from any risks mother and infant may encounter. Neonatologists and infertility specialists must work together to reverse these trends and ensure the least harm.”

The findings from this study reflect one conducted by the University of Adelaide of roughly 300,000 patients in Southern Australia who had received assisted conception between January 1986 and December 2002. Published in January 2014 in PLOS ONE, the study also found higher rates of stillbirth, prematurity, low birth weight and neonatal deaths among ART infants.

But in this Australia study, even singletons from assisted conception were more likely to be stillborn or have low birth weight than babies born from spontaneous conceptions. Outcomes varied by type of assisted conception. For example, very low and low birth weight, very preterm and preterm birth, and neonatal death were markedly more common in singleton births from IVF, and to a lesser degree, in births from intra-cytoplasmic sperm injection (ICSI) where the one sperm is injected directly into the egg. Using frozen-embryos eliminated all significant adverse outcomes associated with ICSI but not with IVF.

In my next post, I’ll look more closely at the financial costs of babies born through assisted technology and what this might mean for insurance coverage.

Miriam Zoll is a member of the Our Bodies Ourselves board of directors, an independent journalist and the author of the new book, “Cracked Open: Liberty, Fertility and the Pursuit of High-Tech Babies.“ 

This blog was previously published on the USCAnneberg Reporting on Health Member Blog and is reposted with permission. Image by TipsTimesAdmin via Flickr.


January 13, 2014

A Woman’s Life Has Ended, but Hospital Insists on Life Support for Fetus Against Family’s Wishes

Right now in Fort Worth, Texas, 33-year-old Marlise Munoz lies in a hospital bed, brain dead after experiencing a blood clot in her lungs. Munoz’s family has been prohibited from honoring her wishes to be removed from life support.

Why? Munoz is pregnant.

When her clot happened, Munoz was 14 weeks pregnant; she’s now 20 weeks pregnant. Texas is one of 12 states in which a pregnancy at any stage invalidates a woman’s advance directive for her end-of-life care. The other states are Alabama, Idaho, Indiana, Kansas, Kentucky, Michigan, Missouri, South Carolina, Utah, Washington, and Wisconsin.

According to the Center for Women Policy Studies, additional states can invalidate a pregnant woman’s wishes and force her to be kept on life support if it’s “probable” that the fetus will develop to the point of live birth. A few more states have similar rules but limit them to women whose fetuses are already viable.

The New York Times notes that some experts in medical ethics have said they believe the hospital is misinterpreting Texas state law prohibiting medical officials from cutting off life support to a pregnant patient. At this point, Munoz’s fetus is not viable outside of her uterus, and it’s unclear whether it was compromised by the amount of time she went without medical attention following her collapse or the subsequent deterioration of her body: 

Mrs. Munoz’s parents and her husband, Erick Munoz, 26, remain in limbo, even as they and other relatives help care for the Munozes’ 15-month-old son, Mateo. Mr. Munoz has returned to his job as a firefighter but continues to sit by his wife’s side at the hospital. She had been due to give birth in mid-May, but the hospital’s plans for the fetus — as well as its health and viability — remain unknown. Mr. Machado [Marlie Munoz's father] said he had been told by the hospital’s medical team that his daughter might have gone an hour or longer without breathing before her husband woke and discovered her, a situation he believes has seriously impaired the fetus. “We know there’s a heartbeat, but that’s all we know,” he said.

Mrs. Machado said the doctors had told her that they would make a decision about what to do with the fetus as it reached 22 to 24 weeks, and that they had discussed whether her daughter could carry the baby to full term to allow for a cesarean-section delivery. “That’s very frustrating for me, especially when we have no input in the decision-making process,” Mr. Machado added. “They’re prolonging our agony.”

Lynn Paltrow of the National Advocates for Pregnant Women has commented:

What is quite stunning about these statutes for women is that they don’t even take into account a woman’s pain. A woman could be in excruciating pain and near death’s door and they still would force her to suffer. These are extraordinary laws creating separate unequal status for pregnant women in which they lose control of medical decision making, the right to bodily integrity and right to be free of excruciating pain.

Not being allowed to die in peace, or watching a family member be denied their wishes, is the stuff of nightmares. This extreme situation, however, isn’t the only one in which pregnant women’s freedoms have been restricted.

In October, there was some media coverage of Alicia Beltran’s case. Beltran had beaten a drug addiction and was 14 weeks pregnant when her doctor and a social worker tried to force her to take an anti-addiction drug and took her to court when she refused.

The National Advocates for Pregnant Women has documented hundreds of U.S. cases of pregnant women who were subjected to or threatened with incarceration, detention, or forced medical or other interventions that the state decided were in the best interest of the fetus — not the woman.

A petition has been launched asking Texas Attorney General Greg Abbott to leave this decision to Marlise Munoz’s family. To learn more about “pregnancy exclusion laws,” read “Marlise Munoz Case Shines Light on Dehumanizing ‘Pregnancy Exclusion’ Laws,” by Lynn Paltrow and Katherine Taylor.


January 3, 2014

How to Fix the “Travesty” of U.S. Maternity Care – And Ensure Women Have a Full Range of Choices

Anna Fettby Anna Fett

“So, when am I going to get a grandbaby?”

We have not even been married a month and already my mother-in-law has begun peppering my husband and me with this loaded question.

Babies are still the furthest thing from my mind. I moved to Cambridge with big dreams of pursuing a master’s degree and then plowing onward toward doctoral studies. I know very few people who attempt graduate studies and motherhood simultaneously, and for me the former currently takes precedent over the latter.

Besides the occasional prodding from my family, I rarely think about becoming a mother — that is, until I happened to read a startling headline on the JAMA Forum that caught my attention: “Transforming the Costly Travesty of U.S. Maternity Care.”

My curiosity was piqued; while I knew there are problems in the healthcare system, I was unaware that maternity care in particular was suffering a “travesty.”

The article by Dr. Diana Mason begins by ranking the United States as 46th in the world on maternal mortality “with a rate that has doubled since 1987 and is twice that of 31 other nations.” I was shocked.

The fact that the United States could be so far behind other countries was disturbing, but even more troubling was my ignorance on this issue. How did I not know this? Why are we not all discussing the quality of maternity care?

Moreover, how could this be? — especially given the fact that maternal and newborn care is also the most costly reason for hospitalization in the United States.

My brain attempted to process this debacle. We are paying too much for maternal-newborn care without meeting the same standards of quality of many other countries in the world.

Even though pregnant women in America comprise “a largely healthy population that needs few procedures or technological interventions,” writes Mason, the system is set up to encourage unnecessary procedures, such as cesarean sections — “now the most common operating room procedure in the United States” — despite the fact that normal vaginal births cost 30 percent less.

Suddenly “travesty” did not seem such a stretch.

The goal of Mason’s article is to develop ways of improving maternal-newborn care while also reducing costs, which she believes can be done by shifting to the midwifery model of care. I admit hearing the term “midwifery” instantly conjured images of the Middle Ages for me, but in reality midwives still play prominent roles around the world, and in the United States there is a push to expand midwifery services.

There are now 250 birth centers that follow the model that “maternity services should be provided by certified and licensed midwives and family physicians,” while obstetricians should be reserved for “high-risk pregnancies.”

Maternity care at these facilities could be a much more cost effective option than hospitals if health insurance companies and Medicaid were required to pay “birth centers at 100% of the rate of hospitals for the same or equivalent codes, such as for normal vaginal deliveries,” writes Mason. Families have difficulty taking advantage of what would be a cheaper option because their insurance does not cover deliveries by family physicians or midwives.

As I absorbed this article, a deeper concern struck: The transformation that Mason envisions must also encompass the American way of thinking about maternity care. Instead of viewing the professional provider as the one who delivers a mother’s newborn, the midwifery framework holds that the mother gives birth “with the support of the professional” and “with physician and hospital back-up as needed.”

If we aligned our public policy with the midwifery framework, we could appreciate returning the power of choice to American mothers. Women should be able to decide where to give birth — in the hospital, birth center, or home — and they should be able to decide who will attend them: midwives, family physicians, or obstetricians.

But this can only happen after improving insurance and Medicaid coverage, implementing policies that allow women to choose among these options, and ensuring that midwives receive the education and protection they need, as Mason writes, to “practice to the full extent of their training.” Only by tackling the factors Mason raises can we ensure that women have the full range of choices they need to get the maternity care that is right for them and their family.

When, or even if, my husband and I decide to have children, it is a choice that we get to make when it is right for us — despite my mother-in-law’s best attempts at interference. When we have so many choices ahead of us in life, it seems obvious that we should also have options of where and how to receive maternity care.

I am now joining the ranks of those who want to make the transformation of U.S. maternity care a reality.

Anna Fett is a master of theological studies candidate at Harvard Divinity School with a focus in women and gender studies as well as Islamic studies. She will graduate in May 2014.


December 3, 2013

Science Says: Emergency Contraception Does Not Block Implantation of a Fertilized Egg

Last week, in a post about how some types of emergency contraception are less effective or ineffective in women weighing more than 165 pounds, we mentioned that the European equivalent to Plan B One-Step was getting a new label that will note the problem.

Let’s take a look at the other reason for the label change: European health officials have determined — and want to make clear — that the drug “cannot stop a fertilized egg from attaching to the womb.”

This is a big issue, as abortion opponents have long opposed EC on the grounds that it might prevent a fertilized egg from implanting in the uterus. U.S. labels of levonorgestrel-containing emergency contraceptive pills, such as Plan B, don’t directly refute the possibility.

But as The New York Times noted last year, recent science suggests that this is not the case; the pills work only by preventing ovulation and fertilization.

Last week, NYT reporter Pam Belluck noted how the FDA and other health agencies responded to the scientific studies:

References to the possibility of blocking implantation were then removed from the websites of the National Institutes of Health and the Mayo Clinic. And an F.D.A. spokeswoman, Erica Jefferson, said that “the emerging data on Plan B suggest that it does not inhibit implantation.”

On Tuesday, Ms. Jefferson reiterated that view. The drug agency has not moved to change the label, saying manufacturers must request a change. Plan B One-Step’s manufacturer, Teva Pharmaceuticals, declined to comment. It had previously said scientific evidence suggested that the pill did not disrupt implantation.

Although pregnancy is not medically considered to have begun until a fertilized egg has successfully implanted in the lining of the uterus, media coverage around this topic has often obscured this distinction and promoted a false idea that emergency contraception is the same thing as the abortion pill (RU-486) or abortion in general. Medical professionals generally assert that “emergency contraception is not effective after implantation; therefore, it is not an abortifacient.”

Effect on Lawsuits
Hobby Lobby is one for-profit corporation that filed suit to avoid complying with Obamacare coverage for contraception, claiming that forms of contraception that could interfere with the implantation of a fertilized egg are tantamount to abortion. The Supreme Court will hear the case, focusing on whether for-profit companies can be required to provide coverage that may conflict with the private religious beliefs of the business owners.

As Linda Greenhouse wrote in an op-ed about challenges to the contraception mandate under the Affordable Care Act, a coalition of medical groups, led by Physicians for Reproductive Health, filed a brief in the case, noting in part that “the weight of the scientific evidence establishes that the FDA-approved contraceptives and emergency contraceptive are not abortifacients.”

Read Greenhouse’s column for an excellent look at how the religious-based challenges represent a culture war on “modernity.” For more on the lawsuits, SCOTUSblog is a smart resource.

And we highly recommend the Emergency Contraception website for easy-to-understand fact sheets, such as this one: “Does emergency contraception cause an abortion?


November 13, 2013

Researchers Explain How Anti-Abortion Legislation Threatens Women’s Health

Protest rally against Texas HB2 and SB1 on July 15

July 15 protest rally in Austin against anti-abortion legislation / Photo by Mirsasha

There have been a number of recent articles and campaigns detailing, often from a personal perspective, how legislation restricting access to abortion will harm women’s health.

A new article that will be published in the journal Contraception goes a step further — it draws on research to address the specific hardships women face and urges healthcare providers to push back against such restrictive measures.

The authors — researchers from university medical centers and health policy organizations such as Ibis Reproductive Health who have collaborated together before on matters of abortion and women’s health — open with a sharply worded question: “What happens when abortion access is severely restricted for 26 million Americans? Texas is about to find out.”

Texas, as you might recall, passed a law in July — the subject of State Sen. Wendy Davis’s epic filibuster – that mandates hospital admitting privileges for abortion providers; requires abortion facilities to meet the same standards as ambulatory surgical centers; bans most abortions after 20 weeks post-fertilization (22 weeks “pregnant”); and restricts use of medication for abortion to an outdated regimen. A lawsuit was filed to try to overturn some of these restrictions.

The admitting privileges requirement was temporarily blocked this month, then reinstated, causing up to a third of abortion clinics to suddenly close and forcing women to scramble for alternatives. The issue may end up in front of the Supreme Court. (More wrangling took place this week; view the latest coverage at RH Reality Check).

Despite claims that the new restrictions are for women’s “safety,” the authors report that the evidence suggests something different: “Evidence from other countries indicates that severely restricting abortion does not reduce its incidence — it simply makes unsafe abortion more common.”

Among the public health concerns raised in this article is the potential increase in the number women attempting to induce their own abortions:

In 2012, we conducted a survey with 318 women seeking abortion in six cities across the state to assess the impact of the 2011 restrictions. We found that 7% of women reported taking something on their own in order to try to end their current pregnancy before coming to the abortion clinic. This proportion was even higher — about 12% –among women at clinics near the Mexican border. Misoprostol and herbs were the methods women more commonly mentioned. By comparison, a nationally representative survey of abortion patients in 2008 found that 2.6% reported ever taking something to attempt to self-induce an abortion. The confluence of extremely limited access to abortion in the context of poverty, access to misoprostol from Mexico, as well as familiarity with the practice of self-induction in Latin America, makes it particularly likely that self-induction will become more commonplace in Texas.

Early medical abortion with misoprostol is a safe and effective regimen and is  recommended by the World Health Organization in settings without access to mifepristone. But if women do not have accurate information, they may use ineffective dosages and may not realize the abortion failed until much later in pregnancy, forcing them to seek a second-trimester abortion or continue the pregnancy and have a child they do not want or feel they cannot care for. Using misoprostol in the second trimester also increases the risk of hemorrhage that might require surgical intervention or transfusion, as well as the risk of uterine rupture if inappropriately high dosages are used, especially with a history of prior cesarean delivery. And while misoprostol is unquestionably a safe method to self-induce abortion, women may use a variety of less effective and more dangerous methods to end a pregnancy on their own, including taking herbs or self-inflicting abdominal trauma.

The authors also explain that a reduction in the number of clinics, due to the provision requiring clinics to meet the standards of ambulatory surgical centers (ASCs), is likely to cause delays for women seeking care, resulting in later, more costly abortions. They describe the following scenario involving delays and travel burdens:

In 2011, 2,634 women living in the Valley obtained an abortion. Neither of the two existing abortion clinics in the Valley is an ASC, and one of the clinics has already announced its planned closure. The nearest ASC is in San Antonio, about 250 miles away, adding about eight hours of travel time to the process of obtaining an abortion. If a woman chooses a medical abortion, state law requires her to make this long journey at least three times. These barriers are likely to be too great for many women.

The three visits rule is due to a provision in Texas law requiring doctors to follow an outdated regimen for medical abortion. Most U.S. providers, they note, use a newer protocol, which has been found safe and effective — and requires only two visits instead of three. They write:

Texas is only one of several states attempting to regulate abortion out of existence — a trend that should be deeply troubling to the medical community. First, it represents a stunning incursion into the physician’s exam room, allowing state representatives to dictate how doctors should practice medicine. Second, it is in blatant contradiction to evidence-based medicine.

And they call on physicians to be more involved in protesting this type of legislation:

As the fight for abortion rights in Texas moves from the legislature to the courts, it is critical that reproductive health specialists — both clinicians and researchers — add their voices to this outcry, highlighting the negative impact of these restrictions and demanding that all women have the right to comprehensive health care services.

The article, “The Public Health Threat of Anti-Abortion Legislation,” will appear in an upcoming issue of Contraception.


October 9, 2013

Studies Look at Access to Family Planning Services Provided at Federally Qualified Health Centers

A pair of newly published studies in the journal Contraception look at the types and access to family planning services provided at community health clinics that are considered a popular primary care option for low-income women of reproductive age.

The studies, produced by researchers at the George Washington University School of Public Health, examine the services at Federally Qualified Health Centers (FQHCs). These health clinics provide primary and preventive care on a sliding scale, primarily to low-income and uninsured patients. It’s also worth noting that when states attempt to defund Planned Parenthood clinics, these are clinics to which many women may get directed for care.

The authors anticipate that these health centers will become an even more important part of care as the Affordable Care Act is fully implemented and Medicaid is expanded. One of the co-authors is Dr. Susan Wood, who resigned her post as director of the FDA’s Office of Women’s Health in 2005 in protest over delays in approving over-the-counter access to emergency contraception.

In the first study, “Scope of Family Planning Services Available in Federally Qualified Health Centers,” researchers surveyed several hundred FQHCs about on-site care, including approaches to pregnancy prevention and STI/HIV testing and treatment, as well as referrals of patients to other sites, staffing issues, and other aspects of care. While they found that almost all of the FQHCs provided at least one contraceptive method, the type and accessibility of those methods varied.

Slightly more than half of the centers were able to dispense oral contraceptives on site rather than sending patients elsewhere with a prescription. Slightly more than a third (36 percent) offered both oral contraception and longer acting IUDs and/or implants on-site. If a woman has to go to another location, there may be consequences such as incurring lost work time that may make it harder to follow through.

Also, only about a third of the surveyed centers received Title X family planning funding (it’s not clear whether some clinics had not applied, or did apply and were rejected). The researchers found that while pretty much all of the centers provided access to oral contraception, the Title X-funded clinics were more likely to provide the full range of contraceptive options.

A companion paper, “Accessibility of Long Acting Reversible Contraceptives (LARC) in Federally-Qualified Health Centers (FQHCs),” looks specifically at the survey results on long-acting contraceptive options, including intrauterine devices (IUDs) and implants. The study found that slightly more than half of the FQHCs offered IUDs on-site, while about a third offered contraceptive implants on site. For the rest of them, patients would have to be referred elsewhere to receive the devices.

The authors again found that clinics receiving Title X funds were more likely to provide these options.


September 24, 2013

How Can You Be Sure You’re Getting An Insurance Policy That Covers Maternity Care?

Michelle Andrews of Kaiser Health News answers an important question about maternity care coverage. Read more from the KHN series Insuring Your Health.

Q. My wife and I are newlyweds. We are looking into family insurance plans and are curious about maternity coverage, rates and any limitations. I’m seeing a lot of companies don’t cover maternity benefits or impose six-month restrictions. It seems really complicated and not helpful, to say the least. Any information you can provide will help.

A. This is one of the problems that the health law was designed to address.

The Pregnancy Discrimination Act requires companies with 15 or more workers that offer health insurance to provide maternity coverage for workers and their spouses. But the law doesn’t apply to plans sold on the individual market.

Only 12 percent of those individual plans provide maternity coverage, according to an analysis published last year by the National Women’s Law Center. Plans that do cover maternity services may have a separate deductible of up to $10,000 and impose a waiting period of up to a year before members can use the services, the study found.

All that will change next year. Starting in January, the Affordable Care Act requires all new individual and small group health plans to cover 10 “essential health benefits,” and maternity and newborn care is one of them.

Insurers can’t impose waiting periods for maternity coverage nor charge women higher rates than men, as typically occurs now.

If you buy a plan on the individual market now, chances are you’ll pay extra for maternity coverage, if you can find it at all. But even if you buy a plan now, there’s nothing to stop you from shopping for a plan that meets the new maternity coverage requirements when your state’s health insurance marketplace launches in October. Your new coverage could begin in January, says Carrie McLean, director of customer care at online vendor eHealthInsurance.com.

If you and your wife do become pregnant before year’s end, you may benefit from another provision of the Affordable Care Act. Under current law, insurers on the individual market typically consider pregnancy to be a pre-existing medical condition and refuse to issue policies to people who are pregnant.

Starting in January, “Nobody can ask them if they’re pregnant and then deny them coverage,” says Judy Waxman, NWLC’s vice president for health and reproductive rights.

Kaiser Health News is an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communication organization not affiliated with Kaiser Permanente. 


September 5, 2013

California Governor Was Right to Veto Bill Allowing Researchers to Pay Women for Their Eggs

by Marcy Darnovsky, Ph.D. and Susan Berke Fogel, J.D.


OBOS is publishing a series of posts on egg donors and the ethical, legal, and health aspects of egg donation. Also read: one woman weighs the risks of donating her eggs to a friend, and a new group forms to share the perspectives of egg donors.


Last month, California Gov. Jerry Brown vetoed a bill that would have allowed researchers to pay women for having their eggs harvested and retrieved. His move was warmly welcomed by women’s health and public interest groups including Our Bodies Ourselves, National Women’s Health Network, Pro-Choice Alliance for Responsible Research, Alliance for Humane Biotechnology and Center for Genetics and Society. (Disclosure: see author affiliations.)

Echoing the longstanding concerns of many progressives about the serious risks of egg retrieval, Brown’s brief but eloquent veto message recognized that “in medical procedures of this kind, genuinely informed consent is difficult because the long term risks are not adequately known.” He also acknowledged that low-income women would face disproportionate temptations to discount the risks. “Putting thousands of dollars on the table only compounds the problem,” Brown wrote.

The vetoed bill, AB 926, was sponsored by the fertility industry’s trade organization, the American Society for Reproductive Medicine. It was supported by several mainstream women’s organizations, and breezed through the Democratic-dominated legislature. Ironically, as Brown noted, the law that this bill would have overturned was approved by near-unanimous votes in both houses.

That 2006 measure established protections for women who provide eggs for research and limited payments to reimbursement for expenses connected to the egg retrieval procedure. “After careful review of the materials which both supporters and opponents submitted, I do not find sufficient reason to change course,” Brown wrote.

The governor’s veto appears to have caught the bill’s supporters by surprise, and their response has been strongly negative, to the say the least. California NOW’s Facebook page asked “WTF Jerry Brown?” and went on to claim that Brown’s move was “consistent with his Jesuit Catholic Monk values” and that “he ignores science and women’s health in favor of the Catholic Conference’s beliefs that women getting compensated equally with male donors is high tech prostitution!”

Along similar lines, another supporter penned a rancorous Huffington Post piece with a headline that accused Brown of treating women like “children and the mentally handicapped.”

Oddly, most of the attacks on the governor — and some media accounts of his veto — have been silent about the existence of progressive and pro-choice opposition to AB 926. Some flatly mischaracterize the opposition as being solely religious and anti-choice. Others briefly acknowledge that pro-choice groups and individuals opposed the bill but describe them as part of a strange-bedfellows “coalition.”

There was indeed a coalition but it did not include any anti-choice groups. Rather it brought together diverse organizations including, besides our groups, Alliance for Humane Biotechnology, Black Women’s Health Imperative, Breast Cancer Action, and Friends of the Earth.

In addition to misrepresenting the nature of the opposition to the bill, its supporters largely failed to actually address the arguments against paying women to provide eggs for research. Although the state’s major newspapers published thoughtful op-eds raising questions about the issue (opinion pieces appeared in the Los Angeles TimesSan Francisco Chronicle and Sacramento Bee), proponents of paying women to provide eggs for research tended to repeat their talking points rather than answer the questions that were raised: Do we have sufficient information about the long-term effects of egg retrieval to ensure the health and future fertility of the women providing the eggs? Is there even enough information to permit “informed” consent? Might the payments for eggs be coercive to low-income women? Can researchers get the supply of eggs they need without resorting to financial incentives?

AB 926 supporters argued that paying for eggs for research is a matter of “equity for women,” which seems to mean several different things at once. One is that women should be paid for providing eggs because men are paid for providing sperm. UC Berkeley medical anthropologist Nancy Scheper-Hughes pointed out the fallacy of this analogy: Selling sperm and selling eggs are totally different matters, she wrote: “One is pleasurable and safe, the other is a complicated and invasive procedure.”

AB 926 supporters also argued that providing eggs for research should be compensated because it is analogous to enrolling in clinical trials, for which healthy people are paid. This too is misleading. In clinical trials, scientists study their subjects to determine the effects of a drug or procedure on the people taking the drug. But scientists do not study the effects of egg-harvesting drugs and procedures on the healthy young women whose eggs they want for their experiments. The object of their interest is only the eggs, not the women.

Finally, AB 926 supporters pointed out that people who need young women’s eggs for their own fertility treatments pay for them, and asked why researchers shouldn’t be permitted to do the same. That brings us to the core question: Should we expand the market in human eggs?

Given that many women who have undergone egg retrieval in the fertility context have experienced serious complications, and that the procedure’s risks are still grossly understudied, we believe that adequate safety data must be collected before we can have a sufficient evidence base on which to make that decision. A well-designed, multi-center prospective trial is long overdue.

AB 926 supporters claimed that they occupy the pro-science and pro-research camp, and that anyone who opposes them (including Gov. Brown) is “anti-science.” But they have had nothing to say about the well-documented short-term egg harvesting risk of ovarian hyper stimulation syndrome, which can cause organ damage, ovarian rupture, and in rare instances death. They also ignored evidence that the drugs used in egg retrieval may be associated with higher rates of cancer and infertility, and the lack of follow-up studies to ascertain what the risks really are.

In 2007, a report by the prestigious Institute of Medicine concluded that too little research had been done on egg retrieval. It noted that with “more data it will be possible to quantify the various risks of oocyte (egg) donation much better than can be done today and to put numbers to the risks that a donor may face.”

Not much has changed since then. But those who believe that it’s fine for women to “work” as egg providers seem indifferent to understanding the occupational hazards it entails, and to investigating what might be done to minimize the dangers.

Currently, New York is the only state that explicitly authorizes payments beyond reimbursement for women’s eggs for research. The practice is prohibited in far more countries than allow it.

We at the Center for Genetics and Society and the Pro-Choice Alliance for Responsible Research have been calling for years now for clinical studies that look at the long-term health effects of retrieving eggs, for both fertility and research. The American public assumes that medical procedures and drugs have undergone careful study and that treatments have been proven safe and effective before being widely used.

Let us be clear: To date, we do not have well-designed, prospective studies of the effects of egg retrieval. Let us start collecting that information and until we have it in hand, let’s rein in the market for eggs instead of expanding it. Doing so will benefit not just the young women who might provide researchers with eggs, but also the many women who undergo egg retrieval for their own or other people’s fertility treatments.

* * *

This guest column was originally published at Huffington Post and has been reprinted with permission.

Marcy Darnovsky, Ph.D., is Executive Director at the Center for Genetics and Society, a public affairs organization working to encourage responsible uses and effective societal governance of reproductive and genetic technologies. She speaks and writes widely on human biotechnologies, focusing on their social justice, human rights, health equity, and public-interest implications.

Susan Berke Fogel, J.D. is the co-founder of the Pro-Choice Alliance for Responsible Research (PCARR), working on cutting edge issues at the intersection of human genetic biotechnology and women’s health and rights. She is also the Director, Reproductive Health for the National Health Law Program, where she is a national expert on reproductive health law, low-income health programs and religious restrictions in health care.


Young women are increasingly being recruited to donate eggs for infertility and research purposes, though numerous health questions remain unanswered. Our Bodies Ourselves is calling for the creation of a mandatory health registry to facilitate long-term tracking and studies to better understand the risks of egg extraction. Please support the Petition for Human Egg Extraction Health Registry & for Warnings on Ads and Notices Seeking Egg Donors, started by OBOS, the Alliance for Humane Biotechnology, Pro-Choice Alliance for Responsible Research, and the Center for Genetics and Society, and endorsed by other organizations.


August 23, 2013

Studies Show How Abortion Restrictions Hurt Women; New Investigative Report Shows Why More Restrictions Are Medically Unnecessary

We recently wrote about the Turnaway Study, a research project that involved following women who were denied an abortion because they were past the provider’s gestational age limit and comparing their outcomes to women who received an abortion (either during the first trimester or at near-limit, when the women were almost out of time). Women were recruited for the study from “last stop” abortion clinics — those where there’s not a provider with a later gestational age limit within 150 miles.

A new paper released in the American Journal of Pubic Health begins to present results from that study, focusing on the reasons for delays in seeking abortion care. The research has been conducted by the Advancing New Standards in Reproductive Health group at UCSF’s Bixby Center for Global Reproductive Health.

One of the findings provides further evidence of important disparities in access to abortion care: the women who received abortions in the first trimester instead of near the limit were more likely to have a college degree and to have a higher income.

For women who were turned away or had near-limit abortions, “money” and “finances” were the most likely reasons for delay. The authors report that reasons for delay among women who were turned away for being over the gestational age limit included travel and procedure costs (58.3 percent of “turnaways” reported this issue), not recognizing the pregnancy (almost half of turnaways), insurance problems, not knowing where to find abortion care (reported by a third of turnaways), and not knowing how to get to a provider.

Interestingly, the near-limit women in this study reported less difficulty deciding to have abortions than the women who had the procedure during the first trimester. This finding runs counter the anti-abortion notion that women who have late-term abortions have simply been irresponsible in waiting so long to make a decision.

The authors also performed some calculations to try to estimate how many women are turned away each year due to gestational age limits. They concluded that 4,143 women in 2008 were forced to carry their unwanted pregnancies to term because of gestational age limits. This does not include additional women who would have been turned away for medical, financial or parental consent reasons. We can only assume this number will increase if the current anti-abortion push for 20-week limits gains ground.

In related news, the National Women’s Law Center has released a new report, “‘Shut That Whole Thing Down:’ A Survey of Abortion Restrictions Even in Cases of Rape.” A year after former Missouri Rep. Todd Akin’s remarks on abortion and rape (Happy Road Trip Anniversary!) NWLC has analyzed state and federal abortion restrictions proposed in the first six months of 2013 for how they would affect victims of rape.

Astonishingly, NWLC found that the vast majority of proposed legislation would create barriers to abortion for rape victims. For example, 27 provisions in the 38 state provisions restricting women’s access to abortion would apply to a woman whose pregnancy resulted from rape. These include provisions such as forced ultrasounds and requiring women to listen to a fetal heartbeat where there were no exceptions for rape victims.

“The GOP could have learned an important lesson: Picking on rape victims, even in the context of abortion, doesn’t play very well with the voting public,” writes Jill Filipovic at Salon. “Instead, the Republican party seems to have internalized the message that marginalizing rape victims is ok, as long as you don’t brag about it.”

And in case you missed it, RH Reality Check published an impressive series of investigative stories this week that proved abortion is already highly regulated and overwhelmingly safe. There’s a huge database of state documents available for review.


August 8, 2013

Taking the Stigmatization of Abortion Providers to a New Level

by Carole Joffe

No school district, employee or agent thereof, or educational service provider contracting with such school district shall provide abortion services. No school district shall permit any person or entity to offer, sponsor or otherwise furnish in any manner any course materials or instruction relating to human sexuality or sexually transmitted diseases if such person or entity is an abortion services provider, or an employee, agent or volunteer of an abortion services provider.

Carole JoffeThe above provision is contained in a nearly 50-page bill (pdf) that recently went into effect earlier this year in Kansas. (A judge temporarily blocked two other provisions of the law, but allowed this one to remain.)

To be sure, the relentless assault on abortion that we are currently seeing in other state legislatures — Texas, Ohio, and North Carolina, among others — are far more consequential in the short run. Ambulatory surgical center (ASC) and hospital admitting privilege requirements really do have the capacity to shut down clinics; in Texas, the number of Texas abortion facilities could go from 47 to five in that huge state.

Already, due to a similar ASC requirement, earlier rammed through the Pennsylvania legislature as a cynical response to the Gosnell scandal, a number of clinics in Pennsylvania have closed. And the bans on abortions after 20 weeks, adopted by a number of states, will affect a relatively small number of women, but typically those in desperate medical and/or social condition.

But other provisions of abortion legislation, of which the Kansas one cited above is a prime example, do a different kind of damage. They further the stigmatization and marginalization of abortion providers by making clear that these individuals are not welcome in that most central of community institutions: the schools. It is not just participation in sex education from which Kansas providers are barred.

As Stephanie Toti, senior attorney at the Center for Reproductive Rights, which is challenging this law, told me, “This is unprecedented discrimination against abortion providers. … The prohibition on providers serving as ‘agents’ of a school district has the effect of barring them from serving as chaperones on field trips and engaging in most other volunteer activities.”

So abortion providers are at this moment banned from Kansas schools — and supposedly this will promote the safety of adult women getting abortions, as is the typical sanctimonious rationalization of the various laws we are seeing.

I asked several lawyer colleagues if they knew of other instances in which a whole occupational category was banned by law from volunteering in schools. They did not. Indeed, as far as I can tell, only sex offenders as a class are de facto banned from school grounds.

This shocking ban on abortion providers’ involvement in the schools leads me to recollect other instances I have encountered of attempts to isolate this group and keep them from community involvement. I think of a provider I’ve written about who I call Bill Swinton (not his real name), a family medicine doctor in a small town in the Pacific Northwest. He was deeply involved in both his church and his community, and served for three terms on the local school board. But he was defeated for a fourth term in the late 1980s, as the abortion wars intensified; needless to say, his status as a provider was the key factor in his defeat.

I think as well of another doctor I’ve written about named Susan Golden (also not her real name), in a town in the Midwest, who integrated abortion provision into her family medicine practice. When she and her partner planned to take part in a community health fair, presenting on the care of newborns, the entire event was abruptly cancelled by the anti-abortion owner of the facility where the fair had been scheduled to take place.

As disturbing as these incidents were, they did not have the force, or the legitimization, of law. The Kansas provision does — and as such, takes the stigmatization of abortion providers to a new level.

Assuming the Kansas law, including this provision, is not overturned, we can only speculate as to what effects it might have.

Speaking personally, I remember as a child the enormous pride I felt when my father, a cardiologist, came to my elementary school with his microscope and showed the class wondrous things. As a working mother, I recall how much I valued occasional volunteer stints in my daughters’ schools, getting to know both their classmates and other parents.

It is very disturbing to contemplate that providers and their children will be deprived of these experiences. And it is equally disturbing to contemplate the messages that others in the community will receive from such a ban.

This provision truly is stigma on steroids.

Carol Joffe is the author of “Dispatches from the Abortion Wars” and a professor at the Bixby Center for Global Reproductive Health. This article originally appeared at RH Reality Check and is reprinted with permission.


July 12, 2013

State by State: Laws Restricting Abortion and Family Planning as of Mid-2013

 abortion restrictions enacted at midyear for 2007 through 2013

If you’re having trouble keeping up with the assault on abortion rights across the states, you’re not alone.

While we’ve been hearing a lot out of Texas, and some from North Carolina and Ohio, many other states have enacted regulations restricting access to healthcare.

These include obstacles such as requirements for hospital admitting privileges for providers, bans on medication abortions by telemedicine and abortion after 20 weeks, and biased counseling laws — requiring, for instance, that women be provided with information falsely linking abortion to breast cancer.

Other new laws, such as restrictions on family planning funding, have further affected women’s access to reproductive health services.

How bad is it? According to updated information from the Guttmacher Institute, states enacted 106 provisions related to reproductive health and rights in the first six months of 2013 alone. This includes 43 restrictions on access to abortion — the second-highest number ever at the mid-year mark, and as many as were enacted in all of 2012.

Guttmacher points out a glimmer of sunshine as well: Among the numerous restrictions, some states saw new laws to expand comprehensive sex education, make STI treatment of partners easier, and increase access to emergency contraception for women who have been sexually assaulted.

Rachel Maddow this week looked at the overall impact of state-by-state anti-abortion laws, showing how states under Republican control since the 2011 elections are restricting access. Maddow also provides more information on some of the individual states.

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


July 10, 2013

CIR Prison Investigation Opens Another Chapter on Sterilization of Women in U.S.

We learned this week of an appalling story involving coerced sterilization of women — an issue that never seems to disappear completely from view despite a long and painful history.

The Center for Investigative Reporting found that at least 148 female inmates in two California prisons were sterilized between 2006 to 2010 — and there may be 100 more incidents dating back to the late 1990s.

Due to supposedly strict limits on sterilization of inmates, state approval was supposed to be obtained prior to these procedures. CIR reports that not only were approvals not obtained, but former inmates report being coerced into agreeing to sterilization.

CIR reporter Corey G. Johnson writes:

The women were signed up for the surgery while they were pregnant and housed at either the California Institution for Women in Corona or Valley State Prison for Women in Chowchilla, which is now a men’s prison.

Former inmates and prisoner advocates maintain that prison medical staff coerced the women, targeting those deemed likely to return to prison in the future.

Crystal Nguyen, a former Valley State Prison inmate who worked in the prison’s infirmary during 2007, said she often overheard medical staff asking inmates who had served multiple prison terms to agree to be sterilized.

“I was like, ‘Oh my God, that’s not right,’ ” Nguyen, 28, said. “Do they think they’re animals, and they don’t want them to breed anymore?”

Pressure was applied particularly to women with multiple children, and doctors apparently tried to bypass the required approval process. CIR reports that when Daun Martin, the Valley State Prison medical manager between 2005 and 2008, became aware of the restrictions, she and the prison’s OB-GYN, Dr. James Heinrich, worked around them:

“I’m sure that on a couple of occasions, (Heinrich) brought an issue to me saying, ‘Mary Smith is having a medical emergency’ kind of thing, ‘and we ought to have a tubal ligation. She’s got six kids. Can we do it?’” Martin said. “And I said, “Well, if you document it as a medical emergency, perhaps.’”

The story prompted The Sacramento Bee to call for a full review into whether “anyone ought to have been disciplined,” and to “make sure all the necessary safeguards are now in place.”

Forced sterilization is unfortunately nothing new in the United States: 33 states at one time allowed it for “eugenic” purposes, often targeting people of color and people with mental illnesses.

The phrase “Mississippi appendectomy” has come to describe much of this abuse, referring to the sterilization of poor black women — especially in the South — who were sterilized without their consent and sometimes without their knowledge.

Back in 2002, Oregon’s governor issued an apology for forced sterilizations carried out on women who were in state care (including, according to one article, “wayward teenage girls”). North Carolina only formally repealed its last forced sterilization law in 2003. The Winston-Salem Journal did a detailed series on these abuses in 2002. West Virginia repealed a law allowing sterilization of those deemed “mentally incompetent” just a few months ago, and it just took effect.

While these states tend to claim that sterilization abuses stopped in the late 1970s, political fighting continues in many states about whether to compensate and how to recognize victims.

Where laws have ended forced sterilization practices, however, it appears that coercion has continued to thrive.

CIR asks that anyone with knowledge of the sterilization abuses in California prisons — whether as a victim, family member, or medical or prison employee — to share their experience via this form or to contact CIR’s Corey G. Johnson directly (916-504-4085, ext. 202 or cjohnson AT cironline.org).


July 8, 2013

Lessons Learned: Why Midwives Should Matter to Everyone

by Eliza Duggan

eliza duggan“Interesting! … What’s that?”

This is the typical response I received when I told people, especially my peers, that I was writing my senior thesis on midwifery. I became accustomed to saying, “I’m writing on midwifery — midwives,” since most people have at least heard the term “midwife.”

The initial lack of knowledge was discouraging; however, the best parts of my project were the conversations that followed. The more I researched and wrote on midwifery, the more it became clear to me that not only are young people interested in birth and midwifery, but this knowledge could be vital to our futures.

As The New York Times recently reported, U.S. maternity care is the costliest in the world. And yet according to the 2010 World Health Statistics, we rank behind dozens of countries when it comes to such benchmarks as maternal, neonatal and infant mortality rates.

A Times follow-up story on the lack of insurance coverage for midwifery care notes that “in many European countries, midwives attend to most pregnancies, often in clinics, resulting in maternity charges that are a fraction of those in the United States.”

Growing up in a small town in Maine, a place where midwives are well known and well respected in the community, I have always been familiar with home birth. Even with this experience, I did not really think about the political complexity of midwifery, nor the unique position that midwifery holds in relatively rural areas like mid-coast Maine, until I moved away.

I went to Boston for college, and in 2011 I took an internship with the women’s advocacy organization Our Bodies Ourselves. For one of the projects I worked on, I promoted midwifery legislation in Massachusetts that aims to expand the rights of nurse-midwives and license and regulate home birth midwives. The bill didn’t pass then, but it has been reintroduced in the 2013-2014 session.

The more I dove into the issue, however, the more I became surprised at the ambivalent and sometimes even hostile reception to the very idea of midwifery. I had assumed that the famously liberal citizens of Massachusetts would generally have the same attitude towards midwives and home birth that I had. When brainstorming ideas for my senior honors thesis at Boston College, I was compelled to investigate this issue further.

In the fall of 2012, I began doing extensive research on the history of midwifery and how it had become so marginalized in Massachusetts. I interviewed countless home birth midwives, nurse-midwives, childbirth educators, public health experts, and consumers in order to gauge attitudes toward maternity care in Massachusetts.

One of the most troubling things that I found was not only were few people interested in this issue, but the vast majority of people who were involved already had children. Most people my age were unfamiliar with midwives and the topic of childbirth as a whole.

This isn’t surprising; we’re usually not encouraged to consider how we feel about childbirth until we or someone we know becomes pregnant, so often we don’t have a clear sense of our options or knowledge about the process. After getting over their initial discomfort, my friends and classmates became intensely curious about childbirth, and most of them had lots of questions.

While working on my thesis, I realized that there is a need for discussion about childbirth before pregnancy. We need to know our options so we can make informed decisions about how we want our children to be brought into the world — and so we can support public policies that are best for mothers and babies.

This, I believe, should be an easy fix. The countless conversations I had with my peers have shown that pregnancy and birth are interesting topics, and young men and women are eager for accurate information, too.

Eliza Duggan is a 2013 graduate of Boston College, where she majored in English and women’s studies. Her time at OBOS and her thesis work inspired her to pursue women’s advocacy. She will be a first-year law student at the University of California at Berkeley Law School in the fall.


July 3, 2013

Egg Donation is Made to Look Easy, but Questions and Health Risks Remain

First in a series on egg donors and the egg donation process.

by Ryann Summers

Recently, a former co-worker and his romantic partner sent me a text message that left me reeling.

It essentially read: Hey, can I have ur eggs? Thx.

Few couples would be better equipped to raise a well-loved child than these two men, and I fully supported their decision to start a family. But I wondered how we had arrived at the point where this request has become so casual that it can be communicated in fewer than 140 characters. At least take me out to dinner.

I don’t fault my co-worker; his question mirrors how the issue is presented in our culture. As a woman in her early 20s, I am bombarded by advertisements seeking my eggs.

Recently when I was riding the T in Boston, I found myself staring at the face of a smiling baby, and a dollar amount. It seems, well, easy.

Egg donation payments range anywhere from $5,000 to $10,000; some solicitations offer amounts as high as $20,000, or even $100,000, for donors with specific characteristics. I could definitely benefit from thousands of dollars, and hey, I probably have eggs to spare, right?

These attractive compensation offers lack any balancing information about risks and hazards, creating a deus ex machina temptation: As far as I know, I have the potential to help create life for a deserving future parent — and make a staggering profit.

These two potential outcomes are, in fact, quite possible. It can be life-changing and rewarding to help others realize their dream of having children. The sky-high payment — sky-high, at least, to many college students, the prime demographic — is just gravy in this scenario.

But in a different light, it can be a bit like putting a price on the creation of life. Or, tilt again, and it’s simply reimbursement for the donor’s time, as well as the physical risk and discomfort.

So I dug a little deeper, and what I found is while the perspective may shift, there are some immutable realities that are rarely included in donor discussions.

Unlike the process men undergo to donate sperm, the preparation and procedure involved in egg donation require a longer-term commitment — a woman’s body is hormonally altered through the process, and she undergoes surgery.

I’d like to see ads note that fact, along with the known risks of egg donation. The ads don’t mention ovarian hyperstimulation syndrome (OHSS), a condition that causes the ovaries to swell and become painful in about one-fourth of women who use injectable fertility drugs. (OHSS generally goes away after a week or so, but in severe cases it can cause rapid weight gain, abdominal pain, vomiting and shortness of breath.)

Nor do they mention that the surgery to remove the eggs can sometimes lead to complications, including cramping, bleeding and infection.

Egg donors also need to be told that the long-term risks of egg donation remain largely unknown. There is little long-term safety data on the infertility drugs commonly used to stimulate egg production, and there have been no follow-up studies on women who have donated their eggs.

This lack of safety information has led Our Bodies Ourselves and other women’s health advocates to call for a mandatory egg donor registry that will allow researchers to track the long-term health of women who have donated eggs. The Infertility Family Research Registry, a voluntary registry, is based at the Dartmouth Hitchcock Medical Center (see below for more more information).

In addition to physical risks, there are the possible psychological reactions to consider. While donors generally undergo both physical and psychological testing before the process begins, it is impossible for donors to predict with certainty the emotional impact of this procedure.

A 2008 study on egg donors’ experiences published in Fertility and Sterility found that almost one in five women reported lasting psychological effects, some positive and some negative, including “concern for and/or attachment to their eggs and/or potential offspring, concern that the donor or resultant child might want a relationship with them in the future” and “stress resulting from the donation process as a whole.”

“Women need to look at the risk involved very carefully, and pay attention to what they’re being told about risks, not just to what they’re being offered to do it,” Nancy Kenney, co-author of the study, told HealthDay News.

As a member of the target demographic, I want complete and balanced information. With the prospect of such a permanent and life-altering decision, I need to know the risks and rewards.

Other women do, too. Three women who donated their eggs have begun collecting personal stories from fellow donors with the hope of creating a self-advocacy group.

“Some of us consider egg donation to be the best thing we’ve ever done. Others do not feel that way at all. Whatever her stance, each donor’s story is welcome here,” they write in the mission statement at WeAreEggDonors.com.

I personally decided against donating my eggs. I sympathized with the overwhelming process my former co-worker and his partner were experiencing, but I told them that I personally did not feel that egg donation was the right choice for me.

I knew very little about egg donation back then, but I did know enough not to match his casual request, delivered via text, with a casual promise that might worry me for years to come.

Plus: OBOS is actively encouraging infertility clinics and centers across the country to promote awareness of the Infertility Family Research Registry based at the Dartmouth Hitchcock Medical Center. Learn more about ongoing studies.

Read more about issues and concerns related to egg donation, particularly from a nursing perspective, in this article from MCN, The American Journal of Maternal/Child Nursing.

A Boston College alumna, Ryann Summers served for two years as a bilingual program advocate at Voices Against Violence, providing counseling and advocacy services to Spanish-speaking survivors of domestic violence. As an undergraduate, she founded and facilitated a support group for student survivors of sexual assault. An avid yogi and writer, Ryann aims to explore women’s public health themes regularly for OBOS.