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

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

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

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

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

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

Every year in the United States alone, more than 12,000 women are diagnosed and more than 4,000 women die of cervical cancer, a preventable disease that disproportionately affects women of color.

January is Cervical Cancer Awareness Month, and the National Latina Institute for Reproductive Health (NLIRH) is launching “¡Acábalo Ya! Working Together to End Cervical Cancer.” The campaign is aimed at educating Latinas about this disease and how to protect their health; raising the profile of cervical cancer prevention as a national reproductive justice and women’s health priority; and advocating for greater access to the tools and care needed to prevent, detect, and eventually end cervical cancer.

The NLIRH is hosting a blog carnival this week on the topic: What will it take to end cervical cancer? Read more on Why Cervical Cancer is a LGBT Issue by Verónica Bayetti-Flores, NLIRH policy research specialist; Cervical Cancer Awareness Month: Trans Men and Genderqueer/Gender Nonconforming People by the National Center for Transgender Equality; Screen More Women for Cervical Cancer – Not the Same Women More Often! by Kate Ryan, program coordinator, National Women’s Health Network; and Thank YOU Affordable Care Act for Helping Cervixes Stay Healthy by Keely Monroe, program coordinator, National Women’s Health Network.

The following text on disparities in access to Pap tests and HPV vaccines has been adapted from the 2011 edition of “Our Bodies, Ourselves.”

* * * * * * *

Most women who die of cervical cancer never had regular Pap tests, had false-negative results, or did not receive proper follow-up.

In the United States, socioeconomic and racial disparities are evident in statistics for cervical cancer. Vietnamese immigrants are five times more likely to be diagnosed with cervical cancer than white women. African-American and Native-American women are twice as likely to die of the disease as are white women. In one study, Hispanic women had about twice the cervical cancer incidence of non-Hispanic women in border counties near Mexico, and Hispanic women are 1.5 times more likely to die from cervical cancer as compared to non-Hispanic white women.

Disparities are due, at least in part, to women of color having less access to Pap screening and regular health care. It is quite possible that those women with the highest rates of cervical cancer will also have less access not only to Pap screening but also to the HPV vaccine. Until our health care system addresses such disparities in access, girls and women likely to benefit the most from this vaccine may well not be able to choose it.

To ensure more equal access to any adolescent vaccine, adequate infrastructure and resources must be made available. Some recommend implementation of school-based adolescent immunization programs similar to those formerly in place for delivery of hepatitis B vaccines. The United Kingdom and Australia have volunteer, nationally supported school-based campaigns that have resulted in high HPV vaccine coverage for about 70 percent of girls.

Currently, school-based health programs and routine preventive care visits for adolescents are limited in the United States, making it highly difficult to provide good access to HPV vaccines, especially the type of access needed to ensure all three required vaccine doses are administered. Available data suggest HPV vaccine coverage in the United States is low (less than 50 percent), and the proportion of girls receiving all three doses of the HPV vaccine is even lower (less than 25 percent).

Pap Tests Essential for Prevention and Treatment

HPV vaccines do not protect against all types of HPV associated with cervical cancer, and it is currently unclear how long they remain effective or whether booster shots will be needed to maintain protection throughout adulthood. Thus, regular Pap tests among sexually active women remain essential for cervical cancer prevention. Resources should not be diverted away from Pap screening programs to pay for the unusually expensive cervical cancer vaccine. Because Merck marketed Gardasil with a campaign that unnecessarily frightened girls, young women, and parents, many people now have a distorted view of this disease, the vaccine, and the continued importance of Pap screening.

There is no question that HPV vaccines represent an important scientific advance in the field of vaccine research, but exaggerating their potential benefit in places such as North America will not serve us well. In countries where there is little or no access to Pap screening, current HPV vaccines might have much more potential for saving lives if their costs were reduced considerably and if adequate infrastructure to prove them responsibly were securely in place.

The District of Columbia and dozens of states — many of which have been lobbied by vaccine makers to expand vaccination requirements — have introduced legislation to require, fund, or educate the public about the HPV vaccine. However, since 30 percent of infections are now caused by virus types for which the HPV vaccines do not provide protection, universal access to Pap tests remains critically important. Unfortunately, many girls in underserved communities (where HPV infection rates are often high) have less access to both the Pap test and the HPV vaccine.

For example, as of September 2009, when the CDC released its first state-level statistics for Gardasil, only 15.8 percent of girls in the relatively poor state of Mississippi had received the vaccine, compared with 54.7 percent of girls in the relatively wealthy state of Rhode Island. Partly because of greater access to Pap testing, the cervical cancer mortality rate in Rhode Island was already 50 percent lower than in Mississippi — which means the girls in Rhode Island are at much lower risk of contracting HPV to start with.

To reduce disparities for Latinas and other under-served women, we will need to make systemic changes in our health care system to increase access to screening and vaccinations for those who need it most.

At an historic Home Birth Consensus Summit in Virginia last month on “The Future of Home Birth in the United States: Addressing Shared Responsibility,” a group of 68 national and international experts developed nine key common ground statements that provide a foundation for continued dialogue and collaboration across sectors in the maternity care field.

The statements were posted this week at homebirthsummit.org, along with comment about the scope and context of the meeting. The site also includes information about why the summit was necessary and the process involved in reaching consensus. Action plans relating to these statements will be posted soon.

As one of the participants in the three-day summit, I was impressed with our collective commitment — despite different perspectives and areas of disagreement about out-of-hospital birth — to a common goal of improving maternal and newborn care for families choosing to give birth at home or in freestanding birth centers.

Mark Sloan, a pediatrician and writer who attended the summit, briefly explains the history of home birth in United States, offering context for why the summit marks a significant moment: “The representatives of all the major midwifery organizations — MANA (Midwives Alliance of North America) and ACNM (American College of Nurse-Midwives) — as well as ACOG (American College of Obstetricians and Gynecologists), FIGO (International Federation of Gynecology and Obstetrics), and the AAP (American Academy of Pediatrics) sat together in the same room to discuss home birth for probably the first time in history.”

One of the agreed-upon statements emphasized our belief that “collaboration within an integrated maternity care system is essential for optimal mother-baby outcomes. All women and families planning a home or birth center birth have a right to respectful, safe, and seamless consultation, referral, transport and transfer of care when necessary. When ongoing inter-professional dialogue and cooperation occur, everyone benefits.”

The ninth and last statement reads: “We recognize and affirm the value of physiologic birth for women, babies, families and society and the value of appropriate interventions based on the best available evidence to achieve optimal outcomes for mothers and babies.”

Other statements address improving the current liability system, the licensure of maternity care professionals, increased participation by consumers in multi-stakeholder initiatives, and the creation of an equitable maternity care system without disparities in access, delivery of care, or outcomes. See below for the full list.

The remarkable collegiality and constructive dialogue among the stakeholders present enabled the group to develop these nine core principles as well as commit to a variety of future collaborations. This is an important first step towards achieving improved outcomes for childbearing women and their families in this country.

As Saraswathi Vedam, director of the Division of Midwifery at the University of British Columbia and chair of the Home Birth Consensus Summit Steering Committee, noted: “When you have an issue as controversial as home birth, there are always going to be differences of opinion among various types of providers, policy-makers and even among consumers. But all of us recognize that for women who choose home birth, it’s our shared responsibility to work toward policies that will make that choice as safe as possible.”

Summit participants included obstetricians, family physicians and midwives, non-professionals serving in advocacy roles, insurers, attorneys, ethicists, administrators, policy makers, researchers, and others with expertise in epidemiology, public health, midwifery, obstetrics, pediatrics, nursing, sociology, medical anthropology, law, and health policy research.

We invite your comments on the statements below.

STATEMENT 1
We uphold the autonomy of all childbearing women.

All childbearing women, in all maternity care settings, should receive respectful, woman-centered care. This care should include opportunities for a shared decision-making process to help each woman make the choices that are right for her. Shared decision making includes mutual sharing of information about benefits and harms of the range of care options, respect for the woman’s autonomy to make decisions in accordance with her values and preferences, and freedom from coercion or punishment for her choices.

STATEMENT 2
We believe that collaboration within an integrated maternity care system is essential for optimal mother-baby outcomes. All women and families planning a home or birth center birth have a right to respectful, safe, and seamless consultation, referral, transport and transfer of care when necessary. When ongoing inter-professional dialogue and cooperation occur, everyone benefits.

STATEMENT 3
We are committed to an equitable maternity care system without disparities in access, delivery of care, or outcomes. This system provides culturally appropriate and affordable care in all settings, in a manner that is acceptable to all communities.

We are committed to an equitable educational system without disparities in access to affordable, culturally appropriate, and acceptable maternity care provider education for all communities.

STATEMENT 4
It is our goal that all health professionals who provide maternity care in home and birth center settings have a license that is based on national certification that includes defined competencies and standards for education and practice.

We believe that guidelines should:

allow for independent practice
facilitate communication between providers and across care settings
encourage professional responsibility and accountability, and
include mechanisms for risk assessment.

STATEMENT 5
We believe that increased participation by consumers in multi-stakeholder initiatives is essential to improving maternity care, including the development of high quality home birth services within an integrated maternity care system.

STATEMENT 6
Effective communication and collaboration across all disciplines caring for mothers and babies are essential for optimal outcomes across all settings.

To achieve this, we believe that all health professional students and practitioners who are involved in maternity and newborn care must learn about each other’s disciplines, and about maternity and health care in all settings.

STATEMENT 7
We are committed to improving the current medical liability system, which fails to justly serve society, families, and health care providers and contributes to:

inadequate resources to support birth injured children and mothers;
unsustainable healthcare and litigation costs paid by all;
a hostile healthcare work environment;
inadequate access to home birth and birth center birth within an integrated health care system, and;
restricted choices in pregnancy and birth.

STATEMENT 8
We envision a compulsory process for the collection of patient (individual) level data on key process and outcome measures in all birth settings. These data would be linked to other data systems, used to inform quality improvement, and would thus enhance the evidence basis for care.

STATEMENT 9
We recognize and affirm the value of physiologic birth for women, babies, families and society and the value of appropriate interventions based on the best available evidence to achieve optimal outcomes for mothers and babies.

Many U.S. users of cosmetics may not realize that they do not require FDA testing or approval and the federal agency is not authorized to require a manufacturer to recall unsafe products from the market. Because cosmetics are not regulated in the same way drugs are, it’s more difficult for consumers to make informed decisions, and the FDA has less power to regulate the cosmetics industry and respond to problems.

The Safe Cosmetics Act of 2011, introduced by Janice Schakowsky (IL-D), is intended to help close some of these gaps in cosmetics regulation.

The Act would give the government the power to recall unsafe cosmetics, require better disclosure of ingredients, establish additional safety standards and require manufacturers to submit data on the safety of their products, mandate reporting of adverse health effects, allow the banning of ingredients found to have reproductive or cancer-causing effects, encourage alternatives to animal testing, address worker safety, along with other measures.

The Campaign for Safe Cosmetics, which promotes the legislation and greater consumer awareness of cosmetic safety concerns, has more information at http://www.safecosmetics.org/section.php?id=74.

More info:

• More information on the FDA’s current role in regulating cosmetics
• Rep. Schakowsky’s press release on the Act
• Additional coverage at Good and Forbes

Guest post by Sarah Morison

It was not until I started working at the Global Justice Center that I learned that due to U.S. policy (not law, policy), it is almost impossible for a victim of war rape who becomes impregnated to have the option of abortion. That is because all humanitarian aid that the United States gives in areas of armed conflict to either governments or humanitarian organizations contains a blanket prohibition on any monies being used to provide abortions — or even information about abortion.

Yet under the Geneva Conventions, to which the United States has been a party for over 60 years, “wounded and sick” civilian victims of armed conflict are absolutely guaranteed the right to “comprehensive and non-discriminatory” medical care. The Global Justice Center is therefore contending that the United States is in violation of the Geneva Conventions by maintaining its current abortion restrictions on humanitarian funds in areas of armed conflict.

Our current initiative is the Geneva Project, whereby we are harnessing the power of the Geneva Conventions to tackle the horrible problem of sexual violence deliberately used as a weapon and strategy during armed conflict in many parts of the world. (For more background information, see the GJC’s legal brief, “The Right to an Abortion for Girls and Women Raped in Armed Conflict” [pdf].)

No doubt you have read about the epidemic of war rape going on in places such as the Democratic Republic of the Congo (DRC) and the Sudan, and that occurred during the genocides in Rwanda, the former Yugoslavia, Sierra Leone, and the intransigent conflicts in Columbia. During the recent uprising in Libya, the military was given Viagra to help them carry out rapes against the women living in areas of armed conflict. Right now, ethnic women are being raped by the military in Burma.

The military strategy of raping women is intended as a way of destroying families, communities and cultures. In Rwanda, girls and women were deliberately infected with HIV. In Yugoslavia, girls and women were gang-raped (typical form of war rape), impregnated, and then deliberately detained so as to force them to give birth to a child of a different ethnic group.

International courts have classified war rape as a war crime, and also as a form of torture. For those girls and women who become impregnated, the torture often continues, both psychologically and physically. Denial of abortions in this context frequently leads to desperate measures such as suicide or dangerous self-induced abortions.

We have learned that women being treated for war rape at internationally funded clinics often beg doctors for abortions but are turned away because these clinics can’t risk losing funding. By the time they reach these clinics, the time is often well past for using emergency contraception, which must be taken within a short period of time after the rape. Sometimes several donor countries give aid to an organization providing services to rape victims, but if U.S. funds are pooled with other countries’ funds, the effect is that all such funds are restricted.

The 62nd anniversary of the Geneva Conventions is Friday, Aug. 12. An international “August 12th Campaign” is underway, and we are asking organizations and individuals from around the world to commit to writing President Obama on Aug. 12 to urge him to lift these restrictions through an executive order (the current restrictions were put in place in the waning hours of the Bush administration). Many organizations — both prominent and small — throughout the world have committed to the campaign, which is heartening.

There is also a way for individuals to endorse our campaign, by signing an online petition to the President. I am asking you to read this petition and, if you agree this policy should be changed, add your name to the list. Consider sending the link to your friends and posting your endorsement on Facebook and Twitter.

Thank you all for reading this and for considering giving your support to this critical campaign.

Sarah Morison is an attorney at the Global Justice Center in New York City. The GJC advocates for the implementation of and compliance with international human rights laws and humanitarian laws (laws relating to war), especially those relating to women.

As previously reported, women with health insurance will soon have access to a host of preventive health care services, including contraception, without having to pay out-of-pocket costs such as co-payments, co-insurance and deductibles.

Not surprisingly, the news rankled some conservatives who refuse to acknowledge the long-term economic or health benefits.

Take, for instance, Sandy Rios, a FOX News contributor and vice president of the Family-PAC Federal, a conservative political action committee, who likened women’s health needs to beauty services: ”We’re $14 trillion in debt and now we’re going to cover birth control, breast pumps, counseling for abuse? Are we going to do pedicures and manicures as well?”

Once again, we turn to Stephen Colbert to explain the outrage. And he does so beautifully, noting, for instance, that “a woman’s health decisions are a private matter between her priest and her husband,” and insurance companies should be in the business of covering only “necessary medical expenses — like boner pills.”

Plus, learn what happens when U.S. women get their hands on birth control pills …

If you have ever wished you had a little black book that answered your questions about sexual health and insurance, your wish has come true.

My Little Black Book for Sexual Health — LittleBlackBookHealth.org – is available online to help you navigate the maze. This resource offers information on various topics, including how to obtain low cost insurance and rules that might govern whether birth control is covered by your insurance.

Described as “a guide for getting the health insurance you need to prevent pregnancy until you’re ready,” My Little Black Book is aimed at young people between the ages of 18 and 26; this group is most likely to be uninsured and faces a high rate of unintended pregnancy.

The interactive website is easy to use (or download the PDF version). You can flip through the virtual pages, blow the text up for easy reading, follow the tabs, or click through the table of contents. I found all sorts of helpful information — who is eligible for a school’s student health plan, how to get prescription drug coverage, and what kinds of sexual and reproductive services are covered. It is very user friendly and easy to understand.

My Little Black Book for Sexual Health was developed as part of the Reproductive Empowerment and Decision Making for Young Adults (REaDY) Initiative, a unique statewide public-private partnership led by NARAL Pro-Choice Massachusetts and Ibis Reproductive Health, to prevent unplanned pregnancy and promote sexual health for young adults in the wake of Massachusetts health care reform. A Spanish language version will be available soon.

Nekose Wills is the OBOS program assistant.

The FDA has begun the extraordinary process to revoke approval of the use of the popular drug Avastin to treat advanced breast cancer.

Avastin had received accelerated approval in 2008, but further studies have not shown that the drug improves either overall survival rate or quality of life.

Andrew Pollack of The New York Times notes that the approval is not without some controvery — as “various breast cancer patients and some patient advocacy groups have urged the F.D.A. to keep the drug approved and not deny patients a chance at what they say could be a life-saving therapy.”

Pollack also notes the financial stake the drugmaker Roche has in the drug: “Avastin is the world’s best-selling cancer drug, with annual sales of about $6 billion. Analysts have estimated that revocation of the breast cancer approval could cost Roche $500 million a year or more in lost sales.”

Some Republicans in Congress, moreover, have tried to portray the potential revocation as “an attempt at cost control, the beginning of rationing under the new health care law,” even though the FDA’s actions are part of the system set up in the 1990s to evaluate drugs that have received accelerated approval.

Breast Cancer Action, whose opinion we trust more than Republicans’ when it comes to advocating for the best interests of women, opposed Avastin’s original approval of the drug and sent a letter to the FDA this past July recommending approval be revoked. As BCA Program Manager Kimberly Irish noted in an e-mail concerning the latest news, the FDA’s decision is a matter of medical justice:

In 2007, BCA was the only breast cancer organization to actively oppose the use of Avastin for metastatic breast cancer patients because of its failure to improve overall survival or quality of life, its side effects and its high price tag. We applaud the FDA for recommending that Roche’s request for full approval of Avastin for advanced breast cancer treatment be denied.

The interests of patients must come before the profits of companies manufacturing the treatments. We need to continue to demand better drugs for people with metastatic disease. We have a long way to go to end this epidemic but the FDA’s decision to put patient needs before drug company profits is at least a step in the right direction.

This week, the Illinois House of Representatives is expected to vote on the Home Birth Safety Act (SB 3712) to license certified professional midwives (CPMs).

Passage of the bill would allow CPMs to legally attend home births throughout the state. While approximately 800 babies are born at home in Illinois, only six out of 102 counties have legal, licensed home birth providers (CPMs, nurse midwives or doctors).

“As a result, families are resorting to giving birth at home unassisted (the national rate for this increased by 10% last year) or crossing the border to give birth in hotels in ‘legal’ states such as Wisconsin, or working with underground midwives,” reads a petition in favor of the bill.

There are 27 states that recognize direct-entry midwives, 25 through licensure, which is provided by the North American Registry of Midwives.

For the first time in 30 years, the bill made it out of a House committee in May, but passage is far from certain.

“It’s an uphill battle in the House,” Democratic State Rep. Robyn Gabel,the bill’s chief sponsor, told The New York Times earlier this year. Jessica Reaves writes:

That the bill has made it this far is testament to the midwifery community’s newfound political acumen and its first lobbyist, hired by the Coalition for Illinois Midwifery in 2006.

The bill’s opponents, including the American College of Obstetrics and Gynecology, the Illinois State Medical Society and the American Medical Association, argue that home births are inherently more dangerous than births in medically supervised settings. Also resisting the bill, though more quietly, are members of rural midwifery groups that have operated under the radar and off the grid for years, and would prefer to remain that way.

“We just don’t think home is a safe environment for delivery,” said Dr. Jacques Abramowicz, co-director of the Fetal and Neonatal Medicine Center at Rush University Medical Center and a Fellow of the American College of Obstetrics and Gynecology. “Childbirth is very dynamic, and it can be a very dangerous process. In the vast majority of cases, nothing happens. However, if an emergency occurs, it happens very fast — in two, three, four minutes.”

Rachel Dolan Wickersham, president of the Coalition for Illinois Midwifery and the vice president of the Illinois Council of Certified Professional Midwives, is the midwife groups’ lobbyist. She said she was frustrated by the bill’s opponents in the medical community.

“There’s just no room for negotiation,” Ms. Wickersham said. “It’s a turf battle. It’s about power and control. These women are going to have babies at home. There’s no question about that. Why would anyone want to keep the situation so that the person attending them has no regulated training or is afraid to transport them to a hospital in an emergency?”

Illinois Families for Midwives has put together information about the bill and is encouraging supporters to contact their representatives and, if possible, travel to Springfield on Wednesday.

In the health resource center at Our Bodies Ourselves, you’ll find a statement signed by dozens of physicians, midwives and women’s health advocates who support 1.) expanding options for hospital-based midwifery care (utilizing certified nurse midwives and certified midwives); and 2.) licensing and regulating certified professional midwives in order to make the option of home birth as safe as possible.

by Cory L. Richards | Guttmacher Institute

Rand Paul, a candidate for the U.S. Senate from Kentucky, caused a stir last week when he argued that too many births in Kentucky are paid for by Medicaid, the joint federal-state insurance program for low-income Americans.

According to Kentucky’s Cabinet for Health and Family Services, Medicaid pays for about half of the state’s 57,000 annual births. Paul is quoted by the Associated Press as saying that “Half of the people in Kentucky are not poor. We’ve made it too easy.”

In reality, paying for a pregnancy can be anything but easy. According to the March of Dimes, maternity care costs more than $8,800 (pdf), on average, and these costs can quickly escalate into the tens of thousands of dollars if complications arise (for instance, in the case of a premature birth).

That’s why having insurance coverage is so critical. Employer-based group plans usually have good maternity care coverage, but most low-income women don’t get insurance through the workplace. And the National Women’s Law Center has documented that in the individual insurance market, few plans include maternity care coverage (pdf) at all.

The recently enacted health care reform law would require all private insurance plans to cover maternity care starting in 2014. Meanwhile, however, insurance trends are moving in the wrong direction.

According to a Guttmacher Institute analysis of new Census Bureau data, 2.3 million reproductive-age women lost private insurance coverage between 2008 and 2009 alone, bringing the total covered to fewer than six in 10.

That’s where Medicaid comes in. While income eligibility ceilings under the program in general are usually well below the official federal poverty line, federal Medicaid law requires all states to cover pregnancy-related care for women with incomes up to 133 percent of poverty. Kentucky and most other states have — wisely — decided to raise that level even further. Still, Kentucky’s eligibility, at 185 percent of poverty (which is typical among the states), amounts to only about $34,000 a year for a family of three.

Medicaid’s role in providing quality care for low-income pregnant women and their infants is not only a moral imperative. It’s also sound public health policy, considering the many negative health consequences that await mothers and children if they do not obtain appropriate care.

Financial hurdles — particularly for the uninsured and underinsured — can lead to delayed or substandard care, and are an important reason why the United States lags behind most other developed countries in rates of maternal mortality and preterm births.

Another reason is that so many pregnancies in the United States, particularly among low-income women, are unintended — making Medicaid coverage of family planning services equally critical. Publicly funded contraceptive counseling and services empower low-income women to prevent pregnancies they don’t want to have and become pregnant only when they want to be, thereby maximizing their chances of having a healthy pregnancy and giving birth to a healthy infant.

Realizing these significant health benefits, 21 states have also increased their Medicaid income eligibility ceilings for family planning services (pdf), often pegging them to the same income level they have for pregnancy-related care. (Kentucky, unfortunately, is not one of them, but nearby states like Virginia, Arkansas and Missouri are.)

The impact is significant: Publicly funded family planning services — the bulk of which are provided by Medicaid — avert 1.94 million unintended pregnancies each year. These pregnancies would result in 860,000 unintended births, 810,000 abortions and 270,000 miscarriages.

Given these benefits, conservatives of all stripes, including Paul, should strongly support publicly subsidized contraceptive services. Fiscal conservatives should applaud the fact that, by helping low-income women prevent births they themselves do not want to have, these services save almost $4 in public expenditures for every $1 invested.

Social conservatives should be reassured that without them, the U.S. abortion rate would be two-thirds higher than it is. And pro-business conservatives should appreciate the value of enabling women to postpone childbearing while they complete their education, undergo job training or establish themselves in their career.

In short, Medicaid’s role as the safety-net insurer of both pregnancy-related care and family planning services is essential to the health of millions of American women and infants. It truly is smart, fiscally responsible government at its best—and it deserves support from across the political spectrum.

Cory L. Richards is the executive vice president and vice president for public policy at the Guttmacher Institute

Related: For more information, check out these articles from Guttmacher:

• The potential of health care reform to improve pregnancy-related services and outcomes
• The impact of the recession on reproductive-age women
• State-level data on the insurance status of reproductive-age women (Insurance Status, under Services and Financing)
• Contraception as an integral component of preventive care for women
• The impact of publicly funded family planning services
• States that have expanded Medicaid eligibility for family planning services (pdf)

California Governor Arnold Schwarzenegger has vetoed AB 1900, a bill requiring the Corrections Standards Authority to develop standards on the shackling of pregnant women, and to prohibit pregnant inmates from being shackled by the wrists or ankles during transport, labor and delivery, and recovery, unless deemed necessary for safety.

The veto is somewhat surprising, because the bill was approved unanimously every time it came up for a vote in the state Senate and Assembly.

The Governor argued in his veto that the bill “would require the Corrections Standards Authority (CSA) to develop guidelines concerning the shackling of pregnant inmates and wards during transport. However, CSA’s mission is to regulate and develop standards for correctional facilities, not establish policies on transportation issues to and from other locations.”

I’m no expert on the correctional system in California, so I don’t know whose job it would be to set standards on inmate transport if it is not the CSA’s. Do any of our California readers have any insight on this?

In a commentary for the San Francisco Chronicle, Karen Shain of Legal Services for Prisoners with Children called the veto “particularly mean spirited” and described the bill as “an inexpensive solution to a human rights problem.”

Jodi Jacobson at RH Reality Check has additional commentary. Please also see our previous posts on the shackling of pregnant inmates for further background and discussion.

If you’re in Massachusetts, please ask your state representative to urge House Speaker Robert DeLeo to bring an important midwifery bill to a vote. Text of the bill — House 4810: An Act Relative to Certified Professional Midwives and Enhancing the Practice of Nurse-Midwives – can be found here.

The bill was just released from the House Policy and Steering Committee and is now in Third Reading, chaired by Rep. Vincent Pedone of Worcester.  The legislative session closes on Saturday, July 31. If it’s not voted on by then, the bill would die and have to be reintroduced in the next legislative session.

If you’re able to discuss the bill with your legislator or a staff member, please be aware that some legislators have misinformation about the midwifery bill’s content, especially regarding the items below. Here’s some background:

1. The Massachusetts Medical Society strongly objects to CNMs functioning without direct MD supervision, yet has articulated no sound basis for this objection. Nationally, ACOG already supports the elimination of direct supervision of CNMs by physicians, acknowledging that it is not required for safe practice, and 44 other states no longer have such requirements.

2. Some legislators incorrectly think that the bill would provide new prescription-writing privileges for nurse-midwives — this is not really the case. Nurse-midwives already have prescription-writing privileges but can now exercise these privileges only if an MD is technically providing supervision, which amounts merely to a review of sample prescriptions on a quarterly basis.

Because of hospital accrediting rules, this clause prevents CNMs from admitting patients in labor under the midwives’ own names; prevents CNMs from serving on hospital committees that determine maternity care policies; and bars them from control of their own practice environment. This undermines the ability of CNMs to provide the most effective care. (CNMs already have independent prescription authority in most other states, including New Mexico, New Hampshire, Washington, Arkansas and Oregon, and the District of Washington.)

3. Although the legislation has already been rewritten to accommodate concerns about the age at which a midwife could begin training (it was changed from 18 to 21), legislators are still being misled about this fact. There are, by the way, no such age requirements that we have been able to find in the Massachusetts statutes with respect to the education of nurses.

4. Another objection is that the bill does not require a midwife to carry malpractice insurance. In almost all states, malpractice insurance is not required by statute, and it would be unfair to single out one professional group in this regard. Some would argue that such a requirement would violate equal protection clauses.

Because the “risk pool” of homebirth midwives across the country is small, malpractice insurance has never been available for homebirth midwives, despite the concerted efforts of national and local organizations over several decades. Requiring CPMs to adhere to a standard that is impossible is another mechanism to restrain trade and prevent access to home birth midwives.

Childbearing women who want to be protected by malpractice insurance have the option of delivery in facilities, where such insurance coverage is required. Moreover, the Massachusetts legislature could follow a few other states in making disclosure of this absence of malpractice insurance coverage part of a required informed consent procedure. The malpractice insurance issue is not a credible objection to this bill.

Please share this news, and thanks for taking the time to take action on this important piece of legislation!

Two aspects of recent health reform legislation may help expand access to affordable contraception and family planning services. The first of these is a provision that allows states – through their Medicaid programs – to receive federal funding to cover family planning and related services and supplies for individuals not otherwise eligible for Medicaid.

This coverage would be available to individuals (women and men) who are not currently pregnant and whose income does not exceed an income eligibility level established by the state (similar to special eligibility rules for pregnant women who wouldn’t otherwise quality for Medicaid). Family planning-related services that may be covered include STI diagnosis and treatment, treatment of urinary tract infections, treatment of major complications from family planning procedures such as IUD insertion, and vaccines and other preventive services when provided as part of routine family planning visits.

States will basically have to opt in to this coverage by submitting some paperwork to the Centers for Medicare & Medicaid Services (CMS), the federal agency that oversees Medicaid. States will also set the eligibility guidelines for coverage up to a certain threshold. It is not yet clear how many or which states will be offering this coverage, which will expand access to family planning services for people who earn to much to qualify for Medicaid but who are having difficulty affording this care.

Another provision of the health care reform legislation that will take effect in late September, often referred to as the “Mikulski amendment,” requires that health plans cover preventive care and screenings (at no cost to the individual) for women. The coverage must be based on current evidence-based recommendations of the United States Preventive Services Task Force, and must includevaccines recommended by the CDC, and other care and services “as provided for in comprehensive guidelines supported by the Health Resources and Services Administration [HRSA]for purposes of this paragraph.”

What’s not clear is what guidelines the HRSA will support. Some have suggested that because HRSA doesn’t seem to have its own set of guidelines now, these will need to be created. I think another possible interpretation is that HRSA will identify an existing set of guidelines to support (such as from ACOG or another professional or governmental health organization). Whether new standards have to be created or HRSA simply designates some existing guidelines to support will determine how much room there is to advocate for services, but what will happen is not entirely clear at the moment.

A recent Guttmacher policy review has more on this issue, specifically on whether contraception might be included as preventive care. Guttmacher’s Adam Sonfield has also written about the issue for CNN, concluding:

In short, the case for ensuring family planning services are comprehensively integrated into women’s preventive care and insurance coverage is compelling. More and better contraceptive use will lead to more pregnancies that are planned and wanted, which will lead to more women who are healthy during their pregnancies and whose babies are born healthy. Who could argue with that?

The National Latina Institute for Reproductive Health is planning a “virtual cafecito” to discuss the issue of whether family planning will be included as a preventive service and to discuss strategies for ensuring that Latinas and other women have access birth control options as a preventive service. The call-in discussion will occur Wednesday, July 4 at 1pm EST; register online to participate.

We recently wrote about a proposed rule change that would protect patients’ rights to choose and designate their own visitors during a hospital stay. The change would make hospital visitation much easier for LGBTQ patients and their partners. At the time, we indicated that while public comment would be open for 60 days before the rule could be made official, the proposal hadn’t been posted yet for comment.

The proposed rule is now posted for public comment at Regulations.gov. Comments are being accepted until 11:59 pm Eastern time on August 27, 2010. Click on “Submit Comment” at the top of the page to weigh in on the proposed rule.

Once comments are submitted and uploaded, you’ll be able to view them here. (You won’t see any just yet, as none have been uploaded as of this writing.) You can also sign up for email alerts on this item and use the “Share” options to post to Twitter, Facebook, and other services.

Last month, Christine posted some resources for shopping for health insurance in light of the Patient Protection and Affordable Care Act, which institutes a number of changes in health insurance availability and coverage.

This month, one of the provisions of that Act was enacted to further aid in insurance shopping. The government is now offering a website where residents of any state can identify affordable health insurance coverage options in their state.

The website, HealthCare.gov, provides an online tool individuals and families can use to search for insurance and healthcare options. Under the “Find Insurance Options” section, you can put in information about your state, status (healthy individual, senior, young adult, etc.), age, and other non-personal details to find information about available plans in your area for individuals and families, including those considered “high risk” because they have a pre-existing health condition.

You can also find out if there are health care facilities near you that provide free or low-cost care.

The “Understand the New Law” section provides information on the Act and a timeline of when the various provisions will be implemented, and the “Information for You” section provides details specifically for families with children, individuals, people with disabilities, seniors, young adults, and employers.

The site also links to other federal sources of information, like Hospital Compare for healthcare quality data by hospital/location, and healthfinder for disease prevention information.