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!

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.

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.

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.

More than 30 years later, Chodorow’s call appears as challenging as ever — at least in the United States, where parental leave is still unpaid (putting us behind 177 nations, including Haiti and Afghanistan, that provide all women, and in some cases men, income and time off after the birth of a child) and only 12 weeks long, which discourages even willing men from taking over child-rearing duties.

Four years before the publication of Chodorow’s landmark text, however, Sweden had already become the first country to replace maternal leave with parental leave, and Sweden has continued to break new ground by spurring a revolution in male attitudes toward and male participation in childcare. Katrin Bennhold of The New York Times writes:

85 percent of Swedish fathers take parental leave. Those who don’t face questions from family, friends and colleagues. As other countries still tinker with maternity leave and women’s rights, Sweden may be a glimpse of the future.

In this land of Viking lore, men are at the heart of the gender-equality debate. The ponytailed center-right finance minister calls himself a feminist, ads for cleaning products rarely feature women as homemakers, and preschools vet books for gender stereotypes in animal characters. For nearly four decades, governments of all political hues have legislated to give women equal rights at work — and men equal rights at home.

Swedish mothers still take more time off with children — almost four times as much. And some who thought they wanted their men to help raise baby now find themselves coveting more time at home.

But laws reserving at least two months of the generously paid, 13-month parental leave exclusively for fathers — a quota that could well double after the September election — have set off profound social change.

Bennhold goes on to describe the positive effects of this change, such as a lowering of divorce rates and an increase in shared custody when a divorce does occur. It has undeniably transformed what it means to be a man.

Birgitta Ohlsson, European affairs minister, puts it in the terms of an old feminist maxim: “Now men can have it all — a successful career and being a responsible daddy. It’s a new kind of manly. It’s more wholesome.”

For more on how father’s leave in Sweden came to be so popular, read this side piece on politician Bengt Westerberg, who in the 1990s “championed the introduction of the first dedicated father month — 30 days of paid parental leave that could not be transferred to the mother — to encourage reluctant men like himself to do their bit and overhaul Swedish society in the process.”

Despite the fact that Sweden and other countries are far ahead of the United States when it comes to supporting fair and equitable childcare, it’s important to remember that progressives in the United States have been fighting for some form of paid parental leave for almost 100 years.

Yes, 100 years. As Sharon Lerner reminds us in the Washington Post:

As far back as 1919, when the Model T was switching from a crank to an electric starter, the U.S. government came close to signing on to an International Labor Organization agreement, supported by 33 countries, that said women workers should receive cash benefits in addition to job-protected leave for 12 weeks in the period surrounding childbirth. That same year, Julia Lathrop, the chief of the Labor Department’s children’s bureau, issued a report on international maternity leave policy in which she decried the United States as “one of the few great countries which as yet have no system of State or national assistance in maternity.” She had recently returned from Europe, where Germany and France had paid-leave laws that had been in place for decades.

The entire article is a very enlightening history lesson — revealing the twisted politics that have held back justice and common sense for far too long. For more on that subject, check out Lerner’s new book, “The War on Moms: On Life in a Family-Unfriendly Nation.”

The ACLU and Planned Parenthood have further commentary.

Norsigian and Shaffer also propose next steps for progressives who share the goal of affordable universal health care. Check it out, and let us know what you think in the comments!

A CDC representative from the Women’s Health and Fertility Branch of the agency’s Division of Reproductive Health has now informed us that the resulting outline for an action plan – “Outline for a National Action Plan for the Prevention, Detection, and Management of Infertility” [PDF] – can now be circulated. Our Bodies Ourselves is one of many organizations engaged in the review of the document, alongside other professional, advocacy, consumer health, and educational organizations and institutions.

As the background section explains, some infertility may be preventable through public health approaches:

Known or potential causes of infertility include genetic abnormalities, environmental, occupational, and infectious agents, certain diseases, delayed childbearing, and behavioral risk factors. We do not know what proportion of the infertility burden can be prevented, but it may be substantial.

The authors provide examples such as effects of sexually transmitted infections, as well as environmental and occupational hazards, and concerns that some risk factors for infertility may disproportionately affect those experiencing “social and racial disparities in health status.”

The plan includes four main goals:

1) To reduce the burden of infertility and impaired fecundity in the United States by promoting behaviors that maintain fertility, by promoting prevention, early detection, and treatment of infections (such as chlamydia) and other medical conditions that lead to infertility, and by removing or reducing environmental and occupational threats to fertility;
2) To improve access to the diagnosis and treatment of infertility and eliminate disparities in infertility care;
3) To improve the efficacy and safety of infertility treatment; and
4) To improve the quality of life of people who live with infertility in the US.

The plan outline document lists numerous strategies for surveillance, prevention research, policy development, evidence-based patient care guidelines, public education, expanded prevention and infertility care services, and other approaches, which should form the basis of a more detailed full action plan.

Download the Plan Outline

In a newly published perspective piece for the New England Journal of Medicine, representatives of the FDA’s transparency initiative describe the task force’s work to date, including release of a website, FDA Basics, “to answer fundamental questions about how the agency does its work.”

Today, the agency has released a report [PDF] from the task force outlining draft proposals “for expanding the disclosure of information by the agency while maintaining confidentiality for trade secrets and individually identifiable patient information.”

The proposal document is fairly technical and seems to assume a fair bit of background knowledge of FDA procedures and policies, but it includes proposals such as disclosing information about commonly observed violations associated with FDA-regulated products, the status of terminated and withdrawn new drug and device applications, and summary safety and efficacy information related to investigational new drug applications (data that may not have been published in the medical literature) when the agency determines the information is necessary to protect the public health

The agency will be accepting public comment on the proposal, including which draft proposals should be given priority, until July 20, 2010 via regulations.gov (direct link for comments not yet available). The FDA has also set up a transparency-related blog for updates on these efforts.

Added: you can now go here at Regulations.gov to submit comment, due by July 20, 2010.

The Panel’s recently released report, “Reducing Environmental Cancer Risk: What We Can Do Now,” [PDF] focuses on potential risks posed by contaminants in the environment from industrial, manufacturing, agricultural, medical, military, natural, and other sources, and provides recommendations for reducing environmental cancer risks. For example, the report discusses the radiation exposure from medical CT scans, mercury emissions from coal-fired power plants, and pesticide exposures.

The Panel’s report calls for further research into environmental causes of and contributors to cancer, stronger regulation and enforcement related to hazardous substances, better disclosure to the public of potential hazards created, inclusion of environmental and public health advocates in developing research and policy agendas and information dissemination, minimization of radiation exposure from medical sources, attention to the unequal burden of exposure, and increased use of safer alternatives.

It also calls for a move away from “current reactionary approaches to environmental contaminants in which human harm must be proven before action is taken to reduce or eliminate exposure” to a more “precautionary, prevention-oriented approach.” (For more information on what such an approach would look like, see The Precautionary Principle on the OBOS website.)

The free report also includes a number of recommendations for individuals to reduce their exposure to potentially harmful chemicals.

A representative of the American Cancer Society has criticized the report, arguing that “the report is unbalanced by its implication that pollution is the major cause of cancer…its conclusion that ‘the true burden of environmentally (i.e. pollution) induced cancer has been grossly underestimated’ does not represent scientific consensus. Rather, it reflects one side of a scientific debate that has continued for almost 30 years.”

The chairman of the panel has reportedly responded, “This is an evenhanded approach, and an evenhanded report. We didn’t make statements that should not be made.” A representative of Utah Physicians for a Healthy Environment, in a commentary for The Salt Lake Tribune, further criticized the ACS’s response, commenting that the ACS’s focus on “lifestyle factors” such as diet and exercise reflects a “blame the victim” philosophy that trivializes environmental risks. He also questions the ACS’s relationship with corporate donors who could possibly be affected by increased regulation and enforcement.

Orac at Respectful Insolence (ScienceBlogs) has detailed commentary on the report, including discussion of the ACS’s reaction – the full post is well worth a read.